Difference in mortality rates in hospitalized COVID-19 patients identified by cytokine profile clustering using a machine learning approach: An outcome prediction alternative.

COVID-19 is a disease caused by the novel Coronavirus SARS-CoV-2 causing an acute respiratory disease that can eventually lead to severe acute respiratory syndrome (SARS). An exacerbated inflammatory response is characteristic of SARS-CoV-2 infection, which leads to a cytokine release syndrome also known as cytokine storm associated with the severity of the disease. Considering the importance of this event in the immunopathology of COVID-19, this study analyses cytokine levels of hospitalized patients to identify cytokine profiles associated with severity and mortality. Using a machine learning approach, 3 clusters of COVID-19 hospitalized patients were created based on their cytokine profile. Significant differences in the mortality rate were found among the clusters, associated to different CXCL10/IL-38 ratio. The balance of a CXCL10 induced inflammation with an appropriate immune regulation mediated by the anti-inflammatory cytokine IL-38 appears to generate the adequate immune context to overrule SARS-CoV-2 infection without creating a harmful inflammatory reaction. This study supports the concept that analyzing a single cytokine is insufficient to determine the outcome of a complex disease such as COVID-19, and different strategies incorporating bioinformatic analyses considering a broader immune profile represent a more robust alternative to predict the outcome of hospitalized patients with SARS-CoV-2 infection.

La doble heterocigosis por la mutación común en el codón 39 (C>T) (β0) y la deleción siciliana (δβ0) 13.4 kb causa una beta-talasemia transfusión dependiente en dos pacientes costarricenses

Las talasemias son desórdenes autosómicos recesivos de las cadenas de hemoglobina que poseen expresión clínica variable según el tipo de mutación o deleción. Presentamos el caso de dos jóvenes mujeres costarricenses no relacionadas entre sí y ambas diagnosticadas con la mutación común en el codón 39 (C>T) (β0) en combinación con la deleción siciliana (δβ0) 13.4 kb. La caracterización de doble heterocigota no había sido descrita antes en la literatura médica, y discutimos el significado de este genotipo que causa un defecto tipo β0 talasemia transfusión dependiente.

Thalassemia are autosomal recessive disorders of hemoglobin chains with variable clinical expression depending on the type of mutation or deletion present. We present the common codon 39(C>T) (β0) in combination with the δβ0 13.4 kb Sicilian deletion in two non-related young women from Costa Rica. We report the characterization of the compound heterozygous not previously described phenotype, and discuss the significance of this genotype combination with a transfusion dependent β0 defect Thalassemia.

Anatomical Engineering and 3D Printing for Surgery and Medical Devices: International Review and Future Exponential Innovations.

Three-dimensional printing (3DP) has recently gained importance in the medical industry, especially in surgical specialties. It uses different techniques and materials based on patients' needs, which allows bioprofessionals to design and develop unique pieces using medical imaging provided by computed tomography (CT) and magnetic resonance imaging (MRI). Therefore, the Department of Biology and Medicine and the Department of Physics and Engineering, at the Bioastronautics and Space Mechatronics Research Group, have managed and supervised an international cooperation study, in order to present a general review of the innovative surgical applications, focused on anatomical systems, such as the nervous and craniofacial system, cardiovascular system, digestive system, genitourinary system, and musculoskeletal system. Finally, the integration with augmented, mixed, virtual reality is analyzed to show the advantages of personalized treatments, taking into account the improvements for preoperative, intraoperative planning, and medical training. Also, this article explores the creation of devices and tools for space surgery to get better outcomes under changing gravity conditions.

Consumo de alimentos en comederos ambulantes como factor de riesgo para síntomas dispépticos en estudiantes de medicina / Street food consumption as a risk factor for symptoms of dyspepsia in medical students

Resumen Introducción: los estudiantes universitarios muchas veces realizan su alimentación en comederos ambulantes, lo que puede ser causa de sintomatología digestiva, pero esto no se ha evidenciado en estudios en dicha población. Objetivo: determinar si el consumo de alimentos en comederos ambulantes está asociado con síntomas dispépticos en los estudiantes de medicina peruanos. Material y métodos: se realizó un estudio multicéntrico de datos secundarios, del encuestado de 1797 estudiantes de medicina en ocho facultades de medicina, se calculó una potencia estadística del 93 %. El padecimiento de síntomas dispépticos se asoció con el antecedente de consumo de alimentos en comederos ambulantes. Se obtuvo estadísticas de asociación con modelos bivariados y multivariados. Resultados: El rango de dispepsia funcional varió entre el 9 % y el 28 % y el de consumo de alimentos en comederos ambulantes, entre 1 % y 5 %. En el análisis multivariado, consumir alimentos en comederos ambulantes era un factor asociado con la mayor frecuencia de padecer dispepsia funcional (razón de prevalencia ajustada [RPa]: 1,45; intervalo de confianza [IC] 95 %: 1,09-1,94; p = 0,010); además, otras variables que resultaron significativas fueron el sexo femenino (RPa: 1,40; IC 95 %: 1,15-1,71; p = 0,001) y los que comían en horarios similares (RPa: 0,76; IC 95 %: 0,61-0,94; p = 0,012), ajustadas por la edad y el semestre académico que cursaban. Conclusiones: Los estudiantes que consumían sus alimentos en comederos ambulantes tenían mayor frecuencia de padecer síntomas dispépticos, esto debe ser vigilado por las autoridades sanitarias y universitarias, ya que puede generar repercusiones a corto y largo plazo.

