• Paediatric snakebite envenoming: the world's most neglected 'Neglected Tropical Disease'?

      Pach, Sophie; Le Geyt, Jacqueline; Gutiérrez, José María; Williams, David; Maduwage, Kalana Prasad; Habib, Abdulrazaq Garba; Gustin, Rafael; Avila-Agüero, María Luisa; Ya, Kyaw Thu; Halbert, Jay (NLM (Medline), 2020-12-01)
      Snakebite disproportionally affects children living in impoverished rural communities. The WHO has recently reinstated snakebites on its list of Neglected Tropical Diseases and launched a comprehensive Strategy for the Prevention and Control of Snakebite Envenoming. In the first of a two paper series, we describe the epidemiology, socioeconomic impact and key prevention strategies. We also explore current challenges and priorities including the production and distribution of safe and effective antivenom.
      Acceso abierto
    • Pancreatitis aguda debido a intususcepción gastroduodenal

      Salazar Alarcón, Jorge Luis; Arones Collantes, Ricardo Alfredo; León Estrella, Miguel Ángel; Peña Peña, Carlos Saúl; jorgesalazar635@gmail.com (Elsevier España S.L., 2016-10)
      Introducción: Los pólipos gástricos adenomatosos son poco frecuentes y generalmente se encuentran en el examen endoscópico de rutina. La intususcepción gastroduodenal es una com- plicación poco frecuente de los pólipos gástricos y ha sido raramente descrita como una causa de pancreatitis aguda. Caso clínico: Presentamos el caso de un varón de 68 anos ̃ el cual ingresa de urgencia con dolor abdominal, náuseas y vómitos catalogados en un inicio como pancreatitis aguda de etiología biliar; incidentalmente se descubre un pólipo gástrico pediculado intususceptado a duodeno como causa de la pancreatitis aguda. Se realizó tratamiento endoscópico de urgencia y trata- miento definitivo con cirugía abierta.
      Acceso abierto
    • Pancreatitis por citomegalovirus en inmunocomprometidos. Reporte de casos

      Salazar Huayna, Lourdes; Vélez Segovia, Eduardo; Ruelas Figueroa, José; Mendo Urbina, Fernando; Montiel-Gonzales, Marco (Asociación Colombiana de Gastroenterología, 2014-07-14)
      We report two cases of pancreatitis secondary to cytomegalovirus infections which were tested by reverse transcription polymerase chain reaction (RT-PCR) in patients with human immunodefi ciency virus (HIV). Other causes were ruled out by laboratory fi ndings. Both patients were treated with ganciclovir and improved clinically and as indicated by laboratory fi ndings. This condition should not be ignored in HIV-positive patients in spite of the absence of the clinical characteristics of acute pancreatitis.
      Acceso abierto
    • Pancreatitis por hipercalcemia secundaria a un adenoma de paratiroides y la presencia de un carcinoma papilar tiroides asociado

      Robles Cuadros, Juan Martín; Lastarria Bamberger, Carlos; Murillo Pérez, Diego; Rivas Ceballos, Jesús; Piscoya, Alejandro (2015-07-31)
      La pancreatitis aguda por hipercalcemia secundaria a hiperparatiroidismo primario es una etiología infrecuente. Presentamos una paciente mujer de 77 años que presentó dolor abdominal en hemiabdomen superior y vómitos; colecistectomizada, no bebe alcohol ni presenta dislipidemia. Los estudios de laboratorio mostraron, amilasa de 394 U/L y lipasa de 906 U/L, calcio sérico 17,93 mg/dL y el PTHi 441 pg/ml. En la TEM de cuello, se observó bocio multinodular (nódulos de 9 y 7 mm) en el lóbulo izquierdo de tiroides y un nódulo en paratiroides. La paciente fue sometida a una paratiroidectomía superior derecha y una hemitiroidectomía del mismo lado. Después de la cirugía, los niveles de Ca sérico y PTHi disminuyeron. Asimismo, como hallazgo en la biopsia, se encontró carcinoma papilar variante folicular de tiroides. Este reporte explica las posibles teorías de asociación entre adenoma paratiroideo y pancreatitis por hipercalcemia y describe además la asociación con carcinoma papilar variante folicular de tiroides, no antes descrito.
      Acceso abierto
    • Passive smoking could still represent a risk factor in Mexican children with asthma

