Factores asociados a la mala adherencia al tratamiento antirretroviral en pacientes VIH positivo

Introducción: La infección por el virus de inmunodeficiencia humana representa un problema de salud pública en el mundo. La adherencia a la terapia antirretroviral es necesaria para alcanzar un estado de supresión viral máxima y disminuir la tasa de infecciones oportunistas. Sin embargo, diversos son los factores que pueden influir en la adherencia terapéutica. Objetivo: Identificar los factores de riesgo asociados a la mala adherencia a la terapia antirretroviral en pacientes con el virus de inmunodeficiencia humana. Métodos: Se empleó un estudio con diseño observacional, analítico, de tipo casos y controles. El tamaño muestral fue de 276, a partir del cual 138 fueron casos y 138 controles. Los datos recolectados fueron analizados utilizando métodos de estadística descriptiva y estadística inferencial. Resultados: El análisis multivariado determinó una asociación estadísticamente significativa entre la variable adherencia al tratamiento antirretroviral y las variables depresión (odds ratio OR ajustado= 2,15), esquema de terapia antirretroviral alternativo (OR ajustado= 2,40), efectos secundarios (OR ajustado= 4,24) y cambio en la adherencia durante el estado de emergencia (OR ajustado= 5,67), independientemente de las otras variables intervinientes. Conclusiones: La depresión, el uso del esquema de terapia antirretroviral alternativo, la presencia de efectos secundarios a terapia antirretroviral y el cambio en la adherencia durante el estado de emergencia aumentan el riesgo de mala adherencia a la terapia antirretroviral.

Introduction: Human immunodeficiency virus infection represents a public health public problem in the world. Adherence to antiretroviral therapy is necessary to achieve a state of maximum viral suppression and decrease the rate of opportunistic infections. However, there are several factors that can influence therapeutic adherence. Objective: To identify the risk factors associated with poor adherence to antiretroviral therapy in patients with the human immunodeficiency virus. Methods: A study with an observational, analytical, case-control type design was used. The sample size was 276, from which 138 were cases and 138 controls. The collected data was analyzed using methods of descriptive statistics and inferential statistics. Results: The multivariate analysis determined a statistically significant association between the variable adherence to antiretroviral treatment and the variables depression (adjusted Odds Ratio OR = 2.15), alternative antiretroviral therapy scheme (adjusted OR= 2.40), side effects (adjusted OR= 4.24), and change in adherence during the state of emergency (adjusted OR= 5.67) independently of the other intervening variables. Conclusions: Depression, the use of alternative antiretroviral therapy regimens, the presence of side effects to antiretroviral therapy, and the change in adherence during the state of emergency increase the risk of poor adherence to antiretroviral therapy.

IgA Vasculitis Followed by IgA Nephropathy Without an Identifiable Trigger: The Same Disease or a Spectrum of Related Conditions?

IgA vasculitis and IgA nephropathy are characterized by IgA deposition in blood vessels and glomerular mesangium, respectively. The former is far more common in the pediatric population, while the latter presents more often in adulthood. A consensus regarding whether these two conditions are manifestations of the same disease that occurs on a spectrum has not yet been reached, and, to our knowledge, no clinical trials to address this question have been conducted. Here, we describe a 27-year-old patient who presented to the emergency department multiple times before being diagnosed with IgA vasculitis with no identifiable trigger and soon after developed IgA nephropathy. This case highlights the importance of ruling out these conditions, especially IgA vasculitis, in adults presenting with a petechial rash, but also the need for studies that investigate whether and how these conditions are related so that patients can be appropriately diagnosed and treated as efficiently as possible.

Impacts of snow-farming on alpine soil and vegetation: A case study from the Swiss Alps.

