RSS 1.0Medicina
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Childhood Maltreatment and Somatic Symptoms in Adulthood: Establishing a New Research Pathway(S. Karger AG, 2025-01-14)Background: Somatic symptoms, such as chronic pain, fatigue, and gastrointestinal disturbances, are commonly reported in individuals with a history of childhood maltreatment (CM), which includes various forms of abuse and neglect experienced before age 18. Although CM is strongly associated with somatic symptoms, the specific relationships between CM subtypes and these symptoms, as well as the mechanisms connecting them, remain insufficiently understood. This review examines the complex interaction between CM and somatic symptoms, which often coexist with mental disorders and significantly impact quality of life and healthcare systems. Summary: Somatic symptoms, frequently a mix of "explained"and "unexplained"conditions, are associated with personal distress and pose diagnostic challenges. CMhas been linked to these symptoms through neurobiological mechanisms, such as HPA axis dysregulation and allostatic load, while theoretical models emphasize the roles of hyperawareness, cultural factors, and vulnerability in symptom development. However, existing research often fails to account for specific CM subtypes, the full range of somatic symptoms, and cultural and situational factors, leading to inconsistencies in findings. Key Messages: Bridging gaps in literature requires adopting the World Health Organization's CM subtype definitions and ICD- 11 codes (MA00-MH2Y) to encompass a broader spectrum of somatic symptoms. Employing rigorous methodologies, such as systematic reviews and meta-analyses, is essential for advancing understanding. These approaches can enhance diagnostic accuracy, support tailored interventions, and promote a biopsychosocial framework for CM research, ultimately improving patient outcomes and alleviating societal burdens.
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Impact of Metallurgical Features on the Cyclic and Torsional Properties of Five Reciprocating Instruments Manufactured With Blue Thermal Treatment(John Wiley and Sons Inc, 2025-01-01)This study evaluated the metallurgical and mechanical properties of five reciprocating instruments with blue thermal treatment. A total of 200 NiTi rotary instruments (25.08 and 40.06) were used: Reciproc Blue (RB), RC Blue (RCB), Only One File (OOF), Blue T (BT), and Rec Blue File (RBF). The cyclic fatigue test was performed in an artificial canal with a curvature angle of 60° and a curvature radius of 5 mm (n = 20). The time to fracture was recorded (TTF). The torsional test was performed to evaluate the maximum torsional strength and angular deflection of the instrument's tip (n = 20). Differential Scanning Calorimetry (DSC) and x-ray diffractometry (XRD) were used to assess the metallurgical features. ANOVA and Tukey tests were used for statistical comparison. The OOF 25.08 and 40.06 exhibited higher TTF than the other groups (p < 0.05). There was no significant difference among OOF, RBF, and RB 25.08 regarding the torsional strength (p > 0.05). RCB 40.06 had the lowest torsional strength (p > 0.05). DSC analysis indicated that OOF had higher austenite start and finishing temperatures. XRD analysis revealed that the 25.08 and 40.06 instruments of OOF had the highest peaks of the martensite phase. Variations in metallurgical phases and temperature transformations affected the mechanical properties of the instruments.
