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  • The psychosocial impact of dental aesthetics and experiencing discrimination at a Peruvian public hospital among outpatients

    Carbajal, Claudia; Rodriguez, Talib; Falconi, Diego Proano (Public Library of Science, 2022-08-01)
    Aim To evaluate the association between outpatient's perceived psychosocial impact of dental aesthetics and experiencing discrimination at a Peruvian public hospital. Material and methods Cross-sectional study in a Peruvian public hospital, where 207 outpatients (18-30 years old) were surveyed. We asked participants about self-reported experiences of discrimination in the last six months at a Peruvian public hospital using a question from the Peruvian National Household Survey on Living Conditions and Poverty (ENAHO) 2017. We also measured the perceived psychosocial impact of dental aesthetics with the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Additionally, we evaluated age, sex, ethnicity, education, income, and reason for being discriminated against. Association was assessed with Poisson regression using a robust estimator of variance and reporting prevalence ratios with 95% confidence intervals in crude and adjusted models. Results About two out of every five participants having experienced discrimination at a Peruvian public hospital in the last six months. On our adjusted estimates, we found discrimination to be positively associated with two components of the psychosocial impact of dental aesthetics, which were social impact (PR 1.02, 95% CI 1.00-1.04) and the psychological impact (PR 1.07, 95% CI 1.04-1.10). Conversely, dental self-confidence (PR 0.96, 95% CI 0.93- 0.98) was negatively associated with discrimination. Conclusions The perceived psychosocial impact of dental aesthetics is associated with experiencing discrimination among outpatients from a Peruvian public hospital. We advocate for structural changes to address discrimination in healthcare spaces by corresponding governmental authorities.
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  • Learning of Pharmacogenetics in human medicine students through PBL and ICTs

    Medina, Maritza Placencia; Valencia, Javier Silva; Bustamante, Carlos García; Valerio, Julián Villarreal; Álvarez, Rosa Pando; Casavilca, Michan Malca; Contreras-Pizarro, Carlos Heber (Universidad Politecnica de Valencia., 2022-01-01)
    Objective: To describe the learning achievement after training in pharmacogenetics based on PBL and ICT and its persistence four years later in human medicine students of a public university in Peru. Materials and Methods: 160 students who received training on the pharmacogenetics of warfarin applying PBL and ICT were evaluated. The instrument was based on a clinical problem applied immediately after training and 4 years later. Results: Results of the first evaluation indicated a good analytical resolution of the problem with argumentation in the genetic conditions of the patient. The evaluation after four years showed that 89% of the students continued at higher levels of learning. Conclusion: It was shown that the use of a meaningful learning methodology with PBL and ICT can make knowledge last and serve in the future for decision-making in the selection of medication.
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  • Near-hanging Injury in a Pediatric Patient

    Espinoza-Espinoza, Yudit; Morocho-Pinedo, Milene; Alarcon-Braga, Esteban; Carreazo, Nilton Yhuri (Pakistan Pediatric Journal, 2022-06-01)
    Suicide is a public health problem. Suicide by hanging is seen in all ages, starting around the age of 10-12. "Hanging injuries" is the term used to refer to people who survive after hanging. We present the case of a pediatric patient who survived mechanical asphyxia by hanging. A 12-year-old female patient who recently attempted suicide by hanging herself was admitted to the nearest hospital presenting "near-hanging injuries." She received ventilatory support and sedation-analgesia in the Pediatric Intensive Care Unit (PICU), treating cerebral edema with mannitol. Upon discharge, she presented neurological and structural sequelae. Although suicide is one of the most common causes of death in the pediatric population, near-hanging injuries are rare in this setting. Patients with these injuries should be treated aggressively and early to avoid possible complications. In this case, the family's action and the late treatment influenced the lousy evolution of the patient.
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  • Association between Ancestry-Specific 6q25 Variants and Breast Cancer Subtypes in Peruvian Women

