Eficacia y seguridad en condiciones clínicas reales del raltegravir en un hospital de referencia del seguro social peruano / Efficacy and safety in real clinical conditions of Raltegravir in a reference hospital of peruvian social security

INTRODUCCIÓN: El Rategravir pertenece a los inhibidores de integrasas, quedando demostrado y aprobado por diversos ensayos clínicos como un potente antirretroviral seguro y eficaz para el tratamiento de pacientes infectados con el virus de inmunodeficiencia humana (VIH), con buena tolerancia y baja toxicidad, incluyéndose en el esquema de tercera línea o rescate y se inicia cuando los esquemas de primera y segunda línea han fracasado. OBJETIVO: Evaluar la eficacia y seguridad en condiciones clínicas reales del uso de Raltegravir dentro de los esquemas de la Terapia Antiretroviral de Gran Actividad (TARGA) en pacientes con infección por VIH en un hospital de referencia del seguro social en Perú. MÉTODOS: Se realizó un estudio observacional retrospectivo en pacientes con diagnóstico de infección por VIH que iniciaron tratamiento dentro del esquema TARGA basados en Raltegravir con seguimiento y control a los 6 meses. Se presentaron medidas de resumen de frecuencias y porcentajes para las variables cualitativas, así como medias y desviación estándar para las variables cuantitativas en base a los resultados de las pruebas de normalidad. Los datos fueron procesados y analizados en el software estadístico SPSS versión 22. RESULTADOS: El género masculino fue el más afectado con un 76%(n=119) del total. El rango de edad más frecuente fue el comprendido entre los 45 a 55 años (25,4%; n=40). Las comorbilidades más frecuentes fueron Diabetes mellitus e Hipertensión arterial, con reducción exponencial de la carga viral y elevación de los niveles de linfocitos CD4. CONCLUSIÓN: El Raltegravir es eficaz para el tratamiento de pacientes VIH

INTRODUCTION: Rategravir belongs to integrase inhibitors, being demonstrated and approved by several clinical trials as a powerful and safe antiretroviral drug for the treatment of patients infected with human immunodeficiency virus (HIV), with good tolerance and low toxicity, including in the third line or rescue scheme and it starts when the first and second lineas schemes have failed. OBJECTIVE: To evaluate the efficacy and safety in real clinical conditions of the use of Raltegravir within the HAART schemes in patients with HIV infection in a reference hospital of social insurance in Peru. METHODS: A retrospective observational study was performed in patients with a diagnosis of HIV infection who started treatment within the TARGA scheme based on Raltegravir with follow-up and control at 6 months. We presented summary measures of frequencies and percentages for the qualitative variables, as well as means and standard deviation for the quantitative variables based on the results of the normality tests. The data was processed and analyzed in the statistical software SPSS version 22. RESULTS: The male gender was the most affected with 76% (n = 119) of the total. The most frequent age range was between 45 to 55 years (25.4%, n = 40). The most frequent comorbidities were Diabetes mellitus and arterial hypertension, with exponential reduction in viral load and elevation of CD4 lymphocyte levels. CONCLUSION: Raltegravir is effective for the treatment of HIV patients

Migration to study in medical schools of Peru. / Migración para estudiar en escuelas de medicina humana en Perú.

The aim of this study was to describe the frequency of migration to study medicine in Peru. We con ducted a secondary data analysis of the Red-LIRHUS study (2011-2012). We included 3 680 Peruvian students. Approximately, 23.2% migrated for medical school. Less than 1% were international migrants. We found a higher proportion of migrant students in Universities outside of Lima than in Universities in Lima (27.1% vs. 15.8%). There was also a higher proportion of migrants in private universities (28.3% vs. 16.0%) Migrant students were more likely to live alone (27.4% vs. 6.4%) and to report having failed a module/course (51.0% vs. 38.6%) compared to non-migrant students. It is necessary to evaluate potential interventions for the preservation of the well-being of people who migrate for their medical training.

