Cardiac arrhythmias after renal I/R depend on IL-1ß.

AIMS: Cardiac arrhythmias are one of the most important remote complications after kidney injury. Renal ischemia reperfusion (I/R) is a major cause of acute renal injury predisposing to several remote dysfunctions, including cardiac electrical disturbance. Since IL-1ß production dependent on NLRP3 represents a link between tissue malfunctioning and cardiac arrhythmias, here we tested the hypothesis that longer ventricular repolarization and arrhythmias after renal I/R depend on this innate immunity sensor. METHODS AND RESULTS: Nlrp3-/- and Casp1-/- mice reacted to renal I/R with no increase in plasma IL-1ß, different from WT (wild-type) I/R. A prolonged QJ interval and an increased susceptibility to ventricular arrhythmias were found after I/R compared to Sham controls in wild-type mice at 15 days post-perfusion, but not in Nlrp3-/- or CASP1-/- I/R, indicating that the absence of NLRP3 or CASP1 totally prevented longer QJ interval after renal I/R. In contrast with WT mice, we found no renal atrophy and no renal dysfunction in Nlrp3-/- and Casp1-/- mice after renal I/R. Depletion of macrophages in vivo after I/R and a day before IL-1ß peak (at 7 days post-perfusion) totally prevented prolongation of QJ interval, suggesting that macrophages might participate as sensors of tissue injury. Moreover, treatment of I/R-WT mice with IL-1r antagonist (IL-1ra) from 8 to 15 days post perfusion did not interfere with renal function, but reversed QJ prolongation, prevented the increase in susceptibility to ventricular arrhythmias and rescued a close to normal duration and amplitude of calcium transient. CONCLUSION: Taken together, these results corroborate the hypothesis that IL-1ß is produced after sensing renal injury through NRLP3-CASP1, and IL-1ß on its turn triggers longer ventricular repolarization and increase susceptibility to cardiac arrhythmias. Still, they offer a therapeutic approach to treat cardiac arrhythmias that arise after renal I/R.

Hypertension subtypes at high altitude in Peru: Analysis of the Demographic and Family Health Survey 2016-2019.

BACKGROUND: The prevalence of hypertension in Peru has increased over the years. Approximately one third of the Peruvian population lives at high altitudes. This population presents particular physiological, genetic and environmental characteristics that could be related to the prevalence of hypertension and its subtypes. OBJECTIVE: To assess the association between altitude and hypertension in the Peruvian population through an analysis of a nationally representative survey. METHODS: We conducted a cross-sectional analysis of the Demographic and Family Health Survey for the period 2016-2019. We included 122,336 individuals aged 18 years and older. Hypertension was defined according to the JNC-7 guidelines. High-altitude location was defined as a residential cluster located above 2,500 meters above sea level. We utilized generalized linear models from the Poisson family with a log-link function to assess the magnitude of the association between high altitude and hypertension. Additionally, we employed multinomial regression models to analyze the association between high altitude and subtypes of hypertension, including isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). RESULTS: In the adjusted Poisson regression model, we found that the prevalence of hypertension among participants living at high altitudes was lower compared to those living at low altitudes (aPR: 0.89; 95% CI: 0.86-0.93). In the adjusted multinomial regression model, we observed a lower prevalence rate of ISH among participants residing at high altitudes (aRPR: 0.68; 95% CI: 0.61-0.73) and a higher prevalence rate of IDH among participants residing at high altitudes (aRPR: 1.60; 95% CI: 1.32-1.94). CONCLUSIONS: Residents at high altitudes in Peru have a lower prevalence rate of ISH and a higher prevalence rate of IDH compared to those living at low altitudes. Further studies are needed to determine the influence of other biological, environmental, and healthcare access factors on this relationship.

IL-1ß is not critical to chronic heart dysfunction in mice with Chagas disease.

Long after Trypanosoma cruzi infection, 40% of individuals develop a progressive chronic chagasic cardiomyopathy (CCC), with systolic dysfunction and arrhythmias. Since we previously showed IL-1ß mediates the development of systolic dysfunction and cardiac arrhythmias in diabetes mellitus and cardiorenal syndrome, and IL-1ß remains elevated in Chagas disease patients, here we tested the role of IL-1ß in CCC using a mouse model. Mice deficient in IL-1R expression (Il-1r-/- ) survived acute T. cruzi infection with greater parasitemia than controls but did not lose weight as wild-type (WT) did. At the chronic stage, WT presented prolonged ventricular repolarization intervals (QJ), while Il-1r-/- presented intervals like noninfected controls. Infected Il-1r-/- and WT did not differ in stroke volume (SV), the incidence of cardiac arrhythmias on electrocardiography (EKG), whole heart action potential duration (APD), or the incidence of triggered activity after S1-S2 protocol, which is a measure of susceptibility to cardiac arrhythmias. We also treated chronically infected WT mice with an IL-1R antagonist, anakinra. Treatment shortened the QJ interval but did not improve the SV or the incidence of cardiac arrhythmias on EKG. Anakinra failed to reduce triggered activity following the electrical extra-stimulation protocol. In conclusion, the absence of functional IL-1ß/IL-1R signaling did not prevent or reverse the decrease of SV or the incidence of cardiac arrhythmias induced by chronic T. cruzi infection, implying this is not a critical mechanism in generating or maintaining CCC. Since similar cardiac abnormalities were previously credited to IL-1ß signaling, ruling out this mechanism is important to discourage further attempts of IL-1ß blockade as a therapeutical measure.

