ACTA MEDICA PERUANA Acta Médica Peruana es la revista científica oficial del Colegio Médico del Perú; tiene como finalidad difundir el conocimiento médico a la comunidad médica y científica a nivel nacional e internacional. Colegio Médico del Perú en-US ACTA MEDICA PERUANA 1018-8800 Monkeypox a new global emerging disease Ciro Maguiña Vargas Michell Espinal Ramírez Copyright (c) 2022 ACTA MEDICA PERUANA 2022-09-20 2022-09-20 39 3 10.35663/amp.2022.393.2470 Association between increased abdominal circumference and secondary dyslipidemia or insulin resistance in obese adolescents <p><strong>Objective:</strong> To determine the association between increased abdominal circumference and secondary dyslipidemia or insulin resistance in obese adolescents treated at the National Institute of Child Health (INSN). <strong>Method:</strong> Analytical, cross-sectional and retrospective study. Anthropometric data are expressed in standard deviations (SD) and biochemical data according to reference ranges. To demonstrate an association between increased abdominal circumference (AC) and secondary dyslipidemia or insulin resistance, the Pearson Chi 2 test was used, with a significance level of less than 0.05. To assess the correlation between the CA and CA/height indicators with the various parameters, a multiple regression model was performed (p&lt;0.05). <strong>Results:</strong> 181 cases (52.5% males) were admitted; average of 12.1 years; 22.1% prepubertal and 77.9% pubertal. The mean SD-BMI was 2.7 (2.0 - 4.9) and 25.9% had severe obesity. AC was increased by 89.5%. AC was more associated with dyslipidemia than BMI (p = 0.05) but less than the AC/height indicator (p = 0.02). The indicators CA and CA/height showed a positive correlation with high levels of insulin and HOMA-IR (p&lt;0.05); while estimated values of coefficients under multiple regression model, showed significance with insulin, HOMA-IR and TGP; and, significant prediction for basal glycemia in prepubertal children (p&lt;0.05). <strong>Conclusions:</strong> Abdominal obesity was predominant, more than half had dyslipidemia, there was no statistically significant association between WC and dyslipidemia, but there was between WC and WC/height with high levels of basal glycemia, insulin, HOMA-IR and TGP.</p> Dustin Oswaldo Nuñez García Copyright (c) 2022 ACTA MEDICA PERUANA 2022-09-29 2022-09-29 39 3 10.35663/amp.2022.393.2333 Endoscopic Mucosal Resection (EMR) for polyps and complex-adenoma lessions of the colon. Recopilation of 15 years of experience (2004-2018) <p><strong>Background:</strong> Detection and resection of colonic polypoid sessile and flat lesions, prevents the development of colon cancer. Endoscopic mucosal resection (EMR) has emerged in the 70´s and improved in the 80´s, as an alternative treatment of this lesions and is considered the procedure of choice nowadays, being able to avoid major surgical procedures. <strong>Objectives:</strong> Evaluation of the results and complications of the technique by endoscopists of a reference center. Review of indications and limitations of the technique. <strong>Material and methods:</strong> Descriptive, retrospective and observational analysis of patients treated with endoscopic mucosal resection technique at a referral center in Lima, Peru, between January 2004 and December 2018.<br>EMR Technique was used in polypoid lesions greater than 1 cm. The bloc resection and the piecemeal resection technique was used for those lesions up to 3 cm and more. We evaluated complications and results according to the technique as recurrence rate, performing tracking in all cases with endoscopic follow up. <strong>Results:</strong> 756 lesions and patients (338 women and 298 men) The average age was 61.9 years (37-91 years) and the average lesion size of 20.3 mm (10-50 mm). En bloc or one-piece resection was performed in 78.04 %(590) and piece meal in 21.96%(166) achieving endoscopic and pathological resection. The complication rate in our series was 6.74% and managed endoscopically and with conservative measures and no surgery. Mean follow-up was 18 months (3-24 months) and overall local recurrence rate was 2.49%. After-procedure,<br>additional surgical treatment was performed in 15 cases with pathologic piece report and intramucous adenocarcinoma (IM-ADCA). 