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 Diphtheria in Peru after 20 years http://www.amp.cmp.org.pe/index.php/AMP/article/view/1935 Herminio R. Hernandez Diaz Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-29 2020-12-29 37 4 10.35663/amp.2020.374.1935 Nosocomial diarrheal disease caused by Clostridioides difficile in a national hospital in Lima, Peru http://www.amp.cmp.org.pe/index.php/AMP/article/view/1051 <p><strong>Objective:</strong> to determine frequency, incidence, and to describe clinical and epidemiological characteristics of patients with nosocomial diarrheal disease caused by Clostridioides difficile in Edgardo Rebagliati-Martins National Hospital in Peru, between April to July 2019. <strong>Material and methods:</strong> this is an observational and cross-sectional study that was performed in Internal Medicine, Intensive Care, Hematology, Gastroenterology, and Emergency services. Active surveillance of patients more than 18-years old who had three or more non-formed stools in a 24-hour period at 48-hours after being admitted to the hospital. A diagnostic algorithm was used, including glutamate dehydrogenase and A and B C. difficile fecal toxins. In case of discordant results, nucleic acid amplification for toxin producing genes tests were performed. <strong>Results:</strong> out of 107 patients with nosocomial diarrheal disease, 12 were positive for C. difficile, with 11.2% frequency (95% CI: 6.44 – 18.82). One patient was NAP1-BI-027 positive. The maximum incidence was found in the hematology service (5.54 x 10000 patientsday). Seven (7/12, 58.3%) patients were male and average age was 64.58 ± 21.34 years. The most frequently prescribed antibacterial agent prior to the diarrheal disease was meropenem (9/12, 75%). Only two patients had received clindamycin. Most patients (8/12, 66.7%) had an initial non severe episode. Overall mortality was 28% (95% CI: 20.27–37.38) and four deceased patients had C. difficile infection. <strong>Conclusions:</strong> The frecuency of nosocomial diarrheal disease caused by C. difficile in our institution was lower than that reported in another public hospital in Lima. Rational use of antibacterial agents and preventative measures may explain these findings.</p> Ofelia Castillo-Contreras Cesar Soriano-Alvarez Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-03 2020-12-03 37 4 10.35663/amp.2020.374.1051 Functional dependence and type 2 diabetes mellitus in elderly subjects covered by Peruvian Social Security: analysis of ENSSA-2015 http://www.amp.cmp.org.pe/index.php/AMP/article/view/1075 <p><strong>Objective:</strong> to estimate the prevalence of functional dependence and to assess its association with type 2 diabetes mellitus (DM) in elderly subjects registered in Peruvian Social Security (EsSalud) in 2015. <strong>Materials and methods:</strong> this is a secondary analysis of the National Socioeconomic Healthcare Access Survey performed in EsSalud members in 2915 (ENSSA-2015), a survey performed in households using two-stage probabilistic sampling that was representative at a national level of population registered in EsSalud. Functional dependence was assessed using the Katz index (≥ 1 point). DM was determined by participants’ self- report. Adjusted prevalence rates (aPR) were estimated according to potential confounding factors using multiple log-Poisson regression alongside their 95% confidence intervals (CI) and p-values. All analyses took into account the complex sampling used in ENSSA-2015. <strong>Results:</strong> nearly eleven thousand participants (10,985) out of 12,805 eligible subjects were included in the analysis. Prevalence values for partial and severe functional dependence were 12.9% (95% CI: 11.9–13.8) and 6.0% (95% CI: 5.3–6.7), respectively. The prevalence of functional dependence (partial or severe) in diabetic subjects was 23% higher than that of non-diabetics, after controlling for potential confounding factors (aPR 1.23; 95% CI: 1.04–1.44; p= 0.013). <strong>Conclusions:</strong> nearly one of five elderly subjects registered in EsSalud had some degree of functional dependence (partial or severe). Also, DM was associated with a greater likelihood for having functional dependence in this population.