    Zavala, Valentina A.; Casavilca-Zambrano, Sandro; Navarro-Vásquez, Jeannie; Castañeda, Carlos A.; Valencia, Guillermo; Morante, Zaida; Calderón, Monica; Abugattas, Julio E.; Gómez, Henry; Fuentes, Hugo A.; Liendo-Picoaga, Ruddy; Cotrina, Jose M.; Monge, Claudia; Neciosup, Silvia P.; Huntsman, Scott; Hu, Donglei; Sánchez, Sixto E.; Williams, Michelle A.; Núñez-Marrero, Angel; Godoy, Lenin; Hechmer, Aaron; Olshen, Adam B.; Dutil, Julie; Ziv, Elad; Zabaleta, Jovanny; Gelaye, Bizu; Vásquez, Jule; Gálvez-Nino, Marco; Enriquez-Vera, Daniel; Vidaurre, Tatiana; Fejerman, Laura (American Association for Cancer Research Inc., 2022-08-01)
    Background: Breast cancer incidence in the United States is lower in Hispanic/Latina (H/L) compared with African American/ Black or Non-Hispanic White women. An Indigenous American breast cancer-protective germline variant (rs140068132) has been reported near the estrogen receptor 1 gene. This study tests the association of rs140068132 and other polymorphisms in the 6q25 region with subtype-specific breast cancer risk in H/Ls of high Indigenous American ancestry. Methods: Genotypes were obtained for 5,094 Peruvian women with (1,755) and without (3,337) breast cancer. Associations between genotype and overall and subtype-specific risk for the protective variant were tested using logistic regression models and conditional analyses, including other risk-associated polymorphisms in the region. Results: We replicated the reported association between rs140068132 and breast cancer risk overall [odds ratio (OR), 0.53; 95% confidence interval (CI), 0.47-0.59], as well as the lower odds of developing hormone receptor negative (HR-) versus HR+ disease (OR, 0.77; 95% CI, 0.61-0.97). Models, including HER2, showed further heterogeneity with reduced odds for HR+HER2+ (OR, 0.68; 95% CI, 0.51-0.92), HR-HER2+ (OR, 0.63; 95% CI, 0.44-0.90) and HR-HER2- (OR, 0.77; 95% CI, 0.56-1.05) compared with HR+HER2-. Inclusion of other risk-associated variants did not change these observations. Conclusions: The rs140068132 polymorphism is associated with decreased risk of breast cancer in Peruvians and is more protective against HR- and HER2+ diseases independently of other breast cancer-associated variants in the 6q25 region. Impact: These results could inform functional analyses to understand the mechanism by which rs140068132-G reduces risk of breast cancer development in a subtype-specific manner. They also illustrate the importance of including diverse individuals in genetic studies.
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  • Hospitalizations and mortality of patients with heart failure in the COVID-19 era in Peru

    Hernández-Vásquez, Akram; Visconti-Lopez, Fabriccio J.; Alburqueque-Cruz, Renato; Rojas-Roque, Carlos (Elsevier B.V., 2022-01-01)
    Objectives: The worldwide heart failure (HF) prevalence is 8.52 per 1000 inhabitants, with a global economic burden of 346.17 billion dollars. With the COVID-19 pandemic, the focus of medical care has changed to treating the morbidity and mortality of patients with COVID-19 and reducing medical procedures or visits to patients with HF, with the impact being greater in low- and middle-income countries. Methods: We performed an interrupted time series analysis of HF to determine the changes in the trend of hospitalizations and in-hospital mortality of HF patients before and after the mandatory lockdown in Peru. Results: A total of 18,514 adults were included in the analysis. Monthly hospital admissions immediately decreased by 599 (95% confidence interval [CI]: 113 to 1085) and the difference in slope before and after the lockdown was 6.4 hospital admissions (95% CI: −4 to 18). In-hospital mortality increased by 18% (95% CI: −8%–43%) and the difference in slope before and after the lockdown was −0.3% (95% CI: −0.9%–0.25%). Conclusions: There was a reduction in hospitalizations and an increase in the in-hospital mortality of patients with HF before and after the mandatory lockdown due to the COVID-19 pandemic in Peru.
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  • Association between Lipid Profile and Apolipoproteins with Risk of Diabetic Foot Ulcer: A Systematic Review and Meta-Analysis