      Pinedo Pichilingue, Aranza; Quijano Ono, Javier (Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI), 2014-07-03)
      We have read with interest the article by Bedolla et al. [1] and we believe the lack of association between passive smoking and asthma might be a consequence of the way the variable was measured. They defined passive smoking as follows: “smoking was considered as passive when one or more cigarettes were consumed by one or by both parents in the presence of the children”. We would like to highlight some factors that could have been taken into count when defining this variable: time of smoking, frequency and number of cigarettes.
      Acceso abierto
    • Perceived stress and high fat intake: A study in a sample of undergraduate students

      Vidal, E. Jair; Alvarez, Daily; Martinez-Velarde, Dalia; Vidal-Damas, Lorena; Yuncar-Rojas, Kelly A.; Julca-Malca, Alesia; Bernabe-Ortiz, Antonio (Public Library of Science, 2018-03-09)
      Objectives Different studies have reported the association between perceived stress and unhealthy diet choices. We aimed to determine whether there is a relationship between perceived stress and fat intake among undergraduate medical students. Methods/Principal findings A cross-sectional study was performed including first-year medical students. The outcome of interest was the self-report of fat intake assessed using the Block Screening Questionnaire for Fat Intake (high vs. low intake), whereas the exposure was perceived stress (low/ normal vs. high levels). The prevalence of high fat intake was estimated and the association of interest was determined using prevalence ratios (PR) and 95% confidence intervals (95% CI). Models were created utilizing Poisson regression with robust standard errors. Data from 523 students were analyzed, 52.0% female, mean age 19.0 (SD 1.7) years. The prevalence of high fat intake was 42.4% (CI: 38.2%–46.7%). In multivariate model and compared with those with lowest levels of stress, those in the middle (PR = 1.59; 95%CI: 1.20–2.12) and highest (PR = 1.92; 95%CI: 1.46–2.53) categories of perceived stress had greater prevalence of fat intake. Gender was an effect modifier of this association (p = 0.008). Conclusions Greater levels of perceived stress were associated with higher fat intake, and this association was stronger among males. More than 40% of students reported having high fat consumption. Our results suggest the need to implement strategies that promote decreased fat intake.
      Acceso abierto
    • Percepción de la formación durante el residentado médico en hospitales del Ministerio de Salud de Lima, Perú

      Herrera Añazco, Percy; Hernández, Adrian V.; Sánchez Rivas, Flor; Arana Maestre, Christian; silamud@gmail.com (Instituto Nacional de Salud (INS), 2014-09-29)
      Cartas al editor
      Acceso abierto
    • Perception about chagas disease and the risk of oral transmission in Andoas, Loreto, Peru

      Cabrera, Rufino; Valderrama, Yadira; Meza, Juan Ramón (Instituto Nacional de Salud, 2020-01-01)
      Carta al editor.
      Acceso abierto
    • Perception of medical students about courses based on peer-assisted learning in five Peruvian universities

      Soriano-Moreno, Anderson N.; Delgado-Raygada, Jose E.; Peralta, C. Ichiro; Serrano-Diaz, Estefania S.; Canaza-Apaza, Jaquelin M.; Toro-Huamanchumo, Carlos J. (BioMed Central Ltd., 2020-01-01)
      Objectives: Peer-assisted learning (PAL) is a supportive strategy in medical education. In Peru, this method has been implemented by few universities. However, there are no consistent studies evaluating their acceptability by medical students. The objective of this study was to evaluate the perception of medical students about PAL in five Peruvian universities. Results: A total of 79 medical students were included in the study. The mean age was 20.1 ± 1.9 years, 54% were female, and 87% were in the first 4 years of study. Most of the students were satisfied with classes and peer teachers. Similarly, most of the students agreed with the interest in developing teaching skills. It was also observed that 97% of students approved to implement PAL in medical education programs.
      Acceso abierto
    • Perception of physicians about medical education received during their Nephrology residency