NOD Mice Recapitulate the Cardiac Disturbances Observed in Type 1 Diabetes.

This work aimed at testing the hypothesis that NOD/ShiLtJ mice (NOD) recapitulate the cardiac disturbances observed on type 1 diabetes (T1D). NOD mice were studied 4 weeks after the onset of hyperglycemia, and NOR/Lt mice matched as control. Cardiac function was evaluated by echocardiography and electrocardiography (ECG). Action potentials (AP) and Ca2+ transients were evaluated at whole heart level. Heart mitochondrial function was evaluated by high-resolution respirometry and H2O2 release. NOD mice presented a reduction in hearth weight. Mitochondrial oxygen fluxes and H2O2 release were similar between NOD and NOR mice. ECG revealed a QJ interval prolongation in NOD mice. Furthermore, AP duration at 30% of repolarization was increased, and it depicted slower Ca2+ transient kinetics. NOD mice presented greater number/severity of ventricular arrhythmias both in vivo and in vitro. In conclusion, NOD mice evoked cardiac electrical and calcium handling disturbances similar to the observed in T1D. Graphical Abstract .

[Oestrus ovis ophthalmomyiasis at an urban area in Southern Peru]. / Oftalmomiasis por Oestrus ovis en un área urbana al sur del Perú.

Ophthalmomyiasis is the ocular infestation by dipterous larvae. It has been described in patients from rural areas, poor hygiene, or contact with animals. However, there are sporadic reports of this infestation in urban areas. We present the case of a young man without risk factors, from an urban area in southern Peru, in whom we found 10 larvae at ocular conjunctiva. The larvae were identified as Oestrus ovis, a fly that usually infests sheep and goats as part of their life cycle. We made a brief review of the case, highlighting the importance of adequately identifying the species that cause myiasis as well as its life cycle.

Religious affiliation and the intention to choose psychiatry as a specialty among physicians in training from 11 Latin American countries.

The worldwide scarcity of psychiatrists makes the identification of the factors associated with the intention to choose this specialty an important issue. This study aims to evaluate the association between religious affiliation and the intention to choose psychiatry as a specialty among medical students from 11 Latin American countries. We conducted a cross-sectional, multi-country study that included first- and fifth-year students of 63 medical schools in 11 Latin-American countries between 2011 and 2012. The main outcome and measures were the intention to pursue psychiatry as a specialty over other specialties (yes/no) and religious affiliation (without: atheist/agnostic; with: any religion). A total of 8308 participants were included; 53.6% were women, and the average age was 20.4 (SD = 2.9) years. About 36% were fifth-year students, and 11.8% were not affiliated with any religion. Only 2.6% had the intention to choose psychiatry; the highest proportion of students with the intention to choose psychiatry was among students in Chile (8.1%) and the lowest among students in Mexico (1.1%). After adjusting for demographic, family, academic as well as personal and professional projection variable, we found that those who had no religious affiliation were more likely to report the intention to become a psychiatrist [OR: 2.92 (95%CI: 2.14-4.00)]. There is a strong positive association between not having a religious affiliation and the intention to become a psychiatrist. The possible factors that influence this phenomenon must be evaluated in greater depth, ideally through longitudinal research.

Frequency and characteristics of gallbladder cancer at a referral hospital in southern Peru, 2009-2014: a descriptive study. / Frecuencia y características del cáncer de vesícula biliar en un hospital de referencia al sur del Perú, 2009-2014: estudio descriptivo.

INTRODUCTION: Gallbladder cancer is a rare neoplasm, its frequency is variable in the regions of Peru. OBJECTIVE: To determine the frequency and describe the clinical characteristics of gallbladder cancer in southern Peru. METHODS: The reports of the anatomopathological department of the Honorio Delgado Regional Hospital were selected from all samples of cholecystectomies performed between 2009 and 2014 and those that had some result compatible with gallbladder cancer were looked for. Subsequently, the clinical histories were searched to obtain the characteristics of these patients. RESULTS: Of 2991 cholecystectomies, 75 (2.5%) had gall bladder cancer. The most frequent symptom in both groups was pain (96.7%), followed by nausea (87.5%) and vomiting (65.0%). The majority of patients were women (83.3%) older than 60 years (65.0%). The most frequent histological type was the adenocarcinoma (80.0%). CONCLUSION: The frequency of gallbladder cancer in a reference hospital in southern Peru is 2.51%, higher than that reported in other studies in the central and northern regions of Peru.

