Risk factors associated with dengue complications and death: A cohort study in Peru.

BACKGROUND: Dengue has emerged as an unprecedented epidemic in Peru, and it is anticipated that this issue will escalate further owing to climate change. This study aimed to determine the risk factors associated with death from dengue in patients treated at Hospital II in Pucallpa, Peru. METHODOLOGY: This retrospective cohort study collected information from the medical records of patients with a diagnosis of dengue treated at Hospital II Pucallpa-Peru between January 2019 and March 2023. The primary outcome was death, and the secondary outcome was death, development of severe dengue, or Intensive Care Unit (ICU) admission. Cox regression models were used to determine risk factors. FINDINGS: The clinical records of 152 patients were evaluated, with a median age of 27.5 years (interquartile range, 11-45). Among all patients, 29 (19.1%) developed severe dengue, 31 (20.4%) were admitted to the ICU, and 13 (8.6%) died during follow-up. In the survival analysis, bilirubin >1.2 mg/dL was associated with a higher risk of death aHR: 11.38 (95% CI: 1.2 106.8). Additionally, factors associated with poor prognosis included having 1 to 3 comorbidities aRR: 1.92 (1.2 to 3.2), AST ≥251 U/L aRR: 6.79 (2.2 to 21.4), history of previous dengue aRR: 1.84 (1.0 to 3.3), and fibrinogen ≥400 mg/dL aRR: 2.23 (1.2 to 4.1). SIGNIFICANCE: Elevated bilirubin was associated with death from dengue, whereas an increase in comorbidities and a history of previous dengue were related to a poor prognosis of the disease. Early identification of severe dengue would be more feasible with improved access to laboratory testing, particularly in tropical areas with a high dengue incidence.

Fetal death and its association with indicators of social inequality: 20-year analysis in Tacna, Peru.

OBJECTIVE: The aim of this study was to evaluate the rates of fetal mortality in a Peruvian hospital between 2001 and 2020 and to investigate the association of indicators of social inequality (such as access to prenatal care and education) with fetal mortality. METHODOLOGY: We conducted a retrospective cohort study, including all pregnant women who attended a Peruvian hospital between 2001 and 2020. We collected data from the hospital's perinatal computer system. We used Poisson regression models with robust variance to assess the associations of interest, estimating adjusted relative risks (aRR) and their 95% confidence intervals (95% CI). RESULTS: We analyzed data from 67,908 pregnant women (median age: 26, range: 21 to 31 years). Of these, 58.3% had one or more comorbidities; the most frequent comorbidities were anemia (33.3%) and urinary tract infection (26.3%). The fetal mortality ratio during the study period was 0.96%, with the highest rate in 2003 (13.7 per 1,000 births) and the lowest in 2016 (6.1 per 1,000 births), without showing a marked trend. Having less than six (aRR: 4.87; 95% CI: 3.99-5.93) or no (aRR: 7.79; 6.31-9.61) prenatal care was associated with higher fetal mortality compared to having six or more check-ups. On the other hand, higher levels of education, such as secondary education (aRR: 0.73; 0.59-0.91), technical college (aRR: 0.63; 0.46-0.85), or university education (aRR: 0.38; 0.25-0.57) were associated with a lower risk of fetal death compared to having primary education or no education. In addition, a more recent year of delivery was associated with lower fetal mortality. CONCLUSION: Our study presents findings of fetal mortality rates that are comparable to those observed in Peru in 2015, but higher than the estimated rates for other Latin American countries. A more recent year of delivery was associated with lower fetal mortality, probably due to reduced illiteracy and increased access to health care between 2000 and 2015. The findings suggest a significant association between indicators of social inequality (such as access to prenatal care and education) with fetal mortality. These results emphasize the critical need to address the social and structural determinants of health, as well as to mitigate health inequities, to effectively reduce fetal mortality.

Imposter syndrome and its associated factors in medical students in six Peruvian faculties.

OBJECTIVE: To determine the factors associated with impostor syndrome in medical students from six regions of Peru. MATERIAL AND METHODS: A multicentre, cross-sectional study was conduced on students from first to the sixth year in six Peruvian regions. Sociodemographic, academic, and psychological characteristics were included through the Depression, Anxiety, and Stress Scale-21, the Rosenberg Self-Esteem Scale and the Clance Imposter Phenomenon Scale. Generalised linear models were performed using crude and adjusted estimated prevalence ratios. RESULTS: Of 2,231 medical students, 54.3% were female and 30.6% had the impostor phenomenon. An association was found between the PI and those who suffered from depression (aPR=1.51; 95%CI, 1.27-1.79), anxiety (aPR=2.25; 95%CI, 1.75-2.90), stress (aPR=1.37; 95%CI, 1.19-1.57), and being female (aPR=1.12; 95%CI, 1.01-1.26). CONCLUSIONS: Three out of 10 medical students suffer from PI; having some level of depression, anxiety, stress, being a woman, and/or attending the fourth academic year were predisposing factors for their development.

