Factors associated with the discontinuation of hormonal contraceptives in women of Lima, Peru.

INTRODUCTION: Family planning is a right and a tool that offers the possibility of choosing how many children to have. Its importance lies in the possibility of avoiding an unwanted pregnancy and its consequences. Our objective was to determine the factors associated with discontinuing hormonal contraceptives in women of childbearing age who attended the La Libertad Health Center in January 2023. METHODS: The study was observational, analytical, and cross-sectional. A total of 100 women of childbearing age who were users of hormonal contraceptives were included. Descriptive statistics were performed, frequency measurements and measures of central tendency were calculated, bivariate statistics were performed and the prevalence ratio (PR) was calculated, and a robust Poisson regression model was performed to assess the associated independent factors. All calculations were made with a confidence level of 95%. RESULTS: The educational level (PR=1.74; 95% CI: 1.22-2.48, p=0.006), the distance to the health center (PR=7.32; 95% CI: 1.1-48.5, p=0.001), having presented adverse events (PR=26.38; 95% CI: 3.8-183, p=0.001), and that the health staff had not identified the need for contraception (PR=3.12; 95% CI: 0.87-11.10, p=0.01) were associated with stopping a hormonal contraceptive. After introducing the variables to the regression model, the only independently associated factor was having presented an adverse event with the use of hormonal contraceptives (adjusted prevalence ratio, APR=3.33; 95% CI: 2.1-5.2, p<0.001). CONCLUSIONS: In this population, the factors associated with the discontinuation of hormonal contraceptives were education level, distance to the health center, having presented some adverse event with its use, and that health staff had not identified the need for contraception. The only independently associated factor was having presented an adverse event.

Ultrastructural skin alterations of healthy subjects with anti-desmoglein 1 antibodies in endemic areas to pemphigus foliaceus: A case series.

Background: Endemic pemphigus foliaceus and endemic pemphigus vulgaris are autoimmune dermatologic disorders endemic to the Peruvian Amazon. Objective: To determine the ultrastructural skin alterations of three healthy subjects with anti DSG-1 antibodies in areas endemic to pemphigus foliaceus and pemphigus vulgaris in the Peruvian Amazon. Patients and methods: Case series carried out from data of three clinically healthy subjects positive to anti DSG-1 antibodies, from Peru. This study consists of a sub-analysis of data gathered in a previous study. Results: Ultrastructural results are presented from the skin biopsies of three clinically healthy patients positive to anti-desmoglein 1 (DSG-1) antibodies. High Resolution Optical Microscopy (HROM) showed the absence of acantholysis. Transmission Electron Microscopy (TEM) showed the widening of intercellular space between keratinocytes, the presence of vacuoles in intercellular space with granular material and cytoplasmic vacuolization, loss of desmosome structure, loss of normal distribution among tonofilaments and lateral separation among cells in the stratum basale. Conclusion: According to our results, healthy subjects that present anti-desmoglein 1 antibodies can develop ultrastructural alterations that are visible through transmission electron microscopy but not through conventional optical microscopy.

Características clínico-epidemiológicas de adolescentes multíparas atendidas en el Instituto Nacional Materno Perinatal de Lima, Perú / Clinical-epidemiological characteristics of adolescent multiparous patients attendedat the Instituto Nacional Materno Perinatal of Lima, Perú