</p> Rofilia Ramirez-Ramirez Percy Soto-Becerra Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-02 2020-12-02 37 4 10.35663/amp.2020.374.1075 Risk factors for in-hospital mortality in SARS-CoV-2 pneumonia adult patients from Lima, Peru http://www.amp.cmp.org.pe/index.php/AMP/article/view/1676 <p><strong>Objective:</strong> this study aimed to describe the main factors associated to mortality in a cohort of patients hospitalized with SARS-CoV-2 pneumonia in a public hospital in Lima, Peru. <strong>Materials and methods:</strong> this was a retrospective cohort study, with a non-random convenience sampling. Adult patients with confirmed/suspicious SARS-CoV-2 pneumonia with rapid and/or molecular tests were included. Demographic, clinical, laboratory, tomographic and treatment variables were identified. Descriptive statistics, bivariate analysis, and Poisson regression techniques were used to determine the adjusted relative risk (aRR). <strong>Results:</strong> 122 patients were included, 70.5% were male, with a mean age of 55.8 years, with a history of obesity (25.4%) and high blood pressure (HBP, 13.1%). The multivariate analysis of clinical factors identified that age (aRR 1.03; 95% CI: 1,00-1.06; p=0.021), body mass index (BMI; aRR 1.03; 95% CI: 1.01-1.05; p=0.006), HBP (aRR 1.68; 95% CI: 1.09-2.56; p=0.017), PaO2/FiO2 index (aRR 0.99; 95% CI: 0.99-1.00; p&lt;0.001), exposure to lopinavir/ritonavir (LPV/r; aRR 0.83; 95% CI: 0.76-0.91; p &lt;0.001), and systemic corticosteroids (aRR 1.18; 95% CI: 1.09-1.27; p&lt;0.001) were significantly associated with mortality. <strong>Conclusions:</strong> Age, BMI, HBP, PaO2/FiO2 index, and exposure to corticosteroids and LPV/r were associated with mortality in our cohort of patients hospitalized with SARS-CoV-2 pneumonia.</p> Milton J. M. Rodriguez-Zuniga Ana Quintana-Aquehua Víctor Hugo Díaz-Lajo Katerinee Soledad Charaja-Coata Walter Suriel Becerra-Bonilla Kori Cueva-Tovar Giancarlo A. Valle-Gonzalez Paol Rojas-De-La-Cuba Connie Arly Alva-Gutierrez Belen Cerpa-Chacaliaza Alberto Mendoza-Ticona Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-29 2020-12-29 37 4 10.35663/amp.2020.374.1676 Sarcopenia, in-hospital mortality and prolonged hospital stay in elderly subjects admitted to a Peruvian reference hospital http://www.amp.cmp.org.pe/index.php/AMP/article/view/1071 <p><strong>Objective:</strong> to determine whether sarcopenia is an associated factor to in-hospital mortality and prolonged hospital stay (PHS) in elderly subjects admitted to Hipolito Unanue National Hospital (HUNH) between December 2019 and March 2020. <strong>Materials and methods:</strong> this is an observational prospective cohort study performed in elderly subjects admitted to the Medicine Service in HUNH. Crude and multivariate analysis were performed using Poisson regression, aiming to determine a relationship between sarcopenia and in-hospital mortality and PHS by relative risk (RR). <strong>Results:</strong> nearly half of all patients (49.4%) in the study had sarcopenia, 12.3% died, and 32.5% had PHS. The crude analysis showed an association between sarcopenia and in-hospital mortality (RR: 4.69, 95% CI: 1.62–13.10, p=0.004); nonetheless, when an adjusted analysis was performed, this significance value got lost (p=0.097). No significant association was found between sarcopenia and PHS (p=0.673). <strong>Conclusion:</strong> sarcopenia is a condition affecting a large proportion of hospitalized elderly subjects, and it is associated to a higher risk of dying during hospitalization. There is no association between sarcopenia and PHS.</p> Keyla E. Ramos-Ramirez Alonso Soto Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-29 2020-12-29 37 4 10.35663/amp.2020.374.1071 Reference values of spirometry parameters in healthy workers at different altitude levels in Peru http://www.amp.cmp.org.pe/index.php/AMP/article/view/1061 <p><strong>Objective:</strong> to estimate reference values for spirometry parameters in healthy workers at different altitude levels in Peru. <strong>Materials and methods:</strong> we performed a secondary analysis of records from occupational medical examinations carried out between May and June 2019 in workers at four different altitude levels: level 1: 0-100 m above sea level (ASL) (Trujillo, Pisco, Marcona, Lima), level 2: 2.300–2.800 m ASL (Arequipa and Cajamarca), level 