Síndrome del impostor y sus factores asociados en estudiantes de Medicina de seis facultades peruanas

Objetivo: Determinar los factores asociados con el síndrome del impostor (IP) en estudiantes de Medicina de 6 facultades peruanas. Material y métodos: Estudio multicéntrico transversal analítico realizado en estudiantes del primer al sexto año en 6 regiones peruanas. Se incluyeron características sociodemográficas, académicas y psicológicas mediante la escala de depresión, ansiedad y estrés, la escala de autoestima de Rosenberg y la escala del Fenómeno del Impostor de Clance. Los modelos lineales generalizados se construyeron mediante razones de prevalencia estimada brutas y ajustadas. Resultados: De 2.231 estudiantes de Medicina, el 54,3% eran mujeres y el 30,6% padecía IP. Se encontró asociación entre el IP y la depresión (RPa = 1,51; IC95%, 1,27-1,79), la ansiedad (RPa = 2,25; IC95%, 1,75-2,90), el estrés (RPa = 1,37; IC95%, 1,19-1,57) y el sexo mujer (RPa = 1,12; IC95%, 1,01-1,26). Conclusiones: De cada 10 estudiantes de Medicina, 3 sufren IP; tener depresión, ansiedad o estrés, ser mujer y/o cursar el cuarto anno fueron los factores predisponentes.

Objective: To determine the factors associated with impostor syndrome in medical students from six regions of Peru. Material and methods: A multicentre, cross-sectional study was conduced on students from first to the sixth year in six Peruvian regions. Sociodemographic, academic, and psychological characteristics were included through the Depression, Anxiety, and Stress Scale-21, the Rosenberg Self-Esteem Scale and the Clance Imposter Phenomenon Scale. Generalized linear models were performed using crude and adjusted estimated prevalence ratios. Results: Of 2,231 medical students, 54.3% were female and 30.6% had the impostor phenomenon. An association was found between the PI and those who suffered from depression (aPR=1.51; 95%CI, 1.27-1.79), anxiety (aPR = 2.25; 95%CI, 1.75-2.90), stress (aPR=1.37; 95%CI, 1.19-1.57), and being female (aPR = 1.12; 95%CI, 1.01-1.26). Conclusions: Three out of 10 medical students suffer from PI; having some level of depression, anxiety, stress, being a woman, and/or attending the fourth academic year were predisposing factors for their development.

Improving documentation of anticoagulation and antiplatelet recommendations after outpatientendoscopy.

Clear documentation of instructions for resuming anticoagulant and antiplatelet (AC/AP) medications after gastrointestinal endoscopy is essential for high-quality postprocedure care. Yet, these recommendations are frequently absent, which may impact patient safety. We aimed to improve documentation of postprocedural AC/AP instructions through targeted interventions during outpatient endoscopy at a Veterans Affairs Medical Center using validated Quality Improvement methodology. We identified patients on AC/AP agents presenting for outpatient oesophagogastroduodenoscopy or colonoscopy and found restart recommendations were documented in only 59.4% of procedures at baseline. After two intervention cycles, which included provider education, nursing prompts and alterations to endoscopic documentation software, postprocedure documentation increased by 26.7%-86.1% when compared with baseline (p<0.001). These interventions, which require low-resource utilisation, could be part of standardised processes readily implemented at other institutions to help potentially reduce postprocedure patient confusion, medication errors and complications.

Factors associated with the non-use of health services in LGBTI people from Peru. / Factores asociados a la no utilización de servicios de salud en personas LGBTI de Perú.

OBJECTIVE: To determine the factors associated with the non-use of health services in a sample of the lesbian, gay, bisexual, transgender, and intersex population of Peru. MATERIALS AND METHODS: Analytical cross-sectional study, analysis of secondary data from the First LGBTI Survey of Peru. Those who suffered from a medical condition during the last twelve months and had to receive medical attention were considered a variable of interest. Crude prevalence ratios (PRc) and adjusted (PRa), with 95% confidence intervals (95% CI) were calculated using Poisson regressions with robust variance. Three models were developed, adjusted to variables grouped according to sexual orientation, gender identity, and intersexuality. RESULTS: 55.4% were male at birth, the median age was 25 years (IR: 21-30). 16% stated that they had not sought medical attention. The three models presented a negative association in having suffered a chronic disease, infectious, contagious diseases, and mental illness and those who expressed their orientation openly. Not being respected for the gender they identified with was related to not using the services in model 3. Models 1 and 3 included a positive association with not being respected with the gender identified. CONCLUSION: Suffering from a mental illness, an infectious contagious disease, a chronic disease, and not being treated with respect according to their gender identity are factors associated with the non-use of health services.