Introducción. El embarazo adolescente es un problema de salud pública con consecuencias médicas y sociales. Objetivo. Determinar las características clínicas y epidemiológicas de las adolescentes multíparas atendidas en el Instituto Nacional Materno Perinatal entre 2014 y 2016. Material y métodos. Estudio descriptivo de serie de casos. La población estuvo constituida por todas las adolescentes puérperas multíparas atendidas en el Instituto Nacional Materno Perinatal entre 2014 y 2016 cuyos datos fueron incluidos en el Sistema Informático Perinatal. Resultados. Se incluyó un total de 567 adolescentes, el 96,3% de las pacientes pertenecían a la adolescencia tardía, eran convivientes (80,8%), con secundaria incompleta (51,3%), amas de casa (88,7%), con mediano riesgo social (54,7%) e IMC pre gestacional normal en el 57,7%. La mayoría (70.7%) fueron gestantes no controladas, con inicio tardío de controles prenatales (75{5%), predominancia de partos a término (86{2%) y eligieron a los inyectables (45{9%) como anticoncepción al egreso. La mayoría tuvo dos embarazos (85,7%), dos partos (95,9%), ningún aborto (89,2%) y hubo predominio de partos vaginales (67,5%). Conclusión. Las características clínicas y epidemiológicas de las multíparas adolescentes son similares a estudios previos realizados en Perú, con excepción del predominio de partos a término. Palabras Claves: embarazo; adolescencia; paridad; cesárea

Introduction. Adolescent pregnancy is a public health problem with medical andsocial consequences. Objective.Determine the clinical and epidemiological characteristics of multiparous puerperal adolescents attendedat the Instituto Nacional Materno Perinatal between 2014 and 2016. Material and methods.A descriptive case series study. The population was made up of all the multiparous adolescent postpartum women attended at the Instituto Nacional Materno Perinatal between 2014 and 2016 whose data were included in the Perinatal Computer System. Results.A total of 567 adolescents were included,96.3% of the patients belonged to late adolescence, were living in common law union (80.8%), with incomplete secondary education (51.3%), housewives (88.7%), with medium social risk (54.7%) and normal pregestational BMI in 57.7%; the majority (70.7%) were uncontrolled pregnant women, with late onset of prenatal controls (75.5%), predominance of term deliveries (86.2%) and they chose injectables (45.9%) as contraception at discharge. The majority had two pregnancies (85.7%), two deliveries (95.9%), no abortion (89.2%) and predominance of vaginal deliveries (67.5%). Conclusions.The clinical and epidemiological characteristics of adolescent multiparous are similar to previous studies carried out in Peru, with the exception of predominance of term deliveries. Key words:pregnancy; adolescence; parity; cesareansection

Apendicitis aguda en inicio de trabajo de parto. Reporte de caso / Acute appendicitis atthe onset of labor.A Case Report

Apendicitis aguda es la secuencia de inflamación, perforación, formación de absceso y peritonitis, causado con mayor frecuencia por obstrucción del lumen apendicular. La apendicitis es la patología quirúrgica no obstétrica más frecuente en el embarazo. Su incidencia puede ser variable y se presenta con mayor proporción durante el primer y segundo trimestre de gestación. Se presenta el caso de una paciente de 34 años de edad, con 36 semanas de gestación. Se diagnostica abdomen agudo quirúrgico y posible apendicitis aguda complicada. En sala de operaciones se confirma diagnóstico de apendicitis aguda complicada, revelando un plastrón apendicular y evolución favorable. Durante la gestación el diagnóstico de la apendicitis es difícil debido a los cambios anatómicos y fisiológicos que se producen, por lo que recalcamos la importancia de describir esta condición en el embarazo. Palabras Clave: apendicitis; embarazo; abdomen agudo.

Acute appendicitis is the sequence of inflammation, perforation, abscess formation and peritonitis, most frequently caused by obstruction of the appendicular lumen. Appendicitis is the most frequent non-obstetric surgical pathology in pregnancy. Its incidence can be variable and occurs with a greater proportion during the first and second trimester of pregnancy. The case of a 34-year-old patient with 36 weeks of gestation is presented. Surgical acute abdomen and possible complicated acute appendicitis are diagnosed. In the operating room, the diagnosis of acute appendicitis was confirmed, revealingan appendiceal plastron and favorable evolution. During pregnancy, the diagnosis of appendicitis is difficult due to the anatomical and physiological changes thatoccur, so we emphasize the importance of describing this condition during pregnancy. Key Words:appendicitis; pregnancy; acute abdomen.

HIV treatment cascade in regions of Peru with the highest HIV prevalence.