13 of 15 local recurrences at 12 months follow up were treated endoscopically and 2 had surgical treatment. <strong>Conclusions:</strong> Endoscopic mucosal resection (EMR) or Mucosectomy is a technique performed by experts endoscopists and shows low rates of recurrence and complications with suitable material for pathologic examination. It reduces open and laparoscopic surgery.</p> Simon Yriberry Hector Velarde Criado Fernando Salazar Muente José Antonio Barriga Briceño Carlos Barreda Costa Roberto Piccini Larco Diego Suárez Arellano Claudia Recavarren Asencios Patrick Emanuel Copyright (c) 2022 ACTA MEDICA PERUANA 2022-09-29 2022-09-29 39 3 10.35663/amp.2022.393.2404 Relationship of nutritional status and triglycerides/HDL-c index in adults cared for in a public hospital <p><strong>Objective.</strong> To determine the relationship between the nutritional status and the triglycerides /c-HDL ratio in adolescents treated in a public hospital. <strong>Materials and methods.</strong> Descriptive, cross-sectional, observational and retrospective study. Made up of 447 adults, 321 women and 126 men between 18 - 60 years of age who were treated by the nutrition service at Hospital I - Rioja - EsSalud during the period from March 2017 to June 2018. The status was determined nutrition according to the body mass index (BMI) and the TG/HDL-C ratio as a ratio of triglycerides and HDL cholesterol. <strong>Results.</strong> The mean age of the adults was 41.4 ± 12.7 years. A total mean TG/HDL-c index of 4.40 ± 1.45 was obtained, it was higher in women (4.62 ± 1.40) than in men (3.84 ± 1.44); likewise, obesity (4.76 ± 1.36) and overweight (4.57 ± 1.52) were the nutritional states that presented a higher index. A positive and significant correlation (r=0.397) with a p=0.000 was found between the Body Mass Index (BMI) and the TG/c-HDL index. <strong>Conclusion.</strong> There is a positive and statistically significant relationship between the body mass index and the TG/HDL-c ratio. The ratio of TG/c-HDL was higher in the nutritional status of obesity and overweight, exceeding the value of the population mean.</p> Edwar Paul Cachay Barboza Copyright (c) 2022 ACTA MEDICA PERUANA 2022-09-20 2022-09-20 39 3 10.35663/amp.2022.393.2393 Reason for Consultation and Waiting Time in Public Health Establishments during the COVID-19 pandemic, Perú 2020. <p><strong>Objective:</strong> Identify whether the reason for care influences the waiting time in the health facility in the PeruvianpopulationduringtheCOVID-19 pandemic,according to analysis by ENAHO2020. <strong>Material and Methods:</strong> Crosssectional study with secondary analysis of data from the ENAHO of the Institute of Statistics and Informatics (INEI) done in year 2020. For the analysis, regarding the reason for going to the health facility, symptoms were considered compatible with COVID- 19 and other acute symptoms. <strong>Results:</strong> Data of 1363 participants were analyzed No association was found between reason for consultation and waiting time. In the multivariate analysis found an association with female sex (PR: 2,97; IC: 1,09 – 1,54), being attended in centers of Ministerio de Salud (MINSA) establishment (PR:2,18; CI: 1,02 – 1,59)) and be attended by a doctor (PR: 6,52; IC: 1,53 – 2,21). <strong>Conclusión:</strong> Variables that have association with longer waiting time were female sex, MINSA as establishment of attendance and profesional of attendane is the doctor.