OBJETIVO: Determinar los factores asociados a la no utilización de servicios de salud en una muestra de la población de lesbianas, gais, bisexuales, transgénero e intersexuales (LGBTI) de Perú. MATERIALES Y MÉTODOS: Estudio transversal analítico, análisis de datos secundarios de la Primera Encuesta LGBTI de Perú. Se tomó como variable de interés a las personas que tuvieron alguna enfermedad durante los últimos doce meses y que tuvieron que recibir atención médica. Se calcularon razones de prevalencias crudas (RPc) y ajustadas (RPa), con intervalos de confianza al 95% (IC   95%), usando regresiones de Poisson con varianza robusta. Se desarrollaron tres modelos, ajustados a variables agrupadas en correspondencia con la orientación sexual, identidad de género e intersexualidad, respectivamente. RESULTADOS: El 55,4% fueron registrados como varones al nacer, la mediana de la edad fue 25 años (Rango intercuartil: 21-30). El 16% manifestó no haber buscado atención médica. Los tres modelos presentaron una asociación negativa respecto de padecer una enfermedad crónica, enfermedad infectocontagiosa, enfermedad mental y en quienes expresaban su orientación abiertamente. El no ser respetados por el género con el que se identificaban estuvo relacionado a no usar los servicios en el modelo 3. Los modelos 1 y 3, incluyeron una asociación positiva con no ser respetados con el género que se identifica. CONCLUSIÓN: Padecer de alguna enfermedad mental, una enfermedad infectocontagiosa y una enfermedad crónica además de no ser tratado con respeto según el género con el que se identifica son factores asociados a la no utilización de los servicios de salud.

Imposter Syndrome and its Associated Factors in Medical Students in Six Peruvian Faculties. / Síndrome del impostor y sus factores asociados en estudiantes de Medicina de seis facultades peruanas.

OBJECTIVE: To determine the factors associated with impostor syndrome in medical students from six regions of Peru. MATERIAL AND METHODS: A multicentre, cross-sectional study was conduced on students from first to the sixth year in six Peruvian regions. Sociodemographic, academic, and psychological characteristics were included through the Depression, Anxiety, and Stress Scale-21, the Rosenberg Self-Esteem Scale and the Clance Imposter Phenomenon Scale. Generalised linear models were performed using crude and adjusted estimated prevalence ratios. RESULTS: Of 2,231 medical students, 54.3% were female and 30.6% had the impostor phenomenon. An association was found between the PI and those who suffered from depression (aPR=1.51; 95%CI, 1.27-1.79), anxiety (aPR=2.25; 95%CI, 1.75-2.90), stress (aPR=1.37; 95%CI, 1.19-1.57), and being female (aPR=1.12; 95%CI, 1.01-1.26). CONCLUSIONS: Three out of 10 medical students suffer from PI; having some level of depression, anxiety, stress, being a woman, and/or attending the fourth academic year were predisposing factors for their development.

Características y factores asociados al maltrato percibido en internos de medicina en Perú / Characteristics and associated factors with mistreatment perception in medical interns in Peru

RESUMEN Objetivo: Determinar las características y factores asociados a la percepción de maltrato en internos de medicina del Perú. Materiales y métodos : Estudio multicéntrico, transversal y analítico. Se encuestaron a internos de medicina de dieciocho hospitales del Perú. Se aplicó una encuesta entre marzo y abril del 2016 que incluían características sociodemográficas y una escala que media la percepción de maltrato psicológico, físico y sexual. Se realizaron modelos lineales generalizados y se estimaron razones de prevalencia crudas y ajustadas (RPa) con intervalos de confianza al 95%. Resultados : Participaron 418 internos de medicina. El maltrato psicológico, físico y sexual percibido fue de 91,9%; 55,5% y 34%, respectivamente. Los factores asociados con el maltrato psicológico fueron proceder de una universidad privada (RPa:1,07; IC95%:1,01- 1,13), respecto al maltrato físico fueron la edad (RPa: 1,08; IC95%: 1,05-1,12), realizar internado en un hospital de la selva (RPa: 1,27; IC95%: 1,03-1,56) y en un hospital del Seguro Social (RPa:0,66; IC95%:0,44-0,94) y para el maltrato sexual el ser mujer (RPa:1,52; IC95%:1,15-2,01). Conclusiones : Existe una alta percepción de maltrato reportado por los internos de medicina siendo el psicológico el más frecuente. Existen diferencias en la percepción de maltrato psicológico y físico según el tipo de financiamiento de la universidad de procedencia y del hospital donde se realiza el internado. Una alta frecuencia de maltrato sexual fue reportada por mujeres luego de los tres primeros meses del internado hospitalario.

