Self-reported perceptions and knowledge of telemedicine in medical students and professionals who enrolled in an online course in Peru.

BACKGROUND: Telemedicine has become more relevant during the COVID-19 pandemic. However, medical students and professionals do not acquire competences in telemedicine during their training. Our objective was to describe the self-reported perception and baseline knowledge of telemedicine among medical students and professionals enrolled in a virtual course. METHODS: Cross-sectional study that included physicians or medical students aged 18 years or older who were interested in a free virtual telemedicine course and who completed the data collection questionnaire. We used a Likert scale to assess the self-reported perceptions of four domains related to telemedicine. The participants were grouped into three levels for each domain: low, medium and high. We also objectively assessed telemedicine knowledge by means of 10 questions, with a cut-off point of 50% of correct answers. The Fisher's exact test, the Chi-square test, and the Mann-Whitney U test were used for the comparison of categorical data. A p-value < 0.05 was considered statistically significant. RESULTS: We included 161 participants: 118 medical students and 43 physicians. We observed no significant differences between medical students and physicians in self-reported perceptions of knowledge, security, or utility of telemedicine. However, students had a high self-reported perception of the disadvantages of telemedicine especially related to patient security (p = 0.018), efficiency of care (p = 0.040), and the possibility of medical malpractice (p = 0.010) compared to physicians. Nearly half of the students (n = 53,44.9%) and physicians (n = 22,51.7%) answered 50% or more of the questions related to telemedicine knowledge correctly. CONCLUSION: Among the physicians and medical students enrolled in the course, the students perceived the disadvantages of telemedicine more frequently. Although physicians and students have limited knowledge of telemedicine, there appears to be no influence of experience and prior training in telemedicine.

A proof-of-concept study with SOM3355 (bevantolol hydrochloride) for reducing chorea in Huntington's disease.

AIMS: The study's aim is to investigate the efficacy and safety of SOM3355 (bevantolol hydrochloride), a ß1 -adrenoreceptor antagonist with recently identified vesicular monoamine transporter type 2 inhibitory properties, as a repositioned treatment to reduce chorea in Huntington's disease (HD). METHODS: A randomized, placebo-controlled proof-of-concept study was performed in 32 HD patients allocated to 2 arms of 4 sequential 6-week periods each. Patients received placebo and SOM3355 at 100 and 200 mg twice daily in a crossover design. The primary endpoint was improvement by at least 2 points in the total maximal chorea score in any active drug period compared with the placebo period. RESULTS: The primary endpoint was met in 57.1% of the patients. Improvements ≥3, ≥4, ≥5 and ≥6 points vs. placebo treatment were observed in 28.6, 25.0, 17.9 and 10.7% of the patients, respectively. A mixed-model analysis found a significant improvement in the total maximal chorea score of -1.14 (95% confidence interval, -2.11 to -0.16; P = .0224) with 200 mg twice daily SOM3355 treatment compared with placebo treatment. These results were paralleled by Clinical and Patient Global Impression of Change ratings (secondary endpoints). An elevation in plasma prolactin levels by 1.7-1.9-fold was recorded (P < .005), probably reflecting the effect on the dopamine pathway, consistent with vesicular monoamine transporter type 2 inhibition. The most frequent adverse events during SOM3355 administration were mild to moderate. CONCLUSION: Within the limits of this study, the results suggest that SOM3355 reduces chorea in patients with HD and is well-tolerated. Larger studies are necessary to confirm its therapeutic utility as an antichoreic drug. EudraCT number: 2018-000203-16 and ClinicalTrials.gov Identifier: NCT03575676.

Implementación del servicio de teleconsulta con énfasis en gastroenterología en la Red de Clínicas San Pablo (Perú) durante la pandemia por COVID-19

Objetivo: Describir las atenciones del servicio de teleconsulta en la Red de Clínicas San Pablo (RCSP) durante la pandemia por COVID-19, con énfasis en la especialidad de gastroenterología. El estudio: Estudio descriptivo. Se revisaron los datos del Sistema de Historias Clínicas Electrónicas y el sistema administrativo de la RCSP. Hallazgos: La RCSP incluye 8 sedes (5 en Lima). Entre abril 2020 y diciembre 2021, se realizaron 1 156 253 atenciones (6,6% de estas por teleconsulta). Las especialidades con más teleconsultas fueron medicina interna y endocrinología. Las especialidades con más consultas presenciales fueron gineco-obstetricia y traumatología. Gastroenterología fue la novena especialidad más frecuente en teleconsulta y la quinta en consulta presencial. Los diagnósticos más frecuentes de esta especialidad, tanto para consulta presencial como teleconsulta, fueron dispepsia y enfermedad del reflujo gastroesofágico Conclusión: Se reporta la implementación del servicio de teleconsulta en la RCSP. Además, se brindan lecciones aprendidas en este proceso.