OBJECTIVES: To describe the HIV treatment cascade and care continuum in regions of highest HIV prevalence in Peru. METHODS: An observational longitudinal study was carried out in 14 tertiary hospitals in Peru. These are the main hospitals that administer antiretroviral treatment (ART) in the regions that represent approximately 95% of reports of HIV/AIDS cases in Peru in 2013. We included individuals older than 18 years newly diagnosed with HIV from 1 January 2011 to 31 December 2012. Medical records were reviewed until 2015. RESULTS: A total of 2119 people living with HIV (PLHIV) were identified in the selected health facilities (mean age = 35.26 years, 78% male). 97.25% [1845/1897; 95% confidence interval (CI): 96.4-97.9%] of the patients attended the consultation at least once during the follow-up, but only 64.84% (885/1365; 95% CI: 62.2-67.4%) attended within a month after the diagnosis. After starting ART, 74.63% (95% CI: 71.9-77.2%) of PLHIV remained in healthcare. Regardless of the time after diagnosis, 88.40% (1837/2078; 95% CI: 86.9-89.7%) of PLHIV started ART during the observation time. However, 78.68% (95% CI: 76.8-80.4%) did so during the first post-treatment year and only 28.88% (95% CI: 27.9-31.9%) after 1 month. After starting treatment, it was observed that 51.60% (95% CI: 49.2-54%) of PLHIV reached viral suppression during the follow-up period. CONCLUSIONS: Further analysis and improvements in the definition of indicators are required to achieve conclusive results; however, these data will give us a general understanding of the progress of Peruvian health policies in achieving the goal established by the WHO.

Arsenicism by Chronic Exposure to Mine Tailings in Peru: An Analysis of 17 Cases with Lesions on Skin and/or Annexes.

Objective: To characterize the epidemiology and clinical manifestations of arsenicism from chronic exposure to mine tailings in people with lesions on their skin and/or annexes in two mining districts in the highlands of Peru. Materials and Methods: In this case series study, we included 17 people that presented arsenical lesions in skin and annexes which were identified in two prior studies. We evaluated age, occupation, place of exposure, time of exposure, time of disease, manifestations on skin and annexes, location of lesions, severity, and 24-hour urine clearance of arsenic. Results: The average time of exposure was 16.5 ± 14.7 years, and the average length of disease was 9.8 ± 8.1 years. In this study, 70.6% were men, 41.2% were farmers and 17.6% were underage. The most frequent main manifestations in skin and annexes were plantar keratosis (23.5%), palmar (11.8%), palmoplantar (11.8%) and thoracic keratosis (5.9%). Other manifestations were palmoplantar keratosis with thoracic hyperpigmentation (17.6%), Mees' lines (17.6%) and hyper/hypopigmentation in thorax and back (11.8%). With relation to the severity of lesions, 35.3% were grade 1 (mild), 29.4 % were grade 0 (asymptomatic), 29.4 % were grade 2 (moderate), and 5.9% were grade 3 (severe). The median of 24-hour urine clearance of arsenic was 55 µg/L/24 hours. No cases of skin cancer were presented. Conclusion: The studied cases of arsenicism with lesions on skin and/or annexes by exposure to mine tailings present with differential characteristics in comparison to other forms of arsenicism such as less severity, lower urine clearance of arsenic, and absence of skin cancer cases.

Exposure to Atmospheric Ozone Disruption and Altitude Over 3500 m.a.s.l. are Associated with a Higher Prevalence of Photodermatoses in Pediatric Population of High-Altitude in Peru.

