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The aim of this study was to describe the frequency of migration to study medicine in Peru. We conducted 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.

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Objetivos. Realizamos una revisión sistemática para evaluar los efectos y la seguridad de la descontinuación en hospitalización en comparación con la continuación de los inhibidores de la enzima convertidora de angiotensina y los bloqueadores de los receptores de angiotensina (IECA/ARA) en pacientes con COVID-19 hospitalizado. Métodos. Realizamos una búsqueda sistemática en PubMed, Scopus y EMBASE desde el inicio hasta el 04 de diciembre del 2022. Incluimos estudios observacionales y ensayos clínicos aleatorizados (ECA) que compararon los efectos y la seguridad de continuar con IECA/ARA en comparación con descontinuarlos en pacientes con COVID-19 hospitalizados. Los tamaños de los efectos para las variables dicotómicas se expresaron como riesgos relativos (RR) e intervalos de confianza (IC) del 95%. Para las variables continuas, los efectos se expresaron como diferencia de m...

Coronavirus disease 2019 (COVID-19) has caused more than 32 million cases and almost a million deaths. Recent reviews have evidenced the role of hypertension in prognosis, nevertheless, its association with immunosuppression in COVID-19 context has not been studied. It was performed a cross-sectional analysis of a large Mexican population with the infection (n= 681 890). Prevalence of immunosuppression and hypertension was 1.10% and 19.50%, respectively. The adjusted model evidenced that hypertension was significantly associated with immunosuppression (odds ratio=1.18, 95% CI=1.11-1.25). Furtherresearch in pathways thatjustify the association between hypertension and immunosuppression in COVID-19 patients is recommended.

Objective: To learn about the disagreements among geriatricians from a Latin American country (Peru) as to the palliative therapy for dementia. Materials and methods: A descriptive and cross-sectional study. The population consisted of Peruvian geriatricians and geriatrics residents surveyed during August 2019. A non-probability convenience sampling was used. Considering a total population of 277 geriatricians in Peru and a design effect of 1.0, the minimum sample size was 162 geriatricians. The survey included different questions focused on geriatricians’ decisions on the daily clinical practice of terminal care in dementia. To ensure a better understanding of the answers, a typical case of the disease was presented. Results: One hundred sixty-two (162) doctors were surveyed, most of whom were geriatricians (81.48 %). Regarding the global level of attitudes and knowledge of palliative...

Objetive. The critical reading of scientific articles allows the medical community, above all, to improve the context of decision making. The great amount of scientific production worldwide makes use of observational studies, however, a significant proportion is not useful for decision making, not because of its methodological limitations but because of errors in its application. Many studies published in relation to coronavirus 2019 disease have limitations and require statistical, epidemiological and clinical tools to be able to assess them and incorporate them into the practice of evidence-based medicine. In this review, we analyze the different observational research designs and with the help of examples we will see the different steps in the research process.

“Objective: We aimed to identify factors associated with severe accidental burns in patients ≤12 years old. Materials and methods: We conducted a matched case-control study, in which we retrospectively reviewed the medical records of children treated in a single institution from 2014-2016. We classified the cases (patients with severe burns) and controls (patients with non-severe burns) according to the criteria of the American Burn Association. We used multivariate conditional logistic regression analysis to identify the relationship between the etiology of burns and their severity. Results: We reviewed 180 cases and 90 controls. The most common etiology of burns was boiling water in both cases (65.6%) and controls (83.3%). Most burns occurred inside the home (84.1%) and in the afternoon (37.4%). Multivariate analysis identified that severe burns were mainly due to exposure to fire ...

“Objective: We aimed to identify factors associated with severe accidental burns in patients ≤12 years old. Materials and methods: We conducted a matched case-control study, in which we retrospectively reviewed the medical records of children treated in a single institution from 2014-2016. We classified the cases (patients with severe burns) and controls (patients with non-severe burns) according to the criteria of the American Burn Association. We used multivariate conditional logistic regression analysis to identify the relationship between the etiology of burns and their severity. Results: We reviewed 180 cases and 90 controls. The most common etiology of burns was boiling water in both cases (65.6%) and controls (83.3%). Most burns occurred inside the home (84.1%) and in the afternoon (37.4%). Multivariate analysis identified that severe burns were mainly due to exposure to fire ...