Objective: To describe the assistance provided by the teleconsultation service in the San Pablo Clinic Network (RCSP) during the COVID-19 pandemic, with an emphasis on the specialty of gastroenterology. The study: Descriptive study. Data from the Electronic Medical Records System and the RCSP administrative system were reviewed. Results: The RCSP includes 8 locations (5 in Lima). Between April 2020 and December 2021, 1,156,253 visits were made (6.6% of these by teleconsultation). The specialties with the most teleconsultations were internal medicine and endocrinology, and the specialties with the most face-to-face consultations were gynecology-obstetrics and traumatology. Gastroenterology was the ninth most frequent specialty in teleconsultation and the fifth in face-to-face consultation. The most frequent diagnoses of this specialty, both for face-to-face consultation and teleconsultation, were dyspepsia and gastroesophageal reflux disease Conclusion: The implementation of the teleconsultation service in the RCSP is reported. In addition, lessons learned in this process are provided.

A Study of Drug Repurposing to Identify SARS-CoV-2 Main Protease (3CLpro) Inhibitors.

The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wreaked havoc all over the world. Although vaccines for the disease have recently become available and started to be administered to the population in various countries, there is still a strong and urgent need for treatments to cure COVID-19. One of the safest and fastest strategies is represented by drug repurposing (DRPx). In this study, thirty compounds with known safety profiles were identified from a chemical library of Phase II-and-up compounds through a combination of SOM Biotech's Artificial Intelligence (AI) technology, SOMAIPRO, and in silico docking calculations with third-party software. The selected compounds were then tested in vitro for inhibitory activity against SARS-CoV-2 main protease (3CLpro or Mpro). Of the thirty compounds, three (cynarine, eravacycline, and prexasertib) displayed strong inhibitory activity against SARS-CoV-2 3CLpro. VeroE6 cells infected with SARS-CoV-2 were used to find the cell protection capability of each candidate. Among the three compounds, only eravacycline showed potential antiviral activities with no significant cytotoxicity. A further study is planned for pre-clinical trials.

Efectividad del aplicativo de resultados críticos para el apoyo al diagnóstico y terapéutico de pacientes crónicos atendidos en una Clínica privada entre el 2017 y 2018 / Effectiveness of the critical results application to support the diagnosis and therapy of chronic patients treated in a private clinic between 2017 and 2018

Introducción: La oportuna prestación de servicios de salud es clave para reducir la morbimortalidad de pacientes crónicos, especialmente cuando se requiere una atención frente a un resultado crítico de exámenes auxiliares. En ese contexto, se evalúa un aplicativo web de resultados críticos en una Clínica privada acreditada por Joint Commission International (JCI). Objetivos: el presente estudio busca evaluar la efectividad de un aplicativo web en el reporte de resultados críticos de pacientes crónicos. Material y métodos: Se realizó un estudio de cohorte retrospectiva. Se compararon dos etapas: la etapa de línea de base (implementación del software) versus la etapa final (evaluación). Resultados: Se registraron 122 resultados críticos de pacientes crónicos en la etapa de implementación y 113 en la etapa de evaluación. Se encontró una disminución en la media del tiempo de respuesta del profesional en la etapa de evaluación con relación a la etapa de implementación. La transcripción en los registros incrementó del 75,4% al 93,8% p<0,001, la continuidad de la atención por el mismo médico incrementó del 41,0% al 54,9% p<0,03. Asimismo, se redujo en 68% la probabilidad de fallecimiento. Conclusiones: El aplicativo web de resultados críticos mejoró el registro de la atención y redujo la mortalidad de pacientes crónicos que tuvieron un resultado crítico.