Snow-farming is one of the adaptive strategies used to face the snow deficit in ski resorts. We studied the impact of a shifting snow-farming technique on a pasture slope in Adelboden, Switzerland. Specifically, we compared plots covered by a compressed snow pile for 1.5, 2.5 or 3.5 years, which then recovered from the snow cover for three, two or one vegetation seasons, respectively, with control plots situated around the snow pile. In plots with >1.5 years of compressed snow pile, plant mortality was high, recovery of vegetation was very slow, and few plant species recolonized the bare surface. Soil biological activity decreased persistently under prolonged snow cover, as indicated by reduced soil respiration. The prolonged absence of fresh plant litter and root exudates led to carbon (C) limitation for soil microbial respiration, which resulted in a significant decrease in the ratio of total organic carbon to total nitrogen (TOC/TN) under the snow pile. Microbial C, nitrogen (N) and phosphorus (P) immobilization decreased, while dissolved N concentration increased with compressed snow cover. Longer snow cover and a subsequent shorter recovery period led to higher microbial C/P and N/P but lower microbial C/N. Nitrate and ammonium were released massively once the biological activity resumed after snow clearance and soil aeration. The soil microbial community composition persistently shifted towards oxygen-limited microbes with prolonged compressed snow cover. This shift reflected declines in the abundance of sensitive microorganisms, such as plant-associated symbionts, due to plant mortality or root die-off. In parallel, resistant taxa that benefit from environmental changes increased, including facultative anaerobic bacteria (Bacteroidota, Chloroflexota), obligate anaerobes (Euryarchaeota), and saprophytic plant degraders. We recommend keeping snow piles in the same spot year after year to minimize the area of the impacted soil surface and plan from the beginning soil and ecosystem restoration measures.

Factores asociados a dolor lumbar en trabajadores sanitarios de un hospital de referencia del Perú

Introducción: El dolor lumbar es una condición inevitable en todo el personal del rubro de la salud, con llevando desde malestar físico hasta una incapacidad funcional del individuo. Objetivo: Determinar los factores asociados a dolor lumbar entre los trabajadores sanitarios en un hospital de referencia del Perú. Metodología: El presente estudio es observacional, analítico, de corte transversal, temporalmente prospectivo, con muestreo no probabilístico. La población estuvo conformada por trabajadores sanitarios del Hospital Santa Rosa de Pueblo Libre durante el periodo de junio a diciembre del año 2022. Resultados: El análisis multivariado determinó que el ser hombre (OR: 2.818, p valor: 0.017), tener sobrepeso (OR:1.782, p valor: 0.013), demanda laboral alta (OR: 4.750, p valor: 0.026), realizar actividad física (OR: 3.610, p valor: 0.031) y tener antecedentes de trauma lumbar (OR: 2.423, p valor: 0.034), fueron factores estadísticamente significativos que se asociaron al dolor lumbar. Discusión: Se pudo observar que, los factores asociados a dolor lumbar fueron el sexo masculino, el sobrepeso, la demanda laboral alta, el realizar actividad física y el antecedente de trauma lumbar. Conocer estas variables permitirá realizar esquemas y charlas preventivas para afrontar esta recurrente patología.

Introduction: Low back pain is an unavoidable condition in all health personnel, ranging from physical discomfort to functional disability of the individual. Objective: To determine the factors associated with low back pain among health workers at a reference hospital in Peru. Methods: This study is observational, analytical, cross-sectional, temporally prospective, with non-probabilistic sampling. The population was made up of health workers from the Hospital Santa Rosa de Pueblo Libre during the period from June to December of the year 2022. Results: The multivariate analysis determined that being a man (OR: 2.818, p value: 0.017), being overweight (OR:1.782, p value: 0.013), high labor demand (OR: 4.750, p value: 0.026), performing physical (OR: 3.610, p value: 0.031) and having a history of low back trauma (OR: 2.423, p value: 0.034) were statistically significant factors associated with low back pain. Discussion: It was possible to observe that the factors associated with low back pain were the male sex, being overweight, high work demand, physical activity and a history of low back trauma. Knowing these variables will make it possible to carry out preventive schemes and talks to deal with this recurring pathology.

An Unusual Case of Lung Adenocarcinoma Metastasis to the Tricep Muscle: Four Years Disease-Free After Surgical Resection and Radiotherapy.

Lung cancer is one of the leading causes of cancer-related death worldwide. Lung cancer commonly metastasizes to the liver, bone, and brain, but metastasis to skeletal muscles is rare. The development of metastasis in skeletal muscles indicates stage IV disease with a poor prognosis. The most effective treatment strategy is unclear. Palliative radiotherapy is often used to treat skeletal muscle metastases, and patient survival is poor, with an average survival of one year. Here we discuss the case of a 76-year-old female diagnosed with lung adenocarcinoma with metastasis to the trapezius muscle. Initially, she was treated with stereotactic body radiotherapy for stage T1 lung adenocarcinoma. Her follow-up surveillance positron emission tomography (PET) scan in 11 months showed an abnormal focal area of increased activity localizing to the long head of the right triceps muscle. The diagnosis was confirmed with an ultrasound-guided biopsy of the trapezius muscle. Following that, the patient underwent wedge resection of the right middle and upper lobe of the lung and partial right trapezius resection. Afterward, she was given radiation therapy at the tricep resection site. She remained disease-free for four years after excision and radiation therapy.