INTRODUCCIÓN: El cáncer de vesícula biliar es una neoplasia poco común, y su frecuencia es variable en las regiones de Perú. OBJETIVO: Determinar la frecuencia y describir las características clínicas del cáncer de vesícula biliar en un hospital de referencia al sur de Perú. MÉTODOS: Estudiamos los informes de todas las muestras de colecistectomías realizadas entre los años 2009 y 2014, en el servicio de anatomía patológica del Hospital Regional Honorio Delgado. Además, revisamos las historias clínicas de los pacientes que tuvieran algún resultado compatible con cáncer de vesícula biliar. RESULTADOS: De 2991 colecistectomías, 75 (2,5%) tuvieron cáncer de vesícula biliar. El síntoma más frecuente en ambos grupos fue el dolor (96,7%), seguido de náusea (87,5%) y vómitos (65,0%). La mayoría de pacientes fueron mujeres (83,3%) mayores de 60 años (65,0%). El tipo histológico más frecuente fue el adenocarcinoma (80,0%). CONCLUSIÓN: La frecuencia de cáncer de vesícula biliar en un hospital de referencia del sur de Perú, es de 2,5% mayor a la reportada en otros estudios en las regiones centro y norte del país.

[Effect of oxytocin on the levels of malondialdehyde, nitric oxide, and s100b protein in newborns]. / Efecto de la oxitocina en los niveles de malondialdehído, óxido nítrico y proteína s100b en el recién nacido.

OBJECTIVES: To assess the effects of the administration of oxytocin during labor management on the levels of malondialdehyde (MDA), nitric oxide (NO), and S100B protein in newborns. MATERIALS AND METHODS: We selected 80 term pregnant women without obstetric and fetal pathology, forming two groups: pregnant women with normal delivery and pregnant women conducted with oxytocin. Blood was collected immediately after delivery from the umbilical cord vein to measure MDA, ON and from the artery for protein S100B. The concentration of MDA and ON was quantified by spectroscopic methods and the protein S100B by ELISA. RESULTS: Values of 3.4 uMol/L and 3.6 uMol/L of MDA and 1.4 uMol/L and 1.8 uMol/L of NO were obtained in the oxytocin and control group, respectively, without significant difference; S100B levels were higher in the oxytocin managed group, with a median of 1.36 µg/L compared to the normal delivery group 1.11 µg/L (p=0.03). There was no relationship between the dose of oxytocin administered and the levels of MDA, ON, and S100B. CONCLUSIONS: There is no difference between MDA and NO levels between pregnant women undergoing a normal or managed birth. There is a significant difference in S100B protein levels in newborns born via an oxytocin-managed delivery. There is no relationship between oxytocin dose and levels of oxidative stress and S100B protein.

Objetivos. Evaluar los efectos de la administración de oxitocina en la conducción del parto en los niveles de malondialdehído (MDA), óxido nítrico (ON) y proteína S100B en el recién nacido. Material y Métodos. Se seleccionó a 80 gestantes a término sin patología obstétrica y fetal, formando dos grupos: Gestantes con parto normal y conducidas con oxitocina. Se extrajo sangre inmediatamente después del parto de la vena de cordón umbilical para medir MDA, ON y de la arteria para la proteína S100B. Se cuantificó la concentración de MDA y ON por métodos espectroscópicos y la proteína S100B por ELISA. Resultados. Se tuvo valores de 3,4 uMol/L y 3,6 uMol/L de MDA y 1,4 uMol/Ly 1,8 uMol/L de ON en el grupo conducido con oxitocina y control respectivamente sin diferencia significativa, los niveles de S100B fueron mayores en el grupo conducido con oxitocina, con una mediana de 1,36 µg/L comparado con el grupo de parto normal 1,11 µg/L (p=0,03). No hubo relación entre la dosis de oxitocina administrada y los niveles de MDA, ON y S100B. Conclusiones. No hay diferencia entre los niveles de MDA y ON entre las gestantes con parto normal y conducidas. Hay diferencia significativa en los niveles de proteína S100B en recién nacidos de parto con oxitocina. No hay relación entre la dosis de oxitocina y los niveles de estrés oxidativo y proteína S100B.

A case report of intramyocardial bridge on right coronary artery. / Reporte de un caso de puente intramiocárdico en arteria coronaria derecha.