Introduction:Currently, the use of health technologies in the health system has become a subject of constant study and innovation. In this context, in an institution accredited by the Joint Commission International (JCI), a web application was implemented to manage critical results, which were defined as results that could put the patient's life at risk. Objectives: this study seeks to evaluate the effectiveness of an application in reporting critical results. Material and methods: Aretrospective cohort study was carried out. Two stages were compared: the baseline stage (software implementation) versus the final stage (evaluation). Results: 122 critical results were registered in the implementation stage and 113 in the evaluation stage. Adecrease was found in the average response time of the professional in the evaluation stage in relation to the implementation stage. The transcription in the records increased from 75.4% to 93.8% p <0.00, the continuity of care by the same doctor increased from 41.0% to 54.9% p <0.03. Likewise, the probability of death was reduced by 68%. Conclusions: Intheevaluationstage,mortalitydecreasedandthe transcription in the information registry of the critical results application improved towards the patient's clinical history. Likewise, it was possible to optimize the quality of care by ensuring that the follow-up of the patient throughout the entire care is carried out by the same doctor.

Efectividad del aplicativo de resultados críticos para el apoyo al diagnóstico y terapéutico de pacientes crónicos atendidos en una Clínica privada entre el 2017 y 2018 / Effectiveness of the critical results application to support the diagnosis and therapy of chronic patients treated in a private clinic between 2017 and 2018

RESUMEN Introducción: La oportuna prestación de servicios de salud es clave para reducir la morbimortalidad de pacientes crónicos, especialmente cuando se requiere una atención frente a un resultado crítico de exámenes auxiliares. En ese contexto, se evalúa un aplicativo web de resultados críticos en una Clínica privada acreditada por Joint Commission International (JCI). Objetivos: el presente estudio busca evaluar la efectividad de un aplicativo web en el reporte de resultados críticos de pacientes crónicos. Material y métodos: Se realizó un estudio de cohorte retrospectiva. Se compararon dos etapas: la etapa de línea de base (implementación del software) versus la etapa final (evaluación). Resultados: Se registraron 122 resultados críticos de pacientes crónicos en la etapa de implementación y 113 en la etapa de evaluación. Se encontró una disminución en la media del tiempo de respuesta del profesional en la etapa de evaluación con relación a la etapa de implementación. La transcripción en los registros incrementó del 75,4% al 93,8% p<0,001, la continuidad de la atención por el mismo médico incrementó del 41,0% al 54,9% p<0,03. Asimismo, se redujo en 68% la probabilidad de fallecimiento. Conclusiones: El aplicativo web de resultados críticos mejoró el registro de la atención y redujo la mortalidad de pacientes crónicos que tuvieron un resultado crítico.

ABSTRACT Introduction: Currently, the use of health technologies in the health system has become a subject of constant study and innovation. In this context, in an institution accredited by the Joint Commission International (JCI), a web application was implemented to manage critical results, which were defined as results that could put the patient's life at risk. Objectives: this study seeks to evaluate the effectiveness of an application in reporting critical results. Material and methodo: A retrospective cohort study was carried out. Two stages were compared: the baseline stage (software implementation) versus the final stage (evaluation). Results: 122 critical results were registered in the implementation stage and 113 in the evaluation stage. A decrease was found in the average response time of the professional in the evaluation stage in relation to the implementation stage. The transcription in the records increased from 75.4% to 93.8% p <0.00, the continuity of care by the same doctor increased from 41.0% to 54.9% p <0.03. Likewise, the probability of death was reduced by 68%. Conclusions: In the evaluation stage, mortality decreased and the transcription in the information registry of the critical results application improved towards the patient's clinical history. Likewise, it was possible to optimize the quality of care by ensuring that the follow-up of the patient throughout the entire care is carried out by the same doctor.

Experiencia del Complejo Hospitalario San Pablo (Perú) en la implementación de un sistema de historias clínicas electrónicas

En Perú, la mayoría de establecimientos de salud, tanto públicos como privados aún se gestionan con formatos de historias clínicas en papel. La migración al sistema de información de historias clínicas electrónicas (SIHCE) es un gran reto en múltiples aspectos. El Complejo Hospitalario San Pablo (CHSP) está conformado por once establecimientos de salud distribuidos en cuatro departamentos del Perú. En el presente artículo relatamos el proceso de implementación del SIHCE en el CHSP mediante el circuito del software, para el cual se siguieron los siguientes pasos: 1) Decisión de implementar un sistema de HCE, 2) Constitución del comité, 3) Benchmarking y evaluación del proveedor, 4) Plan de implementación, 5) Reuniones de coordinación, 6) Pruebas, 7) Capacitaciones, 8) Go Live, y 9) Implementación por réplica. Asimismo, reflexionamos sobre las lecciones aprendidas durante este proceso, las cuales giran en torno a dos ángulos: gestión frente al cambio y modificaciones en los procesos. La experiencia presentada en el presente artículo podría ser de utilidad para otras instituciones prestadoras de salud que deseen o estén en proceso de implementar un SIHCE en un contexto similar al nuestro.