ABSTRACT Objective: To determine the characteristics and factors associated with the perception of abuse in medicine interns of Peru. Material and Methods : This is a cross-sectional multicenter and analytical study. Medicine interns from eighteen Peruvian hospitals were interviewed. A survey was administered between March and April 2016, which included socio-demographic characteristics and a scale measuring psychological and physical abuse, as well as sexual harassment perception. Generalized linear models were used and crude and adjusted prevalence rates (aPR) were estimated, with 95% confidence intervals (CI). Results: 418 medical interns participated in the study. Psychological and physical abuses were perceived by 91,9% and 55,5% of the studied population. Sexual harassment was perceived by 34% of all interviewed interns. Associated factors with psychological abuse were studied in a private university (aPR: 1.07; 95% CI: 1.01-1.13). Factors associated with physical abuse were age (aPR: 1.08; 95% IC: 1.05-1.12), performing internship in an Amazonian area hospital (aPR: 1,27; 95% CI: 1,03-1,56), and in a Social Security Hospital (aPR: 0,66; 95% CI: 0,44-0,94); and for sexual harassment, being female was the main associated factor (aPR: 1,52; 95% CI: 1,15-2,01). Conclusions: There is a high perception of abuse experienced by medicine interns, being psychological abuse the most frequent condition. There are some differences in the perception of psychological and physical abuse, according to the medical school the interns come from, as well as with respect to the healthcare facility where internship is performed. A high frequency of sexual harassment was reported by female interns after three months of having started their training period.

Factores asociados a la no utilización de servicios de salud en personas LGBTI de Perú

Objetivo: Determinar los factores asociados a la no utilización de servicios de salud en una muestra de la población de lesbianas, gais, bisexuales, transgénero e intersexuales (LGBTI) de Perú. Materiales y métodos: Estudio transversal analítico, análisis de datos secundarios de la Primera Encuesta LGBTI de Perú. Se tomó como variable de interés a las personas que tuvieron alguna enfermedad durante los últimos doce meses y que tuvieron que recibir atención médica. Se calcularon razones de prevalencias crudas (RPc) y ajustadas (RPa), con intervalos de confianza al 95% (IC 95%), usando regresiones de Poisson con varianza robusta. Se desarrollaron tres modelos, ajustados a variables agrupadas en correspondencia con la orientación sexual, identidad de género e intersexualidad, respectivamente. Resultados: El 55,4% fueron registrados como varones al nacer, la mediana de la edad fue 25 años (Rango intercuartil: 21-30). El 16% manifestó no haber buscado atención médica. Los tres modelos presentaron una asociación negativa respecto de padecer una enfermedad crónica, enfermedad infectocontagiosa, enfermedad mental y en quienes expresaban su orientación abiertamente. El no ser respetados por el género con el que se identificaban estuvo relacionado a no usar los servicios en el modelo 3. Los modelos 1 y 3, incluyeron una asociación positiva con no ser respetados con el género que se identifica. Conclusión: Padecer de alguna enfermedad mental, una enfermedad infectocontagiosa y una enfermedad crónica además de no ser tratado con respeto según el género con el que se identifica son factores asociados a la no utilización de los servicios de salud.

Objective: To determine the factors associated with the non-use of health services in a sample of the lesbian, gay, bisexual, transgender, and intersex population of Peru. Materials and methods: Analytical cross-sectional study, analysis of secondary data from the First LGBTI Survey of Peru. Those who suffered from a medical condition during the last twelve months and had to receive medical attention were considered a variable of interest. Crude prevalence ratios (PRc) and adjusted (PRa), with 95% confidence intervals (95% CI) were calculated using Poisson regressions with robust variance. Three models were developed, adjusted to variables grouped according to sexual orientation, gender identity, and intersexuality. Results: 55.4% were male at birth, the median age was 25 years (IR: 21-30). 16% stated that they had not sought medical attention. The three models presented a negative association in having suffered a chronic disease, infectious, contagious diseases, and mental illness and those who expressed their orientation openly. Not being respected for the gender they identified with was related to not using the services in model 3. Models 1 and 3 included a positive association with not being respected with the gender identified. Conclusion: Suffering from a mental illness, an infectious contagious disease, a chronic disease, and not being treated with respect according to their gender identity are factors associated with the non-use of health services.

Esophageal contractile segment impedance from high-resolution impedance manometry correlates with mean nocturnal baseline impedance and acid exposure time from 24-hour pH-impedance monitoring.