Intramyocardial bridges are a coronary circulation anomaly. They usually occur on the path of the anterior descending artery and are classified as superficial or deep. During a routine autopsy, we found—and report—an intramyocardial bridge in large part of the right coronary artery pathway, including the sinoatrial and posterior descending branch. The patient did not show signs of coronary insufficiency, and died from an acute respiratory failure caused by aspiration pneumonia. Due to the infrequency of cases of intramyocardial bridges of the right coronary artery without concomitant clinical symptoms or signs, we conducted a literature review in this regard.

Los puentes intramiocárdicos son una anomalía de la circulación coronaria. Estos suelen presentarse en el trayecto de la arteria descendente anterior y se clasifican en superficiales o profundos. Reportamos el hallazgo de un puente intramiocárdico en el trayecto de la arteria coronaria derecha, incluida su rama sinoauricular y descendente posterior durante la disección de rutina de un cadáver. El paciente al parecer no presentó signos relativos a insuficiencia coronaria y falleció debido a una insuficiencia respiratoria aguda causada por neumonía aspirativa. Debido a la presencia limitada de casos sobre puente intramiocárdico de la arteria coronaria derecha, realizamos una revisión de la literatura al respecto y planteamos algunas conclusiones.

[Surgical treatment of choledocholithiasis in a patient with situs inversus totalis: a case report and literature review]. / Tratamiento quirúrgico de coledocolitiasis en situs inversus totalis: reporte de caso y revisión de la literatura.

Situs inversus totalis (SIT) is a rare condition, in which there is transposition of the thoraco-abdominal organs. This situation leads to diagnostic and therapeutic difficulties in patients with acute surgical abdomen. The objective of this report is to present the case of a patient who presented with colonic pain in the epigastrium and left hypochondrium, in which the diagnosis of SIT, cholelithiasis and choledocholithiasis was reached after the respective imaging studies. Once the diagnosis was made, treatment was performed through retrograde endoscopic cholangiopancreatography (ERCP) and subsequent surgical exploration of bile ducts. Both procedures were failed due to technical difficulties generated by the patient's condition. In conclusion, in spite of the report of successful cases in the literature of ERCP and surgical treatment of the biliary tract in SIT, there may be situations that do not allow a successful approach, so meticulous surgical planning and the use of support methods are necessary In the management of these patients.

El situs inversus totalis es una rara condición en la que existe trasposición de los órganos torácicos abdominales. Esta situación da lugar a dificultades diagnósticas y terapéuticas en pacientes con cuadros de abdomen agudo quirúrgico. El objetivo de este reporte es dar cuenta del caso de un paciente que presentó con dolor de tipo cólico en epigastrio e hipocondrio izquierdo. Luego de los estudios imagenológicos del caso, el paciente fue diagnosticado como situs inversus totalis, con colelitiasis y coledocolitiasis. El tratamiento fue realizado mediante una colangiopancreatografía retrograda endoscópica y posterior exploración quirúrgica de vías biliares. Ambos procedimientos fueron fallidos, debido a dificultades técnicas generadas por la condición del paciente. En conclusión, pese al reporte de casos exitosos en la literatura de colangiopancreatografía retrograda endoscópica y tratamiento quirúrgico de la vía biliar en situs inversus totalis, pueden existir situaciones que no permitan un abordaje exitoso. Es por ello que una planificación quirúrgica meticulosa y el uso de métodos de apoyo son necesarios en el manejo de estos pacientes.

Estrés psicológico en estudiantes de una universidad pública peruana durante la primera ola de COVID-19 / Psychological stress in students of a peruvian public university during the first wave of COVID-19

RESUMEN Introducción. La pandemia de COVID-19, la cuarentena, y la suspensión de actividades fueron estresores psicológicos importantes. Los estudiantes universitarios son una población vulnerable a niveles de estrés aumentado. Objetivo. Determinar los niveles de estrés psicológico e identificar factores asociados en estudiantes universitarios. Métodos. Estudio transversal y observacional. Aplicamos una encuesta en línea sobre características relacionadas a los estudios universitarios y la Escala de Percepción Global de Estrés de 13 ítems (EPGE-13). El cuestionario se aplicó en el marco de la primera ola de la pandemia por COVID-19. Se consideró estrés alto a aquellos alumnos con puntuación superior al percentil 75. Los puntajes de la EPGE-13 fueron comparados según diversas características de los estudiantes con la prueba T de Student o U de Mann Whitney. Además, se realizó un análisis multivariado para reconocer los factores relacionados con estrés alto. Resultados. Participaron 2647 estudiantes universitarios. 1566 (59,2%) fueron de sexo femenino. La edad de los alumnos fue de 21 años (RIC: 19 - 23). El puntaje promedio de estrés fue de 27,6 ± 7,1. Las variables relacionadas con un nivel de estrés alto fueron el sexo femenino, el año académico universitario, tener cursos pendientes, enfermedad crónica, y preocuparse por el futuro. Conclusión. Durante la primera ola de COVID-19 los estudiantes universitarios presentaron altos niveles de estrés. Ser mujer, el año académico, tener cursos pendientes, enfermedad crónica y preocuparse por el futuro fueron factores de riesgo para presentar nivel alto de estrés en una universidad estatal de Perú.