Objective: To determine if exposure to atmospheric ozone disruption and other factors are associated with photodermatoses in the high-altitude pediatric population in Peru. Materials and Methods: A cross-sectional study based on data obtained from studies of dermatological diseases among the population exposed to mine tailings in Peru which included children under the age of 18 in 6 population centers located over 2500 meters above sea level (m.a.s.l). We evaluated the presence of photodermatoses and possible associated factors obtaining the adjusted odds ratio (aOR) and confidence intervals (CI). Results: 594 children below the age of 18 participated in this study, 53.0% girls, the average age was 10.4 ± 4.1 years. 51.3% were exposed to a mini hole in the ozone layer, 60.1% resided at an altitude over 3500 m.a.s.l and 51.9% presented cutaneous manifestations of atopy upon physical examination. The prevalence of photodermatoses was 64.8%, of which the most frequent were actinic prurigo (49.3%), pityriasis alba (18.5%) and actinic cheilitis (4.4%). The multivariate analysis found that residing in a region exposed to the mini hole in the ozone layer (aOR = 4.23; CI 95%: 2.32-7.72) and residing at an altitude over 3500 m.a.s.l (aOR = 2.76; CI 95%: 1.57-4.86) were both independent associated factors to photodermatoses. Conclusion: A high prevalence of photodermatoses exists among the pediatric population living at high-altitude in Peru. Residing in a region exposed to a mini hole in the ozone layer and residing over 3500 m.a.s.l constituted associated factors.

Asociación entre depresión y deterioro cognitivo en adultos mayores de un centro de atencion integral de Lima

RESUMEN Fundamento: la salud psíquica y cognitiva de los adultos mayores puede presentar cambios relacionados con el envejecimiento. Con frecuencia la depresión conlleva deterioro cognitivo, condiciones que deben identificarse para la detección oportuna y prevención de daños. Objetivo: determinar la asociación entre el nivel de depresión y deterioro cognitivo en adultos mayores de un centro de atención integral de la ciudad de Lima, Perú. Métodos: se realizó un estudio transversal y analítico en adultos mayores de 60 años, asistentes a un centro de adultos mayores de Lima, entre enero y julio 2017. Se consideró como variable dependiente al deterioro cognitivo y las variables independientes fueron: la depresión y las características sociodemográficas. Se realizó estadística descriptiva basada en el cálculo de frecuencias, porcentajes, dispersión y medidas de tendencia central. Para encontrar la asociación entre las variables independientes y el deterioro cognitivo se utilizó la prueba de Chi cuadrado o la prueba exacta de Fisher. Los cálculos se realizaron con un nivel de confianza de 95 %. Resultados: el promedio de edad fue de 67,4± 7,4 años. El 20,7 % presentó depresión y el 31,0 % deterioro cognitivo. En el análisis bivariado se encontró que la edad de 70 años a más (p<0,001; OR=23,0 I.C. [6,68-79,15]), el nivel educativo no superior (p=0,015; OR=4,63 IC95 º% [1,25-17,16] y depresión (p=0,012; OR=3,82 I.C.95 % [1,3-11,24]) estuvieron asociados con el deterioro cogntivo. El análisis multivariado se encontró que solo la edad estuvo asociada a deterioro cognitivo (p<0,001; OR=24,93 IC95 % [6,04-97,74]). Conclusiones: una mayor edad, el bajo nivel educativo y la depresión estuvieron asociados al deterioro cognitivo, de estos factores, solo la edad de 70 años y más fue un factor independiente asociado al deterioro cognitivo.

ABSTRACT Background: the mental and cognitive health of older adults can present changes related to aging. Depression often leads to cognitive impairment, conditions that must be identified for timely detection and prevention of damage. Objective: to determine the association between the level of depression and cognitive impairment in older adults from a comprehensive care center in the city of Lima, Perú. Methods: a cross-sectional and analytical study was carried out in adults over 60 years of age, attending a center for the elderly in Lima, between January and July 2017. Cognitive deterioration was considered the dependent variable and the independent variables were depression and characteristics. sociodemographic. Descriptive statistics were performed based on the calculation of frequencies, percentages, dispersion and measures of central tendency. To find the association between the independent variables and cognitive impairment, the Chi-square test or Fisher's exact test was used. The calculations were made with a confidence level of 95 %. Results: the average age was 67.4±7.4 years. 20.7 % presented depression and 31.0 % cognitive impairment. In the bivariate analysis, it was found that the age of 70 years or more (p<0.001; OR=23.0 I.C. [6.68-79.15]), the educational level not superior (p=0.015; OR=4, 63 95% CI [1.25-17.16] and depression (p=0.012; OR=3.82 95% CI [1.3-11.24]) were associated with cognitive impairment. that only age was associated with cognitive impairment (p<0.001; OR=24.93 CI95 % [6.04-97.74]). Conclusions: older age, low educational level and depression were associated with cognitive impairment, of these factors, only age 70 years or older was an independent factor associated with cognitive impairment.