In Peru, the vast majority of health facilities, both public and private, still have medical record formats on paper. Migration to the electronic health records information system (SIHCE) has been seen to be a great challenge in many respects. The San Pablo Hospital Complex (CHSP) is made up of eleven health establishments distributed in four departments of the country. In this article we report the process of implementing the SIHCE in the CHSP through the software circuit, for which the following steps were followed: 1) Decision to implement an EHR system, 2) Constitution of the committee, 3) Benchmarking and evaluation 4) Implementation plan, 5) Coordination meetings, 6) Testing, 7) Trainings, 8) Go Live, and 9) Implementation by replication. Likewise, we reflect on the lessons learned during this process, which revolve around two angles: management versus change and process modifications. The experience presented in this paper could be of use to other healthcare providers that wish or are in the process of implementing an SIHCE system in a context similar to ours.

Prevalence of dental anxiety in patients attending the dental service of two hospitals managed by the Ministry of Health of Peru / Prevalencia de ansiedad dental en pacientes del servicio de odontología de dos hospitales del Ministerio de Salud del Perú

Objective: To determine the level of dental anxiety in dental patients from two hospitals managed by the Ministry of Health of Peru, between August-September 2015. Material and Methods: Cross-sectional, comparative, and observational study, carried out between August and September 2015, including a total of 660 adult patients from the Dental Service of the Hospitals Regional Docente de Trujillo and Belén de Trujillo, Peru. A questionnaire based on the Modified Dental Anxiety Scale (MDAS) (Cronbach's Alpha=0.77) was applied to the participating subjects. Student's t test for independent groups and the Mann-Whitney U test were used for the analysis of the results, considering a significance level of 5%. Results: The mean total anxiety score for the population was 12.05 (SD=3.76). Females (mean=12.56) presented greater anxiety than males (mean=11.53) (p<0.001), young adults (Me=12.60) presented greater anxiety than subjects in mid-adulthood (Me=11.10) (p<0.001). No difference was found in terms of hospitals (p=0.386); 96.06% of the patients evaluated presented dental anxiety, 4.09% had extreme anxiety. Conclusion: The mean dental anxiety of the studied population coincides with the level of moderate anxiety. Females and young adults presented greater anxiety. No difference was found with respect to hospitals. Likewise, 96.06% of the evaluated patients presented dental anxiety, 4.09% had extreme anxiety.

Objetivo: Determinar la ansiedad dental en pacientes odontológicos de dos hospitales del Ministerio de Salud del Perú, agosto-septiembre, 2015.Material y Métodos: El presente estudio de corte transversal, comparativo y observacional, se desarrolló entre agosto y septiembre del 2015 e incluyó un total de 660 pacientes adultos del Servicio de Odontología de los hospitales Regional Docente de Trujillo y Belén de Trujillo. Se les aplicó un cuestionario basado en la Escala de Ansiedad Dental Modificada (Alfa de Cronbach=0.77). Para el análisis de resultados se empleó la prueba t de Student para grupos independientes y la prueba U de Mann-Whitney, considerando un nivel de significancia del 5%. Resultados: La puntuación media total de ansiedad para la población fue de 12.05 (DE=3.76), el sexo femenino (Me=12.56) presentó mayor ansiedad que el masculino (Me=11.53) (p<0.001), la adultez joven (Me=12.60) presentó mayor ansiedad que la adultez media (Me=11.10) (p<0.001). No se encontró diferencia en cuanto a hospital (p=0.386). El 96.06% de los pacientes evaluados presentaron ansiedad dental, siendo el 4.09% de ansiedad extrema. Conclusión: La ansiedad dental media de la población estudiada coincide en el nivel de ansiedad moderada. El sexo femenino y los adultos jóvenes presentaron mayor ansiedad. No se encontró diferencia con respecto a los hospitales. Asimismo, el 96.06% de los pacientes evaluados presentaron ansiedad dental, siendo el 4.09% de ansiedad extrema.