</p> Enrique O. Bedoya-Ismodes Eliana Ortiz-Revollar Pedro Mendoza-Arana Copyright (c) 2022 ACTA MEDICA PERUANA 2022-09-20 2022-09-20 39 3 10.35663/amp.2022.393.2423 La Health management in care for the indigenous and afro-peruvian population in the COVID-19 pandemic <p><strong>Objective:</strong> To determine the barriers in the management of health facilities that serve the indigenous and Afro-descendant population in Peru. <strong>Material and methods:</strong> A virtual survey on health management was designed for first level health care personnel in 89 health facilities (EESS) in 27 provinces during October and November 2021. <strong>Results:</strong> In 73% of the EESS, the personnel reported not knowing the plan against the third pandemic wave, 14.8% of the EESS reported not being trained in the management of COVID-19, in 22.7% of the EESS they met to coordinate how to face the third pandemic wave, in 83% of the EESS the personnel reported not having a budget for their plan against COVID-19. <strong>Conclusions:</strong> There are barriers in the vision, management and budget in EESS that serve indigenous and Afro-Peruvian populations, which would affect the effective execution of strategies for the control of the pandemic by COVID-19.</p> Gualberto Segovia-Meza Marco Bartolo-Marchena Omar Trujillo-Villaroel German Rivera-Del Río Betty Monteza-Facho María Chara-Santa Cruz Kary Gonzales-Dávila Lucy Lazóriga-Sandoval Copyright (c) 2022 ACTA MEDICA PERUANA 2022-09-29 2022-09-29 39 3 10.35663/amp.2022.393.2409 Ventilation pathways and epitympanic retraction in chronic non-cholestheatomatous otitis media <p><strong>Objective:</strong> To describe the endoscopic findings of the ventilation pathways found during type I tympanoplasty in patients with non-cholesteatomatous COM (chronic otitis media). <strong>Materials and methods:</strong> Cross-sectional descriptive study, we evaluated 32 patients with non-cholesteatomatous COM with and without epitympanic retraction (ER) (Grade I-III, according to Mirko Tos classification), with a history of type I tympanoplasty (June, 2018 – January, 2020) in the otorhinolaryngology service of the Arzobispo Loayza National Hospital. Patients with previous middle ear surgeries, with cholesteatomatous COM, with ER grade IV and surgical acts not digitally stored were excluded. <strong>Results:</strong> 71.8% of patients presented ER (Grade I 3.0%, grade II 30.0% and grade III 56.5%), all presented blocked tympanic isthmus (TI). 68.8% of participants with ER presented complete tensor fold (TF). A significant relationship was observed between complete TF and blocked IT with ER (p=0.026 and 0.003, respectively). <strong>Conclusions:</strong> The most frequent findings were complete TF and blocked IT, these had a significant association with the presence of ER in patients with non-cholesteatomatous COM.</p> Víctor Hugo Gonzales Diaz Alexandra Banda Víctor Raúl Valdivia Calderón Copyright (c) 2022 ACTA MEDICA PERUANA 2022-09-20 2022-09-20 39 3 10.35663/amp.2022.393.2239 Drug reaction with eosinophilia and systemic symptoms (DRESS) associated with levetiracetam: case report. <p>Drug reaction with eosinophilia and systemic symptoms (DRESS) is a very rare syndrome characterized by skin rash, eosinophilia and systemic compromise. This was initially described in association with antiseizures drugs, but later it was described in association with other drugs. Among antiseizure drugs, it has been described association with aromatic drugs as phenytoin, carbamazepine, phenobarbital, oxcarbazepine and lamotrigine; and non-aromatic antiseizure drugs as gabapentin, zonisamide, valproate, rufinamide and rarely to levetiracetam. The severity of the syndrome is related to the time of exposure to the drug, so early detection is of vital importance. We describe the first case in our country, of a patient with DRESS induced by levetiracetam, and we review the infrequent scientific reports of DRESS in patients exposed to levetiracetam.