Abstract OBJECTIVE: To identify the association between diabetes mellitus type 2 and gait/balance disorder in a retired military geriatric population. MATERIAL AND METHOD: A retrospective cohort study, database secondary analysis was done. Gait and balance disorder was evaluated in a population of retired military personnel from January 2010 to December 2015. An analysis was performed to assess the association of type 2 diabetes mellitus and gait and balance disorder with a Cox regression model, adjusted for age, sex, military rank, chronic kidney disease, hypertension, body mass index, polypharmacy, physical activity, physical performance and osteoarthritis. RESULTS: There were included 1422 retired military patients. The mean age was 77.9 ± 8.5 years. Older adults who had and had not diabetes mellitus 2 were 240 (16.8%) and 1182 (83.1%), respectively. A total of 794 (55.8%) patients h...

“Objectives: We aimed to describe the sociodemographic, clinical, and therapeutic characteristics of Peruvian military personnel diagnosed with HIV. Furthermore, we determined the frequency of highly active antiretroviral therapy (HAART) adherence, the complications and mortality. Methods: We retrospectively reviewed the medical records of patients diagnosed with HIV, confirmed by Western blot at a single institution from 1989-2020. Descriptive analyses were performed for all the variables using mean and standard deviation (SD) in the case of quantitative variables, and frequency and percentage for qualitative variables. Results:Ofthe 161 patients included, 95.7% were males and the mean age was 39.59 years (SD= 16.45 years). Most had college or higher education (67.7%) and were on active duty at diagnosis (77%). 35.4% had AIDS at diagnosis; 28.6% opportunistic infections; and 8.1% tube...

Heart failure with reduced ejection fraction (HFrEF) and nonalcoholic fatty liver disease (NAFLD) are two common comorbidities that share similar pathophysiological mechanisms. There is a growing interest in the potential of targeted therapies to improve outcomes in patients with coexisting HFrEF and NAFLD. This manuscript reviews current and potential therapies for patients with coexisting HFrEF and NAFLD. Pharmacological therapies, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, mineralocorticoids receptor antagonist, and sodium-glucose cotransporter-2 inhibitors, have been shown to reduce fibrosis and fat deposits in the liver. However, there are currently no data showing the beneficial effects of sacubitril/valsartan, ivabradine, hydralazine, isosorbide nitrates, digoxin, or beta blockers on NAFLD in patients with HFrEF. This study highlights the imp...

Background: There have been conflicting studies reporting on survival advantages between breast-conserving surgery with radiotherapy (BCS) in comparison with mastectomy. Our aim was to compare the efficacy of BCS and mastectomy in terms of overall survival (OS) comparing all past published studies. Methods: We performed a comprehensive review of literature through October 2021 in PubMed, Scopus, and EMBASE. The studies included were randomized controlled trials (RCTs) and cohorts that compare BCS versus mastectomy. We excluded studies that included male sex, stage 0, distant metastasis at diagnosis, bilateral synchronous cancer, neoadjuvant radiation/chemotherapy, and articles with incomplete data. We performed a meta-analysis following the random-effect model with the inverse variance method. Results: From 18,997 publications, a total of 30 studies were included in the final analysis: 6...

Objetivo: Evaluar los factores asociados a síndrome coronario agudo (SICA) en pacientes hospitalizados por COVID-19 en el Hospital Nacional Edgardo Rebagliati Martins (Lima, Perú). Materiales y métodos: Estudio de casos y controles. Se captaron a 2 grupos de pacientes con relación al diagnóstico de SICA durante su hospitalización por COVID-19 en el periodo marzo 2020 a marzo 2021 (60 casos y 120 controles). Se midieron factores sociodemográficos, clínicos y datos relacionados al diagnóstico y hospitalización por COVID-19. Se evaluaron las asociaciones, y fuerza de asociación (OR), mediante análisis bivariados no paramétricos y de regresión logística. Resultados: En el análisis bivariado se observó que los antecedentes de hipertensión arterial, insuficiencia cardiaca, enfermedad coronaria, cáncer, síndrome coronario agudo previo se encontraron asociados a presentar SIC...

Background: The Alzheimer’s Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scale is a versatile functional assessment tool for patients with Alzheimer’s disease (AD). We evaluated its performance in controls, Peruvians with MCI or AD. Methods: A cross-sectional study of older adults attending a neurology institute in Lima (Peru) with mild cognitive impairment (MCI), AD or cognitively healthy. Test-retest reliability (intraclass correlation coefficient, ICC; internal consistency, Cronbach’s alpha) and validity were assessed. Results: We enrolled 276 individuals (AD: 113, MCI: 68, controls: 95) with no age, sex, educational level, and depressive symptom differences. Reliability was ideal (ICC: .996), and Cronbach’s alpha was adequate (.937). The ADCS-ADL could not differentiate MCI from controls but did differentiate AD severity. The ADCS-ADL correlated highly with...