Esophageal baseline impedance (BI) acquired during esophageal contraction (contractile segment impedance [CSI]) is proposed to improve BI accuracy in gastroesophageal reflux disease (GERD). We evaluated associations between CSI and conventional and novel GERD metrics. We analyzed high-resolution impedance manometry (HRIM) and ambulatory pH-impedance studies from 51 patients (58.6 ± 1.5 years; 26% F) with GERD symptoms studied off antisecretory therapy. Patients with achalasia or absent contractility were excluded. CSI (averaged across 10 swallows) and BI-HRIM (from the resting landmark phase) were acquired from the distal impedance sensors (distal sensor and 5 cm above the lower esophageal sphincter). Acid exposure time (AET) and mean nocturnal baseline impedance (MNBI) were calculated. Associations between CSI, BI-HRIM, MNBI, and AET were evaluated using correlation (Pearson) and receiver operating characteristic (ROC) analysis. Presenting symptoms included heartburn (67%), regurgitation (12%), cough (12%), and chest pain (10%). CSI-distal and CSI-5 each correlated with BI-HRIM, AET, and distal MNBI. Associations with AET were numerically stronger for CSI-distal (r = -0.46) and BI-HRIM-distal (r = -0.44) than CSI-5 (r = -0.33), BI-HRIM-5 (r = -0.28), or distal MNBI (r < -0.36). When compared to AET <4%, patients with AET >6% had significantly lower CSI-distal and BI-HRIM-distal values but not CSI-5, BI-HRIM-5, or MNBI. ROC areas under the curve for AET >6% were numerically higher for CSI-distal (0.81) than BI-HRIM-distal (0.77), distal MNBI (0.68-0.75), CSI-5 (0.68), or BI-HRIM-5 (0.68). CSI from HRIM studies inversely correlates with pathologic AET and has potential to augment the evaluation of GERD.

Depression and Abuse During Medical Internships in Peruvian Hospitals / Depresión y maltrato en internos de Medicina de hospitales peruanos

ABSTRACT Objective: To estimate the prevalence of depression and abuse and identify the associated factors in medical interns in Peruvian hospitals. Methods: We conducted a multicentre, cross-sectional and analytical study during the months of March to May 2016. We included medical interns from 18 Peruvian hospitals, in Lima and provinces. We used a survey that included sociodemographic data and a scale to measure the perception of abuse (psychological, physical and sexual). In addition, we used the Spanish version of the PHQ-9 to evaluate depression. We used Poisson regression with robust variances to calculate prevalence ratios (PRs). Results: A total of 402 medical interns participated in the study, the median age was 25 [IQR: 21-33], and 52.7% were male. Moreover, 25.4% of them suffered from depression. In the adjusted model, the variables associated with depression were age (PRa = 1.15), the number of hours they sleep per day (PRa = 1.23), being a woman (PRa = 3.33), performing the internship in a province (PRa = 0.25), studying at a public university (PRa = 0.64), living with parents (PRa = 0.65) or alone (PRa = 0.33), and having perceived some type of abuse (PRa = 1.07). Conclusions: A quarter of surveyed medical interns had depression. Early screening is necessary to identify perceived abuse and other triggering depression factors that may adversely affect work performance and overall mental health during medical internships.

RESUMEN Objetivo: Estimar la prevalencia de depresión y maltrato e identificar sus factores asociados en los internos de Medicina de los hospitales peruanos. Métodos: Estudio multicéntrico, transversal y analítico, llevado a cabo durante los meses de marzo a mayo de 2016. Conformaron la población los internos de Medicina en 18 sedes hospitalarias de Lima y provincias. Se aplicó una encuesta que incluía características sociodemográficas y una escala para medir la percepción de maltrato (psicológico, físico y sexual). Asimismo, para evaluar la depresión, se usó el cuestionario PHQ-9 en su versión en español. Se usó regresión de Poisson con varianzas robustas para calcular las razones de prevalencia (RP). Resultados: Participaron 402 internos de Medicina; la mediana de edad fue 25 [intervalo intercuartílico, 21-33] años y el 52,7% eran varones. Además, el 25,4% padecía depresión. En el modelo ajustado, las variables asociadas con padecer depresión son edad (RPa = 1,15), cuántas horas duermen durante el día (RPa = 1,23), ser mujer (RPa = 3,33), realizar el internado en provincia (RPa = 0,25), estudiar en una universidad pública (RPa = 0,64), vivir con sus padres (RPa = 0,65) o solo (RPa = 0,33) y percibir algún tipo de maltrato (RPa = 1,07). Conclusiones: La cuarta parte de los internos encuestados tenían depresión. Es necesario realizar un cribado temprano para identificar posibles maltratos percibidos y otros factores desencadenantes de depresión, y así evitar repercusiones negativas en el desempeño laboral y la salud mental general durante el internado médico.

Depression and Abuse During Medical Internships in Peruvian Hospitals.