Abstract Introduction: University students often eat at street food stalls, which can cause various digestive symptoms, although this has not been evidenced in studies carried out in this population. Objective: To establish whether food consumption in street food stalls is associated with symptoms of dyspepsia in Peruvian medical students. Materials and methods: A secondary data analysis of a multicenter study was conducted. Of 1 797 medical students surveyed in eight medical schools, a statistical power of 93% was calculated. Symptoms of dyspepsia were associated with a history of food consumption in street food stalls. Association statistics were obtained with bivariate and multivariate models. Results: The prevalence of functional dyspepsia varied between 9-28% and food consumption in street stalls between 1-5%. In the multivariate analysis, eating food in the street was a factor associated with a greater frequency of suffering from functional dyspepsia (aPR: 1.45; 95%CI: 1.09-1.94; p=0.010). In addition, other significant variables were the female sex (aPR: 1.40; 95%CI: 1.15-1.71 p=0.001) and people eating at similar times (aPR: 0.76; 95%CI: 0.61-0.94; p=0.012) adjusted for age, and academic term. Conclusions: Dyspepsia symptoms were more common in students who ate their food from street stalls. This should be monitored by health and university authorities, as it can have short- and long-term consequences.

Alpha-thalassemia. Case report alpha-thalassemia in a Costa Rican family, A case report.

This case report highlights the importance for health care providers to be aware of the αlpha-thalassemia syndromes, their relevance to clinical care and family counseling, appropriate diagnostic algorithm for definitive diagnosis.

Set-theory based benchmarking of three different variant callers for targeted sequencing.

BACKGROUND: Next generation sequencing (NGS) technologies have improved the study of hereditary diseases. Since the evaluation of bioinformatics pipelines is not straightforward, NGS demands effective strategies to analyze data that is of paramount relevance for decision making under a clinical scenario. According to the benchmarking framework of the Global Alliance for Genomics and Health (GA4GH), we implemented a new simple and user-friendly set-theory based method to assess variant callers using a gold standard variant set and high confidence regions. As model, we used TruSight Cardio kit sequencing data of the reference genome NA12878. This targeted sequencing kit is used to identify variants in key genes related to Inherited Cardiac Conditions (ICCs), a group of cardiovascular diseases with high rates of morbidity and mortality. RESULTS: We implemented and compared three variant calling pipelines (Isaac, Freebayes, and VarScan). Performance metrics using our set-theory approach showed high-resolution pipelines and revealed: (1) a perfect recall of 1.000 for all three pipelines, (2) very high precision values, i.e. 0.987 for Freebayes, 0.928 for VarScan, and 1.000 for Isaac, when compared with the reference material, and (3) a ROC curve analysis with AUC > 0.94 for all cases. Moreover, significant differences were obtained between the three pipelines. In general, results indicate that the three pipelines were able to recognize the expected variants in the gold standard data set. CONCLUSIONS: Our set-theory approach to calculate metrics was able to identify the expected ICCs related variants by the three selected pipelines, but results were completely dependent on the algorithms. We emphasize the importance to assess pipelines using gold standard materials to achieve the most reliable results for clinical application.

Asociación entre conocimiento y prácticas sobre la infección por VIH en mujeres peruanas: análisis secundario de encuesta nacional

Resumen Introducción: Las mujeres en edad reproductiva podrían considerarse como una población vulnerable a contraer la infección por VIH. La relación entre conocimiento y prácticas no está descrita en un contexto donde los conocimientos, actitudes y prácticas sobre el VIH son inadecuados. Objetivo: Determinar la asociación entre conocimientos y prácticas sobre la infección por VIH en mujeres peruanas en edad reproductiva. Material y Métodos: Análisis de Encuesta Demográfica y de Salud Familiar 2019, cuya muestra fue probabilística, estratificada y bietápica. El análisis consideró a mujeres en edad reproductiva sexualmente activas. Se definió "conocimientos adecuados" a los puntajes superiores al tercil superior de las observaciones al responder 18 preguntas y se determinó la asociación con cada una de las cinco prácticas. Se utilizó estadística descriptiva e inferencial -bivariada y multivariada- con regresión de Poisson para análisis poblacionales. Resultados: La media de respuestas correctas fue 12,6 (IC95%: 12,5-12,7). El 19,2% había usado preservativo en su última relación sexual. Un nivel de conocimientos adecuado estuvo asociado al uso de preservativo en la última relación sexual (RPa: 1,20; IC95%: 1,06-1,36), haber tenido una infección de transmisión sexual y con haberse realizado una prueba diagnóstica para infección por VIH. Conclusiones: Considerando una baja prevalencia de uso de preservativo en la última relación sexual de mujeres peruanas en edad reproductiva, los conocimientos generales adecuados sobre la infección por VIH se asocian con haber realizado esta práctica.