Chronic Atypical Neutrophilic Dermatosis With Lipodystrophy and Elevated Temperature Syndrome: A Systemic Review.

BACKGROUND: Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature syndrome is a rare, hereditary, autoinflammatory disease. However, there are few cases reported in the literature. Therefore, we conduct this systematic review to summarize current evidence. METHODS: We conducted a systematic search in July 2021 using 11 different electronic databases. The included articles were screened according to our inclusion and exclusion criteria and assessed using an appropriate quality assessment tool. Then, the relevant data were extracted and summarized in tables accordingly. Each step of the previous one was done by 3 independent reviewers, and the conflicts were resolved by discussion and sometimes by counseling a senior member. RESULTS: The final included studies were 18 articles with 34 cases (mean age = 8 years, male/female = 19/15). The most reported symptoms and signs were fever 97.1%, erythematous plaques 76.5%, arthralgia 67.6%, hepatomegaly 61.8%, violaceous hue 61.8%, lipodystrophy in extremities 53.1% in addition to low weight and height. Rare features were reported too. The laboratories were not specific, which may be explained by a systemic inflammatory response. Vasculitis was the dominant feature in the skin biopsy, whereas the calcification in the basal ganglia was a prominent sign in many cases. CONCLUSIONS: Fever, skin lesions, and systemic inflammatory response were the prominent features of chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature syndrome. The clinical picture is the main guide in addition to the pathological findings. Mutation detection is the confirmatory test. Prednisolone is the most effective reported treatment for acute presentations in the literature.

Utilidad de la proteína C-reactiva para determinar la gravedad de infección por SARS-CoV-2 en Perú / Usefulness of C-reactive protein to determine the severity of SARS-CoV-2 infection in Peru

INTRODUCCIÓN: En los últimos años se han estudiado diversos biomarcadores para determinar los casos graves de COVID-19. La proteína C-reactiva (PCR) ha mostrado alta sensibilidad en la identificación de pacientes con enfermedad grave y utilidad comparable a la tomografía. OBJETIVO: Determinar la utilidad de la PCR para predecir gravedad de la infección por SARS-CoV-2 en pacientes hospitalizados en el Centro Médico Naval del Perú durante el periodo enero-septiembre del año 2021. MÉTODOS: Se empleó un diseño de tipo cuantitativo, observacional, analítico, retrospectivo, y de tipo prueba diagnóstica. Se calculó un tamaño muestral de 503 pacientes, quienes fueron divididos en dos grupos de acuerdo a su gravedad. RESULTADOS: Se determinó un punto de corte óptimo de 10,92 mg/L de los valores de PCR para el diagnóstico de enfermedad grave por COVID-19. Se calculó un área bajo la curva (AUC) de 0,762 y se obtuvieron valores de sensibilidad, especificidad, valores predictores positivo, negativo y precisión diagnóstica de 78,88%, 66,4%; 41,42%; 87,01%; y 67,27%, respectivamente. El normograma de Fagan mostró una probabilidad posprueba de 41%. En el modelo ajustado fueron significativas la PCR (ORa = 4,853; IC95% 2,987-7,886; p = 0,001), además de la ferritina (ORa = 1,001; IC 95%: 1,001-1,002; p = 0,001) e hipotiroidismo (OR ajustado = 4,899; IC 95%: 1,272-18,872; p = 0,021). CONCLUSIONES: El presente estudio mostró la asociación entre la PCR y la gravedad de infección por SARS-CoV-2 en un modelo ajustado, mostrando su potencial utilidad y contribuyendo a determinar el punto de corte de la PCR en población peruana y su comparación a nivel internacional.

