ACTA MEDICA PERUANA http://www.amp.cmp.org.pe/index.php/AMP 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 Health in the bicentennial and perspectives for a new health system http://www.amp.cmp.org.pe/index.php/AMP/article/view/2170 Augusto Tarazona Fernández Copyright (c) 2021 ACTA MEDICA PERUANA 2021-08-23 2021-08-23 38 2 10.35663/amp.2021.382.2170 Enhanced recovery after surgery in colorectal cancer. Instituto Nacional de Enfermedades Neoplásicas http://www.amp.cmp.org.pe/index.php/AMP/article/view/1922 <p><strong>Aim</strong>: Describe and analyze the safety of the “Enhanced Recovery After Surgery” (ERAS) protocol in elective procedures for colorectal cancer. <strong>Materials and Methods</strong>: Observational study of 272 patients with colorectal cancer who underwent elective surgery from January 2019 to September 2020 at the “Instituto Nacional de Enfermedades Neoplásicas”, Peru, were retrospectively collected. U Mann-Whitney test, Pearson chi-square test and odds ratios (OR) were used for statistical analysis. <strong>Results</strong>: 90 patients were included in the ERAS program with a median postoperative hospital stay of 3 days (range 3-19). Laparoscopic surgery was performed in 53% of the patients with significantly shorter postoperative hospital stay in comparison with the patients who had open surgery (p=0,035). Oral food intake less than 24 hours postoperatively was 91%, and early mobilization in 89% of the cases. The postoperative complication rate was 29%, higher in rectal/anus resection than in colonic resections (40% vs 20%, p=0,043) (OR=2,67, CI 95%: 1,02 – 7,01). Eight patients had a major postoperative complication, four with anastomotic leakage and four required hospital readmission. <strong>Conclusions</strong>: The perioperative management of ERAS program for colorectal cancer in elective surgery is safe and feasible with acceptable morbimortality risk.</p> Andrés Guevara Jabiles Edith Elizabeth Cedeño Ascoy Francisco Manuel Berrospi Espinoza Elena Aguilar Onofre Iván Chávez Passiuri Carlos Luque-Vásquez Vásquez Juan Francisco Olivos Gonzáles Raúl Mantilla Quispe Eloy Ruiz Figueroa Eduardo Payet Meza Copyright (c) 2021 ACTA MEDICA PERUANA 2021-08-23 2021-08-23 38 2 10.35663/amp.2021.382.1922 Prevalence and diagnosis of temporomandibular dysfunction in outpatient adults clinical practice at General Hospital Maria Auxiliadora http://www.amp.cmp.org.pe/index.php/AMP/article/view/2106 <p>The objective of this study was to determine the diagnosis and prevalence of temporomandibular joint dysfunction (TMJD) in Maria Auxiliadora General Hospital in Lima, Peru, during 2019. <strong>Material and Methods</strong>: This is a prospective randomized longitudinal descriptive study. The sample included 76 patients, and Research Criteria for Diagnosing Temporomandibular Joint Disorders were used. <strong>Results</strong>: We found that 73.7% patients were female, particularly belonging to the 30-39 years age group (35.6%). TMJD etiology is multifactorial and it is related to structural, functional, and psychological factors. When diagnosing TMJD, headache was the main symptom (38.1%), and pain on palpation (51.4%) was the most prominent sign on clinical examination, particularly in females (38.2%). Mixed anxiety-depressive disorder, was the most frequent mental status alteration associated with TMJD found on clinical examination (50.0%), and it also was more frequently found in females (38.2%). A combination of general clinical and ear, nose, and throat examination allowed reaching a diagnosis in 77.6% of all subjects. <strong>Conclusion</strong>: Patients with TMJD who present with headache and concomitantly with anxiety-depression, require integrative and early therapy management, so they may be reinstalled to their working environment and improve their productivity. TMJD should be considered as a frequent cause of headache.