Abstract Background: Reproductive-age women are a vulnerable population for HIV infection. The relationship between knowledge and practices is not well described in a context where levels of knowledge, attitudes, and practices about HIV infection are inadequate. Aim: To determine the association between knowledge and practices about HIV infection in Peruvian reproductive-age women. Methods: Analysis of secondary data from the 2019 Demographic and Family Health Survey. It got a probabilistic, stratified, and two-stage sample. We included reproductive-age and actively sexual women. Scores above the upper tertile of the observations were defined as "adequate knowledge" by answering 18 questions. Then, we determined the association between adequate knowledge with each of the five practices. Descriptive and inferential statistics -bivariate and multivariate- were used with the Poisson regression for survey analysis. Results: The mean of correct answers was 12.6 (95% CI: 12.5 - 12.7). 19.2% of Peruvian women had used a condom in the last sexual relationship. An adequate level of knowledge was associated with the use of condoms in the last sexual intercourse (PRa: 1.20; 95% CI:1.06 - 1.36), with having a sexually transmitted infection in the last year, and with having a diagnostic test for HIV infection. Conclusions: Considering a low prevalence of condom use in the last sexual intercourse of Peruvian women of reproductive age, adequate general knowledge about HIV infection has associated with the accomplishment of this practice.

Aplicaciones innovadoras de la robótica y biomédica en la salud pública durante la pandemia del COVID-19 / Robotics and biomedical innovative applications in public health during the COVID-19 pandemic

En la situación actual de propagación a gran escala del COVID-19, mientras aumenta el contagio, el papel de los robots (diseñados con tecnología de Teleoperación e Inteligencia Artificial) en la sociedad se vuelve fundamental, pues necesitan ser utilizados en entornos hospitalarios, entornos urbanos, y también utilizar la consultoría de Telemedicina para tener acceso a todas las comunidades del mundo, a fin de evitar la propagación del virus. Además, se podría promover el trabajo multidisciplinario, entre la ingeniería y las ciencias de la salud en el Continente Americano y a nivel mundial, a través de proyectos de investigación, desarrollo e innovación en Ingeniería Biomédica, con la propuesta de estar preparados para enfrentar una emergencia global y nacional como la actual Pandemia. causado por el SARS-CoV-2.

In the current situation of the large-scale spread of COVID-19, whereas contagion increases, the role of robots (designed with Teleoperation and Artificial Intelligence technology) in society becomes essential, because they need to be used in hospital settings, urban environment, and also using Telemedicine consultancy to have access to all communities in the world, in order to avoid the spread of the virus. In addition, multidisciplinary work could be promoted, among the engineering and health sciences in the American Continent and Worldwide, through research, development and innovation projects in Biomedical Engineering, with the proposal of being ready to face a global and national emergency like the current Pandemic caused by SARS-CoV-2.

[Association between knowledge and practices on HIV infection in Peruvian women: secondary analysis of national survey]. / Asociación entre conocimiento y prácticas sobre la infección por VIH en mujeres peruanas: análisis secundario de encuesta nacional.

BACKGROUND: Reproductive-age women are a vulnerable population for HIV infection. The relationship between knowledge and practices is not well described in a context where levels of knowledge, attitudes, and practices about HIV infection are inadequate. AIM: To determine the association between knowledge and practices about HIV infection in Peruvian reproductive-age women. METHODS: Analysis of secondary data from the 2019 Demographic and Family Health Survey. It got a probabilistic, stratified, and two-stage sample. We included reproductive-age and actively sexual women. Scores above the upper tertile of the observations were defined as "adequate knowledge" by answering 18 questions. Then, we determined the association between adequate knowledge with each of the five practices. Descriptive and inferential statistics -bivariate and multivariate- were used with the Poisson regression for survey analysis. RESULTS: The mean of correct answers was 12.6 (95% CI: 12.5 - 12.7). 19.2% of Peruvian women had used a condom in the last sexual relationship. An adequate level of knowledge was associated with the use of condoms in the last sexual intercourse (PRa: 1.20; 95% CI:1.06 - 1.36), with having a sexually transmitted infection in the last year, and with having a diagnostic test for HIV infection. CONCLUSIONS: Considering a low prevalence of condom use in the last sexual intercourse of Peruvian women of reproductive age, adequate general knowledge about HIV infection has associated with the accomplishment of this practice.

Adaptación y validación de un cuestionario para medir burnout académico en estudiantes de medicina de la universidad Ricardo Palma / Adaptation And Validation Of A Questionnaire To Measure Academic Burnout In Medical University Students

Introducción: Evaluar lLa validez y fiabilidad de un instrumento adaptado al Perú para medir la pre-sencia del Síndrome de Burnout en estudiantes universitarios de la carrera de Medicina Humana en la Universidad Ricardo Palma, tomando como punto de partida el Inventa-rio de Burnout de Maslach - Student Survey (MBI-SS). Métodos: Estudio transversal analítico, con nivel de investigación aplicativo. Se evaluó la validez por análisis de estructura factorial con el método de componentes principales, se apli-caron las pruebas de Kaiser-Meyer Olkin y la rotación Varimax; la confiabilidad por el valor alfa de Cronbach. Resultados: Fueron incluidos 223 estudiantes de la Facultad de Medicina Humana de la Universidad Ricardo Palma, en el periodo noviembre a diciembre del año 2016. La prevalencia de Burnout académico encontrada fue 28,25% (63); La prueba de adecuación de Kaiser-Meyer Olkin tuvo un resultado de 0.813 y la prueba de esfericidad de Barlett de 1007.5 (p<0.000). Se calculó la varianza acumulada explicada por 3 factores fue de 55.4%. El instrumento obtuvo un coeficiente Alfa de Cronbach= 0,794, con correlaciones entre los ítems, Agotamiento Emocional (α= ,855), Cinismo (α=0,623) y Eficacia Académica (α= 0,744). Conclusión: El instrumento adaptado y validado reúne las propiedades psicométricas para ser con-siderado un instrumento útil y fiable inicialmente en estudiantes de medicina humana de la Universidad Ricardo Palma, presentando una adecuada estructura factorial y consis-tencia interna para la determinación del nivel de Síndrome de Burnout Académico.