BACKGROUND: Recently, many biomarkers have been studied to determine severe cases of COVID-19. C-reactive protein (CRP) has shown high sensitivity in identifying patients with severe disease and utility comparable to computed tomography. AIM: To determine the usefulness of CRP to predict the severity of SARS-CoV-2 infection in patients hospitalized at the Naval Medical Center of Peru during the period January-September in the year 2021. METHODS: A quantitative, observational, analytical, retrospective, and diagnostic test type design was used. A sample size of 503 patients was calculated, which were divided into two groups according to their severity. RESULTS: An optimal cut-off point of 10.92 mg/L for CRP levels was determined for the diagnosis of severe COVID-19. An area under the curve (AUC) of 0.762 was calculated and sensitivity, specificity, positive and negative predictive values and diagnostic accuracy values of 78.88%, 66.4%; 41.42%; 87.01%; and 67.27%; respectively. Fagan's normogram showed a post-test probability of 41%. In the adjusted model, CRP (aOR = 4.853; 95% CI 2.987-7.886; p = 0.001), ferritin (aOR = 1.001; 95% CI: 1.001-1.002; p = 0.001) and hypothyroidism (adjusted OR = 4899; 95% CI: 1272-18872; p = 0.021) showed significance. CONCLUSIONS: The present study showed an association between CRP and the severity of SARS-CoV-2 infection in an adjusted model, showing its potential utility and contributing to determine the cut-off point of CRP in the Peruvian population and its international comparison.

Rootstock increases the physiological defence of tomato plants against Pseudomonas syringae pv. tomato infection.

Climate change has intensified the infection of tomato plants by pathogens such as Pseudomonas syringae pv. tomato (Pst). Rootstocks may increase plant tolerance to leaf phytopathogens. The aim of this study was to evaluate the effects of the tolerant Poncho Negro (R) tomato rootstock on physiological defence and the role of hydrogen sulfide (H2S) in susceptible Limachino (L) tomato plant responses to Pst attack. Ungrafted (L), self-grafted (L/L), and grafted (L/R) plants were infected with Pst. Rootstock increased the concentration of antioxidant compounds including ascorbate in the scion. Tolerant rootstock induced an increase of H2S in the scion, which correlated with enhanced expression of the SlAPX2 gene. A high accumulation of salicylic acid was observed in Pst-inoculated grafted L/L and L/R plants, but this was higher in L/R plants. The increase of H2S during Pst infection was associated with a reduction of ethylene in L/R plants. Our study indicates that the Poncho Negro rootstock reduced the symptoms of bacterial speck disease in the Limachino tomato plants, conferring tolerance to Pst infection. This study provides new knowledge about the impact of rootstock in the defence of tomato plants against leaf pathogens that could be used in sustainable management of tomato cultivation.

Epidemiological-clinical characteristics and results of appendiceal plastron management in adult patients from a reference hospital in Peru / Características epidemiológico-clínicas y resultados del manejo de plastrón apendicular en pacientes adultos de un hospital de referencia del Perú

Introduction: Appendicular plastron is considered a progressive form of acute appendicitis, with a national prevalence of 2-10%. Currently management is often controversial. It is that from this context, it seeks to promote studies that can elucidate the variables associated with the management of this condition. Objective: to determine the epidemiological-clinical characteristics associated with the results of the management of the appendiceal plastron in adult patients in a reference hospital in Peru. Methods: Non-experimental study, with a quantitative approach, observational, analytical and cross-sectional design, whose sample consisted of 100 patients with a diagnosis of appendicular plastron. The data collection sheet was applied as an instrument. Likewise, a Poisson regression model was used to respond to the objectives. Results: The multivariate analysis showed that alcohol consumption (p<0.05 RPa=1.12), nausea and vomiting (p<0.05, RPa=1.48), diarrhea (p<0.05; RPa=1.08), duration of symptoms before admission between 3 and 5 days (p<0.05; RPa=1.09), appendiceal mass (p<0.05, RPa=1.18) and bandemia (p<0.05, RPa=1.12) were significantly associated with unsuccessful management results of the appendiceal plastron. Conclusion: There are epidemiological and clinical characteristics associated with the results of the management of the appendicular plastron.

Introducción: El plastrón apendicular se considera una forma progresiva de apendicitis aguda, teniendo una prevalencia a nivel nacional de 2-10%. Actualmente el manejo suele ser controversial. Ante lo expuesto, se busca promover estudios que puedan dilucidar las variables asociadas al manejo de esta condición. Objetivo: determinar las características epidemiológico-clínicas asociadas a los resultados del manejo del plastrón apendicular en pacientes adultos en un hospital de referencia del Perú. Métodos: Estudio no experimental, de enfoque cuantitativo, diseño observacional, analítico y transversal, cuya muestra estuvo conformada por 100 pacientes con diagnóstico de plastrón apendicular. Se aplicó como instrumento la ficha de recolección de datos. Asimismo, se utilizo un modelo de regresión de Poisson para responder a los objetivos. Resultados: El análisis multivariado evidenció que el consumo de alcohol (p<0.05 RPa=1.12), las náuseas y vómitos (p<0.05, RPa=1.48), diarrea (p<0.05; RPa=1.08), duración de síntomas antes del ingreso entre 3 y 5 días (p<0.05; RPa=1.09), masa apendicular (p<0.05, RPa=1.18) y bandemia (p<0.05, RPa=1.12) se asociaron significativamente a resultados de manejo no exitosos de plastrón apendicular. Conclusión: Existe características epidemiológicas y clínicas asociadas a resultados del manejo de plastrón apendicular.