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Filters and recoloring algorithms to improve mobile accessibility for users with color blindness(Association for Computing Machinery, Inc, 2025-01-17)digital accessibility
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Vitamin B12, folate, and homocysteine levels in children and adolescents with obesity: a systematic review and meta-analysis(Frontiers Media SA, 2025-01-01)Background and aims: Childhood and adolescent obesity is a global public health concern. Obesity induces several metabolic disturbances. Several studies have explored the association of vitamin B12, folate, and homocysteine (Hcy) with obesity. This study aimed to synthesize the available evidence regarding the differences in serum levels of vitamin B12, Hcy, and folate among children or adolescents with and without obesity. Methods: A random-effects meta-analysis using the Sidik-Jonkman method and corrected 95% confidence interval (CI) using the truncated Knapp-Hartung standard errors was used for all meta-analyses. Standardized mean difference (SMD) with the corresponding 95% CI was used as the only effect size. The Cochran’s Q test and the I2 statistic were used to evaluate between-study heterogeneity. Publication bias was assessed using funnel plots and the Egger test. Results: Twenty studies were included with a combined study population of 7,791 patients. There were no significant differences between children/adolescents with and without obesity with respect to serum vitamin B12 levels (SMD: −0.24; 95% CI: −0.53 to 0.06; p > 0.05, I2 = 74.93%) and folate levels (SMD: −0.12; 95% CI: −0.29 to 0.06; p > 0.05, I2 = 19.6%). However, children/adolescents with obesity had significantly higher Hcy levels compared to counterparts without obesity (SMD: 0.77; 95% CI: 0.39 to 1.14; p < 0.001, I2 = 86.4%). Conclusion: Children and adolescents with obesity had higher Hcy levels than those without obesity. However, no significant differences were found for vitamin B12 and folate levels. Hcy may play a role in the development of obesity in this population.Acceso abierto
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National Active Case-Finding Program for Tuberculosis in Prisons, Peru, 2024(Centers for Disease Control and Prevention (CDC), 2025-03-01)During January–September 2024, a national active case-finding program in Peru’s prisons screened >38,000 persons for tuberculosis (TB) using chest radiography with automated interpretation and rapid molecular tests. The program found high percentages of TB, rifampin-resistant TB, and asymptomatic infections, demonstrating the urgent need for systematic screening among incarcerated populations.
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The burden of cardiovascular disease in Latin America and the Caribbean, 1990-2019: An analysis of the global burden of disease study(Elsevier Ireland Ltd, 2025-06-01)Introduction: Cardiovascular disease (CVD) remains the leading cause of death globally, including the Latin America and the Caribbean (LAC) region. However, limited research has been conducted on the burden of CVD in this region. Our study aims to investigate the burden of CVD and related risk factors (RFs) in the LAC. Methods: We used data from the Global Burden of Disease (GBD) 2019 to examine CVD prevalence in 33 LAC countries. Prevalence, mortality, and incidence were analyzed using Bayesian regression tools, demographic methods, and mortality-to-incidence ratios. Disability-adjusted life years (DALYs) were calculated, and RFs were evaluated under the GBD's comparative risk assessment framework. Results: Between 1990 and 2019, CVD raw rates in the LAC increased by 116.7 %, while age-standardized prevalence decreased (-9.2 %). CVD raw mortality rose by 71.2 %, but age-standardized death rates fell by 69.8 %. Ischemic heart disease remained the most prevalent condition, with higher rates in men, while women had higher rates of stroke. Age-standardized DALYs decreased by 70.9 %. DALY rates varied across countries and were consistently higher in males. Leading RFs included HTN, high LDL, dietary risks, and elevated BMI. Conclusions: Despite progress in reducing the CVD burden in the LAC region, the impact on mortality and morbidity, particularly related to ischemic heart disease, remains substantial. Tailored interventions are necessary, considering country-specific variations in socio-economic factors, healthcare infrastructure, and political stability.
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Autoscopic phenomena: two cases of psychogenic origin(Universidad Peruana Cayetano Heredia, Facultad de Medicina Alberto Hurtado, 2025-01-01)Autoscopic phenomena include autoscopic hallucination, heautoscopy, and out-of-body experiences. Although their study had been neglected due to their apparent rarity, today they constitute a fruitful source for the study of the neurobiological bases of self and ego sense of consciousness. Its etiology, secondary to organicity, consumption of psychoactive substances and primary psychiatric conditions, also allows us to peer into the eventual connections between classical psychopathology and recent findings of the most sophisticated neurobiology. We present the report of two cases of psychogenic etiology, and postulate the heuristic possibility that, on the basis of the increasing frequency of selfies and related concepts in current human life, autoscopic phenomena may also be augmenting.Acceso abierto