Introduction: Evaluate the validity and reliability of an instrument adapted to Peru to measure the presence of Burnout Syndrome in university students of the Human Medicine career at the Ricardo Palma University, taking as starting point the Burnout Inventory of Maslach - Student Survey (MBI-SS). Methods: Cross-sectional analytical study, with level of application research. Validity was evaluat-ed by factorial structure analysis with the principal components method, Kaiser-Meyer Olkin tests and Varimax rotation were applied; the reliability by the Cronbach alpha val-ue. Results: 223 students from the Faculty of Human Medicine of the Ricardo Palma University were included, from November to December 2016. The prevalence of academic Burn-out found was 28.25% (63); The Kaiser-Meyer Olkin fitness test had a result of 0.813 and Barlett's sphericity test of 1007.5 (p <0.000). The cumulative variance explained by 3 factors was calculated to be 55.4%. The instrument obtained a Cronbach's Alpha co-efficient = 0.794, with correlations between the items, Emotional Exhaustion (α =, 855), Cynicism (α = 0.623) and Academic Efficiency (α = 0.744). Conclusion: The adapted and validated instrument gathers the psychometric properties to be con-sidered a useful and reliable instrument initially in human medicine students of the Ri-cardo Palma University, presenting an adequate factorial structure and internal con-sistency to determine the level of Academic Burnout Syndrome.

La revolución de la cirugía robótica en latino américa y la futura implementación en el sistema de salud del perú / The revolution of robotic surgery in latin america and the future implementation in the healthcare system of Peru

La Cirugía ha marcado un hito en la historia, desde sus orígenes y durante muchos siglos, esta especialidad estaba en estrecha relación con la curación de heridos en combate, una gran evidencia se denota en el caso presentado durante los inicios de la Cirugía Abierta, con las intervenciones llamadas Trepanaciones Craneanas que fueron realizadas en los años 700 a.C. ­ 200 d.C. por la Cultura Paracas en el Perú; con el transcurso del tiempo se fueron perfeccionando diversas técnicas que se complementaron con el uso de nuevos instrumentos y el desarrollo de la tecnología dando lugar a una revolución en las diversas especialidades quirúrgicas.

Surgery has marked a milestone in history, from its origins and for many centuries, this specialty a close relationship with the healing of wounded in combat case presented during the beginning of Open Surgery, with the so-called Trepanaciones Craniaas that were made in the 700 a.C. - 200 AD for the Paracas Culture in Peru; with the During the time the techniques that were complemented with the use were perfected of new instruments and the development of technology leading to a revolution in the various Surgical specialties

Influencia de los hábitos en la depresión del estudiante de medicina peruano: estudio en siete departamentos / Influence of Habits on Depression in the Peruvian Medical Student: Study in Seven Administrative Regions

RESUMEN Objetivo: Determinar la influencia de los hábitos en la depresión del estudiante de medicina de 7 departamentos de Perú. Métodos: Estudio transversal analítico de un análisis secundario de datos. El diagnóstico de depresión se obtuvo según el resultado del test de Zung, considerado positivo ante cualquier grado de esta condición. Además, se comparó esto con otras variables socioeducativas importantes según publicaciones previas. Resultados: De los 1.922 encuestados, el 54,5% (n = 1.047) eran mujeres; la mediana de edad era de 20 [intervalo intercuartílico, 18-22] arios. El 13,5% (n = 259) tenía algún grado de depresión según la escala de Zung. En el análisis multivariable, incrementaron la frecuencia de depresión la mayor cantidad de horas de estudio por día (razón de prevalencias ajustada [RPa] = 1,03; intervalo de confianza del 95% [IC95%], 1,01-1,04; p < 0,001) y que el estudiante trabaje (RPa = 1,98; IC95%, 1,21-3,23; p = 0,006); en cambio, disminuyeron la frecuencia de depresión tener horarios similares para comer (RPa = 0,59; IC95%, 0,38-0,93; p = 0,022) y un lugar fijo donde conseguir sus alimentos (RPa = 0,66; IC95%, 0,46-0,96; p = 0,030), ajustado por el año de ingreso a la universidad. Conclusiones: Se encontró que algunos factores estresantes predisponen a la depresión (trabajar y estudiar más horas por día); en cambio, tener un orden en su rutina diaria disminuye esta condición (tener un lugar y horarios fijos para comer.