Con el objetivo de caracterizar el perfil del estudiante de medicina migrante de primer y quinto año de 32 escuelas de medicina del Perú, se realizó un análisis secundario del estudio Red-LIRHUS (2011-2012). De los 3680 estudiantes peruanos incluidos, uno de cada cuatro (23,2%) fueron migrantes. Menos de 1% fueron migrantes internacionales. Hubo mayor proporción de estudiantes migrantes en universidades de provincias que en universidades de Lima (27,1% vs. 15,8%). Asimismo, hubo mayor proporción de migrantes en universidades privadas (28,3% vs. 16,0%). Los estudiantes migrantes tenían mayor proba bilidad de vivir solos (37,4% vs. 6,4%) y de haber desaprobado cursos (51,0% vs. 38,6%) en comparación con los estudiantes no migrantes. Es necesario evaluar potenciales intervenciones para la preservación del bienestar de las personas que migran para su formación médica.

Migración para estudiar en escuelas de medicina humana en Perú / Migration to study in medical schools of Peru

RESUMEN Con el objetivo de caracterizar el perfil del estudiante de medicina migrante de primer y quinto año de 32 escuelas de medicina del Perú, se realizó un análisis secundario del estudio Red-LIRHUS (2011-2012). De los 3680 estudiantes peruanos incluidos, uno de cada cuatro (23,2%) fueron migrantes. Menos de 1% fueron migrantes internacionales. Hubo mayor proporción de estudiantes migrantes en universidades de provincias que en universidades de Lima (27,1% vs. 15,8%). Asimismo, hubo mayor proporción de migrantes en universidades privadas (28,3% vs. 16,0%). Los estudiantes migrantes tenían mayor proba bilidad de vivir solos (37,4% vs. 6,4%) y de haber desaprobado cursos (51,0% vs. 38,6%) en comparación con los estudiantes no migrantes. Es necesario evaluar potenciales intervenciones para la preservación del bienestar de las personas que migran para su formación médica.

ABSTRACT The aim of this study was to describe the frequency of migration to study medicine in Peru. We con ducted a secondary data analysis of the Red-LIRHUS study (2011-2012). We included 3 680 Peruvian students. Approximately, 23.2% migrated for medical school. Less than 1% were international migrants. We found a higher proportion of migrant students in Universities outside of Lima than in Universities in Lima (27.1% vs. 15.8%). There was also a higher proportion of migrants in private universities (28.3% vs. 16.0%) Migrant students were more likely to live alone (27.4% vs. 6.4%) and to report having failed a module/course (51.0% vs. 38.6%) compared to non-migrant students. It is necessary to evaluate potential interventions for the preservation of the well-being of people who migrate for their medical training.

Efectos clinicos e histopatologicos agudos y subagudos del veneno de Tityus breweri en miocardio de hamsters / Clinical and histopathological effects of acute and subagude of the poison of Tityus breweri in hamsters myocardia

Resumen Los escorpiones del género Tityus presentan la mayor distribución mundial, de mayor importancia clínica, epidemiológica y más peligrosa del continente americano. Las toxinas de su veneno producen perturbación severa de los procesos de excitación y conducción del impulso nervioso. Desde el punto de vista histopatológicos se han observado cambios estructurales en diferentes tejidos de ratones, con el veneno de varias especies de Tityus venezolanos. Objetivo: Describir los efectos clínicos e histopatológicos agudos y subagudos del veneno de escorpión (Buthidae: T. breweri) en el miocardio de hámster. Método: Estudio experimental, exploratoria, descriptivo, analítica y correlacional. Se utilizaron hámsteres de ambos sexos del genero Cricetus y se obtuvo el veneno de 26 escorpiones T. breweri, se escogieron 6 hámster al azar, inyectándoles vía intraperitonial (VIP) veneno de Tityus breweri, 3 sacrificados a los 30 minutos y los otros 3 a los 60 minutos, 3 inyectados con agua destilada constituyeron el grupo control. Resultados: La mayoría de los animales expuestos presentaron manifestaciones de tipo colinérgicas y adrenérgicas. Las alteraciones histopatológicas agudas observadas fueron edema interfascicular y congestión vascular, infiltrado linfohistiocítico perivascular. Al transcurrir 12, 24, 48 y 72 horas de exposición del veneno, no se evidenciaron cambios histopatológicos, lo que hace presumir que se activaron los procesos de reparación de los tejidos dañados. Conclusión: el veneno de T. breweri produjo alteración histológicas agudas y subagudas en el tejido miocárdico en los hámsteres sin evidencia de alteración en el grupo control.