      Herrera Añazco, Percy; Bonilla Vargas, Luis; Hernández, Adrian V.; Silveira Chau, Manuela (Brazilian Society of Nephrology, 2015-10-13)
      Introduction: In Peru there are different hospitals and university programs for training of specialists in nephrology. Objective: To assess the perception of physicians who attend such programs. Methods: We carried out a descriptive cross-sectional national-level study in physicians who were in the last two years of nephrology training during February 2012 and who had graduated from it in 2010 and 2011. A self-applied questionnaire was developed along with the Peruvian Society of Nephrology based on international standards. The questionnaire evaluated: mentoring, clinical training, procedures, external rotations, research and global perception. Results: Forty doctors were surveyed nationwide. 82.5% had tutors, 22.5% of them said their support was poor. A 27.5% described their theoretical formation as deficient. The practical training was perceived as acceptable globally; however, improvements in training on peritoneal dialysis and reading kidney transplant biopsies are necessary. A 90% have national external rotations and 65% reported to have an international rotation. In the assessment of research, 77.5% thought this is deficient. In addition, 82.5% believed that residency should last four years. However, 60% reported that their residency training was good. There is a decrease in the positive perception of the aspects studied among residents regarding graduates. Conclusion: The overall perception of nephrology residency training was considered good; however, areas of tutoring, and academic and research activities on average were deficient.
      Acceso abierto
    • Performance of clinical prediction rules for diagnosis of pleural tuberculosis in a high-incidence setting

      Solari, Lely; Soto, Alonso; Van der Stuyft, Patrick; Unit of General Epidemiology and Disease Control; Institute of Tropical Medicine of Antwerp; Antwerp Belgium; Escuela de Medicina; Universidad Peruana de Ciencias Aplicadas; Lima Peru; Unit of General Epidemiology and Disease Control; Institute of Tropical Medicine of Antwerp; Antwerp Belgium; alonso.soto@upc.edu.pe (John Wiley & Sons Ltd, 2017-10)
      Objectives: Diagnosis of pleural tuberculosis (PT) is still a challenge, particularly in resource-constrained settings. Alternative diagnostic tools are needed. We aimed at evaluating the utility of Clinical Prediction Rules (CPRs) for diagnosis of pleural tuberculosis in Peru. Methods: We identified CPRs for diagnosis of PT through a structured literature search. CPRs using high-complexity tests, as defined by the FDA, were excluded. We applied the identified CPRs to patients with pleural exudates attending two third-level hospitals in Lima, Peru, a setting with high incidence of tuberculosis. Besides pleural fluid analysis, patients underwent closed pleural biopsy for reaching a final diagnosis through combining microbiological and histopathological criteria. We evaluated the performance of the CPRs against this composite reference standard using classic indicators of diagnostic test validity. Results: We found 15 eligible CPRs, of which 12 could be validated. Most included ADA, age, lymphocyte proportion and protein in pleural fluid as predictive findings. A total of 259 patients were included for their validation, of which 176 (67%) had PT and 50 (19%) malignant pleural effusion. The overall accuracy of the CPRs varied from 41% to 86%. Two had a positive likelihood ratio (LR) above 10, but none a negative LR below 0.1. ADA alone at a cut-off of ≥40 IU attained 87% diagnostic accuracy and had a positive LR of 6.6 and a negative LR of 0.2. Conclusion: Many CPRs for PT are available. In addition to ADA alone, none of them contributes significantly to diagnosis of PT.
      Acceso abierto
    • Performance of the FIB-4 index in esophageal varices screening in patients with the diagnosis of liver cirrhosis

      Cá Lamo-Guzmá N, Bernardo; De Vinatea-Serrano, Luis; Piscoya, Alejandro; Segura, Eddy R. (Sociedad de Gastroenterología del Perú, 2020-01-01)
      INTRODUCTION: The diagnosis of esophageal varices in cirrhotic patients is made by the upper gastrointestinal endoscopy. Multiple non-invasive predictors have been studied for the diag-nosis of esophageal varices. The objective of this study is to testthe FIB4 index as screening of esophageal varices in patients with liver cirrhosis. MATERIALS AND METHODS: A cross-sectional analytic study was developed in four national hospital using hepatic cirrhosis patient's medi-cal files. We assessed the information using univariate and bivariate analysis, sensitivity, speci-ficity, predictive positive and negative value, the positive and negative likelihood ratio calcu-lation of the esophageal varices screening and its size. We built ROC curve for every analysis group. RESULTS: The study included 289 liver cirrhosis patients. Most of the patients were male (54.33%). 77.85% patients had esophageal varices. The distribution of varices was 19.03%, 35.99% and 22.84% for large, medium and small varices, respectively. In the FIB-4 index analysis for the presence of varices, it was found a sensitivity of 81.3%, specificity of 37.5% (AUC: 0.57). The calculation for variceal size showed a sensitivity of 81.8%, specificity of 23.9% (AUC: 0.50). In the analysis of FIB-4 index for prophylaxis groups was found a sensitivity of 81.8% and a specificity of 28.5% (AUC: 0.54). CONCLUSIONS: The FIB-4 index has no good performance in the screening for the presence of esophageal varices and its size in liver cirrhosis patients.
      Acceso abierto
    • Peritoneal dialysis in Peru