ABSTRACT Objective: To determine the influence of habits on depression in medical students from 7 Peruvian Regions. Methods: Analytical cross-sectional study of a secondary data analysis. The diagnosis of depression was obtained according to the Zung test result, with any level of this condition being considered positive. This was also compared with other social and educational variables that were important according to previous literature. Results: Of the 1922 respondents, 54.5% (1047) were female. The median age was 20 [interquartile range, 18-22] years, and 13.5% (259) had some degree of depression according to the Zung scale. In the multivariate analysis, the frequency of depression increased with the hours of study per day (RPA= 1.03; 95%CI; 1.01-1.04; P<.001) and the student work (RPA = 1.98; 95%CI; 1.21-3.23; P=.006). On the other hand, decreased the frequency of depression decreased on having similar meal schedules (RPA = 0.59; 95%CI; 0.38-0.93; P=.022), and having a fixed place in which to get food (RPA = 0.66; 95%CI; 0.46-0.96; P=.030), adjusted for the year of college entrance. Conclusions: Some stressors predisposed to depression were found (the work and studying more hours a day). On the other hand, to have order in their daily routine decreased this condition (having a set place and times for meals).

Influence of Habits on Depression in the Peruvian Medical Student: Study in Seven Administrative Regions. / Influencia de los hábitos en la depresión del estudiante de medicina peruano: estudio en siete departamentos.

OBJECTIVE: To determine the influence of habits on depression in medical students from 7 Peruvian Regions. METHODS: Analytical cross-sectional study of a secondary data analysis. The diagnosis of depression was obtained according to the Zung test result, with any level of this condition being considered positive. This was also compared with other social and educational variables that were important according to previous literature. RESULTS: Of the 1922 respondents, 54.5% (1047) were female. The median age was 20 [interquartile range, 18-22] years, and 13.5% (259) had some degree of depression according to the Zung scale. In the multivariate analysis, the frequency of depression increased with the hours of study per day (RPA=1.03; 95%CI; 1.01-1.04; P<.001) and the student work (RPA=1.98; 95%CI; 1.21-3.23; P=.006). On the other hand, decreased the frequency of depression decreased on having similar meal schedules (RPA=0.59; 95%CI; 0.38-0.93; P=.022), and having a fixed place in which to get food (RPA=0.66; 95%CI; 0.46-0.96; P=.030), adjusted for the year of college entrance. CONCLUSIONS: Some stressors predisposed to depression were found (the work and studying more hours a day). On the other hand, to have order in their daily routine decreased this condition (having a set place and times for meals).

Influence of two types of sludge on the biogas production of assorted waste streams and the significance of beef cattle waste and liquid cheese whey in the organic fraction of municipal solid waste.

The aim of this study was to assess the biogas production generated by the anaerobic co-digestion of two co-substrates-liquid cheese whey (LCW) and beef cattle waste (BCW)-mixed with the organic fraction of municipal solid waste (OFMSW) and inoculated with either granular or suspended sludge. At the end of co-digestion, a high biogas yield was observed for the granular sludge mixture of OFMSW and BCW, which provides support for beef cattle waste as a promising substrate for biogas production. The mixture of OFMSW and LCW resulted in an enhancement of biogas production compared to OFMSW alone; however, the characteristics of LCW led to instability during the process. The key finding was that the type of sludge used influences the biogas production of the mixture. For the two sludges tested, the reactors containing granular sludge produced more biogas than those with suspended sludge. Reactors inoculated with a granular sludge produced 70% more biogas with the mixture of OFMSW and BCW compared to those with the suspended sludge. The OFMSW and LCW mixture with granular sludge produced 16% more biogas than with the suspended sludge.

Resistencia bacteriana y factores asociados en pacientes con pie diabético infectado sin desenlace de amputación mayor en un hospital nacional peruano / Bacterial resistance and associated factors in patients with infected diabetic foot with no major amputation outcomes in a Peruvian national hospital

RESUMEN Objetivo: Determinar la resistencia bacteriana y factores asociados en pacientes con pie diabético infectado sin desenlace de amputación mayor. Materiales y métodos: Estudio transversal, analítico, de revisión de historias clínicas de pacientes con pie diabético infectado del 2010-2014 en el Hospital Nacional Edgardo Rebagliati Martins. Según protocolo, las muestras de cultivo consistieron en tejidos que se obtuvieron después de desbridar la zona afectada. Sólo se usaron medios aerobios. Resultados: Se incluyeron 88 pacientes, aislándose 128 bacterias. El 81,8% fue varón con edad promedio de 60,6 años. El 76% tenía tiempo de diabetes >10 años y el 18,7% presentó Hba1c <7,0%. Según clasificación Wagner, 39,8% fue grado 3 y 40,9% grado 4. La infección grado moderada, según IDSA, fue la más frecuente (80,7%), al igual que la isquemia moderada (65,9%) y 44% tuvo infección previa por pie diabético. El 42% de los cultivos fue polimicrobiano, las bacterias aisladas más frecuentes fueron Escherichia coli (23,4%); Enterococcus faecalis (14,1%) y Staphylococcus aureus (13,3%). El 33% de las Enterobacterias fueron productores de betalactamasa de Espectro Extendido (BLEE). Se halló asociación de BLEE con infección previa por pie diabético, mayor PCR y fascitis necrotizante por LRINEC. El 71% de los S. aureus fue meticilino resistente (SAMR), hallándose asociación sólo con PCR alto. Conclusiones: En pacientes con pie diabético sin desenlace de amputación mayor, se encontró una elevada frecuencia de Enterobacterias BLEE positivas y SAMR. Infección previa, PCR alto y LRINEC >8 estuvo asociado a la presencia de BLEE y sólo PCR alto a SAMR