3: 3.200–3.800 m ASL (Huancayo, La Oroya, Orcopampa, and Oyon); and level 4: 4.000–4.400 m ASL (Carhuacoto and Cerro de Pasco). Spirometry reference values for forced expiratory volume during the first second (FEV1), forced vital capacity (FVC), and the FEV1/FVC rate were constructed and compared using a multiple linear regression model. <strong>Results:</strong> we analyzed 33.232 records obtained from healthy workers in different altitude levels in Peru. In male subjects, FVC values were 4,6 ± 0,64 (mean ± standard deviation [SD]); 4,8 ± 0,67; 4,9 ± 0,65; and 4,8 ± 0,65 for altitude levels 1, 2, 3, and 4, respectively. Their corresponding lower limit of normal (LLN) values were 3,58; 3,78; 3,84; and 3,75 for altitude levels 1, 2, 3, and 4, respectively. FEV1 values were 3,8 ± 0,54; 3,9 ± 0,59; 4,0 ± 0,57; and 4,0 ± 0,59 for altitude levels 1, 2, 3, and 4, respectively. Their corresponding LLN values were 2,93; 3,06; 3,13; and 3,08 for levels 1, 2, 3, and 4, respectively. FEV/FVC rates were 0,83 ± 0,05; 0,83 ± 0,05; 0,84 ± 0,05; and 0,84 ± 0,05 for altitude levels 1, 2, 3, and 4, respectively. Their corresponding LLN values were 0,72; 0,71; 0,71; and 0,72 for altitude levels 1, 2, 3, and 4, respectively. <strong>Conclusions:</strong> both FEV1 and FVC spirometry values show mild differences according to altitude levels in the different evaluated areas. Further studies are necessary aiming to confirm our findings.</p> Catherine Llanos-Salcedo Katia Muñoz-Farfán Jorge L. Maguiña Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-30 2020-12-30 37 4 10.35663/amp.2020.374.1061 Barriers for diagnosis and therapy of cervical cancer in a public hospital in Lima, Peru: a qualitative study http://www.amp.cmp.org.pe/index.php/AMP/article/view/1835 <p><strong>Objectives:</strong> To analyze and discuss barriers for diagnosis and therapy of cervical cancer (CC) in a public hospital in Lima, Peru. <strong>Materials and methods:</strong> A qualitative study was performed between December 2019 and March 2020. Observation and detailed interviews were the data collection tools used. In total, 15 detailed interviews with patients and healthcare personnel were carried out. <strong>Results:</strong> For healthcare personnel interviewed, barriers (for good care) are basically lack of personnel and poor hospital infrastructure. This leads to weakening educational campaigns with respect to the importance of adequate screening for CC prevention. For patients, time limitations, lack of knowledge and fear of being exposed to a male healthcare worker are the main barriers for healthcare proper decision making with respect to CC prevention and management. <strong>Conclusions:</strong> The weak Peruvian hospital infrastructure influences educational and promotional activities dedicated to CC. There is also an impact of the time for obtaining results of screening tests and access to gynecological consultation. These delays lead to absence and discontinuation in women self care. All this, additionally to lack of knowledge about CC severity by patients, and also because of prioritization of their working and household tasks, may lead us to reflect on an insufficient performance of our healthcare system with respect to management of this disease.</p> Silvana M. Matassini Eyzaguirre Víctor Luna Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-30 2020-12-30 37 4 10.35663/amp.2020.374.1835 Availability of pediatric cardiovascular surgeons in Peru in 2019 http://www.amp.cmp.org.pe/index.php/AMP/article/view/1810 <p><strong>Objective:</strong> to describe availability of pediatric cardiovascular surgeons and to identify factors influencing accreditation for this specialty in Peru. <strong>Materials and methods:</strong> this is a cross-sectional and descriptive study. A discriminating exponential snowball sampling procedure was performed in pediatric cardiovascular surgeons working in the Peruvian National Cardiovascular Institute. This was carried out in April 2019. Their participation was requested and virtual surveys were carried out. Data collected from closed questions were processed using descriptive statistics. Data from open questions were processed on the basis of their systematization, order, and relationship, so conclusions could be drawn. <strong>Results:</strong> twenty