Historia de la Atención Primaria de Salud en Perú: entendiendo su camino y perspectivas actuales / History of Primary Health Care in Peru: understanding its path and current perspectives

RESUMEN El desarrollo de la atención primaria de salud en el Perú ha logrado importantes hitos en su historia. Los fundamentos sociales que dieron forma a los servicios de salud en el siglo anterior pueden explicarse por eventos durante la época colonial. Además, después de la Declaración de Alma-Ata en 1978, Perú enfrentó varios obstáculos que polarizaron aún más a la población de diferentes estratos económicos. Sin embargo, el Ministerio de Salud, junto con la cooperación internacional, comenzó a desarrollar programas de salud con el objetivo de brindar atención primaria a la población, con resultados fundamentales que ayudaron a unificar a la población y a estar un paso más cerca de lograr una cobertura de atención médica universal. Por lo tanto, en este documento, describimos los eventos que conducen al sistema de salud actual del Perú, los logros de los servicios de Atención Primaria de Salud y el uso de dispositivos tecnológicos para mejorar la salud pública

SUMMARY The development of primary health care in Peru has achieved important milestones in its history. The social foundations that were formed in the health services in the previous century can be explained by events during the colonial era. Furthermore, after the Declaration of Alma-Ata in 1978, Peru faced several obstacles that further polarized the population from different economic strata. However, the Ministry of Health, together with international cooperation, began to develop health programs with the objective of providing primary care to the population, with the fundamental results that will help to unify the population and be one-step closer to achieving universal health care coverage. Therefore, in this document, we describe the events leading to Peru's current health system, the achievements of Primary Health Care services, and the use of technological devices to improve public health.

The scientific production of medical students in Lima, Peru.

BACKGROUND: Research is an important undergraduate competence for physicians. However, few studies have assessed the scientific production of medical students in Latin-America. Thus, this study had the objective to assess the rate and characteristics of research publications by undergraduate medical students in 2016, in Lima, Peru. METHODS: This cross-sectional study included all the students of the eight medical schools in Lima (Peru). The medical students included were collected from the registry of the National Medical Examination (taken during their last year of undergraduate studies) in 2016. To evaluate their research publications, systematic searches were performed in Google Scholar and PubMed during August 2018. RESULTS: We studied data from 1241 medical students (54.2% females) from eight medical schools. 173 (13.9%) students published at least one paper, 102 (8.2%) published at least one original paper, and 30 (2.4%) published at least one original paper in PubMed-Indexed journals. We registered a total of 174 papers authored by medical students, of which 98 (56.3%) were published in Peruvian journals, 128 (73.6%) were published in Spanish, 90 (51.7%) had a medical student as the first author, and 43 (24.7%) had a medical student as the corresponding author. The percentage of students with at least one publication was very heterogeneous across the eight medical schools evaluated (63.6%, 21.4%, 16.8%, 15.1%, 8.2%, 2.0%, 1.9%, and 0.0%). CONCLUSION: Among medical students in Lima, one out of seven had published at least one paper, one out of 12 had published at least one original paper, and one out of 40 had published at least one original paper in PubMed-Indexed journals. Scientific production was very heterogeneous across medical schools.

Quality of clinical practice guidelines approved in Peru between 2015 and 2017 / Calidad de las guías de práctica clínica aprobadas en Perú entre 2015 y 2017

Abstract Introduction: The diagnosis and management of patients with the same medical condition may vary significantly depending on the treating physician. Clinical practice guidelines (CPG) are used to reduce this variation and to promote evidence-based management in clinical practice. Objectives: To describe the characteristics of the CPGs adopted by public health institutions in Peru from July 2015 to September 2017. Materials and methods: Cross-sectional, descriptive study. The following quality criteria were assessed in each CPG: the panel of experts responsible for the development of the CPG; protocols regarding the evidence identification, collection and assessment systems; and the level of evidence supporting each recommendation. Results: 558 CPGs were included, of which 65.8% did not provide information on having an explicit author or only listed one author. In addition, 81.5% did not have citations, nor a reference list, and 97.7% did not clearly provide supporting evidence on how the recommendations were reached. Conclusions: Most of the CPGs did not meet the quality criteria assessed in the present study, thus it is necessary to improve the skills of Peruvian health professionals to develop quality CPGs that adjust to their local context.