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Outcomes and Current State of Deep Inferior Epigastric Perforator Flap Surgery in Peru and Mexico(Lippincott Williams and Wilkins, 2025-02-24)Background: In developing countries, breast reconstruction has multiple barriers, especially related to microsurgical procedures. Our aim was to describe the characteristics and outcomes of patients who underwent deep inferior epigastric artery perforator (DIEP) flap in 2 Latin American countries (Peru and Mexico) performed by recent postgraduate microsurgery fellows. Methods: A retrospective study of a case series of breast cancer patients who underwent DIEP flap surgery in 5 surgery centers in 2 different countries, Peru and Mexico, was conducted. Results: A total of 45 female patients were included, the mean age was 47.62 years with a median body mass index of 24.91 kg/m2. The majority of patients had a presurgical diagnosis of mastectomy (91.1%), whereas 8.9% had chronic radiodermatitis. Moreover, the most common reason for surgical intervention was breast reconstruction after breast cancer surgery (88.9%). The median operative time and length of hospital stay were 8 hours (range 3-14 h) and 6 days (range 3-21 d), respectively. Twenty percent of patients required blood transfusions, 24.4% had venous congestion, and 15.6% presented wound dehiscence. Moreover, 9 (33.3%) patients required reoperation and 6 required salvage procedures (15.6%). Conclusions: Due to the multiple healthcare barriers in these countries, a very low number of DIEP flaps are performed in Peru and Mexico. Outcomes were worse in Peru compared with Mexico, with complication rates similar to those of other Latin American countries but higher than those of interventions performed in more experienced hands in the United States and Europe.Acceso abierto
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The target trial framework in global health research: barriers and opportunities(University of Edinburgh, 2025-01-01)A randomised trial is the best way to make causal inferences when evaluating the effectiveness and safety of health interventions in global health research. Trials, however, are inherently expensive, unfeasible in many scenarios, and may raise ethical issues. In these scenarios, we must turn to analyses of observational data to learn what works. The target trial framework provides an organising principle for the design of observational studies that can lead to clinically interpretable results and analytic approaches that can reduce common biases. In this analysis, we describe the global distribution of data sources used in applications of the target trial framework and discuss barriers to its increased use in global health research, such as limited access to high-quality observational data. We then suggest a cost-effective solution of incorporating the collection of additional high-quality observational data into the implementation of large randomised trials in low- and middle-income countries. We found that the target trial framework is underutilised in observational studies conducted in most low- and middle-income countries. The main barriers are little available data and few trained researchers, which can be overcome by incorporating high-quality observational data collection into the data collection phase of large randomised trials, and by introducing small adjustments to the teaching curriculum.Acceso abierto
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Perioperative Risks Associated with the Use of External Fixators in Adult and Pediatric Patients with Trauma(W.B. Saunders, 2025-04-01)Orthopedic trauma
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Septic shock upon admission to pediatric intensive care units: prognostic analysis of mortality in a retrospective cohort(Permanyer Publications, 2025-01-01)Background: Septic shock is a common cause of admission to pediatric intensive care units (PICU) and is associated with significant mortality. Our objective was to analyze the association between septic shock diagnosis at PICU admission and mortality during hospitalization. Method: This retrospective cohort study was conducted in the PICU of Hospital Nacional Edgardo Rebagliati Martins (HNERM) in Lima, Peru, from January 2018 to December 2021. The sample size was determined based on annual mortality rates, and randomization was used to create two groups: patients with and without septic shock. To evaluate mortality risk, we performed a Poisson regression with robust variances and 95% confidence intervals (CI) using both crude and adjusted models. Results: Of 1,341 patients admitted to the PICU during the study period, 358 were included in the analysis. The study population was 51.9% female, with a median age of 3.7 years. The largest age group was children under 1 year, comprising 29.6% of participants. The septic shock group showed higher rates of mechanical ventila-tion requirement, longer hospital stays, and increased mortality. The risk of mortality was 2.73 times higher in patients admitted with septic shock compared to those admitted with other diagnoses (relative risks: 2.73; 95% CI: 1.36–5.46). Conclusion: Patients admitted to the PICU with septic shock demonstrated a 2.73 times higher risk of death compared to those admitted for other reasons.Acceso abierto