    Ulloque-Badaracco, Juan R.; Mosquera-Rojas, Melany D.; Hernandez-Bustamante, Enrique A.; Alarcón-Braga, Esteban A.; Ulloque-Badaracco, Ricardo R.; Al-Kassab-Córdova, Ali; Herrera-Añazco, Percy; Benites-Zapata, Vicente A.; Hernandez, Adrian V. (Wiley-Hindawi, 2022-01-01)
    Background and Aims. Biomarkers are necessary to stratify the risk of diabetic foot ulcers (DFUs). This systematic review and meta-analysis aimed to evaluate the association between the lipid profile and apolipoproteins with the risk of DFU. Methods. A systematic search was conducted in PubMed, Scopus, Cochrane Library, and Web of Science among adult patients. Cohort and case-control studies were included. Random-effects models were used for meta-analyses, and the effects were expressed as odds ratio (OR) and their 95% confidence intervals (CIs). We evaluated publication bias through Egger's test and funnel plot. Results. A total of 12 cohort studies and 26 case-control studies were included, with 17076 patients. We found that the higher values of total cholesterol (TC), low-density lipoprotein (LDL), triglycerides, and lipoprotein(a) (Lp(a)) were associated with a higher risk of developing DFU (OR: 1.47, OR: 1.47, OR: 1.5, OR: 1.85, respectively). Otherwise, the lower values of HDL were associated with a higher risk of developing DFU (OR: 0.49). Publication bias was not found for associations between TC, HDL, LDL, or TG and the risk of DFU. Conclusions. The high values of LDL, TC, TG, and Lp(a) and low values of HDL are associated with a higher risk of developing DFU. Furthermore, we did not find a significant association for VLDL, ApoA1, ApoB, and ApoB/ApoA1 ratio.
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  • Global Research Trends in the Latarjet Procedure: A Bibliometric and Visualized Study

    Visconti-Lopez, Fabriccio J.; Hernández-Vásquez, Akram; Azañedo, Diego; Sanchez Carbonel, Jose Fernando (NLM (Medline), 2022-07-28)
    Background and Objectives: Latarjet is among the procedures indicated to treat shoulder instability, producing excellent results, including low instability rates and high patient satisfaction. The aim of this study was to report the characteristics of scientific articles that address the subject of the Latarjet procedure through the use of bibliometric analysis. Materials and Methods: Bibliographic searches were performed for original articles published in journals indexed by the Web of Science database until 2021, with no language restrictions. Results: A total of 668 articles published in 87 journals were included. The first publication was in 1981; the most registered publications were in 2018 and 2021 (89 articles), with an annual percentage growth rate of 11.9. Provencher MT was the author with the most published articles, and the institutional affiliation with the most original articles was the Steadman Philippon Research Institute. The most cited article was a study by Burkhart and Beer, and the scientific journal with the most publications on the subject was the Journal of Shoulder and Elbow Surgery. Most published studies included keywords such as dislocation, instability, and meta-analysis. Conclusion: There has been a sustained increase in original articles on the Latarjet procedure. However, the greatest growth in articles has occurred during the last decade, demonstrating the considerable interest among the world scientific community.
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  • Factors Associated with Food Insecurity in Latin America and the Caribbean Countries: A Cross-Sectional Analysis of 13 Countries

    Hernández-Vásquez, Akram; Visconti-Lopez, Fabriccio J.; Vargas-Fernández, Rodrigo (MDPI, 2022-08-01)
    It is estimated that Latin America and the Caribbean (LAC) is the region with the second highest figures for food insecurity (FI) globally, with a prevalence of 40.9% in the entire region. This cross-sectional study analyzes the household factors associated with FI across 13 LAC countries. We used data from the first round of high-frequency phone surveys, conducted by the World Bank. Approximately 4 out of 10 people in LAC experienced FI during the first phase of the COVID-19 pandemic. FI was positively associated with the number of individuals aged from 5 to 18 years, the number of men, the illness, accident, or death of an income-earning household member, and health expenditure due to COVID-19 or other illnesses, as well as the increase in food prices, reduced family income, and job loss by a member of the household. On the other hand, households located in capital cities and those with more bedrooms were less likely to have experienced FI. The design of social policies must focus on the economic deficiencies experienced by the LAC population, with unemployment, reduced income, and high food costs being the main factors that must be addressed to ensure adequate nutrition.
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  • C-Reactive Protein-to-Albumin Ratio and Clinical Outcomes in COVID-19 Patients: A Systematic Review and Meta-Analysis