</p> Juan Benites Teresa Trujillo Herrera Copyright (c) 2021 ACTA MEDICA PERUANA 2021-08-23 2021-08-23 38 2 10.35663/amp.2021.382.2106 Tocilizumab treatment in critical COVID-19: Report from a hospital center [Brief] http://www.amp.cmp.org.pe/index.php/AMP/article/view/1919 <p>A descriptive study was carried out, in which clinical and laboratory characteristics were evaluated in patients with a diagnosis of acute respiratory distress syndrome (ARDS) secondary to SARS-CoV-2 infection and who received Tocilizumab. Twentyfour patients received Tocilizumab, the majority were male (95.8%), the most frequent comorbidity was obesity (33.3%). At the time of receiving Tocilizumab the median PAO2 / FiO2 was 159.5 (IQR 114.5-255, 3). Twenty-one (87.5%) patients presented clinical improvement and 3 (12.5%) died. Fifteen patients (62.5%) developed hepatotoxicity, the majority grade 3 (33.3%) and three (12.5%) patients presented grade 4 liver injury. Eleven patients (45.8%) presented bacterial superinfection, the more common organism being Acinetobacter baumannii. After the administration of Tocilizumab, more than half of the patients presented an adverse reaction; despite this, mortality was low, and the majority had a clinical improvement.</p> Miguel Hueda Zavaleta Fabrizzio Bardales Silva Cesar Copaja Corzo Rodrigo Flores Palacios Luis Barreto Rocchetti Eyner Córdova Tejada Copyright (c) 2021 ACTA MEDICA PERUANA 2021-08-19 2021-08-19 38 2 10.35663/amp.2021.382.1919 Precarious scientific publication amongst Peruvian medical specialists: Analysis of results in Google Academics and Scopus [Brief] http://www.amp.cmp.org.pe/index.php/AMP/article/view/1934 <p><strong>Introduction</strong>: In industrialized countries there is large production of publications from specialized physicians on specific topics regarding their working areas. Reality is quite different in Peru. <strong>Objective</strong>: To determine the rates of scientific paper production found in Google Academics and Scopus, as well as their association with medical specialties. <strong>Methodology</strong>: This is an analytical cross-section study. Randomized sampling of medical specialists registered in the Peruvian College of Physicians was performed. Those who were selected were searched aiming to determine whether they had produced papers in publications that would be found in Google Academics or that would be indexed in the Scopus database. Their lifetime production was reported, together with statistical associations. <strong>Results</strong>: Out of 2108 specialized physicians, 1810 (85.9%) and 2027 (96.2%) had never produced any scientific publication that could have been found in Google Academics or in Scopus indexed journals, respectively. Specialties most frequently found in Google Academics were as follows: gastroenterology (46.3%), dermatology (44.4%), and neurology (42.5%). In Scopus, most frequently found specialties were neurology (15.0%), gastroenterology and dermatology (11.1%, both), and pathology (10.9%). The highest number of production in foreign Scopus-indexed publications was 4 original papers for a corresponding author. There were statistically significant associations with respect to the lowest numbers of Scopus-indexed publications for 15 specialties (p&lt;0.042 for all), and thirteen of them featured no scientific production at all. <strong>Conclusions</strong>: The low number of authors who published scientific papers was surprising, and this may serve as an alert about the low resources available for generating and publishing their research, so strategies for helping in this purpose should be established.