ABSTRACT Introduction. The COVID-19 pandemic, the lockdown, and suspension of activities were important psychological stressors. University students are a vulnerable population for high stress levels. Objective. To determine the levels of psychological stress and identify associated factors in the student population of a peruvian public university. Methods. Cross-sectional observational study. We applied an online survey on characteristics related to university studies and the 13-item Global Perception of Stress Scale (PSS-13). The questionnaire was applied in the framework of the first wave of the COVID-19 pandemic. High stress was considered to be those students with a score above the 75th percentile. We compared the mean scores of the PSS-13 according some students characteristics with the Student's t-test or the Mann-Whitney U-test. In addition, multivariate analyses was performed to recognize factors related to high stress. Results. 2647 university students participated in this study. 1566 (59.2%) were female. The age of the students was 21 years (IQR: 19 - 23). The stress score was 27.6 ± 7.1. The variables related to high level of stress were female sex, university academic year, having pending courses, chronic illness, and worrying about the future. Conclusions. During the first wave of COVID-19, university students presented high levels of stress. Being a woman, the academic year, having pending courses, chronic illness and worrying about the future are risk factors for presenting a high level of stress in a state university in Peru.

Biological accidents in last-year medical students from three hospitals in Lima Peru. / Accidentes biológicos en estudiantes del último año de medicina de tres hospitales de Lima, Perú.

OBJECTIVE: To determine the frequency and characteristics of biological accidents in last-year medical students from three hospitals in Lima. METHODS: Cross-sectional study performed at three Public Health Insurance hospitals in Lima, in December 2014. The study population comprised last-year medical interns. Biological accidents were recorded with a questionnaire of exposure to blood and body fluids based on the formats used by the Exposure Prevention Information Network system and the Centers for Disease Control and Prevention. We inquired about occurrence and number of biological accidents as well as the characteristics of the last accident. Categorical data are presented as absolute and percentage frequencies and numeric data, as median and interquartile ranges. RESULTS: We collected 100 respondents; 85% of them had had a biological accident during the last year, with a median of 2 and interquartile range of 3. The most frequent type of exposure was percutaneous (71.8%) and the most common device was the hollow needle (54.1%). The most frequent place of occurrence and activities at the moment of exposure were at the delivery room (44.7%), while supervising a vaginal delivery (24.7%), and during suturing (24.7%). Three accidents involved high-risk patients, but only one student received antiviral prophylaxis; 49.4% attributed the cause of the accident to fatigue, and 75.3% of accidents are not reported. Gloves are the most used protective barrier (95%). CONCLUSIONS: The frequency of biological accidents among last-year medical students is high. Underreporting and inappropriate use of protective barriers increase the risk of medical students for biological accidents.

OBJETIVO: Determinar la frecuencia y características de los accidentes biológicos en estudiantes del último año de medicina de tres hospitales de Lima. MÉTODOS: Estudio transversal, realizado en tres hospitales del Seguro Social de Salud de Lima, en diciembre de 2014. La población de estudio la constituyen los internos de medicina. Los accidentes biológicos se registraron aplicando un cuestionario sobre exposición a sangre y fluidos corporales, elaborado sobre la base de los formatos utilizados por el sistema Exposure Prevention Information Network y Centers for Disease Control and Prevention. Se interrogó sobre la ocurrencia y número de accidentes biológicos presentados, además de las características del último accidente. Los datos categóricos se presentan como frecuencias absolutas y porcentuales, en tanto los datos numéricos se muestran como mediana y rango intercuartílico. RESULTADOS: En total fueron 100 encuestados. El 85% de ellos presentó algún accidente biológico durante el año, con una mediana de 2 y un rango intercuartílico de 3. El tipo de exposición más frecuente fue el percutáneo (71,8%), siendo el dispositivo más común la guja hueca (54,1%). El lugar y las actividades más frecuentes al momento de la exposición fueron la sala de partos (44,7%), atención de parto (24,7%) y sutura (24,7%). Tres accidentes ocurrieron con pacientes de alto riesgo, pero sólo uno recibió profilaxis antiviral. El 49,4% consideró como causa el cansancio o fatiga. El 75,3% de los accidentes no se reportaron. Los guantes son la medida de protección más utilizada (95%). CONCLUSIÓN: La frecuencia de accidentes biológicos presentados es alta. El escaso reporte y uso inadecuado de barreras de protección, son eventos que elevan el riesgo de los estudiantes de medicina.