Resumen Introducción. El diagnóstico y el manejo de pacientes con la misma condición médica pueden variar de manera significativa de profesional a profesional. Una manera de controlar esta variación y promover un manejo basado en evidencias es mediante el uso de guías de práctica clínica (GPC). Objetivos. Describir las características de las GPC aprobadas por entidades públicas de salud de Perú entre julio de 2015 y setiembre de 2017. Materiales y métodos. Se realizó un estudio transversal descriptivo donde se evaluaron los siguientes criterios de calidad de las GPC: panel de expertos que elaboró la guía; protocolos respecto a los sistemas de identificación, recogida y evaluación de la evidencia, y nivel de evidencia que sustenta cada recomendación. Resultados. Se incluyeron 558 GPC, de las cuales 65.8% no contaba con autor explícito o solo describía un autor y no una lista, 81.5% no contaba con citas ni referencias bibliográficas y 97.7% no sustentaba de forma clara la elaboración de sus recomendaciones. Conclusiones. La mayoría de las GPC no cumplieron los criterios de calidad evaluados en el presente estudio, por tanto es necesario mejorar las habilidades de los profesionales de la salud en Perú para elaborar GPC de calidad.

Tendencias en el número de médicos titulados anualmente en el Perú, 2007-2016 / Trends in the number of physicians annually graduating in Peru, 2007-2016

Objetivo: Describir la tendencia en el número de médicos que se titularon durante el periodo 2007-2016 en Perú, en forma general y en subgrupos de acuerdo a las características ligadas a la universidad en la que cursaron los estudios de pregrado. Materiales y métodos: Estudio descriptivo. Se obtuvo el listado de todos los médicos colegiados entre 2007-2016 por medio de la página web del Colegio Médico del Perú; mientras que la fecha de titulación y universidad de procedencia provino de la página web de la Superintendencia Nacional de Educación Superior Universitaria (SUNEDU). Para evaluar las tendencias, se utilizó la prueba de correlación de Spearman. Resultados: En el periodo de estudio se colegiaron 27 611 médicos a nivel nacional, con una tendencia anual creciente en la cantidad de médicos titulados (p<0,001). Entre los egresados de universidades peruanas, se encontró un incremento del número de médicos que estudiaron en universidades de Lima (p<0,001) y de la región costa (p<0,001). Adicionalmente, se evidenció un incremento en la cantidad de titulados provenientes de universidades privadas de Lima (p<0,001) y de provincias (p<0,001). Conclusiones: El número de médicos titulados aumenta anualmente, con predominio de aquellos provenientes de universidades de Lima, la costa y universidades privadas. Se evidencia la necesidad urgente de políticas que regulen este crecimiento, con la finalidad de evitar problemas de calidad educativa y empleabilidad.

Objective. To describe the trends in the number of physicians who graduated from 2007 to 2016 in Peru, both in a general manner as well as in subgroups based on the school they studied. Materials and Methods. This is a descriptive and retrospective study. A list of all physicians who graduated during the 2007-2016 period was obtained from the Peruvian College of Physicians website. Their graduating dates and the schools where they studied were obtained from the National University Education Superintendence (SUNEDU, according to its Spanish initials). Trends were assessed using the Spearman correlation test. Results: During the study period, 27,611 physicians graduated in Peru. There was an annual increase in the total number of graduates (p<0.001). Amongst graduates from Peruvian medical schools, there was an increase in the number of physicians who studied in Lima (p<0.001) and in the Peruvian coast (p<0.001). Also, there were a greater number of graduated physicians from Lima (p<0.001) and other provinces medical schools (p<0.001). Conclusions. The number of graduated physicians annually increases, particularly those who studied in Lima, the coast, and private medical schools. We evidence an urgent need for policies for regulating this growth, aiming to avoid employability and educational quality problems.