</p> Christian R. Mejía Mario J. Valladares-Garrido Alvaro Oyarce-Calderon Angie N. Nina Rafael Castillo-Mejia Copyright (c) 2021 ACTA MEDICA PERUANA 2021-08-23 2021-08-23 38 2 10.35663/amp.2021.382.1934 Vitamin D deficiency associated with hyperphosphatemia in children http://www.amp.cmp.org.pe/index.php/AMP/article/view/1909 <p>Children with vitamin D deficiency can have normal or high phosphorus despite having a high parathyroid hormone test (PTH). Pseudohypoparathyroidism (PHP) is characterized by hyperphosphatemia. The similarity that can occur between vitamin D deficiency associated with hyperphosphatemia and PHP makes it important to review case reports of vitamin D deficiency associated with hyperphosphatemia to understand why this association may occur and what is the relevance of studying the vitamin D level in children with suspected PHP. The aim of this review was to identify reports of children with vitamin D deficiency associated with hyperphosphatemia and to discuss the mechanisms of this association. Reports of 7 children cases were identified. Vitamin D deficiency could reduce the phosphaturic response to elevated PTH. It is concluded that it is important to rule out vitamin D deficiency in all children with suspected PHP</p> Manuel André Virú-Loza Copyright (c) 2021 ACTA MEDICA PERUANA 2021-08-23 2021-08-23 38 2 10.35663/amp.2021.382.1909 Coinfection with the SARS CoV 2 and the Dengue viruses: Case report http://www.amp.cmp.org.pe/index.php/AMP/article/view/2031 <p>We report the case of coinfection of SARS-CoV-2 and dengue virus, serotype 1 (DENV-1) in Peru, both infections confirmed through molecular techniques. In an adult patient from northern Peru, with good clinical evolution. With this unusual presentation, due to the coincidence of the critical course of dengue with the hyperinflammatory process of COVID-19.</p> Angel Alfrando Moreno Soto Luis Alfredo Espinoza Venegas Crystyan Alls Neufert Siles Montoya Monica de Belen Melendez Maron Copyright (c) 2021 ACTA MEDICA PERUANA 2021-08-23 2021-08-23 38 2 10.35663/amp.2021.382.2031 Laparoscopic cystogastroanastomosis in a pediatric patient: a case report. http://www.amp.cmp.org.pe/index.php/AMP/article/view/1068 <p>The pancreatic disorders, as acute pancreatitis, of biliary etiology are rare in pediatrics, even more the pancreatic pseudocysts. They are liquid collections surrounded of a fibrous capsule without epithelium, secondary to acute pancreatitis. We present the case of a 14-year-old female patient with a history of acute pancreatitis because of biliary etiology, 10 months prior. She complained of intermittent abdominal pain and a palpable mass in the epigastrium. The Imaging studies showed a pancreatic pseudocyst and cholelithiasis. The laparoscopy was chosen because the technical and esthetic benefits for this population. Therefore, a laparoscopic cystogastro-ostomy-anastomosis and cholecystectomy were performed, with good progress. We affirm this technique is a safe and effective method for the management of this pathology in pediatric patients, and it should be considered as the first option in case endoscopic procedures are not available. This is the first report in our settings.</p> Angel Francisco Vera Portilla Berly J. Ocharan Díaz Astrid Ailyn Wong Leyva Copyright (c) 2021 ACTA MEDICA PERUANA 2021-08-19 2021-08-19 38 2 10.35663/amp.2021.382.1068 Atypical carcinoid of thymus in a 39-year-old-man: A case report http://www.amp.cmp.org.pe/index.php/AMP/article/view/1963 <p>The atypical carcinoid (AC) of thymus is the most aggressive and uncommon neoplasm in the anterior mediastinum, that belongs to the neuroendocrine primary tumors of thymus. Most patients are asymptomatic and according to the disease extension they may present with cough, dyspnea, chest pain, and superior cava vein syndrome. This non-specific clinical presentation reduces the likelihood for making an early diagnosis; and this, together with disease stage and lack of surgical resection reduces the survival rate. The aim of this paper is to describe the clinical presentation in a 39-year old male with thymus carcinoid whose diagnosis was based on histopathological studies (carcinoid morphology, 0-1/2 mitoses/mm2 ), necrosis, Ki67, 12%), and immunophenotypic tumor markers [CD56(+), Pankeratin (+), Synaptophysin (+), and TTF-1 (-)].