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Video Versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults: A Systematic Review and Meta-Analysis(Multidisciplinary Digital Publishing Institute (MDPI), 2025-03-01)Background/Objectives: Endotracheal intubation in critically ill patients presents significant challenges due to anatomical and physiological complexities, making airway management crucial. Video laryngoscopy (VL) has emerged as a promising alternative to direct laryngoscopy (DL), offering improved and higher success rates. This systematic review and meta-analysis evaluated the comparative efficacy and safety of VL versus DL in critically ill adults. Methods: A systematic search was conducted in PubMed, Embase, and Cochrane Library through August 2024 following PRISMA-2020 guidelines. Randomized controlled trials comparing VL and DL in critically ill adult patients were included. The RoB 2.0 tool assessed bias, and GRADE evaluated the certainty of evidence. The primary outcome was first-attempt success; secondary outcomes included intubation time, glottic visualization, and complications. Random effects models were used for data synthesis. Results: Fifteen studies (4582 intubations) were included. VL improved first-attempt success rates (RR 1.12; 95% CI: 1.04–1.21; I2 = 87%). It also reduced esophageal intubation (RR 0.44; 95% CI: 0.26–0.75), dental injuries (RR 0.32; 95% CI: 0.16–0.67), and poor glottic visualization. No significant differences were found in hypoxemia, hypotension, or mortality. Conclusions: VL enhances intubation success and reduces specific complications, particularly in difficult airways. However, high heterogeneity and low certainty of evidence warrant further studies to clarify its impact on critical patient outcomes.Acceso abierto
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The translation inhibitors kasugamycin, edeine and GE81112 target distinct steps during 30S initiation complex formation(Nature Research, 2025-12-01)During bacterial translation initiation, the 30S ribosomal subunit, initiation factors, and initiator tRNA define the reading frame of the mRNA. This process is inhibited by kasugamycin, edeine and GE81112, however, their mechanisms of action have not been fully elucidated. Here we present cryo-electron microscopy structures of 30S initiation intermediate complexes formed in the presence of kasugamycin, edeine and GE81112 at resolutions of 2.0-2.9 Å. The structures reveal that all three antibiotics bind within the E-site of the 30S and preclude 30S initiation complex formation. While kasugamycin and edeine affect early steps of 30S pre-initiation complex formation, GE81112 stalls pre-initiation complex formation at a further step by allowing start codon recognition, but impeding IF3 departure. Collectively, our work highlights how chemically distinct compounds binding at a conserved site on the 30S can interfere with translation initiation in a unique manner.Acceso abierto
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A delayed diagnosis of hyperthyroidism in a patient with persistent vomiting in the presence of Chiari type 1 malformation(Walter de Gruyter GmbH, 2025-02-01)Objectives: To present and discuss an uncommon clinical presentation of hyperthyroidism in a female patient with Chiari type 1 malformation. We explore how her medical history influenced the diagnostic process and ultimately contributed to the delayed diagnosis. Case presentation: In this case study, we discuss an unusual presentation of hyperthyroidism in a 35-year-old female with Chiari type 1 malformation. Initially experiencing headaches, tremors, and dizziness, the patient consulted multiple specialists without a clear diagnosis. Later, she developed recurrent vomiting unrelated to food intake, significant weight loss (12 kg), and muscle weakness, leading to her hospitalization. After six months of clinical evaluation with several specialists (neurologists, neurosurgeons, and gastroenterologists), she was, finally, diagnosed with hyperthyroidism by an Internal Medicine physician in another private clinic. Treatment with thiamazole and propranolol led to the improvement of symptoms progressively. This case emphasizes the vital role of clinical reasoning, crucial problem-solving, and decision-making processes while addressing cognitive biases in medical specialization. Besides, it highlights the need for internist evaluation in outpatient care to ensure comprehensive assessment and prompt specialist referrals if needed. Conclusions: This case accentuates the importance of internist evaluation for comprehensive care and timely specialist referrals. Recognizing unusual presentations, like thyrotoxic vomiting, and addressing cognitive biases, such as confirmation and anchor biases, are crucial for accurate and prompt diagnosis. This approach enhances diagnostic accuracy, minimizing unnecessary tests and costs, and alleviates patient suffering.