Eficacia del uso de claves de color en ilustraciones para el aprendizaje de la relación entre estructura y función en un curso de anatomía / Efficacy of using color keys in illustrations for learning the relation structure and function in an anatomy course

Introducción: La enseñanza de la anatomía humana ha hecho uso de diversas estrategias en la formación médica. Frente al surgimiento de nuevos métodos de enseñanza, planteamos un sistema de ilustraciones basado en claves de color que resaltan y simplifican la relación entre estructura y función. Asimismo, comparamos su eficacia frente a otros sistemas tradicionales. Sujetos y métodos: Ejecutamos un estudio experimental en estudiantes de pregrado de Medicina, asignados aleatoriamente en tres grupos que recibieron clases teóricas y prácticas, y material de texto para el aprendizaje de tópicos seleccionados de anatomía del miembro superior. El grupo ‘control’ no recibió material adicional, el grupo ‘tradicional’ recibió ilustraciones de alto realismo y a color y el grupo ‘colores’ recibió ilustraciones que hicieron uso de claves de color para la relación entre estructura y función. Los estudiantes fueron evaluados de forma teórica a través de una evaluación ad hoc y sometidos a una evaluación práctica a través del reconocimiento de estructuras cadavéricas. Los resultados se expresaron como media y desviación estándar. Resultados: En el estudio participaron 82 estudiantes distribuidos en tres grupos. No hubo diferencias en cuanto a edad y sexo. Las calificaciones de la evaluación teórica fueron mayores en el tercil medio de los estudiantes del grupo ‘colores’, 57,8% (5,8%), comparados con el grupo ‘tradicional’, 43,5% (3,9%). No existieron diferencias significativas en la evaluación práctica. Conclusión: El uso de claves de color en las ilustraciones tuvo una eficacia superior en un subgrupo de estudiantes cuando fue comparado con otro tipo de material (ilustraciones de alto realismo) para el aprendizaje de anatomía.(AU)

Introduction: The teaching of human anatomy has made use of various strategies in medical training. Faced with the emergence of new teaching methods, we propose a system of illustrations based on color codes that highlight and simplify the relationship between structure and function. Likewise, we compare its effectiveness against other traditional systems. Subjects and methods: We carried out an experimental study in undergraduate medical students, randomly assigned into three groups that received theoretical and practical classes, and text material for learning selected topics of upper limb anatomy. The ‘control’ group received no additional material, the ‘traditional’ group received highly realistic and colored illustrations, and the ‘colors’ group received illustrations that made use of color keys for the relationship between structure and function. The students were evaluated theoretically through an ad-hoc evaluation, and subjected to a practical evaluation, through the recognition of cadaveric structures. The results were expressed as mean and standard deviation. Results: 82 students participated in the study, divided into three groups. There were no differences regarding age and sex. The theoretical evaluation scores were higher in the middle tertile of the students in the ‘colors’ group: 57.8% (5.8%) compared to the ‘traditional’ group: 43.5% (3.9%). There were no significant differences in the practical evaluation. Conclusion: The use of color codes in illustrations was more effective in a subgroup of students when it was compared to other types of material (highly realistic illustrations) for learning anatomy.(AU)

Síndrome de Noonan e insuficiencia aórtica severa en un paciente adulto / Noonan Syndrome and Severe Aortic Regurgitation in an Adult Patient

Introducción: El síndrome de Noonan es una enfermedad congénita con una incidencia de 1:1000-2500 recién nacidos vivos. Se encuentra subdiagnosticada en nuestro medio debido a la variabilidad clínica, lo cual no permite un adecuado control y seguimiento para detectar complicaciones consecuentes a los defectos cardiovasculares congénitos. En Perú no existen reportes de casos sobre el síndrome de Noonan y sus complicaciones. Objetivo: Discutir la importancia del examen clínico para su adecuado diagnóstico a partir de las características del síndrome de Noonan en un adulto. Caso clínico: Presentamos el caso de un varón de 33 años con síndrome de Noonan, endocarditis infecciosa e insuficiencia aórtica severa. Conclusiones: Se resalta la importancia del examen físico y el uso de criterios diagnósticos para realizar el diagnóstico del síndrome de Noonan(AU)

Introduction: Noonan syndrome is a congenital disease with an incidence of 1: 1000-2500 live newborns. Due to its clinical variability, it is underdiagnosed in our setting, which does not allow adequate control and follow-up to detect complications resulting from congenital cardiovascular defects. In Peru, there are no case reports on Noonan syndrome and its complications. Objective: To discuss the importance of clinical examination for adequate diagnosis of Noonan syndrome, based on the characteristics of the disease in an adult. Clinical case: We present the case of a 33-year-old male patient with Noonan syndrome, infective endocarditis, and severe aortic regurgitation. Conclusions: The importance of physical examination and the use of diagnostic criteria to diagnose Noonan syndrome are highlighted(AU)