Abstract Scorpions of the genus Tityus present the largest distribution of the world, of greater clinical, epidemiological and more dangerous importance of the American continent. The toxins from its venom produce severe disturbance of the excitation and conduction processes of the nerve impulse. From the histopathological point of view structural changes have been observed in different tissues of mice, with the venom of several species of Venezuelan Tityus. Objective: To describe the acute and subacute clinical and histopathological effects of scorpion venom (Buthidae: T. breweri) on the hamster myocardium. Method: Experimental, exploratory, descriptive, analytical and correlational study. Hersters of both sexes of the genus Cricetus were obtained and venom of 26 T. breweri scorpions were obtained, 6 random hamsters were chosen, injecting intravenously (VIP) venom of Tityus breweri, 3 sacrificed at 30 minutes and the other 3 a The 60 minutes, 3 injected with distilled water constituted the control group. Results: Most of the exposed animals presented cholinergic and adrenergic type manifestations. The acute histopathological alterations observed were interfascicular edema and vascular congestion, perivascular lymphohistiocytic infiltrate. At the end of 12, 24, 48 and 72 hours of exposure of the venom, no histopathological changes were evidenced, which suggests that the repair processes of the damaged tissues were activated. Conclusion: T. breweri venom caused acute and subacute histological alterations in myocardial tissue in hamsters with no evidence of alteration in the control group.

Gender Associated with the Intention to Choose a Medical Specialty in Medical Students: A Cross-Sectional Study in 11 Countries in Latin America.

INTRODUCTION: The selection of a medical specialty has been associated with multiple factors, such as personal preferences, academic exposure, motivational factors and sociodemographic factors, such as gender. The number of women in the medical field has increased in recent years. In Latin America, we have not found any studies that explore this relationship. OBJECTIVE: To determine whether there is an association between gender and the intention to choose a medical specialty in medical students from 11 countries in Latin America. METHODS: Secondary analysis of the Collaborative Working Group for the Research of Human Resources for Health (Red-LIRHUS) data; a multi-country project of students in their first year and fifth year of study, from 63 medical schools in 11 Latin American countries. All students who referred intention to choose a certain medical specialty were considered as participants. RESULTS: Of the 11073 surveyed students, 9235 indicated the name of a specific specialty. The specialties chosen most often in the fifth year were General Surgery (13.0%), Pediatrics (11.0%), Internal Medicine (10.3%) and Obstetrics/Gynecology (9.0%). For women, the top choices were Pediatrics (15.8%), Obstetrics/Gynecology (11.0%), Cardiology (8.7%), General Surgery (8.6%), and Oncology (6.4%). In the adjusted analysis, the female gender was associated with the choice of Obstetrics/Gynecology (RP: 2.75; IC95%: 2.24-3.39); Pediatric Surgery (RP: 2.19; IC95%: 1.19-4.00), Dermatology (RP: 1.91; IC95%:1.24-2.93), Pediatrics (RP: 1.83; IC95%: 1.56-2.17), and Oncology (RP: 1.37; IC95%: 1.10-1.71). CONCLUSIONS: There is an association between the female gender and the intention to choose Obstetrics/Gynecology, Pediatrics, Pediatric Surgery, Dermatology, and Oncology. We recommend conducting studies that consider other factors that can influence the choice of a medical specialty.