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Principles of Surgical Treatment of Soft Tissue Sarcomas(Multidisciplinary Digital Publishing Institute (MDPI), 2025-02-01)Soft tissue sarcoma (STS) is a group of highly heterogeneous tumors of mesenchymal origin that have variable primary site locations and clinical behavior. Despite the broad diversity of STS, the standard of care involves surgical resection with or without radiation therapy (RT) to control local recurrence and systemic treatment in select cases. The complexities of STS require a critical understanding of the preoperative work-up process, surgical treatment, and postoperative management. Advanced imaging plays a vital role in the characterization of the soft tissue mass, preoperative biopsy planning, and disease staging. Surgical treatment prioritizes wide resection with negative margins, supported by newer margin classification systems for better prognosis. Further, advancements in surgical technique have enabled limb-salvage surgery to largely replace amputation in the management of these tumors. Additional surgical considerations, such as nerve preservation, vascular reconstruction, and complex tissue closure, further highlight the complexity of STS management. Lastly, postoperative follow-up is critical for the early detection of local or distant recurrences. For complex cases, such as unplanned excisions or invasive tumors, strategies like re-resection may be beneficial. Ongoing research into imaging, chemotherapy, and targeted therapies will further refine management strategies, especially in complex and recurrent cases. This review highlights the essential aspects of STS surgical management and underscores the need for coordinated, multidisciplinary care to enhance both survival and quality of life for affected patients.Acceso abierto
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Relationship between butyrylcholinesterase activity and hepatic transaminases: a cross-sectional study in agricultural workers from Peru(BioMed Central Ltd, 2025-12-01)Introduction: Chronic exposure to pesticides causes various adverse health effects, mainly at a neurological level. However, there is little evidence focused on liver tissue injury and transaminase activity as indicators of effect. Methods: A cross-sectional study was designed based on medical-occupational records of workers from an agro-export company in Peru to associate the levels of butyrylcholinesterase (BChE) transaminases (ALT and AST). Occupational medical records were reviewed to obtain demographic and occupational information and laboratory values of BChE activity and transaminases. Results: We evaluated 459 records, and 69.9% were men. The mean age was 34.9 ± 11.5 years. BChE, ALT, and AST levels were 6238.8 ± 709.1 U/l, 34.4 ± 12.5 U/l, and 22.4 ± 8.5 U/l, respectively. The proportion of inhibited BCHE and elevated transaminase levels was 15.3% and 21.6%, respectively. We found a significant association between BChE inhibition and elevation of transaminases (AST: PR = 0.798, 95%CI: 0.716–0.889; ALT: PR = 0.419, 95%CI: 0.239–0.736). Conclusion: The potential usefulness of transaminases is shown as a biomarker of exposure and monitoring in occupational health programs for the agro-industry.Acceso abierto
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What Abductor Repair Technique Provides the Best Functional Outcomes After Proximal Femur Endoprosthetic Reconstruction for Oncologic Indications? A Systematic Review(Elsevier B.V., 2025-03-01)Background: There is conflicting data regarding the optimal abductor mechanism (AM) repair technique after resection of proximal femur tumors. We sought to compare functional outcomes following tumor resection and reconstruction with proximal femoral replacement based on the AM repair technique utilized. Methods: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We established two study groups based on AM repair technique as follows: soft-tissue reattachment (STr) and greater trochanter preservation (GTp). In the STr group, the gluteus medius and minimus muscles were reattached to the endoprosthesis, whereas in the GTp group, the greater trochanter and gluteal tendons were preserved. The STr group was further subdivided into direct and indirect reattachments. Weighted means adjusting for sample size were calculated. Results: A total of 658 patients from 12 articles were included. Patients who had STr displayed higher Musculoskeletal Tumor Society scores (75 versus 67.3%, P < 0.001), lower rates of Trendelenburg gait (33.9 versus 52.4%, P < 0.01), and ambulation with assistive devices (30.4 versus 54.9%, P < 0.001) compared to the GTp group. Within the STr group, indirect reattachment was associated with higher Musculoskeletal Tumor Society scores (87.2 versus 70.1%, P < 0.001) and lower rates of Trendelenburg gait (3.8 versus 36.3%, P < 0.001) and ambulation with assistive devices (0 versus 42.4%, P < 0.001) compared to direct reattachment. The reattachment hardware failure rate in GTp was 15%. Conclusion: A STr provided superior functional outcomes compared to GTp in tumor-related proximal femoral replacement. From a functional outcome perspective, the use of indirect STr was better compared to direct STr. Level of Evidence: III.