surgeons were surveyed. Of them, 5 reported having had training for their subspecialty, and they declared their main motivation was having undergone a training period during pregraduate or specialty studies, as well as their interest in surgery. Three accredited subspecialists declared they wanted to formalize their practice in Peru, and the other two declared not having formalized their training because of lack of time. Also, eleven surgeons expressed their desire for achieving accreditation. On the other hand, seventeen surveyed professionals declared that Peru requires more subspecialists. <strong>Conclusion:</strong> there is lack of pediatric cardiovascular surgeons in Peru; so increasing posts for such subspecialists is necessary, and also there is an urgent need for increasing, improving, and articulating specialized centers.</p> Miguel Pinto-Salinas Astrid Tauma-Arrué Lesly Mendoza-Guillén Fernando Chavarri-Velarde Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-30 2020-12-30 37 4 10.35663/amp.2020.374.1810 Cardiovascular alterations in patients with excessive erythrocytosis in residents at 5,200 meters above the sea level http://www.amp.cmp.org.pe/index.php/AMP/article/view/1042 <p><strong>Objective:</strong> to describe cardiovascular function and determine cardiac disturbances in patients with and without excessive erythrocyteosis (EE). <strong>Materials and methods:</strong> a prospective, transversal and analytical type study. The sample was of 61 resident patients of the Centro Poblado La Rinconada, located in Puno – Peru, located at 5,200 meters above the sea level. A data collection sheet was used, Qinghai's chronic mountain sickness score was applied, and an experienced cardiologist performed echocardiographies. <strong>Results:</strong> the average age was 44 ± 7 years and the residence time was 16 ± 9.8 years. Of the total number of patients, 80.3% had chronic mountain sickness; of these, 68.9% were mild grade, 6.6% moderate grade and 4.9% severe grade. Among the echocardiographic findings were found: dilation of cardiac cavities (16.4%), slight alteration of the filling of the right ventricle (3.27%), bicuspid aortic valve (3.27%), difficulty filling the left ventricle (8.2%), slight alteration in relaxation and filling of the left ventricle (1.6%), mild aortic insufficiency (1.6%) pulmonary hypertension (1.6%). 83.6% had hemoglobin ≥ 21 mg/dL. <strong>Conclusions:</strong> the group with EE had more cardiac disturbances, the most common cardiac disturbance was the dilation of right heart chambers.</p> Mariela M. Quispe-Trujillo Jeancarlo Tejada-Flores David Ochoa-Torres Kevin O. Morales-Pocco Samir Colquehuanca-Chuquija Solmaria M. Foroca-Mancha Estefani I. Salcedo-Chata Andrei R. Pérez-Machicao Grecia Fanel Vidmard O. Mengoa-Herrera Ivan Hancco-Zirena Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-30 2020-12-30 37 4 10.35663/amp.2020.374.1042 Atypical neuroimaging in patients with COVID-19 in Peru: case report http://www.amp.cmp.org.pe/index.php/AMP/article/view/1858 <p>Reports describing neurological manifestations in patients with COVID-19 have substantially increased in the past months. Nevertheless, findings from neuroimaging studies have been poorly documented because of restrictions due to the need for isolating such patients. Two cases of patients with COVID-19 and clinical neurological manifestations are reported. They underwent brain imaging studies and atypical findings were made in cerebral magnetic resonance imaging. It is necessary to have more detailed and better documented descriptions of neurological manifestations in patients hospitalized with COVID-19 and their respective neuroimaging correlates in order to obtain better knowledge of this condition.