Consumo de hierro y prevalencia de anemia en niños y adolescentes en una comunidad a gran altitud en Perú / Iron consumption and prevalence of anemia in children and adolescents in a high altitude community in Peru

FUNDAMENTOS: Los niños y adolescentes que residen a gran altitud, 3.000 o más metros sobre el nivel del mar (m.s.n.m.) representan un grupo vulnerable que puede tener anemia. El objetivo del presente estudio fue evaluar la relación entre los valores de hemoglobina y los conocimientos, actitudes y prácticas sobre el consumo de hierro en niños y adolescentes de la comunidad de Ayroca, Arequipa, Perú. MÉTODOS: Estudio descriptivo. Se midieron los niveles de hemoglobina en 65 niños y adolescentes de Ayroca, ubicada a 3515 m.s.n.m. Se evaluó el diagnóstico de anemia tanto usando las recomendaciones de corrección por altitud del Ministerio de Salud del Perú (MINSA) como sin corregir. Para determinar los conocimientos, actitudes y prácticas respecto al consumo de hierro, aplicamos el cuestionario KAP de la Food and Agriculture Organization (FAO) para deficiencia de hierro, en los responsables del cuidado de la población de estudio. RESULTADOS: Usando la recomendación del MINSA, del total de niños y adolescentes, el 30,8% tenía anemia leve, 12,3% anemia moderada y 56,9% no tenía anemia. Cuando no se realizó la corrección por altitud el 93,8% no tenía anemia. En cuanto al consumo de hierro no fue diferente entre los menores con anemia y sin anemia. La principal fuente de hierro con la que se preparan los alimentos fue el pollo 28 (60,9%) y la res 18 (39,1%). No se encontró diferencias entre actitudes y prácticas entre los grupos estudiados. CONCLUSIONES: Utilizando el factor de corrección por altitud, no se encontró relación entre la prevalencia de anemia y los conocimientos, prácticas y actitudes con respecto al consumo de hierro, por lo que vemos necesario considerar factores de corrección por altitud exclusivos para la población peruana

BACKGROUND: Children and adolescents residing at high altitudes, 3,000 or more meters above sea level (m.a.s.l.) represent a vulnerable group that may have anemia. The objective of the present study was to evaluate the relationship between hemoglobin values and knowledge, attitudes and practices regarding iron consumption in children and adolescents from the Ayroca community, Arequipa, Peru. METHODS: Descriptive study. Hemoglobin levels were measured in 65 children and adolescents from Ayroca, located at 3,515 m.a.s.l. The diagnosis of anemia was evaluated both using the altitude correction recommendations of the Peruvian Ministry of Health (MINSA) and uncorrected. To determine the knowledge, attitudes and practices regarding iron consumption, we applied the KAP questionnaire of the Food and Agriculture Organization (FAO) for iron deficiency, in those responsible for the care of the study population. RESULTS: Using the MINSA recommendation, of all children and adolescents, 30.8% had mild anemia, 12.3% moderate anemia and 56.9% had no anemia. When the altitude correction was not performed, 93.8% did not have anemia. As for iron consumption, it was not different between children with anemia and without anemia. The main source of iron with which food is prepared was chicken 28 (60.9%) and beef 18 (39.1%). No differences were found between attitudes and practices between the groups studied. CONCLUSIONS: Using the altitude correction factor, no relationship was found between the prevalence of anemia and the knowledge, practices and attitudes regarding iron consumption, so we consider it necessary to consider exclusive altitude correction factors for the Peruvian population

Oftalmomiasis por Oestrus ovis en un área urbana al sur del Perú / Oestrus ovis ophthalmomyiasis at an urban area in Southern Peru

Resumen La oftalmomiasis es la infestación ocular por larvas de dípteros. Ha sido descrita en pacientes provenientes de áreas rurales, higiene deficiente o por contacto con animales. Sin embargo, existen reportes esporádicos de esta infestación en áreas urbanas. Presentamos el caso de un varón joven, sin factores de riesgo, proveniente de un área urbana al sur del Perú, que presentó 10 larvas en la conjuntiva ocular. Las larvas fueron identificadas como Oestrus ovis, una mosca que suele infestar ovejas y cabras como parte de su ciclo de vida. Realizamos una breve revisión del tema, resaltando la importancia de identificar adecuadamente la especie causante de la miasis, así como su ciclo de vida.

Ophthalmomyiasis is the ocular infestation by dipterous larvae. It has been described in patients from rural areas, poor hygiene, or contact with animals. However, there are sporadic reports of this infestation in urban areas. We present the case of a young man without risk factors, from an urban area in southern Peru, in whom we found 10 larvae at ocular conjunctiva. The larvae were identified as Oestrus ovis, a fly that usually infests sheep and goats as part of their life cycle. We made a brief review of the case, highlighting the importance of adequately identifying the species that cause myiasis as well as its life cycle.