Objective: To determine bacterial resistance and its associated factors in patients with infected diabetic foot with no major amputation outcomes. Materials and methods: This is a cross-sectional analytical study, which consisted in reviewing clinical records from patients with infected diabetic foot seen during the period 2010-2014 in the Edgardo Rebagliati- Martins Hospital. According to the protocol, samples for culture consisted in tissues that were obtained after debriding the affected areas. Only aerobic media for cultures were used. Results: Eighty-eight patients were included, and 128 bacterial isolates were obtained. Most of the subjects (81.8%) were male, and their average age was 60.6 years. Three-fourths of all patients (76%) had diabetes for more than 10 years, and 18.7% had Hba1c <7.0%. According to the Wagner classification, 39.8% were grade 3 and 40.9% were grade 4. Moderated grade infections, according to the IDSA, were the most frequent instances (80.7%), as well as moderate ischemia (65.9%) , and 44% of patients had a previous infection on their diabetic foot. Only 42% of all cultures were polymicrobial, and most frequently isolated microorganisms were Escherichia coli (23.4%), Enterococcus faecalis (14.1%), and Staphylococcus aureus (13.3%). One-third (33%) of Enterobacteriaceae were Extended-Spectrum Beta-lactamase (ESBL) producers. There was an association of having ESBL microorganisms with previous diabetic foot infections, higher CRP values and necrotizing fasciitis according to LRINEC. Most S. aureus strains (71%) were methicillin-resistant (MRSA), and this was associated with high CRP values. Conclusions: In patients with diabetic foot with no major amputation outcomes, there was a high frequency of ESBL Enterobacteriaceae and MRSA. The occurrence of a previous infection, high CRP values and LRINEC >8 were associated with the presence of ESBL, and only high CRP values were associated with MRSA

Uso del Smartphone y de Facebook asociado a la autopercepción del rendimiento académico en estudiantes de Medicina peruanos / Use of smartphones and Facebook associated with self-perception of academic performance among Peruvian medical students

El estudio tuvo el objetivo de determinar la asociación entre el uso del Smartphone y de Facebook con la autopercepción del rendimiento académico en estudiantes de una Facultad de Medicina Humana en la serranía peruana. Se realizó un estudio transversal analítico prospectivo. Se trabajó con estudiantes de Medicina de la Universidad Contiental en Huancayo-Perú y se usó una encuesta para medir el uso de Smartphone (teléfonos inteligentes), Facebook, así como la percepción de si estos mejoraban el rendimiento académico. Se realizó estadística bi y multivariada, usando modelos lineales generalizados y con un valor de p< 0,05 como estadísticamente significativo. Se encuestó a 173 estudiantes, el 61 % (106) fueron mujeres y la mediana de edad fue 21 años (rango intercuartílico: 19-22 años). El 76 % (131) manifestó que el Smartphone mejoraba su rendimiento académico. Esto se relacionó en el análisis bivariado de forma positiva con el número de Smartphone, si contaba con aplicaciones para capacitación y si usaba aplicaciones médicas; y negativamente con horas que usaba el Smartphone por semana, si tiene internet en el Smartphone, si usa internet en el Smartphone, la frecuencia de uso de Facebook, la frecuencia en la que se escribía en perfiles Facebook y el número de contactos en Facebook (todas con valores de p< 0,05). En el multivariado ajustado, las horas promedio que usaba el Smartphone por semana se asoció negativamente con la percepción de la mejora del rendimiento académico (RPa: 0,98; IC 95 %: 0,97-0,99). A más horas de uso del Smartphone por semana los estudiantes perciben que esto empeora el rendimiento académico. Esto debería estudiarse para cuantificar la real disminución del rendimiento académico.

The purpose of the study was to determine the association between the use of smartphones and Facebook, and self-perception of academic performance among students from a medical school in the Peruvian highlands. A analytical cross-sectional prospective study was conducted with medical students from the Continental University in Huancayo, Peru. A survey was applied to measure the use of smartphones and Facebook, as well as perception of whether these tools improved academic performance. Bivariate and multivariate statistical analysis was conducted, using generalized linear models, with a p value of < 0.05 as statistically significant. The survey was given to 173 students, 61 % of whom (106) were women. Mean age was 21 years (interquartile range: 19-22 years). 76 % (131) stated that the smartphone improved their academic performance, which was positively related in the bivariate analysis to the number of smartphones and whether they contained training and medical applications, and negatively to the number of hours smartphones were used per week, whether they had Internet access, whether the Internet was accessed from the smartphone, the frequency of use of Facebook, the frequency with which entries were made in Facebook profiles, and the number of Facebook contacts (all with p values of < 0.05). In the adjusted multivariate analysis, the mean number of hours that the smartphone was used per week was negatively associated with the perception of improvement in academic performance (RPa: 0.98; CI 95 %: 0.97-0.99). Students perceive that academic performance worsens as the number of hours of use of smartphones per week increases. This fact should be further studied to quantify the actual decline in academic performance.