Triple Expressor Lymphoma: Presentation With Acute Paraparesis Due to Spinal Cord Compression.

Diffuse large B-cell lymphoma (DBLCL) is the most common type of non-Hodgkin's lymphoma (NHL). Triple expressor lymphoma is a subgroup of non-Hodgkin's lymphomas that exhibits simultaneous overexpression of the MYC, BCL2, and BCL6 genes. This entity is characterized by its aggressive behavior and its poor response to chemotherapy regimens traditionally used, such as the standard R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen. This neoplasm can have varied clinical manifestations according to its initial location and usually has central nervous system (CNS) involvement. This article presents the case of a triple expressor lymphoma with spinal involvement at the level of the thoracic vertebrae in a previously healthy 34-year-old female patient, which lead to acute paraparesis due to spinal cord compression. Nevertheless, appropriate treatment with the DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) regimen resulted in the recovery of the motor and sensory function of the lower extremities.

Factores asociados a bajo conocimiento de bioseguridad en internos de medicina en una universidad del Perú en el contexto de la pandemia COVID-19

Introducción: El derecho a prácticas pre-profesionales amparado bajo la Ley Peruana permite que el estudiante de último año de la carrera de medicina humana comience a participar en procedimientos e intervenciones asistenciales de salud bajo la guía de un médico tutor. Objetivo: determinar los factores asociados a bajo conocimiento en bioseguridad en internos de medicina de una universidad del Perú en el contexto de la pandemia covid-19. Metodología: se realizó un diseño observacional, prolectivo y transversal. La muestra estuvo comprendida por 336 internos de medicina humana, los cuales se seleccionaron por muestreo probabilístico aleatorio simple. Se empleó un instrumento válido y confiable para determinar el nivel de conocimiento en bioseguridad. Se trabajó con un modelo de regresión de binario logarítmico bivariado y múltiple para el cálculo de la razón de prevalencia cruda y ajustada con sus respectivos intervalos de confianza al 95% para los factores asociados al nivel de conocimiento en bioseguridad. Resultados: se encontraron niveles de conocimiento alto, medio y bajo del 44,6%, 26,8% y 28 ,6% respectivamente. El estado civil casado (RPA 0.418, IC95% 0.181 - 0.968), convivir con personas con riesgo para síntomas graves por covid-19 (RPA 0.472, IC95% 0.344-0.647), realizar el internado medico en un hospital y haber sido diagnosticado por covid-19 en los últimos 12 meses (RPA 0.586, IC95% 0.387-0.887) se asociaron a un nivel de conocimiento bajo bioseguridad por modelo de regresión binaria logarítmica múltiple. Discusión: el estado civil casado, el convivir con personas con riesgo para síntomas graves de covid-19, el realizar el internado medico en un centro hospitalario y el haber sido diagnosticado con covid-19 tienen una relación inversamente proporcional con el conocimiento bajo en bioseguridad en internos de medicina en el contexto de la pandemia covid-19.

Introduction: The right to pre-professional practices protected under Peruvian Law allows the student in the last year of the human medicine career to begin to participate in health care procedures and interventions under the guidance of a tutor. Objective: to determine the factors associated with low knowledge of biosafety in medical interns at a university in Peru in the context of the covid-19 pandemic. Methods: an observational, prolective and cross-sectional design was carried out. The sample consisted of 336 human medicine interns, who were selected by simple random probabilistic sampling. A valid and reliable instrument was used to determine the level of knowledge in biosafety. A bivariate and multiple logarithmic binary regression model was used to calculate the crude and adjusted prevalence ratio with their respective 95% confidence intervals for the factors associated with the level of knowledge in biosafety. Results: high, medium and low levels of knowledge of 44.6%, 26.8% and 28.6% respectively were found. Married marital status (RPA 0.418, 95% CI 0.181 - 0.968), living with people at risk for severe symptoms from covid-19 (RPA 0.472, 95% CI 0.344-0.647), undergoing medical internship in a hospital, and having been diagnosed by covid-19 in the last 12 months (RPA 0.586, 95% CI 0.387-0.887) were associated with a level of knowledge under biosafety by multiple logarithmic binary regression model. Discussion: married marital status, living with people at risk for severe symptoms of covid-19, undergoing medical internship in a hospital center and having been diagnosed with covid-19 have an inversely proportional relationship with low knowledge in biosafety. In medical interns in the context of the covid-19 pandemic.