</p> Miguel A. Vences Elliot Barreto-Acevedo Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-16 2020-12-16 37 4 10.35663/amp.2020.374.1858 Acute appendicitis caused by Echinococcus granulosus: report of a case and literature review http://www.amp.cmp.org.pe/index.php/AMP/article/view/948 <p>Acute appendicitis is the most frequent surgical emergency instance in young adults; and its association with parasitic infections is rare. Of these particular cases, appendix location of hydatid cyst is extremely rare; and there have been published reports of such cases only in Iran, India, Tunisia, and Peru. We present the case of a 52-year old male subject born in Puno, with no relevant past medical history, who was admitted with a clinical condition typically consistent with acute appendicitis. When this patient underwent surgery, the appendix was found showing a cystic mass, compatible with complicated Echinococcus granulosus hydatid cyst. Later on, three additional intraabdominal hydatid cysts were identified. There was no surgical or trauma past history, so it was concluded this condition corresponded to disseminated primary intraabdominal location of hydatid disease, including the appendix, liver, and peritoneum.</p> Angel F. Vera-Portilla Gean Zevallos-Delgado Diana Cuayla-Flores Walter Vera-Portilla Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-27 2020-12-27 37 4 10.35663/amp.2020.374.948 Transient cortex blindness and global amnesia after performing left arm arteriography using iopamidol http://www.amp.cmp.org.pe/index.php/AMP/article/view/1188 <p>Iodinated contrast substances may cause different adverse events, most frequently renal involvement and hypersensitivity reactions. Transient cortical blindness and global amnesia are rarely described neurological complications after the administration of contrast substances. We report the case of a 63-year old patient with high blood pressure who presented with cyanosis and cold sensation affecting the second and third digits of his left hand. The patient underwent an arteriography of the left arm, where 50-mL of iopamidol was used as a contrast substance, and he immediately developed occipital headache associated to bilateral blurred vision that rapidly progressed to blindness. A cerebral computed tomography (CT) scan showed occipital subarachnoid hypodense areas, with no mass effect. Eighteen hours after the event, the patient showed retrograde amnesia with persistent amaurosis. His control cerebral CT scan did now show any focal disorder. The patient had a good progression, both bilateral amaurosis and headache subsided thirty hours after the event, and the patient was uneventfully discharged after ten days.</p> Miguel Hueda-Zavaleta Cesar Copaja-Corzo Fabrizzio Bardales-Silva Diana Minchón-Vizconde Lisbeth Rodríguez-Tanta Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-27 2020-12-27 37 4 10.35663/amp.2020.374.1188 Thrombotic microangiopathy in renal transplantation, tacrolimus as a causative agent http://www.amp.cmp.org.pe/index.php/AMP/article/view/1056 <p>Thrombotic microangiopathy (TMA) is an unusual complication associated to the use of tacrolimus in renal transplantation. This condition may be related to infections, antibody-mediated rejection (AMR), disease recurrence or de novo TMA, and toxicity of calcineurin inhibitors. Generally, this condition presents in non-complete forms, which makes diagnosis difficult, and irreversible lesions may supervene. This case features the presence of a viral infection, and data suggesting rejection with the concomitant tacrolimus use. Therapy includes plasmapheresis and the use of monoclonal antibodies such as eculizumab. Nonetheless, in this particular case suspending therapy or switching from tacrolimus to another agent were good cost-effective measures.</p> Juan E. Rodriguez-Mori Denese C. Mego-Arellan Julia Sumire-Umeres Carmen Asato-Higa Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-27 2020-12-27 37 4 10.35663/amp.2020.374.1056 Experience and management of two paediatric patients infected with SARS-CoV-2 with major burn injuries in an intensive care unit http://www.amp.cmp.org.pe/index.php/AMP/article/view/1675 <p>SARS-CoV-2 infection is rapidly disseminating, leading to a world pandemics in which we are also affected. In San Borja Peruvian National Children Health Institute, which is the reference center for surgical pediatric patients, 106 patients infected with SARS-CoV-2 were hospitalized. Of them, 11 presented with burns and two had large burns. The viral infection was diagnosed using molecular testing. We present in detail the case of a pediatric seven-year old patient who had large burns and was taken care of in the intensive care unit. She had asymptomatic SARS-CoV-2 infection, and her outcome was good, with a good prognosis, and she recovered completely and uneventfully. On the other hand, COVID-19 may present as a severe disease leading to a multisystemic inflammatory syndrome with some uncommon clinical manifestations which affect its prognosis , as it was the case with another seven-month old patient who passed away in spite of having received specialized and timely therapy.