Factores asociados a la dependencia de alcohol y tabaco en estudiantes de ocho facultades de medicina peruanas, 2015 / Factors associated with alcohol and tobacco dependence on students of eight peruvians medical schools, 2015

Introduction: The uses of legal drugs are common among university students, but have not done local research to reveal dependence on them. The objective was to determine the factors associated with consumption of tobacco and alcohol in students from eight Peruvian medical schools. Methods: Multicenter cross-sectional study of secondary data, a self-applied questionnaire was used in Peruvian medicine students, the test Cage and Fagerströmwas used to define tobacco consumption and alcohol habit, respectively; in addition to measuring other socio-educational variables. It was obtained statistical association and p values. Results: Of the 1,918 students tested, 55% (1,046) were women and the median age was 20 years. 34% of students consumed regularly tobacco; 9% (178) showed tobacco dependence, increased frequency of alcohol consumption (RPa: 8.39, IC 95%: 4.99-14.09; p < 0.001) and coffee (RPa: 1,72; IC 95%: 1.312.27; p < 0.001); receiving money from family decreased tobacco consumption (RPa: 0.68; IC 95%: 0.49-0.94, p = 0.019). 28% (537) consumed alcohol regularly, increasing its frequency being male (RPa: 1.51; IC 95%: 1.09-2.09, p = 0.012), having failed a course (RPa: 1,17; IC 95%: 1.02-1.33, p = 0.021), the academic semester coursing (RPa: 1.04; IC 95%: 1.01-1.08, p = 0.014) and consumption of tobacco (RPa: 2.89; IC 95%: 2.40-3.47; p < 0.001); also it decreased the frequency of alcohol comsuption daily hours studying (RPa: 0.96; IC 95%: 0.94-0.97;p < 0.001 ). Conclusions: Although the frequency of alcohol consumption and tobacco was not high, this associated some modifiable factors, which may intervene to reduce the frequency and potential consequences.

Introducción: El consumo de drogas lícitas es común entre los universitarios, no se han realizado investigaciones locales que revelen dependencia a las mismas. El objetivo fue determinar los factores asociados a la dependencia alcohólica y al tabaco en estudiantes de ocho facultades de medicina peruanas. Método: Estudio transversal analítico multicéntrico de datos secundarios, se utilizó un cuestionario auto-aplicado en los estudiantes de medicina peruanos, se usó los test de Cage y Fagerstrom para definir dependencia alcohólica y al tabaco, respectivamente; además de medir otras variables socio-educativas. Se obtuvo estadísticos de asociación y valores p. Resultados: De los 1.918 estudiantes evaluados, el 55% (1.046) fueron mujeres y la mediana de edades fue 20 años. El 34% de estudiantes consumía tabaco regularmente; el 9% (178) mostró dependencia al tabaco, aumentando la frecuencia el consumir alcohol (RPa: 8,39; IC95%: 4,99-14,09;p < 0,001) y café (RPa: 1,72; IC95%: 1,31-2,27;p < 0,001); el recibir dinero de su familia disminuyó la frecuencia de consumo de tabaco (RPa: 0,68; IC95%: 0,49-0,94; p: 0,019). Consumían alcohol regularmente un 49%; mostrando dependencia alcohólica un 28% (537), aumentando su frecuencia el ser varón (RPa: 1,51; IC95%: 1,09-2,09; p: 0,012), el haber desaprobado un curso (RPa: 1,17; IC95%: 1,02-1,33; p: 0,021), el semestre académico que cursaban (RPa: 1,04; IC95%: 1,01-1,08; p: 0,014) y la dependencia al tabaco (RPa: 2,89; IC95%: 2,40-3,47;p < 0,001 ); asimismo, disminuyó la dependencia alcohólica, las horas diarias que estudia (RPa: 0,96; IC95%: 0,94-0,97;p < 0,001). Conclusiones: Si bien la dependencia al alcohol y tabaco no fue alta, a esto se asoció algunos factores modificables, en los que se pueden intervenir para disminuir la frecuencia y sus posibles consecuencias.

Uso de teléfonos inteligentes y aplicaciones para la autocapacitación y la telemedicina en médicos peruanos / Use of smartphones and applications for self-training and telemedicine among Peruvian physicians / Uso de telefones inteligentes e aplicações para a autocapacitação e a telemedicina em médicos peruanos

Para determinar la frecuencia de uso de teléfonos inteligentes y aplicaciones para la autocapacitación y la telemedicina se realizó un estudio descriptivo, prospectivo y multicéntrico, en el que preguntamos acerca del uso de la tecnología de la información para la práctica asistencial y la autocapacitación en médicos peruanos. Se midió el uso de teléfonos inteligentes, las aplicaciones y la telemedicina. Se encontró que, de los 1 013 médicos que manifestaron que usaban algún teléfono inteligente, el 65 % (661) fueron hombres y la mediana de edad fue 35 años (rango: 22-74 años). El 48,5 % (460) usaban el teléfono inteligente para la autocapacitación. Medscape fue el más usado para este fin (13 %); el 98 % usaba alguna aplicación para su teléfono inteligente; el 30 % de los que eran docentes usaba alguna aplicación para esta actividad; las aplicaciones más usadas fueron las que permitían el acceso a la web y/o búsqueda de autocapacitación (31 %) y al correo electrónico (30 %). En cuanto al uso de la telemedicina, el 73 % había enviado una imagen/video de un paciente a otro colega, el 29 % había tenido una video-conferencia con otro médico para discutir algún caso de su paciente y el 30 % (269) había usado su teléfono inteligente para una comunicación con algún paciente (sin contar las llamadas). Si bien la gran mayoría de médicos encuestados posee un teléfono inteligente, no todos usan telemedicina o aplicaciones como parte habitual de su práctica asistencial o para su autocapacitación. Este puede ser un recurso importante a ser explotado para la mejora de la prestación de la salud en Perú.