      Vélez Segovia, E.; Salazar Huayna, Lourdes; Alva Bravo, E. (Indian Society of Nephrology, 2014-04-29)
      Cartas al editor
      Acceso abierto
    • Personalized Cognitive Counseling Reduces Drinking Expectancy Among Men Who Have Sex with Men and Transgender Women in Lima, Peru: A Pilot Randomized Controlled Trial

      Passaro, R. Colby; Chávez-Gomez, Susan; Castañeda-Huaripata, Angelica; Gonzales-Saavedra, Williams; Beymer, Matthew R.; Segura, Eddy R.; Nanclares, Francisco; Dilley, James; Cabello, Robinson; Clark, Jesse L. (Springer, 2020-11-01)
      Personalized cognitive counseling (PCC) is an evidence-based intervention designed to modify HIV-related risk behavior. We assessed the impact of PCC on sexual behavior, drinking expectancy, and incidence of sexually transmitted infections (STIs) in a 6-month randomized controlled trial among 153 HIV-uninfected men who have sex with men (MSM) and transgender women (TW) in Peru. Study retention was ≥ 90%, with three HIV infections (3 Control) and 19 cases of GC/CT (10 Control, 9 PCC) at 6 months. There was a decline in condomless receptive anal intercourse in the Control (0.74, 95% CI 0.60-0.91; p < 0.01) and PCC arms (0.72, 0.55-0.94; p = 0.02) at 6-month follow-up. There was a decrease in drinking expectancy at 6 months among participants endorsing alcohol use in the PCC arm (0.89, 0.83-0.96; p < 0.01), versus no change in the Control arm (0.98, 0.92-1.04; p = 0.54). PCC was efficacious in reducing drinking expectancy and HIV risk among MSM and TW in Peru.
      Acceso restringido temporalmente
    • Phenotypic expansion in KIF1A-related dominant disorders: A description of novel variants and review of published cases

      Montenegro-Garreaud, Ximena; Hansen, Adam W.; Khayat, Michael M.; Chander, Varuna; Grochowski, Christopher M.; Jiang, Yunyun; Li, He; Mitani, Tadahiro; Kessler, Elena; Jayaseelan, Joy; Shen, Hua; Gezdirici, Alper; Pehlivan, Davut; Meng, Qingchang; Rosenfeld, Jill A.; Jhangiani, Shalini N.; Madan-Khetarpal, Suneeta; Scott, Daryl A.; Abarca-Barriga, Hugo; Trubnykova, Milana; Gingras, Marie Claude; Muzny, Donna M.; Posey, Jennifer E.; Liu, Pengfei; Lupski, James R.; Gibbs, Richard A. (John Wiley and Sons Inc, 2020-12-01)
      KIF1A is a molecular motor for membrane-bound cargo important to the development and survival of sensory neurons. KIF1A dysfunction has been associated with several Mendelian disorders with a spectrum of overlapping phenotypes, ranging from spastic paraplegia to intellectual disability. We present a novel pathogenic in-frame deletion in the KIF1A molecular motor domain inherited by two affected siblings from an unaffected mother with apparent germline mosaicism. We identified eight additional cases with heterozygous, pathogenic KIF1A variants ascertained from a local data lake. Our data provide evidence for the expansion of KIF1A-associated phenotypes to include hip subluxation and dystonia as well as phenotypes observed in only a single case: gelastic cataplexy, coxa valga, and double collecting system. We review the literature and suggest that KIF1A dysfunction is better understood as a single neuromuscular disorder with variable involvement of other organ systems than a set of discrete disorders converging at a single locus.
      Acceso restringido temporalmente
    • Phylogenetic relationships of Shiga toxin-producing Escherichia coli isolated from Peruvian children