    Zavalaga-Zegarra, Hernán J.; Palomino-Gutierrez, Juan J.; Ulloque-Badaracco, Juan R.; Mosquera-Rojas, Melany D.; Hernandez-Bustamante, Enrique A.; Alarcon-Braga, Esteban A.; Benites-Zapata, Vicente A.; Herrera-Añazco, Percy; Hernandez, Adrian V. (MDPI, 2022-08-01)
    C-reactive protein-to-albumin ratio (CAR) is an independent risk factor in cardiovascular, cerebrovascular, and infectious diseases. Through this study, we investigated the CAR values with respect to the severity and mortality of COVID-19 patients. We performed a systematic review and meta-analysis to retrieve studies that evaluated CAR values upon hospital admission in relation to the severity or mortality of COVID-19 patients. We adopted a random-effect model to calculate the pooled mean difference (MD) and their 95% confidence intervals (CI). Quality assessment was appraised using a Newcastle–Ottawa scale and publication bias was assessed using the Begg-test and funnel plot. We equally performed a subgroup analysis using study location and a sensitivity analysis only with studies with low risk of bias. We analyzed 32 studies (n = 12445). Severe COVID-19 patients had higher on-admission CAR values than non-severe COVID-19 patients (MD: 1.69; 95% CI: 1.35–2.03; p < 0.001; I2 = 89%). Non-survivor patients with COVID-19 had higher CAR values than survivor patients (MD: 2.59; 95% CI: 1.95–3.23; p < 0.001; I2 = 92%). In sensitivity analysis, the relationship remained with a decreasing of heterogeneity for severity (MD: 1.22; 95% CI: 1.03–1.40; p < 0.001; I2 = 13%) and for mortality (MD: 2.99; 95% CI: 2.47–3.51; p < 0.001; I2 = 0%). High CAR values were found in COVID-19 patients who developed severe disease or died.
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  • Evaluation of the broth microdilution plate methodology for susceptibility testing of Mycobacterium tuberculosis in Peru

    Puyén, Zully M.; Santos-Lázaro, David; Vigo, Aiko N.; Coronel, Jorge; Alarcón, Miriam J.; Cotrina, Vidia V.; Moore, David A.J. (BioMed Central Ltd, 2022-12-01)
    Background: Tuberculosis (TB) is a communicable, preventable and curable disease caused by the bacterium Mycobacterium tuberculosis (MTB). Peru is amongst the 30 countries with the highest burden of multidrug-resistant tuberculosis (MDR-TB) worldwide. In the fight against drug-resistant tuberculosis, the UKMYC6 microdilution plate was developed and validated by the CRyPTIC project. The objective of the study was to evaluate the use of the broth microdilution (BMD) plate methodology for susceptibility testing of drug-resistant MTB strains in Peru. Methods: MTB strains isolated between 2015 and 2018 in Peru were used. 496 nationally-representative strains determined as drug-resistant by the routine 7H10 Agar Proportion Method (APM) were included in the present study. The Minimum Inhibitory Concentration (MIC) of 13 antituberculosis drugs were determined for each strain using the UKMYC6 microdilution plates. Diagnostic agreement between APM and BMD plate methodology was determined for rifampicin, isoniazid, ethambutol, ethionamide, kanamycin and levofloxacin. Phenotypes were set using binary (or ternary) classification based on Epidemiological cut-off values (ECOFF/ECV) proposed by the CRyPTIC project. Whole Genome Sequencing (WGS) was performed on strains with discrepant results between both methods. Results: MIC distributions were determined for 13 first- and second-line anti-TB drugs, including new (bedaquiline, delamanid) and repurposed (clofazimine, linezolid) agents. MIC results were available for 80% (397/496) of the strains at 14 days and the remainder at 21 days. The comparative analysis determined a good agreement (0.64 ≤ k ≤ 0.79) for the drugs rifampicin, ethambutol, ethionamide and kanamycin, and the best agreement (k > 0.8) for isoniazid and levofloxacin. Overall, 12% of MIC values were above the UKMYC6 plate dilution ranges, most notably for the drugs rifampicin and rifabutin. No strain presented MICs higher than the ECOFF/ECV values for the new or repurposed drugs. Discrepant analysis using genotypic susceptibility testing by WGS supported half of the results obtained by APM (52%, 93/179) and half of those obtained by BMD plate methodology (48%, 86/179). Conclusions: The BMD methodology using the UKMYC6 plate allows the complete susceptibility characterization, through the determination of MICs, of drug-resistant MTB strains in Peru. This methodology shows good diagnostic performances for rifampicin, isoniazid, ethambutol, ethionamide, kanamycin and levofloxacin. It also allows for the characterization of MICs for other drugs used in previous years against tuberculosis, as well as for new and repurposed drugs recently introduced worldwide.
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  • Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis

    Benites-Zapata, Vicente A.; Ulloque-Badaracco, Juan R.; Alarcon-Braga, Esteban A.; Hernandez-Bustamante, Enrique A.; Mosquera-Rojas, Melany D.; Bonilla-Aldana, D. Katterine; Rodriguez-Morales, Alfonso J. (BioMed Central Ltd, 2022-12-01)
    Introduction: A multicountry monkeypox disease (MPX) outbreak began in May 2022 in Europe, leading to the assessment as a potential Public Health Emergency of International Concern (PHEIC) on June 23, 2022. Some observational studies have partially characterised clinical features, hospitalisations, and deaths. However, no systematic reviews of this MPX outbreak have been published. Methods: We performed a systematic review with meta-analysis, using five databases to assess clinical features, hospitalisations, complications and deaths of MPX confirmed or probable cases. Observational studies, case reports and case series, were included. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95% CI). In addition, we carried out a subgroup analysis according to the continents and a sensitivity analysis excluding studies classified as having a high risk of bias. Results: A total of 19 articles were included, using only 12 articles in the quantitative synthesis (meta-analysis). For 1958 patients, rash (93%, 95% CI 80–100%), fever (72%, 95% CI 30–99%), pruritus (65%, 95% CI 47–81%), and lymphadenopathy (62%, 47–76%), were the most prevalent manifestations. Among the patients, 35% (95% CI 14–59%) were hospitalised. Some 4% (95% CI 1–9%) of hospitalised patients had fatal outcomes (case fatality rate, CFR). Conclusion: MPX is spreading rapidly, with a third of hospitalised patients, but less than 5% with fatal outcomes. As this zoonotic virus spreads globally, countries must urgently prepare human resources, infrastructure and facilities to treat patients according to the emerging guidelines and the most reliable clinical information.
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  • Fibrinogen-to-Albumin Ratio and Blood Urea Nitrogen-to-Albumin Ratio in COVID-19 Patients: A Systematic Review and Meta-Analysis

    Ulloque-Badaracco, Juan R.; Alarcon-Braga, Esteban A.; Hernandez-Bustamante, Enrique A.; Al-kassab-Córdova, Ali; Mosquera-Rojas, Melany D.; Ulloque-Badaracco, Ricardo R.; Huayta-Cortez, Miguel A.; Maita-Arauco, Sherelym H.; Herrera-Añazco, Percy; Benites-Zapata, Vicente A. (MDPI, 2022-08-01)
    Fibrinogen-to-albumin ratio (FAR) and blood urea nitrogen-to-albumin ratio (BAR) are inflammatory biomarkers that have been associated with clinical outcomes of multiple diseases. The objective of this study is to evaluate the association of these biomarkers with the severity and mortality of COVID-19 patients. A systematic search was performed in five databases. Observational studies that reported the association between FAR and BAR values with the severity and mortality of COVID-19 patients were included. Random-effects models were used for meta-analyses, and effects were expressed as Odds Ratio (OR) and their 95% confidence intervals (CI). Publication bias was assessed using the Begg test, while the quality assessment was assessed using the Newcastle Ottawa Scale. A total of 21 studies (n = 7949) were included. High FAR values were associated with a higher risk of severity (OR: 2.41; 95% CI 1.41–4.12; p < 0.001) and mortality (OR: 2.05; 95% CI 1.66–2.54; p < 0.001). High BAR values were associated with higher risk of mortality (OR: 4.63; 95% CI 2.11–10.15; p < 0.001). However, no statistically significant association was found between BAR values and the risk of severity (OR: 1.16; 95% CI 0.83–1.63; p = 0.38). High FAR and BAR values were associated with poor clinical outcomes.
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  • Multiple Biliary Stones: a Rare Long-term Complication after Whipple Procedure