Prevalencia, manifestaciones clínicas y factores asociados al COVID-19 de larga duración / Prevalence, clinical manifestations, and associated factors of long COVID-19

El objetivo fue describir la prevalencia, las manifestaciones clínicas y los factores asociados de COVID-19 de larga duración. Se realizó una búsqueda bibliográfica de revisiones sistemáticas y metaanálisis sobre COVID-19 de larga duración en MEDLINE (vía PubMed) hasta el 7 de abril de 2022. Se encontraron 37 artículos y se incluyeron 3. La calidad de la evidencia fue evaluada a través de los criterios de AMSTAR 2. La prevalencia reportada de COVID-19 de larga duración fue 43% (IC95%: 39% ­ 46%). Las principales manifestaciones clínicas fueron debilidad (41% [IC95%: 25% ­ 59%]), malestar general (33% [IC95%: 15% ­ 57%]), fatiga (31% [IC95%: 24% ­ 39%]), alteración en la concentración (26% [IC95%: 21% ­ 32%]) y sensación de falta de aire (25% [IC95%: 18% ­ 34%]). Los factores asociados a COVID de larga duración incluyeron sexo femenino, severidad de cuadro inicial, edad y presencia de comorbilidades.

The aim was to describe the prevalence, clinical manifestations, and associated factors of long-COVID. Bibliographic research of systematic reviews and meta-analyses was carried out in MEDLINE (through PubMed) until April 7th, 2022. 37 articles were found and 3 were included. Evidence quality was assessed via AMSTAR 2 criteria. Long-COVID prevalence is 43% (IC95%: 39% ­ 46%). Main clinical manifestations were weakness (41% [IC95%: 25% ­ 59%]), malaise (33% [IC95%: 15% ­ 57%]), fatigue (31% [IC95%: 24% ­ 39%]), concentration impairment (26% [IC95%: 21% ­ 32%]), and breathlessness (25% [IC95%: 18% ­ 34%]). Factors associated with long COVID were female sex, initial disease severity, age, and presence of comorbidities.

Asociación entre dependencia funcional y calidad de vida en pacientes adultos mayores oncológicos / Association between functional dependence and quality of life in older adult oncology patients

RESUMEN Introducción: La presencia de comorbilidades modula el proceso de envejecimiento, el diagnóstico de cáncer puede comprometer de manera importante la salud del adulto mayor, lo cual repercute en su calidad de vida. Objetivo: Determinar la asociación entre la dependencia funcional y la calidad de vida en pacientes oncológicos adultos mayores tratados con radioterapia. Métodos: Estudio analítico retrospectivo, realizado en 181 pacientes ambulatorios del Centro Médico Naval del Callao, Perú, varones, mayores de 60 años. Se valoró la dependencia funcional mediante los índices de Barthel y el de Lawton; y la calidad de vida mediante la escala de calidad de vida en adultos mayores de la Organización Mundial de la Salud (WHOQoL-Old). Resultados: Se encontró asociación estadísticamente significativa entre dependencia funcional y calidad de vida, tanto para las actividades básicas de la vida diaria (PR= 1,04 [IC 95 %; 1,01-1,07]) como para las actividades instrumentales de la vida diaria (PR= 1,08 (IC 95 %: 1,01 - 1,13). Conclusiones: En los pacientes adultos mayores oncológicos tratados con radioterapia, se encuentra asociación significativa entre dependencia funcional y una pobre calidad de vida.