Osteosarcoma multicéntrico sincrónico en paciente pediátrico: reporte de un caso / Synchronous multicenter osteosarcoma in a pediatric patient: Report of a case

El osteosarcoma es una neoplasia maligna común del tejido óseo. No obstante, la variante denominada multicéntrica o multifocal, es una entidad rara. Además, si al momento del diagnóstico se identifica más de una lesión se le añade el término sincrónico. Se presenta el primer caso en el Perú de una paciente pediátrica de 9 años referida a nuestro instituto con imágenes radiológicas sugestivas de neoplasia ósea en fémur distal derecho. Posteriormente, se diagnosticó osteosarcoma multicéntrico sincrónico mediante biopsia y exámenes imagenológicos. Recibió tratamiento quimioterapéutico triple con ifosfamida, doxorrubicina y cisplatino, sin mejora en la condición clínica. Posteriormente, desarrolló metástasis pulmonar y recibió tratamiento paliativo con ciclosofamida. En conclusión, el osteosarcoma multicéntrico sincrónico es un tipo de neoplasia ósea maligna, altamente agresiva y de mal pronóstico. Nuestra experiencia con esta triple terapia de quimioterapia no tuvo una buena respuesta clínica. Sugerimos una evaluación individual para el tratamiento de esta variante

Osteosarcoma is a common malignancy affecting bones. However, the multicenter or multifocal variety is a rare condition. Also, if at the time of diagnosis more than one lesion is identified, then the 'synchronous' term is added to the case definition. We present the first case described in Peru of a 9-year old patient who was referred to our institution with radiological images suggesting a bone malignancy in her distal right femur. Afterwards, a synchronous multicenter sarcoma was diagnosed with biopsy and image studies. She received triple chemotherapy with ifosfamide, doxorubicin, and cisplatin, but there was no improvement in her clinical status. Later she developed lung metastases and she received palliative therapy with cyclophosphamide. In conclusion, synchronous multicenter osteosarcoma is a highly aggressive bone malignancy with a poor prognosis. Our experience with triple therapy did not lead to a good clinical response. We suggest individual assessment for treating this variant

Producción científica en diabetes en Perú: Un estudio bibliométrico / Scientific production in diabetes in Peru: A bibliometric study

Objective: to describe the scientific production related to diabetes in Peru between 1996 and 2015. Methods: Bibliometric study. Scientific papers on diabetes published between 1996 and 2015 were identified by authors with Peruvian affiliation in the Web of Science Core Collection (WoS) andScopus databases. The variables of interest were extracted manually We present descriptive results and collaborative networks. Results: We found 81 publications, 75.3% were original articles, of which none evaluated public health interventions and 60.7% received foreign funding; 55.6% had an author affiliated with the Universidad Peruana Cayetano Heredia (UPCH), and 65.4% had a foreign author. Five clusters of international collaboration networks could be distinguished, all with the participation of the UPCH. Conclusion: Peruvian scientific production related to diabetes is low, with an absence of studies evaluating public health interventions, and with collaboration networks focused on UPCH.

Objetivo: describir la producción científica en diabetes en Perú entre 1996 y 2015. Métodos: Estudio bibliométrico. Se identificaron publicaciones científicas sobre diabetes que tuvieran algún autor con filiación peruana, en las bases de datos Web of Science Core Collection (WoS) y Scopus, entre 1996 y 2015. Se extrajeron manualmente las variables de interés. Se presentaron los resultados descriptivos y las redes de colaboración. Resultados: Se encontraron 81 publicaciones, el 75,3% fueron artículos originales, de las cuales ninguno evaluó intervenciones en salud pública y 60,7% recibieron financiamiento extranjero. El 55,6% tuvieron algún autor afiliado a la Universidad Peruana Cayetano Heredia (UPCH), y el 65,4% algún autor extranjero. Se puedo distinguir cinco conglomerados de redes de colaboración internacional, todos con participación de la UPCH. Conclusión: La producción científica peruana en diabetes ha sido baja, con ausencia de estudios que evalúen intervenciones en salud pública, y con redes de colaboración centradas en la UPCH.

Repositioning tolcapone as a potent inhibitor of transthyretin amyloidogenesis and associated cellular toxicity.

Transthyretin (TTR) is a plasma homotetrameric protein implicated in fatal systemic amyloidoses. TTR tetramer dissociation precedes pathological TTR aggregation. Native state stabilizers are promising drugs to treat TTR amyloidoses. Here we repurpose tolcapone, an FDA-approved molecule for Parkinson's disease, as a potent TTR aggregation inhibitor. Tolcapone binds specifically to TTR in human plasma, stabilizes the native tetramer in vivo in mice and humans and inhibits TTR cytotoxicity. Crystal structures of tolcapone bound to wild-type TTR and to the V122I cardiomyopathy-associated variant show that it docks better into the TTR T4 pocket than tafamidis, so far the only drug on the market to treat TTR amyloidoses. These data indicate that tolcapone, already in clinical trials for familial amyloid polyneuropathy, is a strong candidate for therapeutic intervention in these diseases, including those affecting the central nervous system, for which no small-molecule therapy exists.