</p> Atenas Bustamante Juan Miranda Martin Iglesias Kelly Contreras Christian Lector Wieslawa De Pawlikowski Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-30 2020-12-30 37 4 10.35663/amp.2020.374.1675 Use of embolization of the middle meningeal artery in chronic subdural hematoma recurrence http://www.amp.cmp.org.pe/index.php/AMP/article/view/1825 <p>Chronic subdural hematoma (CSDH) is a frequent neurosurgical condition, which may develop recurrence in up to 30% of all cases. Embolization of the middle meningeal artery (MMA) is an adjuvant management strategy for reducing recurrence, especially in patients with risk factors, and it has a low complication rate. We present the case of an 83-year old male with history of anticoagulation, who was admitted in a healthcare facility because of right hemiparesis, dysarthria and gait impairment, and he had been sick for one week. A trepanation and CSDH evacuation were uneventfully performed. One month later, the patient was brought back because of CSDH recurrence, so another trepanation and adequate CSDH evacuation were performed, followed by embolization of the ipsilateral MMA. A control assessment after two months revealed absence<br>of recurrence and neurological improvement. We conclude that MMA embolization was an efficacious adjuvant therapy aiming to reduce CSDH recurrence, and this procedure may be indicated in patients with risk factors for recurrence.</p> John F. Vargas-Urbina Giancarlo Saal-Zapata Rodolfo Rodriguez-Varela Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-30 2020-12-30 37 4 10.35663/amp.2020.374.1825 Clinical practice guideline for the screening, diagnosis, and management of chronic kidney disease stages 1-3 for the Peruvian Social Security (EsSalud) http://www.amp.cmp.org.pe/index.php/AMP/article/view/1843 <p>This paper summarizes the clinical practice guidelines (CPG) for the screening, diagnosis, and management of patients with chronic kidney disease (CKD) stages 1-3 in the Social Security of Peru (EsSalud). A guideline development group (GDG) was established for develop this CPG, which included clinical and methodology specialists, who formulated 08 clinical questions. Systematic searches of systematic reviews and, when considered necessary, primary studies were conducted to answer each question; and relevant evidence was selected. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GDG used the GRADE methodology for reviewing the evidence and for developing recommendations. At the end, this CPG formulated 08 recommendations (04 strong and 04 conditional), 29 points of good clinical practice, and 03 flowcharts were formulated.</p> Jessica Bravo-Zúñiga Juana Hinostoza-Sayas Sergio Goicochea- Lugo Gandy Dolores-Maldonado Ana Brañez-Condorena Alvaro Taype-Rondan Carlos Yanar Pereda Vejarano Carola Medina Sal y Rosas Renzo P. Valdivia-Vega Fernando Mesías Gonzáles Haro Luzmila Livaque Gaona Victor Manuel Conetero Muro Gabriela Ayllón Guerrero Nelly Patricia Huancco Cáceres Cesar Antonio Loza Munarriz Percy Herrera-Añazco Virgilio E. Failoc Rojas Lourdes Carrera-Acosta Raul Timana Ruiz Hector Garavito-Farro Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-06 2020-12-06 37 4 10.35663/amp.2020.374.1843 Ethics, mental health, and COVID-19 http://www.amp.cmp.org.pe/index.php/AMP/article/view/1671 <p>COVID-19, whose first case was confirmed in Peru in March 2020, revealed many deficiencies in our country, not only in its health systems, but also with respect to democracy and moral values of Peruvian society. This paper reviews both ethical and mental health problems, pointing out difficulties between the state and the civil society for working together against the pandemics, and also stating the presence of population groups that instead of protecting themselves, ignore regulations for social distancing and isolation facilitating the transmission of the viral agent. An explanatory scientific and moral hypothesis is proposed aiming to explain such conduct. Also, taking advantage of all the energy generated by a crisis and the possibility of turning this into a developmental current, some measures to be taken by the government are proposed, with the purpose of trying to correct mental health problems that have been affecting the Peruvian society for a long time, aiming to improve its moral and economic development.