ABSTRACT Introduction: The presence of comorbidities modulates the aging process, the diagnosis of cancer can significantly compromise the health of the elderly, which affects their quality of life. Objective: Determine the association between the functional dependence and the quality of life in elderly oncology patients treated with radiotherapy. Methods: Retrospective analytical study, carried out in 181 outpatients of Centro Médico Naval del Callao, Perú, male, older than 60 years. The functional dependence was assessed with Barthel index and Lawton scale; and the quality of life was assessed with World Health Organization Quality of Life-Older Adults Module (WHOQoL-Old). Results: A statistically significant association was found between functional dependence and quality of life, for both the basic activities of daily living (PR= 1.04 [IC 95 %: 1.01-1.07]), and the instrumental activities of daily living (PR= 1.08 [IC 95 %: 1.01 - 1.13]). Conclusion: There was significant association between the functional dependence and the poor quality of life in the elderly oncology patients treated with radiotherapy.

Primary muscular hydatidosis in an endemic area of Peru: report of two cases.

Primary muscular hydatidosis is an infrequent parasitic infection, caused by Echinococcus granulosus. We report 2 cases of female patients with diagnosis of primary muscular hydatidosis of the thigh. Both hail from an endemic area for hydatidosis, and had no pulmonary, hepatic, or systemic involvement. Cyst extraction was performed after the patients were given hypertonic solution, and antiparasitic treatment.

Dependencia funcional en pacientes adultos mayores con diabetes mellitus tipo 2 en Lima, Perú / Functional Dependence in Older Adults Patients with Type 2 Diabetes Mellitus in Lima, Peru

RESUMEN Fundamento: la dependencia funcional contempla la presencia de limitaciones en las actividades diarias y está relacionada con la disminución de todas las capacidades y la interacción con el entorno. Este factor está relacionado con diferentes comorbilidades que se presentan en los adultos mayores. Una de estas comorbilidaes es la diabetes mellitus. Objetivo: determinar la prevalencia de dependencia funcional en pacientes adultos mayores con diagnóstico de diabetes mellitus tipo 2 en la clínica de día y consultorio externo del Centro Geriátrico Naval en el periodo 2010-2015. Método: se realizó un estudio transversal con análisis secundario de la base de datos Texas-Camena UTMB 2010-2015 del Centro de Investigación del Envejecimiento de la Universidad San Martín de Porres. Se consideró como variable dependiente a la dependecia funcional y las variables independientes fueron las características sociodemográficas y los antecedentes personales y patológicos. Se realizó estadística descriptiva basada en el cálculo de frecuencias, porcentajes, dispersión y medidas de tendencia central. Para encontrar la asociacion entre las variables independientes y la dependencia funcional se utilizó la prueba de Chi cuadrado o la prueba exacta de Fisher. Los cálculos se realizaron con un nivel de confianza de 95 %. Resultados: el promedio de edad fue de 77,5± 8 años. En 9 pacientes (3,3 %) se detectó dependencia total; en 5 (1,9 %) fue severa; en 154 (57,0 %) fue moderada; y en 33 (12,2 %) fue baja. De ellos 69 (25,6 %) no tuvieron dependencia. El rango de edad de 83-100 años fue un factor asociado independiente para presentar dependencia funcional (OR=2,64 IC 95 % [1,071-6,510]). Conclusiones: el 73,4 % de la población en estudio presentó algún nivel de dependencia funcional, siendo el rango de edad de 83-100 años un factor independiente asociado para presentar dependencia funcional.

ABSTRACT Background: functional dependence considers the presence of limitations in daily activities and is related to the decrease in all abilities and interaction with the environment. This factor is related to different comorbidities that occur in older adults. One of these comorbidities is diabetes mellitus. Objective: to determine the prevalence of functional dependence in elderly patients diagnosed with type 2 diabetes mellitus in the day clinic and outpatient clinic of the Naval Geriatric Center in the period 2010-2015. Method: a cross-sectional study was carried out with secondary analysis of the Texas-Camena UTMB 2010-2015 database of the San Martín de Porres University Center for Research on Aging. Functional dependence was considered as a dependent variable and the independent variables were sociodemographic characteristics and personal and pathological antecedents. Descriptive statistics were performed based on the calculation of frequencies, percentages, dispersion and measures of central tendency. To find the association between the independent variables and the functional dependence, the Chi-square test or Fisher's exact test was used. The calculations were made with a confidence level of 95 %. Results: the average age was 77.5 ± 8 years. In 9 patients (3.3 %) total dependence was detected; in 5 (1.9 %) it was severe; in 154 (57.0 %) it was moderate; and in 33 (12.2 %) it was low. Of them 69 (25.6 %) did not have dependency. The age range of 83-100 years old was an independent associated factor for presenting functional dependence (OR = 2.64 95 % CI [1.071-6.510]). Conclusions: the 73.4 % of the study population presented some level of functional dependence, with the age range of 83-100 years old being an independent factor associated with presenting functional dependence.