Índice neutrófilo linfocito un marcador predictivo para el diagnóstico de apendicitis aguda complicada

Objetivo: Determinar la capacidad diagnóstica del índice neutrófilo-linfocito (INL) para establecer el diagnóstico de apendicitis aguda complicada en un hospital de referencia nacional del Perú. Material y Método: Estudio observacional, descriptivo, transversal, retrospectivo, de tipo prueba diagnóstica. El tamaño muestral fue de 333 pacientes con diagnóstico de apendicitis aguda, siendo 207 pacientes con apendicitis aguda complicada y 126 pacientes con apendicitis aguda no complicada. Se utilizó un modelo de regresión logística binario para generar una curva COR y estimar las características operativas del Índice neutrófilo linfocito para la apendicitis aguda complicada, así como la probabilidad posprueba para casos positivos y negativos. Resultados: La curva COR del INL presento un AUC de 64,4% (IC 95% 58,3% - 70,5%) con un P-valor < 0,05. La sensibilidad y especificidad para el diagnóstico de apendicitis aguda complicada fueron de 69,08%, 61,11%, respectivamente, a su vez, la probabilidad posprueba para casos positivos y negativos fue de 63% (58 - 68%) y 33% (27% - 39%) respectivamente. Conclusión: El INL posee precisión adecuada para el diagnóstico de la apendicitis aguda complicada, así como variaciones significativas en la probabilidad posprueba cuando los casos son positivos o negativos.

Objective: To determine the diagnostic capacity of the neutrophil-lymphocyte index (NLR) to establish the diagnosis of complicated acute appendicitis in a national Peruvian hospital. Material and Method: Observational, descriptive, cross-sectional, retrospective study, diagnostic test type. The sample size was 333 patients with a diagnosis of acute appendicitis, being 207 patients with complicated acute appendicitis and 126 patients with uncomplicated acute appendicitis. A binary logistic regression model was used to generate a COR curve and estimate the operating characteristics of the Lymphocyte Neutrophil Index for complicated acute appendicitis, as well as the post-test probability for positive and negative cases. Results: The INL COR curve presented an AUC of 64.4% (95% CI 58.3% - 70.5%) with a P-value < 0.05. The sensitivity and specificity for the diagnosis of complicated acute appendicitis were 69.08%, 61.11%, respectively, in turn, the post-test probability for positive and negative cases was 63% (58 - 68%) and 33% (27%) - 39%) respectively. Conclusion: The INL has adequate precision for the diagnosis of complicated acute appendicitis, as well as significant variations in the post-test probability when the cases are positive or negative.

Recaída de linfoma folicular de alto grado en tiroides / Relapse of high grade follicular lymphoma in thyroid

El linfoma folicular de tiroides es una entidad rara que representa menos del 2% de los linfomas extranodales y cuyo principal factor de riesgo es la tiroiditis de Hashimoto. Suele afectar con mayor predisposición a pacientes adultos mayores, en los que con frecuencia se presenta como una masa de crecimiento rápido con compromiso de las estructuras adyacentes en el cuello. Sin embargo, dada su rara incidencia, esta patología debe ser sospechada por el clínico para un diagnóstico temprano oportuno. Aunque en la actualidad no existen guías de manejo estandarizadas para esta entidad, acostumbra tener buena respuesta a radioterapia y quimioterapia. El presente caso describe la historia de un paciente con una recaída de linfoma no Hodgkin de tipo folicular de alto grado localizado en tiroides que se presentó a urgencias con disfonía, parálisis bilateral de cuerdas vocales, cambio en el tono de la voz y disfagia, con el antecedente de un linfoma folicular de alto grado en localización retroperitoneal y en remisión luego de 8 ciclos de quimioterapia con rituximab, ciclofosfamida, doxorubicina, vincristina y prednisona, el cual presentó citorreducción luego del tratamiento con quimioterapia con el protocolo de rituximab, dexametasona, citarabina y cisplatino.