</p> Lesli Alexandra García Floriano Copyright (c) 2021 ACTA MEDICA PERUANA 2021-08-23 2021-08-23 38 2 10.35663/amp.2021.382.1963 Cryptococcal meningitis in a patient with idiopathic CD4+ T lymphopenia http://www.amp.cmp.org.pe/index.php/AMP/article/view/2123 <p>Infection with the human immunodeficiency virus (HIV) is the main risk factor for developing cryptococcal meningitis. However, there is a poorly known entity, idiopathic CD4+ T-cell lymphopenia, which leads to an unexplainable CD4+ circulating T-cell deficit, predisposing patients to many complications, including infections caused by opportunistic microorganisms. We present the case of a patient with cryptococcal meningitis secondary to idiopathic T-CD4+ lymphopenia, which, as far as we know, is the very first case of its kind reported in Peru. This entity should be considered in patients negative for HIV infection developing non-common infections of the central nervous system, since outcome, management, and prognosis may be different in patients with this condition.</p> Jeremy Stefan Esquivel Luna Laura Carolina Zelada Ríos José Humberto Bejarano Ferreyra Copyright (c) 2021 ACTA MEDICA PERUANA 2021-08-23 2021-08-23 38 2 10.35663/amp.2021.382.2123 Detection of EGFR gene mutations in circulating DNA by liquid biopsy in patients with non-small cell lung cancer: Brief review http://www.amp.cmp.org.pe/index.php/AMP/article/view/1978 <p>Lung cancer is a public health problem due to its high morbidity and mortality worldwide and in Peru. In non-small cell lung cancer, the detection of mutations of the epidermal growth factor receptor (EGFR) has been useful for the choice of therapeutics for this disease. In the present article we aim to discuss current and relevant information on the best diagnostic technique for EGFR in patients with non-small cell lung cancer. The main cancer guidelines and two systematic reviews showed evidence in favor of the diagnosis of EGFR gene mutations on liquid biopsy as an alternative to tissue biopsy at the beginning of diagnosis and with a greater acceptance use, in the clinical setting of NSCLC patients with sensitive EGFR mutations. This healthcare technology may be useful in our country, and we propose its use in two clinical scenarios.</p> Virgilio E Failoc-Rojas Copyright (c) 2021 ACTA MEDICA PERUANA 2021-08-23 2021-08-23 38 2 10.35663/amp.2021.382.1978 Genetic mutations that confer resistance to Isoniazid in patients with Tuberculosis in Lima Centro, Perú 2017- 2018 http://www.amp.cmp.org.pe/index.php/AMP/article/view/1892 <p>This a report of the frequency of KatG and inhA genetic mutations that confer resistance to isoniazid in a sample of 777 patients with resistance to isoniazid. GenoType® MTBDRplus test and conventional sensitivity tests by the agar plate method were used. It was found that 54% presented mutation in the KatG gene, associated with higher resistance to streptomycin 76.6% (p &lt;0.05), rifampicin 66.7% (p &lt;0.05) and ethionamide in 33% (p &lt;0.05). inhA gene mutation has a frequency of 46% and was associated with resistance to ethionamide in 68.1% (p &lt;0.05), rifampicin 47.2% (p &lt;0.05) and streptomycin 33% (p &lt;0.05). In this sample, the presences of mutations that confer resistance to isoniazid was associated with resistance to other antituberculosis drugs.</p> Kenneth Vargas Ponce Claudia Trujillo Valencia Trilce Saravia Ruiz Antonio Salas López Felix Llanos Tejada Copyright (c) 2021 ACTA MEDICA PERUANA 2021-08-23 2021-08-23 38 2 10.35663/amp.2021.382.1892 Publications on bioethics and euthanasia in Scopus, Medline / Pubmed, and Scielo http://www.amp.cmp.org.pe/index.php/AMP/article/view/2045 Orlando Daniel Flores Sánchez César Ñique-Carbajal Copyright (c) 2021 ACTA MEDICA PERUANA 2021-08-23 2021-08-23 38 2 10.35663/amp.2021.382.2045 Acral nodular melanoma result of late complication in ungueal melanoma http://www.amp.cmp.org.pe/index.php/AMP/article/view/2099 Andrés Oré Cárdenas Copyright (c) 2021 ACTA MEDICA PERUANA 2021-08-23 2021-08-23 38 2 10.35663/amp.2021.382.2099