    Kirschbaum-Rubin, Steven; Flores-Ortega, Diego (Faculdade de Medicina de Ribeirao Preto - U.S.P., 2022-01-01)
    A hypertensive, diabetic woman underwent a successful Whipple procedure at the age of 84 due to carcinoma of the ampulla of Vater. She presented an extremely rare complication 24 months after the surgery, consisting of acute cholangitis due to multiple biliary lithiases associated with a bilioenteric anastomotic stricture. The diagnosis was confirmed with computed tomography, magnetic resonance cholangiopancreatography, and cholangiography. The patient was successfully treated with multiple percutaneous transhepatic cholangioplasties.
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  • Germline Pathogenic Variant Prevalence Among Latin American and US Hispanic Individuals Undergoing Testing for Hereditary Breast and Ovarian Cancer: A Cross-Sectional Study

    Ossa Gomez, Carlos Andrés; Achatz, Maria Isabel; Hurtado, Mabel; Sanabria-Salas, María Carolina; Sullcahuaman, Yasser; Chávarri-Guerra, Yanin; Dutil, Julie; Nielsen, Sarah M.; Esplin, Edward D.; Michalski, Scott T.; Bristow, Sara L.; Hatchell, Kathryn E.; Nussbaum, Robert L.; Pineda-Alvarez, Daniel E.; Ashton-Prolla, Patricia (NLM (Medline), 2022-07-01)
    PURPOSE: To report on pathogenic germline variants detected among individuals undergoing genetic testing for hereditary breast and/or ovarian cancer (HBOC) from Latin America and compare them with self-reported Hispanic individuals from the United States. METHODS: In this cross-sectional study, unrelated individuals with a personal/family history suggestive of HBOC who received clinician-ordered germline multigene sequencing were grouped according to the location of the ordering physician: group A, Mexico, Central America, and the Caribbean; group B, South America; and group C, United States with individuals who self-reported Hispanic ethnicity. Relatives who underwent cascade testing were analyzed separately. RESULTS: Among 24,075 unrelated probands across all regions, most were female (94.9%) and reported a personal history suggestive of HBOC (range, 65.0%-80.6%); the mean age at testing was 49.1 ± 13.1 years. The average number of genes analyzed per patient was highest in group A (A 63 ± 28, B 56 ± 29, and C 40 ± 28). Between 9.1% and 18.7% of patients had pathogenic germline variants in HBOC genes (highest yield in group A), with the majority associated with high HBOC risk. Compared with US Hispanics individuals the overall yield was significantly higher in both Latin American regions (A v C P = 1.64×10-9, B v C P < 2.2×10-16). Rates of variants of uncertain significance were similar across all three regions (33.7%-42.6%). Cascade testing uptake was low in all regions (A 6.6%, B 4.5%, and C 1.9%). CONCLUSION: This study highlights the importance of multigene panel testing in Latin American individuals with newly diagnosed or history of HBOC, who can benefit from medical management changes including targeted therapies, eligibility to clinical trials, risk-reducing surgeries, surveillance and prevention of secondary malignancy, and genetic counseling and subsequent cascade testing of at-risk relatives.
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  • Entrustable professional activities: Towards standardization of language and meaning in Spanish and Portuguese

    Melo de Andradea, Marcus Vinicius; López, María José; Torresc, Luis Carlos Domínguez; Pérezd, Verónica Daniela Durán; Durantee, Eduardo; Barretod, Samuel Eloy Gutiérrez; Sierraf, Manuel Eduardo Gutiérrez; Casallasc, Julio César García; Francischetti, Ieda; Melanchthonh, Isabel Eugenia Mora; Mendiolad, Melchor Sánchez; ten Catei, Olle (Universidad Nacional Autonoma de Mexico, 2022-07-01)
    The EPAs approach has had a great impact on medical education since it emerged in 2005. Its dissemination has required translation into several languages, sometimes generating terminological and meaning confusion. This paper is the result of an expert consensus procedure regarding the translation of key terms for understanding the EPA approach in Spanish and Portuguese. It was carried out through a process of meaning analysis of each term in its idiomatic context and of the practice of health professionals training in Latin America. Participated on this consensus by twelve professionals, teachers and scholars involved in the implementation and training with EPAs in eight countries, who participated as coordinator, facilitators or participants in the International Course Ins and Outs of EPAs for Latin America.
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  • Asociation between fluid overload and mortality in pediatric patients in the intensive care unit