Follicular thyroid lymphoma is a rare entity that represents less than 2% of extranodal lymphomas; and whose main risk factor is Hashimoto's thyroiditis. This tends to affect older adult patients with greater predisposition, where it usually presents as a rapidly growing mass with compromise of the adjacent structures in the neck. However, given its rare incidence, this pathology should be suspected by the clinician for an early diagnosis. Although there are currently no standardized management guidelines for this entity, it usually responds well to radiotherapy and chemotherapy. The present case describes the history of a patient with a relapse of high-grade follicular-type NHL located in the thyroid who presented to the emergency room with dysphonia, bilateral paralysis of the vocal cords, change in tone of voice and dysphagia, with the history of high-grade follicular lymphoma in retroperitoneal location in remission after 8 cycles of chemotherapy with Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisone, which presented cytoreduction after treatment with chemotherapy with the protocol Rituximab, Dexamethasone, Cytarabine and Cisplatin.

Validación del cuestionario sobre la salud del paciente­9 (PHQ-9) en internos de medicina humana de una universidad de referencia del Perú durante la pandemia COVID-19 / Validation of the Patient Health Questionnaire-9 (PHQ-9) in human medicine interns at a reference university in Peru during the COVID-19 pandemic

Objetivos: Validar un cuestionario para establecer la percepción de dificultades en la elaboración de proyectos de investigación en los estudiantes del área de investigación de la Facultad de Medicina Humana de la Universidad Peruana Los Andes (UPLA). Métodos: Estudio de validación de un cuestionario diseñado y basado en una escala de Likert aplicado a los estudiantes de las asignaturas de Proceso de investigación, Seminario de tesis I y Seminario de tesis II con muestreo probabilístico aleatorio estratificado, análisis de validez del contenido y constructo por juicio de expertos y el análisis estadístico de la confiabilidad con alfa de Cronbach. Resultados: La muestra estuvo constituida por 85 estudiantes que aceptaron ser parte del estudio, de los cuales el 64,70 % pertenecieron al género femenino con una edad media de 23 ± 5 años, asignatura de Seminario de tesis I 36,47%, Proceso de investigación 34,12%, Seminario de tesis II 29,41%; manifestaron dificultades en la elaboración del proyecto de investigación en formulación del marco teórico y metodología el 64,71 %, en redacción de bibliografía y anexos el 62,35 %, en planteamiento del problema y formulación de las hipótesis el 61,18 %, en definición del título el 58,82 % y en elaboración de la administración del plan del proyecto el 47,06 %. La confiabilidad alfa de Cronbach fue 0,969. Conclusiones: El cuestionario es confiable y válido, tiene consistencia interna alta y validez de criterio adecuada.

Objectives: Validate a questionnaire to establish the perception of difficulties in the development of research projects in the students of the research area of ​​the Faculty of Human Medicine of the Peruvian University Los Andes. Methods: Validation study of a questionnaire designed and based on a Likert scale applied to the students of the subjects of Research process, Thesis seminar I and Thesis seminar II with stratified random probability sampling, content validity analysis and construct by expert judgment and statistical analysis of reliability with Cronbach's alpha. Results: The sample consisted of 85 students who agreed to be part of the study, of which 64,70% belonged to the female gender with an average age of 23 ± 5 years, subject of thesis seminar I 36,47%, Process research 34,12%, thesis seminar II 29,41%; 64,71% expressed difficulties in preparing the research project in formulating the theoretical framework and methodology, 62,35% in writing the bibliography and annexes, 61,18% in posing the problem and formulating hypotheses, in definition of the title 58,82% and in preparation of the administration of the project plan 47,06%. Cronbach's alpha reliability was 0,969. Conclusions: The questionnaire is reliable and valid, it has high internal consistency and valid criteria.