Prevalencia de síndrome de burnout en postulantes al examen de residencia médica / Prevalence of Burnout syndrome among Medical Residency applicants

Introducción: Los médicos que se preparan para rendir el examen de residencia médica, están expuestos a estrés laboral, debido a que adicionalmente tienen que trabajar para poder solventar sus estudios. Objetivos: Determinar la prevalencia del síndrome de burnout en médicos generales que se preparan para el examen de residencia médica. Métodos: Se realizó un estudio descriptivo y transversal, se aplicó el cuestionario Maslach Burnout Inventory (MBI) a médicos generales que trabajaban y que se preparaban para rendir el examen de residencia médica, que voluntariamente aceptaron participar en el estudio. Se realizó estadística univariada y bivariada; los cálculos fueron realizados con un nivel de confianza del 95 por ciento. Resultados: Se incluyó a un total de 306 médicos. El 56,9 por ciento fueron de sexo femenino y el promedio de edad fue de 28,5 ± 4,3 años. El 2,3 por ciento (7) de los médicos presentaron síndrome de burnout; las subescalas de despersonalización (42,2 por ciento) y agotamiento emocional (32 por ciento) tuvieron mayores porcentajes de índices altos. Conclusiones: La prevalencia de síndrome de burnout fue baja en los médicos generales que se preparan para el examen de residencia médica. Las subescalas con mayores índices fueron despersonalización y agotamiento emocional(AU)

Introduction: Doctors who are preparing to take the medical residency exam are exposed to work stress, because they have to work to pay their studies. Objectives: To determine the prevalence of Burnout syndrome in general practitioners preparing for the residency exam. Methods: A descriptive and cross-sectional study was carried out, the Maslach Burnout Inventory (MBI) was applied in general practitioners who worked and were preparing to take the medical residency exam were included, who voluntarily agreed to participate in the study. Univariate and bivariate statistics were performed, the calculations were performed with a confidence level of 95 percent. Results: A total of 306 general practitioners were included. 56,9 percent were female and the average age was 28,5 ± 4,3 years. 2,3 percent (7) of the doctors had Burnout syndrome, the subscales of depersonalization (42,2 percent) and emotional exhaustion (32 percent) had higher percentages of high indexes. Conclusions: The prevalence of Burnout syndrome was low in general practitioners preparing for the medical residency examination. The subscales with the highest indices were depersonalization and emotional exhaustion(AU)

Comparison of EQ-5D Values Sets Among South American Countries.

OBJECTIVE: Social health preference sets are necessary for conducting health economic evaluations. Values from other countries are often used when local sets are not available, which may alter the results. We aimed to evaluate the degree of variability of currently available country-specific value sets of the EuroQol EQ-5D instrument from South American countries (SAC). METHODS: We selected EQ-5D value sets from SAC and 2 reference countries. We obtained crosswalk value sets for the countries that use the EQ-5D-3L instrument. We compared the value sets with the Kruskal-Wallis test and then carried out pairwise comparisons with the Sign test. We also assessed correlations among the countries' value sets using the Spearman test. We calculated the absolute difference across countries for each health state, considering a difference of greater than 0.05 relevant. RESULTS: The range of value sets varied greatly. The Peruvian value set had the widest range (1 to -1.076) and the lowest values (median: 0.055; interquartile range: -0.171 to 0.275). The Ecuadorian set had the highest values (median: 0.587; interquartile range: 0.443-0.704). The Peruvian value set also had the greatest proportion of health states (43.6%) with a negative value, and the Uruguayan set had the smallest proportion (0.9%). Differences among countries were significant in all cases, with the greatest difference between Ecuador and Peru (median difference: 0.495; 95% confidence interval: 0.515-0.528). CONCLUSION: Social health preference sets varied greatly among SAC. Using non-local values could distort resource allocation decisions; hence, we recommend that countries obtain and use local value sets.