    Chávez-Valdivia, Alexi; Rojas-Vivanco, Paola; Castañeda, Alejandra; Valdivia-Tapia, María del Carmen; Carreazo, Nilton Yhuri (Sociedad Chilena de Pediatria, 2022-07-01)
    Objective: To assess the association between fluid overload (FO) and other risk factors in the mortality of patients admitted to the Pediatric Intensive Care Unit (PICU). Patients and Method: A historical cohort study was conducted. Pediatric patients older than one month and younger than 18 years who were hospitalized in the PICU for more than 48 hours during 2016 were included. Demographic and clinical data were recorded. FO was calculated as [Sum of daily (fluid in − fluid out)/weight at ICU admission] × 100. Poisson regression analysis was performed to determine factors associated with mortality. Results: 171 patients were included. The median age was 31 months (RIQ 8; 84). Mortality was 8.18%. FO in the surviving population was 7% and 11.5% in the deceased patients (p < 0.05). The adjusted analysis identified FO as a major risk factor for mortality with a Relative Risk 1.32 (1.24-1.40); age and Glasgow Coma Scale were protective factors. Conclusion: Fluid overload is an independent risk factor for mortality in the analyzed PICU cohort.
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  • Association Between Procrastination And Academic Stress In Peruvian Second-Year Medical Students

    León, Eduardo Orco; Saldívar, Daphne Huamán; Rodríguez, Susel Ramírez; Torreblanca, Jonathan Torres; Salvador, Linder Figueroa; Mejia, Christian R.; Reyes, Ibraín Enrique Corrales (Editorial Ciencias Medicas, 2022-01-01)
    Introduction: University medical students are a population exposed to a high academic load, high level of exigency, high demand of time and there are factors that can affect the effectiveness of academic performance, such as stress and procrastination. Objective: Evaluate the association between stress and procrastination in a pilot sample of medical students at a university in Lima, Peru. Material and methods: A cross-sectional analytical study was conducted, where medical students from the Research Methodology course were recruited at a university in the Peruvian capital. In them, stress and procrastination were measured, both with previously validated tests, then these variables were related and adjusted according to their sex and age. For analytical statistics, generalized linear models were used and p-values ≤ 0.05 were considered statistically significant. Results: When performing the multivariate analysis, it was found that there was a relationship between procrastination and male gender (p = 0.001), age (p = 0.035) and stress (p = 0.022) of the respondents. Conclusions: Procrastination maintains in the sample studied an important association with the stress that students have, as well as with their gender and age.
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  • Does Breast-Conserving Surgery with Radiotherapy have a Better Survival than Mastectomy? A Meta-Analysis of More than 1,500,000 Patients

    De la Cruz Ku, Gabriel; Karamchandani, Manish; Chambergo-Michilot, Diego; Narvaez-Rojas, Alexis R.; Jonczyk, Michael; Príncipe-Meneses, Fortunato S.; Posawatz, David; Nardello, Salvatore; Chatterjee, Abhishek (Springer Science and Business Media Deutschland GmbH, 2022-01-01)
    Background: There have been conflicting studies reporting on survival advantages between breast-conserving surgery with radiotherapy (BCS) in comparison with mastectomy. Our aim was to compare the efficacy of BCS and mastectomy in terms of overall survival (OS) comparing all past published studies. Methods: We performed a comprehensive review of literature through October 2021 in PubMed, Scopus, and EMBASE. The studies included were randomized controlled trials (RCTs) and cohorts that compare BCS versus mastectomy. We excluded studies that included male sex, stage 0, distant metastasis at diagnosis, bilateral synchronous cancer, neoadjuvant radiation/chemotherapy, and articles with incomplete data. We performed a meta-analysis following the random-effect model with the inverse variance method. Results: From 18,997 publications, a total of 30 studies were included in the final analysis: 6 studies were randomized trials, and 24 were retrospective cohorts. A total of 1,802,128 patients with a follow-up ranging from 4 to 20 years were included, and 1,075,563 and 744,565 underwent BCS and mastectomy, respectively. Among the population, BCS is associated with improved OS compared with mastectomy [relative risk (RR) 0.64, 95% confidence interval (CI) 0.55–0.74]. This effect was similar when analysis was performed in cohorts and multi-institutional databases (RR 0.57, 95% CI 0.49–0.67). Furthermore, the benefit of BCS was stronger in patients who had less than 10 years of follow-up (RR 0.54, 95% CI 0.46–0.64). Conclusions: Patients who underwent BCS had better OS compared with mastectomy. Such results depicting survival advantage, especially using such a large sample of patients, may need to be included in the shared surgical decision making when discussing breast cancer treatment with patients.
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  • Identifying RO9021 as a Potential Inhibitor of PknG from Mycobacterium tuberculosis: Combinative Computational and in Vitro Studies