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Novel Intermediate ATXN10 Alleles in the Healthy Peruvian Population: A Matter of Indigenous American Ethnic Origin(Springer, 2025-04-01)Spinocerebellar ataxia type 10 (SCA10) is a neurodegenerative disease predominant in Latin American individuals with Indigenous American ancestry. SCA10 is caused by an expansion of ATTCT repeat within the ATXN10 gene. Healthy individuals carry 9–32 ATTCT repeats, whereas SCA10 patients carry an expansion of 280 repeats and higher. Recently, intermediate alleles (over than 32 repeats) have been identified in healthy Peruvian Indigenous American individuals, with unclear significance. This study aims to characterize the variability of the ATTCT repeats within the ATXN10 gene across self-declared Indigenous American and Mestizo subpopulations from Peru. A total of 871 samples (754 Mestizo and 117 Indigenous American) were analyzed using PCR, and RP-PCR when suspecting apparent homozygosity due to larger alleles. 8.7% of the total of healthy individuals (76/871) carry at least one intermediate allele. The 14-repeat allele being the most common for both subpopulations (41.5%). Intermediate alleles were detected in the Peruvian population (4.5%) with a significantly higher frequency among self-declared Indigenous American compared to Mestizo, suggesting a possible association with the ethnic origin. The G allele at the SNP rs41524547 had a frequency of 51.39% in individuals with intermediate alleles, with not significantly difference between subpopulations. Further analysis should be performed to confirm the size and composition of ATTCT repeat tract, as well as the contribution of rs41524547 in SCA10.
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Methodological and reporting quality of Latin American randomized controlled trials in surgery from 2012 to 2022: a meta-research study(Lippincott Williams and Wilkins, 2025-02-01)Background: Latin America is a region where an increasing number of randomized controlled trials (RCTs) in surgery are being conducted. However, there is no evidence regarding the methodological and reporting quality of this studies. Methods: Meta-research study, including RCTs conducted in general surgery and subspecialties, conducted in Latin American centers and published from 2012 to 2022 with inclusion in PubMed and Scopus databases. The CONSORT and Joanna Briggs Checklist for Randomized Controlled Trials tools were used. Results: 83 RCTs met the inclusion criteria. 67.5% (n = 56) were conducted in Brazil. 74.7% (n = 62) of RCTs demonstrated high methodological quality, while only 31.7% (n = 26) exhibited high reporting quality. Out of the 13 methodological quality items, 3 were not fulfilled in more than 50% of the RCTs. Meanwhile, of the 37 reporting quality items, only 15 were met in more than 75% of the RCTs. Conclusions: While the methodological quality of Latin American RCTs in surgery included in PubMed and Scopus is relatively high, there is a predominance of moderate reporting quality. The common failure to comply with specific items in this sample is a phenomenon of great interest for surgical meta-research that warrants deeper exploration. These shortcomings the falsifiability and reproducibility of Latin American RCTs in surgery, which could be improved through scientific training.
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The Lupus Foundation of America Rapid Evaluation of Activity in Lupus Patient-Reported Outcome Predicts Health-Related Quality of Life, Fatigue, and Work Productivity Impairment: Data From the Almenara Lupus Cohort(Lippincott Williams and Wilkins, 2025-01-01)Objective The study aims to evaluate the impact of patient-reported disease activity in other patient-reported outcomes (PROs) in systemic lupus erythematosus (SLE) patients. Methods SLE patients from the Almenara Lupus Cohort were included, and visits were performed every 6 months. Disease activity was assessed with the Lupus Foundation of America Rapid Evaluation of Activity in Lupus (LFA-REAL) PRO, health-related quality of life (HRQoL) with the LupusQoL, fatigue with the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and work productivity impairment with the work productivity and activity impairment (WPAI). Generalized estimating equations were performed for each domain of the LupusQoL, the FACIT-F, and the WPAI. The LFA-REAL PRO measured at the previous visit; multivariable models were adjusted for possible confounders measured at the same visit as the LFA-REAL PRO. The Β (regression unstandardized coefficient) is reported per an increase of 10 units of the LFA-REAL PRO. Results A total of 316 patients and 1116 visits were included. Mean (SD) LFA-REAL PRO at baseline was 240.9 (182.1). LFA-REAL PRO predicted a worse HRQoL in all domains of the LupusQoL, the WPAI, and the FACIT-F, even after adjustment for confounders. Conclusions A higher patient-reported disease activity predicted a worse HRQoL and fatigue as well as a higher work productivity impairment in SLE patients. Patient-reported disease activity should be included in the evaluation of SLE patients on a regular basis as such provides the patients' own perception of their disease. This may have an impact on their adherence to treatment and may result in better outcomes.