Evaluación de un instrumento para cuantificar la estigmatización de la adolescente embarazada en el Perú / Evaluation of an instrument to quantify stigmatization of pregnant adolescents in Peru

El embarazo adolescente es un problema de salud pública que representa una situación que posiciona la vida de la adolescente en una condición de particular vulnerabilidad no solo biomédica, sino también social, siendo particularmente importante la estigmatización hacia la adolescente embarazada. Objetivo: Evaluar psicométricamente un instrumento destinado a cuantificar la estigmatización de la adolescente embarazada. Diseño: Estudio transversal. Lugar: Instituto Nacional Materno Perinatal, Lima, Perú. Participantes: Adolescente puérperas. Intervenciones: Se estudió 292 adolescente puérperas atendidas durante los meses de enero a mayo del 2010. Se usó la Escala de Estigmatización de la Adolescente Embarazada (EEAA), la cual está compuesta de 7 ítems. Para la construcción teórica de la escala, se asumió dos entidades sociales promotoras de la estigmatización: la familia y el entorno social. Para evaluar la predictibilidad de la EEAE se trabajó con la siguiente hipótesis: los mayores niveles de estigmatización están asociados a un menor autoconcepto de la adolescente como madre. Principales medidas de resultados: Coeficiente de alfa de Cronbach, medias, T de student. Resultados: El análisis psicométrico de la EEAE reveló un coeficiente alfa de Cronbach de 0,78, con dos dimensiones que explicaron el 65,8 por ciento de la varianza total. Conclusiones: Se probó la hipótesis planteada: un menor autoconcepto de la adolescente como madre está asociado significativamente a mayores puntajes en la EEAE (p<0,05). La EEAE presentó consistencia alta. Además existió una asociación con un menor autoconcepto materno, por lo que se considera una escala confiable y válida para su uso en adolescentes embarazadas...

Teenage pregnancy is a public health problem that places the status of a teenager in biomedical and social vulnerability, the stigmatization of a pregnant adolescent. Objective: To evaluate psychometrically an instrument to measure stigmatization of pregnant adolescents. Design: Cross-sectional study. Location: National Maternal Perinatal Institute, Lima, Peru. Participants: Adolescent puerperae. Interventions: To 292 postpartum adolescents attended from January through May 2010 an Adolescent Pregnant Stigma Scale (APSS) consisting in 7 items was applied. For the theoretical construction of the scale, two promoter entities of social stigma were assumed: family and social environment. To assess the predictability of APSS the following hypothesis was considered: the higher levels of stigma are associated with a lower self-concept of the adolescent mother. Main outcome measures: Cronbach's alpha coefficient, medians, T student. Results: The psychometric analysis revealed for APSS a Cronbach's alpha coefficient of 0.78; two dimensions accounted for 65.8 per cent of the total variance. Conclusions: The hypothesis was verified: a lower self-concept of the adolescent as a mother was significantly associated with higher scores of APSS (p<0.05). APSS had high consistency. There was also an association with a lower maternal self-concept, making the scale reliable and valid for use in pregnant adolescents...

Triazolopyrimidine compounds containing first-row transition metals and their activity against the neglected infectious Chagas disease and leishmaniasis.

Leishmaniasis and Chagas disease remain a significant global problem. Current treatments have serious disadvantage due to cost, toxicity, long therapy duration and resistance. In the last years increasing interest has arisen in drug development to fight both diseases. Recently, metal-based drugs have revealed as promising drugs in a variety of therapeutic areas. Herein we describe six newly synthesized transition metal complexes with a bioactive molecule 5,7-dimethyl-1,2,4-triazolo[1,5-a]pyrimidine (dmtp). All of them have been characterized by X-ray, spectroscopic and thermal methods. In vitro and in vivo studies (murine model) on the antiproliferative activity of these complexes against Leishmania spp. (Leishmania infantum, Leishmania braziliensis) and Trypanosoma cruzi have been carried out. Our results reveal a strong potential of three of the assayed compounds as antiparasitic agents against the above-mentioned infectious diseases.