OBJECTIVE: To estimate the prevalence of depression and abuse and identify the associated factors in medical interns in Peruvian hospitals. METHODS: We conducted a multicentre, cross-sectional and analytical study during the months of March to May 2016. We included medical interns from 18 Peruvian hospitals, in Lima and provinces. We used a survey that included sociodemographic data and a scale to measure the perception of abuse (psychological, physical and sexual). In addition, we used the Spanish version of the PHQ-9 to evaluate depression. We used Poisson regression with robust variances to calculate prevalence ratios (PRs). RESULTS: A total of 402 medical interns participated in the study, the median age was 25 [IQR: 21-33], and 52.7% were male. Moreover, 25.4% of them suffered from depression. In the adjusted model, the variables associated with depression were age (PRa=1.15), the number of hours they sleep per day (PRa=1.23), being a woman (PRa=3.33), performing the internship in a province (PRa=0.25), studying at a public university (PRa=0.64), living with parents (PRa=0.65) or alone (PRa=0.33), and having perceived some type of abuse (PRa=1.07). CONCLUSIONS: A quarter of surveyed medical interns had depression. Early screening is necessary to identify perceived abuse and other triggering depression factors that may adversely affect work performance and overall mental health during medical internships.

Reutilización de respiradores N95: estrategias de descontaminación aplicables en la pandemia de COVID 19 en Perú / Reusing N95 Respirators: decontamination strategies applicable in COVID-19 pandemics in Peru

RESUMEN El virus SARS-CoV-2 o virus del COVID-19, considerado como emergencia internacional de salud pública, fue declarada posteriormente como una pandemia. Debido a la alta propagación del virus del COVID-19 por medio de droplets, la demanda de los equipos de protección personal (EPP) para el personal de salud ha sido notable, en especial el de los respiradores. Por ende, se hace importante conocer los métodos de descontaminación considerados para su aplicación en nuestro medio; teniendo en cuenta el uso adecuado de medidas de asepsia y antisepsia, garantizando a su vez la integridad del respirador (correas, puente nasal y material de espuma nasal) y contando con el proceso natural de degradación. Los métodos adecuados de desinfección en respiradores descritos son: el uso de hornos esterilizadores (calor seco), autoclave (vapor), radiación ultravioleta (UV) y vaporizadores caseros (olla arrocera con vaporizador). Estos métodos deben ser empleados acordes a las necesidades del personal de salud.

ABSTRACT The SARS-CoV-2 virus, also called COVID-19, was initially considered as an international public health emergency, and later it was declared as a pandemic. Due to the high spread of COVID-19 through droplets, the demand for personal protective equipment (PPE) for healthcare professionals has been remarkable, particularly filtering face-piece particulate respirators. Therefore, it is important to know the decontamination methods proposed for their application in our environment, considering the proper asepsis and antisepsis measures to be used, and also on how to preserve the integrity of the device (straps, nasal bridge and nasal foam material) and counting on its natural degradation process. Adequate methods for disinfecting these devices are as follows: using sterilizing ovens (dry heat), autoclave (steam), ultraviolet radiation (UV) and homemade vaporizers, which should be used according to the needs of the healthcare professionals.

Factores asociados a la realización de actividades de autocuidado en pacientes diabéticos en tres hospitales de Ucayali / Factors Associated With The Performance Of Self-Care Activities In Diabetic Patients In Three Ucayali Hospitals

Objetivo: Determinar cuáles son los factores asociados a la realización de actividades de autocuidado en pacientes diabéticos en tres hospitales de la región de Ucayali durante el 2017. Métodos: Estudio transversal analítico, realizado en tres hospitales en Ucayali en el 2017. La encuesta autoadministrada contó con tres secciones que evaluaban las características generales de los pacientes, los conocimientos a través del Diabetes Knowledge Questionnaire 24 (DKQ­24), la actitud del paciente frente a su enfermedad mediante la Diabetes Attitude Scale (DAS­3) y Summary of Diabetes Self Care Activities Measure (SDSCA) para medir las prácticas de autocuidado. Resultados: La población de estudio estuvo conformada por 572 pacientes, el 50,87% correspondía al sexo femenino, la mediana de la edad fue de 47 años, el 37,57% tenía grado universitario. Se presentaron actividades de autocuidado inadecuadas con respecto al control glucémico y ejercicio con 83,87% y 77,87% respectivamente. Se observó que quienes contaron con un adecuado conocimiento y tuvieron un control estricto contaron con una adecuada adherencia respecto a la dieta de los pacientes diabéticos. Con respecto a realizar ejercicio se pudo determinar que existía una correlación negativa respecto al tiempo de enfermedad del paciente. Asimismo, se determinó que los pacientes con estudios secundarios, técnicos y universitarios presentaban una correlación negativa respecto al control glucémico. Conclusión: Más de la mitad de los pacientes realizaban actividades de autocuidado inadecuados. Además, un adecuado nivel de conocimiento y un control estricto sobre su enfermedad influencian en la adherencia a una buena dieta del paciente.