Escaso número de tesis enmarcadas en las prioridades de investigación en salud en una facultad de medicina peruana / Scant number of theses addressing health research priorities in a Peruvian medical school

El objetivo de este trabajo fue determinar la proporción de tesis de pregrado de una facultad de medicina que se enmarcaron dentro de la agenda de Prioridades de Investigación en Salud (PIS) nacionales o de la región Arequipa. Se realizó un estudio transversal, en el que se evaluaron 624 tesis de pregrado de una universidad peruana en el periodo 2011 al 2017. El 23,4 por ciento (110) de las tesis de los años 2011 al 2015 se enmarcaron en las PIS nacionales 2011-2014 y el 36 por ciento (55) de las correspondientes a los años 2016 y 2017 se ubicaron en las PIS nacionales 2015-2021. El 9,6 por ciento (4) de las tesis de los años 2011 al 2015 se enmarcaron en las PIS de la región Arequipa 2011-2014 y el 36,6 por ciento (56) de tesis de los años 2016 y 2017, en las PIS de la región Arequipa 2015-2021. Se concluyó que una baja proporción de las tesis estudiadas abordan prioridades de investigación en salud(A(

The purpose of the study was to determine the proportion of undergraduate theses written in a medical school which were framed within the national health research priorities (HRP) agenda or dealt with priorities of the Arequipa region. A cross-sectional study was conducted of 624 undergraduate theses written in a Peruvian university from 2011 to 2017. Of the theses written from 2011 to 2015, 23.4 percent (110) had to do with the national 2011-2014 HRPs, whereas 36 percent (55) of those written in 2016 and 2017 responded to the national 2015-2021 HRPs. Of the theses written from 2011 to 2015, 9.6 percent (4) had to do with the 2011-2014 HRPs for the Arequipa region, whereas 36.6 percent (56) of those written in 2016 and 2017 were framed in the 2015-2021 HRPs for the Arequipa region. It was concluded that a low proportion of the theses studied address health research priorities(AU)

Uso de colores en ilustraciones de anatomía para relacionar estructuras, función y patología en el aprendizaje de anatomía humana / Use of colors in anatomy illustrations to relate structures, function and pathology in human anatomy learning

Introducción: El aprendizaje de anatomía humana se ha realizado a lo largo de la historia, de forma teórica y práctica, a través de la disección cadavérica. Diversas teorías de aprendizaje señalan que el uso de claves de colores resulta esencial para mejorar el reconocimiento de estructuras complejas. Por este motivo, el objetivo de este artículo es presentar esta propuesta y describir algunas percepciones de los estudiantes de medicina de una universidad peruana ante esta estrategia. Sujetos y métodos: La estrategia se basa en el uso de diferentes colores para relacionar músculos con sus respectivas inserciones óseas y los nervios que los inervan. En el mismo sentido se hace uso del color para resaltar la dirección y relaciones de las arterias. En última instancia, se hace una relación de la misma clave de color con la función ejercida por determinado grupo muscular y la patología derivada del daño de dicha estructura. Para evaluar la aceptación del método y las percepciones que generó en los estudiantes, se aplicó una breve encuesta con motivos exploratorios en estudiantes de segundo a sexto año de medicina que hubieran usado estas ilustraciones. Resultados: Un 85,6% respondió que las ilustraciones 'son útiles como resumen gráfico de segmentos corporales', y un 84,9%, que 'pueden reproducirlas con facilidad y constituyen una ayuda nemotécnica en el estudio'. Conclusión: Se presenta un método sobre el uso de los colores como recurso para la relación de estructuras, función y patología en las ilustraciones de anatomía humana, el cual genera percepciones positivas en los estudiantes

Introduction: The learning of human anatomy has been carried out throughout history in a theoretical and practical way, through cadaveric dissection. Several learning theories point out that the use of color keys is essential to improve the recognition of complex structures, for this reason the objective of this article is to present this proposal, and to describe some perceptions of the medical students of a Peruvian university before this strategy. Subjects and methods: The strategy is based on the use of different colors to relate muscles with their respective bony inserts and the nerves that innervate them. In the same sense, color is used to highlight the direction and relationships of the arteries. Ultimately, a relation of the same color key is made with the function exerted by a certain muscle group and the pathology derived from the damage of said structure. To evaluate the acceptance of the method and the perceptions it generated in the students, we applied a brief survey with exploratory reasons in students from the second to the sixth year of medicine who have used these illustrations. Results: A 85.6% answered that 'they are useful as a graphic summary of body segments', and a 84.9%, that 'they can reproduce them easily, being a mnemonic aid in the study'. Conclusion: We present a method on the use of colors as a resource for the relationship of structures, function and pathology in human anatomy illustrations, which generates positive perceptions in students