Características clínico - epidemiológicas de los accidentes ofídicos en un hospital de la Amazonía del Perú / Clinico-epidemiologic characteristics of ophidic accidents in a hospital of the amazonia of Peru

Introducción: En el Perú, los accidentes ofídicos son un importante problema de salud pública, debido a una amplia distribución territorial de diferentes tipos de serpientes. Objetivo: Describir las características clínico - epidemiológicas y el manejo de los accidentes ofídicos registrados en un hospital de Perú. Métodos: Estudio de serie de casos, realizado entre enero del 2011 a diciembre 2015 en el Hospital Santa Rosa de Puerto Maldonado. Se revisaron 256 historias clínicas de pacientes con diagnóstico definitivo de ofidismo. Se analizaron variables sociodemográficas, clínicas y evolución de los pacientes. Resultados: El 78,5 por ciento de pacientes fueron varones, el grupo de edad más afectado fueron los adultos. La mayoría de los accidentes ocurrieron en el mes de marzo (12,5 por ciento). Un 39 por ciento de los pacientes se dedicaba al trabajo agrícola. Entre las 16:00 y 19:59 horas se produjeron 35,2 por ciento de los accidentes, 71,1 por ciento reportó como causante del accidente a la serpiente Bothrops atrox. El 71,5 por ciento de las mordeduras se presentaron en miembros inferiores. La mayoría de pacientes recibió tratamiento específico con antibotrópico polivalente (90,6 por ciento). Conclusiones: En la población estudiada, el sexo más afectado es el masculino con una edad entre 27 a 59 años. La serpiente más frecuente causante de los accidentes fue la Bothrops atrox, más conocida entre los pobladores como "jergón". En la mayoría de los casos se administró como tratamiento específico el suero antiofídico(AU)

Introduction: In Peru, ophidian accidents are an important public health problem due to a wide territorial distribution of different types of snakes. Objective: To describe the clinical-epidemiological characteristics and the management of ophidian accidents registered in a hospital in Peru. Methods: Case series study carried out between January 2011 to December 2015 at the Santa Rosa Hospital in Puerto Maldonado, 256 medical records of patients with a definitive diagnosis of ophidism were reviewed. Sociodemographic and clinical variables and the evolution of the patients were analyzed. Results: A total of 78.5 percent of patients were men, the age group most affected were adults. Most of the accidents occurred in March (12.5 percent). 39 percent of the patients were engaged in agricultural work. Between 4:00 p.m. and 7:59 p.m., 35.2 percent of the accidents occurred. 71.1 percent reported the Bothrops atrox snake as the cause of the accident. 71.5 percent of the bites occurred on the lower limbs. Most patients received specific treatment with polyvalent anti-botropic (90.6 percent). Conclusions: In the studied population, the most affected sex is the male with an age between 27 and 59 years. The most frequent snake causing the accidents was the Bothrops atrox, better known among the inhabitants as "jergón". In most cases, antivenom was administered as a specific treatment(AU)

Pregnant woman from southern Peru with rabies infection who delivered a healthy baby.

Rabies in pregnancy is rare with a high mortality. We report a pregnant woman who developed urban rabies from the bite of an infected dog. An emergency Cesarean section was performed at 31 weeks of gestation, and a premature baby was delivered who survived and did not develop rabies. The mother, however, suffered a rapid clinical deterioration and was admitted to intensive care where a Milwaukee protocol was followed. The patient survived 19 months but developed severe neurological sequelae secondary to rabies encephalitis and finally died of respiratory failure.