Objective: To determine which are the factors associated with self-care activities in diabetic patients in three hospitals in the Ucayali region during 2017. Methods: Analytical cross-sectional study, carried out in three hospitals in Ucayali in 2017. The survey self-administered had three sections that assess the general characteristics of the patients, knowledge through the diabetes knowledge questionnaire 24 (DKQ­24), the patient's attitude towards their disease using the diabetes attitude scale (DAS - 3) and Summary of Diabetes Self-Care Activities Measurement (SDSCA) to measure self-care practices. Results: The study population consisted of 572 patients, 50.87% were female, the median age was 47 years old, 37.57% had a university degree. Inadequate self-care activities with respect to glycemic control and exercise were performed with 83.87% and 77.87% respectively. We consider that those who have adequate knowledge and have strict control to have adequate adherence to the diet of diabetic patients. Regarding exercise, it was possible to determine that there is a negative correlation with respect to the patient's illness time. Likewise, it was determined that patients with secondary, technical and university studies had a negative correlation with respect to glycemic control. Conclusion: More than half of the patients carried out inadequate self-care activities. Furthermore, an adequate level of knowledge and strict control over their disease influence the patient's adherence to a good diet

Síndrome de Burnout en médicos de un hospital de la amazonía peruana / Burnout Syndrome in physicians of a hospital in the peruvian amazon

Objetivo: Determinar el Síndrome de Burnout (SBO) en médicos cirujanos de los consultorios externos de un hospital de la Amazonía peruana. Métodos: Estudio transversal analítico; que incluyó a 30 médicos cirujanos que atendieron en los consultorios externos de las especialidades de Medicina, Cirugía, Gineco-Obstetricia y Pediatría del Hospital Regional de Pucallpa, determinando el agotamiento profesional mediante el Inventario de Burnout de Maslach (MBI) y la percepción de la relación médico paciente mediante la escala PREMEPA. Se emplearon modelos lineales generalizados para evaluar razones de prevalencia cruda y ajustada. Resultados:El 76,7% de los médicos fueron varones, ocho de cada diez padecieron SBO. El 20% de los pacientes estuvieron satisfechos con la consulta y sólo el 16,7% indicó tener una mediana relación médico paciente. Se encontró asociación estadísticamente significativa entre quienes padecían SBO y se atendieron en las consultas externas de los servicios de cirugía (RPa: 1.46; IC 95%: 1.20­1.76) , gineco obstetricia (RPa: 1.69; IC 95%: 1.41­2.03) o en aquellos pacientes que se encontraban insatisfechos con la consulta brindada (RPa: 1.59; IC 95%: 1.22-2.07), el haber realizado el residentado médico fue un factor protector a desarrollar SBO (RPa: 0.62; IC 95%: 0.62­0.77). Conclusión: Los pacientes manifiestan tener niveles adecuados de relación médico-paciente a pesar del elevado índice de SBO en médicos, las especialidades quirúrgicas predisponen a desarrollar Burnout.

Objective: To determine Burnout Syndrome (SBO) in physicians treated in the outpatients clinic of a hospital in the Peruvian Amazon during 2017. Methods: Analytical cross-sectional study; which included 30 medical surgeons who attended in the external offices of the specialties of Internal Medicine, General Gynecology and Pediatric Surgery of the Regional Hospital of Pucallpa, professional exhaustion was determined through the Maslach Burnout Inventory (MBI) and the perception of the patient-doctor relationship using the scale (PREMEPA). Generalized linear models were performed by prevalence ratios crude and adjusted estimated with a 95% confidence interval. Results: 76.7% of the doctors were male, eight out of ten suffered Burnout. 20% of the patients were satisfied and only 16.7% indicated they had a median physician-patient medical relationship. Statistically significant association was found among those suffering from Burnout and the outpatient offices were treated of surgery services (RPa: 1.46; 95% CI: 1.20­1.76), obstetric gynecology (RPa: 1.69; 95% CI: 1.41­2.03) or in those patients who were dissatisfied with the consultation provided (RPa: 1.59; 95% CI: 1.22-2.07), having medical residency was a protective factor to develop Burnout (RPa: 0.62; 95% CI: 0.62­ 0.77). Conclusion: Patients claim to have adequate levels of physician-patient relationship despite the high rate of doctors suffering from Burnout, surgical specialties predispose doctors to develop Burnout. However, having performed medical residency predisposed the doctor to have less Burnout Syndrome.