    Arica-Sosa, Alicia; Alcántara, Roberto; Jiménez-Avalos, Gabriel; Zimic, Mirko; Milón, Pohl; Quiliano, Miguel (American Chemical Society, 2022-06-14)
    Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (Mtb). Despite being considered curable and preventable, the increase of antibiotic resistance is becoming a serious public health problem. Mtb is a pathogen capable of surviving in macrophages, causing long-Term latent infection where the mycobacterial serine/threonine protein kinase G (PknG) plays a protective role. Therefore, PknG is an important inhibitory target to prevent Mtb from entering the latency stage. In this study, we use a pharmacophore-based virtual screening and biochemical assays to identify the compound RO9021 (CHEMBL3237561) as a PknG inhibitor. In detail, 1.5 million molecules were screened using a scalable cloud-based setup, identifying 689 candidates, which were further subjected to additional screening employing molecular docking. Molecular docking spotted 62 compounds with estimated binding affinities of-7.54 kcal/mol (s.d. = 0.77 kcal/mol). Finally, 14 compounds were selected for in vitro experiments considering previously reported biological activities and commercial availability. In vitro assays of PknG activity showed that RO9021 inhibits the kinase activity similarly to AX20017, a known inhibitor. The inhibitory effect was found to be dose dependent with a relative IC50value of 4.4 ± 1.1 μM. Molecular dynamics simulations predicted that the PknG-RO9021 complex is stable along the tested timescale. Altogether, our study indicates that RO9021 is a noteworthy drug candidate for further developing new anti-TB drugs that hold excellent reported pharmacokinetic parameters.
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  • Association between time of residence and self-perception of distress, interpersonal relationships, and social role in Venezuelan immigrants in Lima, Peru 2018–19: mixed-methods study

    Delgado-Cáceres, Frank Milton; Silva-Parra, Kevin Angel; Torres-Slimming, Paola A. (BioMed Central Ltd, 2022-12-01)
    Background: Immigrants arriving in a new country face changes that affect their social, employment, and migratory status. We carried out a mixed-methods study in the rapidly growing Venezuelan immigrant population in Lima, Peru. The objective was to determine whether there was an association between time in Peru and self-perception of symptom distress (SD), interpersonal relationships (IR), and social role (SR). Methods: The quantitative central component consisted of a cross-sectional study, surveying 152 participants using the Outcome Questionnaire 45.2 (OQ-45.2). The qualitative component, based on phenomenology, explored experiences and challenges during the migration process. Semi-structured in-depth interviews were conducted in 16 informants. Results: An association that was observed was the increase in the risk of clinically significant SR score with additional years of age. All informants mentioned having witnessed or experienced xenophobia in Peru. Every informant stated that significant labor differences existed between the countries. The most reported somatic symptoms were symptoms of anxiety and alterations of sleep. Additionally, no informant expressed a desire to remain in Peru long term. Conclusions: A minority of participants registered a clinically significant total score and in each of the three domains of SD, IR, and SR. No association between months in Lima and the self-perception of distress was found. However, this could be due to the short amount of time spent in Peru and any change in self-perception might only be perceived after years or decades spent in Peru. This study is one of the first to use mixed-methods to explore the mental health of the immigrant Venezuelan population.
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