</p> Elliot Barreto Copyright (c) 2022 ACTA MEDICA PERUANA 2022-09-29 2022-09-29 39 3 10.35663/amp.2022.393.2167 Intestinal obstruction due to gallstone ileus: a case report <p>Gallstone ileus (BI) is defined as intraluminal mechanical intestinal obstruction by one or more gallstones; who have emigrated through a biliodigestive fistula, established as a complication of cholelithiasis. We present the case of a 59-year-old woman with a history of arterial hypertension, with a preoperative tomographic diagnosis of intestinal obstruction due to biliary ileus (Rigler's triad), for which she underwent emergency surgery, deciding to perform an enterolithotomy and schedule her second intervention in two months. BI is an uncommon cause of intestinal obstruction in elderly patients, with high morbidity and mortality. It requires a high index of suspicion in the presence of intermittent intestinal obstruction and a history of biliary colic. Rigler's triad is only present in a third of patients, for which tomography is the study of choice. Treatment is controversial, but the most widely used is enterolithotomy.</p> Angel F. Vera-Portilla Malory Jamille Minaya Ruiz Walter Alberto Vera Portilla Javier Huanca Báez Patricia Pardo Apaza Copyright (c) 2022 ACTA MEDICA PERUANA 2022-09-20 2022-09-20 39 3 10.35663/amp.2022.393.2383 3D cloning technique applied in surgical planning for sagital craneosynostosis in latin america-peru: case report <p>Sagittal craniosynostosis is the premature closure of the sagittal suture, causing functional and structural alterations. The treatment is surgical, and there are currently various techniques, which require planning and training to achieve optimal results. We present the case of a 1-year-old male with abnormal anteroposterior growth of the skull, indicating brain tomography without contrast, showing sagittal synostosis. Surgical planning of the technique to be developed is carried out using a real-scale personalized 3D model. The patient progresses well and is discharged. Finally, essential 3D cloning technology for neurosurgical education and development allows access to high-precision, low-cost tactile models that improve the quality of craniosynostosis management.</p> Cristian Eugenio Salazar Copyright (c) 2022 ACTA MEDICA PERUANA 2022-09-20 2022-09-20 39 3 10.35663/amp.2022.393.2351 Left Glossopharyngeal neuralgia: a rare pathology. A case report <p>Glossopharyngeal neuralgia is a rare pathology, with a sharp and stabbing pain in the tonsillar fossa, angle of the jaw and base of the tongue. Its main etiology is neurovascular compression, which can be diagnosed with a brain MRI. Its management is mainly medical with drug, especially carbamazepine and oxcarbazepine, and if there is no response, surgery is performed through microvascular decompression and interposition of soft material (polytetrafluoroethylene) with or without transection of IX cranial nerve. We present the case of a 64-year-old woman, with controlled hypertension, with classic pain, who did not relieve pain with 5 antineuropathic drugs and 1 opioid derivative. Brain MRI with FIESTA sequence shows a neurovascular compression of the glossopharyngeal nerve with the left PICA. Microvascular decompression of the glossopharyngeal nerve was performed, with resolution of the symptoms and without recurrence, and she was discharged soon. We concluded that the surgical management of this pathology in refractory cases to medical treatment is an option with good success rates and low morbidity.</p> John F. Vargas Urbina Fernando Palacios Santos Alejandro Rosell Ortiz Manuel Lazón Ayala Copyright (c) 2022 ACTA MEDICA PERUANA 2022-09-20 2022-09-20 39 3 10.35663/amp.2022.393.2380 Ruptured blister like aneurysm with satisfactory management using remodeling technique – Case report <p><strong>Introduction:</strong> Blister-like aneurysms are small, complex, smaller than 3mm, with high rate of morbidity and mortality, as well as rebleeding and recurrence. They are difficult to treat and microsurgical and endovascular techniques are current treatment modalities. Endovascular technique has the lowest rate of complications. <strong>Clinical case:</strong> 74-year-old woman, admitted with 6 hours of sudden sensory disorder. The CT scan shows diffuse subarachnoid hemorrhage predominantly on the left side. A cerebral angiography showed a blister-like aneurysm of the left middle cerebral artery trifurcation. The patient was treated with coiling and remodeling technique, achieving a complete occlusion. <strong>Conclusion:</strong> Blister-like aneurysms are complex and rare, whereas endovascular therapy is a safe and effective alternative with low complication rate.