      Contreras, C. A.; Ochoa, T. J.; Ruiz, J.; Lacher, D. W.; Rivera, F. P.; Saenz, Y.; Chea-Woo, E.; Zavaleta, N.; Gil, A. I.; Lanata, C. F. (Society for General Microbiology (SGM), 2014-06-10)
      The aim of this study was to determine the prevalence, virulence factors (stx, eae, ehxA and astA) and phylogenetic relationships [PFGE and multilocus sequence typing (MLST)] of Shiga toxinproducing Escherichia coli (STEC) strains isolated from four previous cohort studies in 2212 Peruvian children aged ,36 months. STEC prevalence was 0.4% (14/3219) in diarrhoeal and 0.6% (15/2695) in control samples. None of the infected children developed haemolytic uraemic syndrome (HUS) or other complications of STEC. stx1 was present in 83% of strains, stx2 in 17 %, eae in 72 %, ehxA in 59% and astA in 14 %. The most common serotype was O26: H11 (14%) and the most common seropathotype was B (45 %). The strains belonged mainly to phylogenetic group B1 (52 %). The distinct combinations of alleles across the seven MLST loci were used to define 13 sequence types among 19 STEC strains. PFGE typing of 20 STEC strains resulted in 19 pulsed-field patterns. Comparison of the patterns revealed 11 clusters (I–XI), each usually including strains belonging to different serotypes; one exception was cluster VI, which gathered exclusively seven strains of seropathotype B, clonal group enterohaemorrhagic E. coli (EHEC) 2 and phylogenetic group B1. In summary, STEC prevalence was low in Peruvian children with diarrhoea in the community setting. The strains were phylogenetically diverse and associated with mild infections. However, additional studies are needed in children with bloody diarrhoea and HUS.
      Acceso abierto
    • Physical activity levels by glycemia status: A population-based cross-sectional study in Peru

      Ganoza-Calero, Antonelhla M.; Cuadros-Torres, Milagros; Bernabé-Ortiz, Antonio (Elsevier Ltd, 2021-04-01)
      Objective: To assess whether the prevalence of low physical activity levels and time spent watching TV differ depending on glycemia status. Methods: A secondary analysis using data from a population-based study was conducted. Two were the outcomes: physical activity levels, derived from the International Physical Activity Questionnaire, and sitting time watching TV. The exposure was glycemia status, defined based on results of the oral glucose tolerance tests (OGTT): euglycemia, dysglycemia, and T2DM. The T2DM group was further split into: aware and unaware of T2DM diagnosis. Prevalence ratios (PR) and 95% CI were reported using Poisson regression models. Results: Data of 1607 individuals, mean age 48.2 (SD: 10.6) years, 809 (50.3%) females, were analyzed. Dysglycemia and T2DM was present in 16.9% (95% CI: 15.1%–18.8%) and 11.0% (95% CI: 9.5%–12.6%) of participants, respectively. A total of 605 (37.6%; 95% CI: 35.2%–39.9%) participants had low levels of physical activity and 1019 (63.3%; 95% CI: 60.9%–65.7%) subjects spent ≥2 h per day sitting watching TV. In multivariable model, there was no significant association between glycemia status and physical activity levels (PR = 1.14; 95% CI: 0.95–1.36). Similar result was found between glycemia status and sitting time watching TV. However, those aware of T2DM diagnosis were more likely to have low levels of physical activity (PR = 1.31; 95% CI: 1.06–1.61) compared to the euglycemia group. Conclusions: We found a no relationship between glycemia status and physical activity level or sitting time watching TV, pointing out similar levels of physical (in)activity among those with euglycemia, dysglycemia and T2DM. Individuals aware of having T2DM were 30% more likely to have low physical activity levels compared to the euglycemic group. There is a need to increase physical activity levels among T2DM individuals.
      Acceso restringido temporalmente
    • Physical Exertion Immediately Prior to Placental Abruption: A Case-Crossover Study