Estudio de caso control en amenaza de parto pretermino y sus factores de riesgo en gestantes en un hospital de referencia del Peru durante la pandemia COVID-19

RESUMEN El objetivo del presente estudio fue determinar la relación entre la amenaza de parto pretermino y sus factores de riesgo en gestantes atendidas en un hospital de referencia del Perú durante la pandemia covid-19, con énfasis en la infección de tracto urinario. Se realizó un diseño de tipo casos y controles no emparejado, con una muestra representativa, con un tamaño muestral de 92 casos y 92 controles por muestreo probabilístico aleatorio simple, se realizó un modelo de regresión logística para la infección de tracto urinario y la amenaza de parto pretermino para el cálculo del Odds Ratio e intervalos de confianza al 95%. Se reportó una asociación para la amenaza de parto pretermino con las variables gestante añosa 3.159 (IC95% 1.66 - 6.02), menos de seis controles prenatales 3.9 (IC95% 2.084 - 7.298), paridad 0.353 (IC95% 0.180 - 0.691), antecedente de parto pretermino 2.843 (IC95% 1.253 - 5.639) e infección de tracto urinario 2.843 (IC95% 1.253 - 5.639). Se concluye que la infección de tracto urinario se asocia a la amenaza de parto pretermino en gestantes atendidas en un hospital de referencia peruano.

ABSTRACT The objective of the present study was to determine the relationship between the threat of preterm birth and its risk factors in pregnant women treated at a referral hospital in Peru during the covid-19 pandemic, with emphasis on urinary tract infection. An unpaired case-control type design was carried out, with a representative sample including 92 cases and 92 controls selected by simple random probabilistic sampling. A logistic regression model was carried out for urinary tract infection and threat of preterm birth for calculating the Odds Ratio and 95% confidence intervals. An association was reported for the threat of preterm birth with the variables: elderly pregnant woman 3.159 (95% CI 1.66 - 6.02), less than six prenatal controls 3.9 (95% CI 2.084 - 7.298), parity 0.353 (95% CI 0.180 - 0.691), history of preterm birth 2843 (95% CI 1253-5639) and urinary tract infection 2843 (95% CI 1253-5639). It is concluded that urinary tract infection is associated with the threat of preterm birth in pregnant women treated in a Peruvian reference hospital.

Factores asociados a bronquiolitis en pacientes menores de 2 años atendidos en un hospital de referencia del Perú

RESUMEN Introducción: La bronquiolitis se considera una patología respiratoria de etiología viral, frecuente a nivel de infantes. Existen diversos determinantes que contribuyen a su desarrollo dentro de esta población. El conocer dichos factores permitirá ejecutar medidas preventivas, así como disminuir el número de casos. Objetivo: Determinar los factores asociados a bronquiolitis en pacientes menores de 2 años atendidos en un hospital de referencia del Perú. Materiales y Métodos: se realizó un diseño de tipo casos y controles no emparejado, con una muestra representativa, con un tamaño muestral de 174 casos y 174 controles por muestreo probabilístico aleatorio simple, se realizó un modelo de regresión logística para los factores asociados al lactante y la madre para el cálculo del Odds Ratio e intervalo de confianza al 95% respecto a la variable dependiente bronquiolitis aguda Resultados: se reportó una asociación para la bronquiolitis aguda con las variables prematuridad 3.02 (IC95% 1.54 - 5.92), bajo peso al nacer 1.85 (IC95% 1.07 - 3.20), género femenino 2.89 (IC95% 1.72 - 4.86), madre adolescente 3.82 (IC95% 2.13 - 6.86) y madre sin grado de instrucción 3.02 (IC95% 1.83 - 11.87). Conclusión: los factores de prematuridad, bajo peso al nacer y género femenino del lactante y el grado de instrucción y condición adolescente de la madre se asocian al bronquiolitis aguda en pacientes menores de 2 años.

ABSTRACT Introduction: Bronchiolitis is considered a respiratory pathology of viral etiology that is frequent in infants. There are several determinants that contribute to its development within this population. Knowledge of these factors will allow preventive measures to be in place, as well as reduce the number of cases. Objective: To determine the factors associated with bronchiolitis in patients under 2 years of age treated at a reference hospital in Peru. Materials and Methods: an unpaired case-control type design was carried out, with a representative sample, with a sample size of 174 cases and 174 controls by simple random probabilistic sampling, a logistic regression model was carried out for the factors associated with the infant. and the mother for the calculation of the Odds Ratio and 95% confidence interval regarding the dependent variable acute bronchiolitis. Results: an association was reported for acute bronchiolitis with the following variables: prematurity 3.02 (95% CI 1.54 - 5.92), low birth weight 1.85 (95% CI 1.07 - 3.20), female gender 2.89 (95% CI 1.72 - 4.86), teenage mother 3.82 (95% CI 2.13 - 6.86) and mother with low educational level 3.02 (95% CI 1.83 - 11.87). Conclusion: prematurity, low birth weight, female gender, birth to an adolescent mother and maternal low educational levels are associated with acute bronchiolitis in patients under 2 years of age.