</p> John F. Vargas Urbina Rodolfo Rodriguez Varela Osmar Ordinola Cruz Giancarlo Saal Zapata Copyright (c) 2022 ACTA MEDICA PERUANA 2022-09-20 2022-09-20 39 3 10.35663/amp.2022.393.2381 Gallbladder gangrene due to hemorrhagic cholecystitis in a patient without risk factors: a case report <p>Hemorrhagic cholecystitis is a rare complication of acute cholecystitis, but with high mortality. Clinically it is identical to acute cholecystitis, and it does not usually present with gastrointestinal bleeding. We present the case of a 57-year-old man, with no history or use of anticoagulants, referred to our hospital for a "gallbladder tumor", after tomographic and cholangioresonance studies, associated with a drop in serum hemoglobin, suspicion of him is defined. He enters the operating room and a gangrenous gallbladder is evident, containing clots and stones. Confirming his diagnosis with histopathological study.</p> <p>Due to its clinical similarity, it should be considered in patients with a history of anticoagulant therapy, trauma, malignancy, or findings consistent with acalculous cholecystitis. But it can occur in patients with no history and be associated with cholelithiasis. Early diagnosis of this potentially fatal complication is important to facilitate urgent surgical management, imaging support being necessary for its suspicion.</p> Angel F. Vera-Portilla Walter Alberto Vera-Portilla George Christian Manrique Sila Paola Karolina Cuadros Bedregal Jonathan Misael Berrio Quintanilla Javier Huanca Báez Copyright (c) 2022 ACTA MEDICA PERUANA 2022-09-20 2022-09-20 39 3 10.35663/amp.2022.393.2349 Facing the third COVID-19 wave at the Emergency Department of the Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú, 2021 <p>Peru has been one of the countries most affected by the COVID-19 pandemic. After having suffered two devastating epidemic waves, the emergency department of the Edgardo Rebagliati Martins National Hospital maintained the challenge of constantly and dynamically preparing to face a third wave that has already hit many countries around the world. For this, the department prepared itself in all areas, to contribute to reducing the impact of the disease, guaranteeing not only the quality of care, but also the safety of health personnel, modulating the work and mental load generated by the pandemic over-demand. In this way, the department was better prepared when the third wave occurred. In conclusion, constant and dynamic preparation is essential to face the increase in cases; as well as to guarantee the safety and wellbeing of health personnel.</p> Luis Chucas Ascencio Giuliana Matos-Iberico Julio Roldan-López Einer Arévalo-Salvador Ciro Salazar-Jauregui Ricardo Rodríguez-Gonzales Letty Rivas-Ibarra Cesar Rojas-Moya Waldo Taipe-Humani Edwin Neciosup Orrego Humberto Clavijo Cáceres Copyright (c) 2022 ACTA MEDICA PERUANA 2022-09-20 2022-09-20 39 3 10.35663/amp.2022.393.2267 Discussing strategies for continuity in the care of people who live with HIV (PLHIV) in the context of SARS CoV 2 pandemic (COVID-19) RUBEN DARIO VASQUEZ BECERRA Ana Vera Rosa Terán Carlos Benites Copyright (c) 2022 ACTA MEDICA PERUANA 2022-10-12 2022-10-12 39 3 10.35663/amp.2022.393.2359 Intervenciones educacionales para incrementar la farmacovigilancia en una unidad de salud de familia Ana Rita Ribeiro Barbosa Filipa Fontes Joana Nuno Susana Fernandes Dinis Brito Copyright (c) 2022 ACTA MEDICA PERUANA 2022-09-20 2022-09-20 39 3 10.35663/amp.2022.393.2260