      Chahal, Harpreet S; Gelaye, Bizu; Mostofsky, Elizabeth; Sanchez, Sixto E; Mittleman, Murray A; Maclure, Malcolm; Pacora, Percy; Torres, Jose A; Romero, Roberto; Ananth, Cande V; Williams, Michelle A; harpreet.chahal@mail.utoronto.ca (Oxford University Press, 2018-10-01)
      While there is consistent evidence that episodes of physical exertion are associated with an immediately higher risk of acute ischemic vascular events, the risk of placental abruption immediately following episodes of physical exertion has not been studied. In a multicenter case-crossover study, we interviewed 663 women with placental abruption at 7 Peruvian hospitals between January 2013 and August 2015. We asked women about physical exertion in the hour before symptom onset and compared this with their frequency of physical exertion over the prior week. Compared with times with light or no exertion, the risk of placental abruption was 7.8 (95% confidence interval (CI): 5.5, 11.0) times greater in the hour following moderate or heavy physical exertion. The instantaneous incidence rate ratio of placental abruption within an hour of moderate or heavy physical exertion was lower for women who habitually engaged in moderate or heavy physical activity more than 3 times per week in the year before pregnancy (rate ratio (RR) = 3.0, 95% CI: 1.6, 5.9) compared with more sedentary women (RR = 17.3, 95% CI: 11.3, 26.7; P for homogeneity < 0.001), and the rate ratio was higher among women with preeclampsia/eclampsia (RR = 13.6, 95% CI: 7.0, 26.2) than among women without (RR = 6.7, 95% CI: 4.4, 10.0; P for homogeneity = 0.07).
      Acceso restringido temporalmente
    • Phytochemical Screening, Total Phenolic Content, Antioxidant and Cytotoxic Activity of Chromolaena laevigata on Human Tumor Cell Lines

      Herrera-Calderon, Oscar; Arroyo-Acevedo, Jorge; Rojas-Armas, Juan; Chumpitaz-Cerrate, Victor; Figueroa-Salvador, Linder; Enciso-Roca, Edwin; Tinco-Jayo, Johnny (SCIENCEDOMAIN international, 2017-12-16)
      Aims: Cancer is the first cause of death in the Peruvian population; searching alternative treatments of medicinal plants constitute a promissory field to find new anticancer drugs. The main objective in this study was to evaluate the phytochemical screening, total phenolic content, antioxidant and cytotoxic activity of ethanol extract of Chromolaena laevigata (C. laevigata) on human tumor cell lines. Study Design: The fresh leaves of C. laevigata were soaked with ethanol followed by phytochemical screening using standard methods. Place and Duration of Study: Laboratory of Applied Chemistry, Faculty of Pharmacy and Biochemistry, Universidad Nacional San Luis Gonzaga de Ica, Ica, Peru; Laboratory “Abraham Vaisberg Wolach”, Universidad Peruana Cayetano Heredia, Lima, Peru. Methodology: Phytochemical screening was assessed by using chemical reactives. Total phenolic content (TPC) was developed using Folin Ciocalteu reactive and the antioxidant activity was determined against DPPH and ABTS radicals by spectrophotometry. The cytotoxic activity was determined on human tumor cell lines followed as: MCF-7, H-460, HT-29, M-14, K-562 and DU-145. Results: Phytochemical study confirmed flavonoids and phenolic compounds in ethanol extract. TPC resulted 45.21 ± 3.5 mg of gallic acid equivalent/g of dried extract. The highest antioxidant extract for DPPH and ABTS radical scavenging tests were IC50 = 11.66 ± 1.0 μg/mL, IC50= 12.45 ± 0.50 μg/mL respectively. Ethanolic extracts (μg/mL) showed a low cytotoxicity on human tumor cell lines (CI50 > 20 μg/mL) for DU-145, HT-29, MCF-7 and M-14. Whereas, for H-460, and K562 tumor cell lines showed high cytotoxicity. Conclusion: In our findings, C. laevigata demonstrated a high antioxidant and total phenolic content. The ethanol extract exhibited better cytotoxic effect compared with 5-FU. Hence, This medicinal plant could be effective to prevent chronical diseases as cancer and oxidative stress disorders.
      Acceso abierto
    • Pileflebitis: reporte de caso y revisión de literatura

      Lizeth Mirtha Flores Anaya; Cinthia Katherine León Lozada; Torres Damas, William Lovel (Medwave Estudios Limitada, 2015-10-13)
      Se presenta el caso de un paciente varón de 50 años que acude a la emergencia del Hospital Dos de Mayo, Lima, Perú, por presentar fiebre, dolor abdominal, diarrea e ictericia. Se plantea un cuadro de infección intestinal como diagnóstico inicial. Es derivado al área de Medicina Interna donde se realizan diversos exámenes de laboratorio y auxiliares, dentro de los cuales se indica realizar una tomografía computarizada abdominal. El estudio imagenológico confirmó el diagnóstico de pileflebitis, iniciando tratamiento con antibióticos y anticoagulantes. La respuesta y evolución fueron favorables
      Acceso abierto