“Background: Many low- and middle-income countries, including Latin America, lack access to biomarkers for the diagnosis of prodromal Alzheimer's Disease (AD; mild cognitive impairment due to AD) and AD dementia. MRI visual rating scales may serve as an ancillary diagnostic tool for identifying prodromal AD or AD in Latin America. We investigated the ability of brain MRI visual rating scales to distinguish between cognitively healthy controls, prodromal AD and AD. Methods: A cross-sectional study was conducted from a multidisciplinary neurology clinic in Lima, Peru using neuropsychological assessments, brain MRI and cerebrospinal fluid amyloid and tau levels. Medial temporal lobe atrophy (MTA), posterior atrophy (PA), white matter hyperintensity (WMH), and MTA+PA composite MRI scores were compared. Sensitivity, specificity, and area under the curve (AUC) were determined. Results: Fifty...

Background:The Alzheimer’s Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scale is a versatile functionalassessment tool for patients with Alzheimer’s disease (AD). We evaluated its performance in controls, Peruvians with MCI orAD.Methods:A cross-sectional study of older adults attending a neurology institute in Lima (Peru) with mild cognitive impairment(MCI),ADor cognitively healthy. Test-retest reliability (intraclass correlation coefficient, ICC; internal consistency, Cronbach’salpha) and validity were assessed.Results:We enrolled 276 individuals (AD: 113, MCI: 68, controls: 95) with no age, sex, educational level, and depressivesymptom differences. Reliability was ideal (ICC: .996), and Cronbach’s alpha was adequate (.937). The ADCS-ADL could notdifferentiate MCI from controls but did differentiateADseverity. The ADCS-ADL correlated highly with nearly all too...

“Background: Many low- and middle-income countries, including Latin America, lack access to biomarkers for the diagnosis of prodromal Alzheimer's Disease (AD; mild cognitive impairment due to AD) and AD dementia. MRI visual rating scales may serve as an ancillary diagnostic tool for identifying prodromal AD or AD in Latin America. We investigated the ability of brain MRI visual rating scales to distinguish between cognitively healthy controls, prodromal AD and AD. Methods: A cross-sectional study was conducted from a multidisciplinary neurology clinic in Lima, Peru using neuropsychological assessments, brain MRI and cerebrospinal fluid amyloid and tau levels. Medial temporal lobe atrophy (MTA), posterior atrophy (PA), white matter hyperintensity (WMH), and MTA+PA composite MRI scores were compared. Sensitivity, specificity, and area under the curve (AUC) were determined. Results: Fifty...

Introduction: Chronic Pancreatitis (CP) is a fibroinflammatory condition with debilitating symptoms. Quality of life is severely affected in patients with CP and they are likely to suffer from mental health disorders, including depression. We conducted a systematic review and meta-analysis assessing the prevalence of depressive symptoms and depression in patients with CP. Methods: MEDLINE (OVID), PsycINFO, Cochrane Library, Embase, CINAHL Complete, Scopus and Web of Science were searched until July 2022 to identify manuscripts reporting the prevalence of depressive symptoms and depression (diagnosed clinically or with a validated scale without language restriction) in patients with Chronic Pancreatitis. The pooled prevalence was calculated using a random effects model. Heterogeneity was assessed by the inconsistency index (I2). Results: Among 3647 articles identified, 58 studies were ide...

Abstract BACKGROUND: Work stress is described as the reaction obtained after exposure to demands and pressures that do not fit the individual’s capacity. OBJECTIVE: To determine the prevalence of stress associated with work and factors related with the workers of the Peruvian Navy (MGP). MATERIAL AND METHOD: A retrospective, analytical study in which the data of civil and military participants were reviewed during 2015, from an independent database, which collected their data through an online survey sent by electronic messaging. The data was analyzed in the STATA program version 13.0. RESULTS: There were included data of 207 participants. The general prevalence of work stress was 51.6%. In the participants with the highest number of comorbidities, there was a higher prevalence of severe stress (45.7%) as in the participants with depression (39.2%). The good quality of life was identif...