</p> Alberto Perales Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-16 2020-12-16 37 4 10.35663/amp.2020.374.1671 Clinical practice guideline for the screening and management of the mild depressive episode at the first level of care for the Peruvian Social Security (EsSalud) http://www.amp.cmp.org.pe/index.php/AMP/article/view/1648 <p>This paper summarizes the clinical practice guide (CPG) for the screening and management of mild depressive episode at the first level of care in the Social Security of Peru (EsSalud). A guideline development group (GDG) was established for develop this CPG, which included clinical and methodology specialists, who formulated 06 clinical questions. Systematic searches were conducted in Pubmed and GPC repositories to answer each question, and relevant evidence was selected. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GDG used the GRADE methodology for reviewing the evidence and for developing recommendations. At the end, this CPG formulated 07 recommendations (03 strong and 04 conditional), 28 points of good clinical practice, and 02 flow charts were formulated.</p> Beatrice Macciotta-Felices Carla Moron-Corales Matilde Luna-Matos Víctor Gonzales-Madrid Amelia Melgarejo-Moreno Jessica Hanae Zafra-Tanaka Sergio Goicochea-Lugo Raisa N. Martinez-Rivera Wendy Nieto-Gutierrez Fabian Fiestas-Saldarriaga Alvaro Taype-Rondan Raul Timana-Ruiz Hector Garavito-Farro Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-30 2020-12-30 37 4 10.35663/amp.2020.374.1648 Hipolito Unanue in Cadiz http://www.amp.cmp.org.pe/index.php/AMP/article/view/1270 <p>Hipólito Unanue's participation in the Cortes of Cádiz has not been the subject of a detailed investigation that allows to know his public and private performance during his stay in Spain. The purpose of this article is to make a first approach to this under-studied episode of the life of the "father of Peruvian medicine".</p> Ricardo I. Alvarez-Carrasco Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-16 2020-12-16 37 4 10.35663/amp.2020.374.1270 IgG-positive for COVID-19 and deficiencies in Peruvian regulations: apropos of a case http://www.amp.cmp.org.pe/index.php/AMP/article/view/1823 Eduardo Ortega-Guillen Giovanni Meneses Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-02 2020-12-02 37 4 10.35663/amp.2020.374.1823 An approach on mental health of children, adolescents and caregivers in the COVID-19 context in Peru http://www.amp.cmp.org.pe/index.php/AMP/article/view/1851 Fiorella Rusca-Jordan Carla Cortez-Vergara Benilde Cecilia Tirado-Hurtado Mariella Strobbe-Barbat Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-16 2020-12-16 37 4 10.35663/amp.2020.374.1851 Detection of katG and inhA mutations to guide the use of isoniazid and ethionamide in the treatment of multidrug-resistant tuberculosis in Peru http://www.amp.cmp.org.pe/index.php/AMP/article/view/1049 Samuel Pecho-Silva Ana C. Navarro-Solsol Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-16 2020-12-16 37 4 10.35663/amp.2020.374.1049 Medical internship during the COVID-19 pandemic: the problem of pre-professional medical practitioners in the face of Peruvian legislation http://www.amp.cmp.org.pe/index.php/AMP/article/view/1852 Fitzgerald A. Arroyo-Ramirez Daniel Rojas-Bolivar Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-30 2020-12-30 37 4 10.35663/amp.2020.374.1852 Prolonged disease or post-COVID-19 sequela? http://www.amp.cmp.org.pe/index.php/AMP/article/view/1866 Augusto Tarazona-Fernandez Erik Rauch-Sánchez Orlando Herrera-Alania Edén Galán-Rodas Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-30 2020-12-30 37 4 10.35663/amp.2020.374.1866 Young adults hospitalized by COVID-19 http://www.amp.cmp.org.pe/index.php/AMP/article/view/1924 Jannin Salcedo-Matienzo Ernesto Zavala-Flores Stephanie Salazar-Gavino Bartolome Eunofre-Hipolo Alfredo Berrocal-Kasay Copyright (c) 2020 ACTA MEDICA PERUANA 2020-12-27 2020-12-27 37 4 10.35663/amp.2020.374.1924