Conocimientos sobre emergencias médicas en estudiantes de Medicina de la Universidad Nacional de Ucayali / Knowledge about medical emergencies among medical students from the National University of Ucayali

Introducción: El manejo oportuno de las emergencias médicas resulta fundamental si se tiene en cuenta que constituyen eventos cuyas consecuencias inmediatas representan un riesgo para la vida. Objetivo: Evaluar los conocimientos sobre emergencias médicas en estudiantes de Medicina de la Universidad Nacional de Ucayali, Perú. Métodos: Estudio analítico transversal. Se evaluaron 243 estudiantes del primero al sexto años de la Facultad de Medicina Humana de la Universidad Nacional de Ucayali. Se utilizó un instrumento previamente validado que contaba con 10 reactivos, que calificaron el nivel de respuesta inmediata ante una emergencia médica. Resultados: El 54,2 por ciento (n = 129) fue de sexo femenino y el 61,8 por ciento (n = 84) cursaba ciencias básicas. Asimismo, el 35,5 por ciento (n = 84) de los encuestados aprobaron el test. Los factores asociados a la aprobación del test se asociaron con estar cursando el segundo (RPa:4.88; IC 95 por ciento: 1,80-13,27), tercero (RPa: 3,14; IC 95 por ciento: 1,08-9,17), cuarto (RPa: 5,16; IC 95 por ciento: 1,85-14,37), quinto (RPa: 4,86; IC 95 por ciento: 1,77-13,37) y sexto (RPa: 4,49; IC 95 por ciento: 1,61-12,54) años de Medicina; y haber desaprobado algún curso (RPa: 1,39; IC 95 por ciento: 1,02-1,94) y realizado anteriormente algún curso de reanimación cardiopulmonar (RPa: 1,42; IC 95 por ciento:1,02-1,98). Conclusiones: Menos de la mitad de los encuestados tenía conocimientos adecuados sobre la atención inmediata de emergencias médicas. Las variables asociadas a un mejor nivel de conocimientos fueron el estar cursando algún año de estudio diferente al primero y el haber llevado algún curso de reanimación cardiopulmonar(AU)

Introduction: Timely management of medical emergencies is crucial, since the immediate consequences of those events may pose a threat to life. Objective: Evaluate the knowledge about medical emergencies among medical students from the National University of Ucayali, Peru. Methods: An analytical cross-sectional study was conducted. The study sample was 243 first-to-sixth-year students from the School of Human Medicine of the National University of Ucayali. A previously validated tool was used which included ten variables ranking the level of immediate response to a medical emergency. Results: 54.2 percent (n = 129) of the sample were female and 61.8 percent (n = 84) studied basic sciences. 35.5 percent (n = 84) of the respondents passed the test. The factors associated to passing the test were the following: being in second year (RPa: 4.88; CI 95 percent: 1.80-13.27), third year (RPa: 3.14; CI 95 percent: 1.08-9.17), fourth year (RPa: 5.16; CI 95 percent: 1.85-14.37), fifth year (RPa: 4.86; CI 95 percent: 1.77-13.37) or sixth year (RPa: 4.49; CI 95 percent: 1.61-12.54) of medical school, having failed a course (RPa: 1.39; CI 95 percent: 1.02-1.94) or having attended a cardiopulmonary resuscitation course (RPa: 1.42; CI 95 percent: 1.02-1.98). Conclusions: Less than half of the respondents had appropriate knowledge about immediate management of medical emergencies. The variables associated to a better level of knowledge were being attending a school year other than the first and having attended a cardiopulmonary resuscitation course(AU)

Alcohol consumption and suicide risk in medical internship: A Peruvian multicentric study.

INTRODUCTION AND AIM: Suicide and harmful alcohol consumption are major health problems, especially in medical students. This study aimed to evaluate the association between risk for alcohol abuse and suicide risk in medical interns of Peruvian hospitals. DESIGN AND METHODS: We conducted a multicentre cross-sectional study in medical interns from 18 Peruvian hospitals. We measured suicide risk, risk for alcohol abuse, depression and self-esteem using the Plutchik Suicide Risk Scale, CAGE, Zung Self-Rating Depression Scale and Rosenberg Self-Esteem Scale, respectively. We used χ2 and Student t-tests for descriptive analysis. To evaluate the association between risk for alcohol abuse and suicide risk we generated crude and adjusted Poisson regression models with robust variance and estimated prevalence ratios with 95% confidence intervals. RESULTS: We surveyed 433 medical interns. The prevalence of suicide risk and risk for alcohol abuse was 19.6% and 27.5%, respectively. We found significant differences in suicide risk according to age (P < 0.001), region of origin (P = 0.002), with whom the participant lived (P < 0.001), university of origin (P = 0.040), type of hospital (P = 0.042), family history of attempted suicide (P = 0.043), self-esteem level (P < 0.001) and alcohol consumption (P < 0.001). In the adjusted model, age (PRa: 1.11, 95% confidence interval 1.05-1.17) and risk for alcohol abuse (PRa: 7.60, 95% confidence interval 4.46-12, 96) were associated with suicide risk. DISCUSSION AND CONCLUSIONS: Two out of 10 medical interns had a positive screening for suicide risk. Age and especially risk for alcohol abuse were the associated variables.