A multicenter descriptive prospective study was conducted to determine the frequency of the use of smartphones and applications for self-training and telemedicine. Data were collected with a questionnaire about the use of information technology for clinical practice and self-training among Peruvian physicians. Measurements were taken of the use of smartphones, applications and telemedicine. Of the 1 013 physicians who stated they used some sort of smartphone, 65 % (661) were men and mean age was 35 years (range 22-74 years); 48.5 % (460) used the smartphone for self-training; Medscape was the resource most commonly used for this purpose (13 %); 98 % had applications on their smartphone; 30 % of those who taught used applications for their teaching; the applications most commonly used were those providing access to the web and/or self-training searches (31 %) and to electronic mail (30 %). With respect to the use of telemedicine, 73 % had sent an image or video of a patient to a colleague; 29 % had participated in a videoconference with another physician to discuss a case, and 30 % (269) had used their smartphone for communication with a patient (apart from calls). The vast majority of the physicians surveyed owned a smartphone, but not all used telemedicine or applications habitually as part of their clinical practice or for self-training. Wider use of these resources could help improve healthcare in Peru.

Para determinar a frequencia de uso de telefones inteligentes e aplicações para a autocapacitação e a telemedicina se realizou um estudo descriptivo, prospectivo e multicêntrico, no que perguntamos acerca do uso da tecnologia da informação para a práctica assistencial e a autocapacitação em médicos peruanos. Mediu-se o uso de telefones inteligentes, as aplicações e a telemedicina. Foi encontrado que, dos 1 013 médicos que manifestaram que usavam algum telefone inteligente, o 65 % (661) foram homens e a mediana de idade foi 35 anos (faixa: 22-74 anos). O 48,5 % (460) usava o telefone inteligente para a autocapacitação. Medscape foi o mais usado para este fim (13 %); o 98 % usava alguma aplicação para seu telefone inteligente; o 30 % dos que eram docentes usava alguma aplicação para esta actividade; as aplicações mais usadas foram as que permitiam o acesso à web e/ou busca de autocapacitação (31 %) e ao correio electrônico (30 %). No que diz respeito ao uso da telemedicina, o 73 % tinha enviado uma imagem/vídeo dum paciente a outro colega, o 29 % tinha tido uma vídeo-conferência com outro médico para discutir algum caso de seu paciente e o 30 % (269) tinha usado seu telefone inteligente para uma comunicação com algum paciente (sem contar as chamadas). Haja que a grande maioria de médicos entrevistados possui um telefone inteligente, não todos usam telemedicina ou aplicações como parte habitual de sua práctica assistencial ou para sua autocapacitação. Este pode ser um recurso importante a ser explorado para a melhora da prestação da saúde em Peru.

[Functional dyspepsia in students of eigth peruvians medical schools. Influence of the habits]. / Dispepsia funcional en estudiantes de ocho facultades de medicina peruanas. Influencia de los hábitos.

Functional dyspepsia impacts on quality of life. Due to its multifactorial etiology its characterization proves difficult, especially in populations at risk such as medical students. Objetives: To determine if behavioral and harmful habits of medical students from eight universities of Peru were associated to functional dyspepsia. Methods: Multicentric, cross-sectional study. A self-administered questionnaire was taken among students enrolled in eight medical faculties in Peru. Functional dyspepsia was measured using a validated test; diet characteristics, alcohol, tobacco, coffee or energy drinks consumption were considered behavioral habits. Furthermore, others from the social and educational sphere were measured. Bivariate and multivariate statistical analyses were made. Results: From a total of 1.923 students, the median of the ages was 20, 55% were women and 24% suffered from functional dyspepsia. Factors which diminished the frequency of functional dyspepsia were masculine gender (aPR:0,75; 95%CI:0.64-0.87; p < 0,001), hours spent studying (aPR:0,97; 95%CI:0,96-0,99; p < 0,001) and eating following a fixed schedule (aPR:0,80; 95%CI:0,67- 0,95; p = 0,013); however, having failed a course increases the frequency of functional dyspepsia (aPR:1.24; 95%CI:1.13-1.37; p < 0,001)adjusted for age, as well as difficulties to fall asleep and depression. Conclusion: Many medical students suffered from functional dyspepsia, this being related to several behavioral variables; therefore further studies as well as educational institutions' intervention is required, due to the short and long term problems that may arise from this situation.

Monozygotic Twin Pregnancy Associated with In Vitro Fertilization: Report and Revision of Three Cases Presented in a Clinic at 10,925 Feet Above Sea Level.

3 cases of monozygotic twin pregnancies associated with IVF presented at Centro de Fertilidad y Ginecología del Sur. In this study, we describe the cases and review the literature, noting possible related factors.