• Tecnologías de la información para resolver contingencias en la afiliación al régimen subsidiado de salud en Perú: "Resuelve tu afiliación"

      Villegas-Ortega, José; Loyola-Martínez, César; Santisteban-Romero, Javier; Manchego-Lombardi, Mónica; Lozada-Urbano, Michelle; jvillegas@susalud.gob.pe (Instituto Nacional de Salud (INS), 2016-09)
      The National Health Authority (SUSALUD) has developed an online platform, "ReSUelve tu afiliación", with the intent to solve the problems with health service access experienced by Peruvian citizens who hold health insurance policies through institutions that manage health insurance funds (IAFAS). This platform virtually articulates the main IAFAS in Peru, which receives requests from any user requiring an update on his/her affiliation status to be resolved within 24 hours. Nearly 8 months after the implementation of this platform, more than 55 thousand applications have been resolved, thus ensuring timely access to health services under the corresponding user coverage form. As a result, this platform has helped to guarantee citizens' rights to health service access in the face of infringement caused by delays in affiliation processing among the different IAFAS in Peru.
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    • Telemedicina: posible respuesta a deficiencias del manejo del infarto de miocardio agudo

      Anduaga-Beramendi, Alexander; Beas, Renato; Rojas-Ortega, Alex; rojasortega04@hotmail.com (Elsevier B.V., 2017-10)
      Carta al Editor
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    • Técnica quirúrgica para el tratamiento de fisuras labiales bilaterales asimétricas

      Rossell Perry, Percy; Gavino Gutiérrez, Arquímedes; prossell3p@hotmail.com (Colegio Médico del Perú, 2014-08-11)
      Introduction: The anatomy of bilateral cleft lip is different for each patient, and many authors have described modifications of the traditional repairing techniques in order to achieve more individualized designs and better results. The techniques described by Millard and Mulliken are probably the most commonly used all over the world for repairing bilateral cleft lip; however, there are some short-comings when trying to repair asymmetric forms of bilateral cleft lip. So, we designed this technique aiming to correct asymmetry in bilateral cleft lip. This technique is based on a double advancement and lateral rotation concept placing the scars over the natural lines between the esthetic subunits of the upper lip. Matherial and Methods: This is a retrospective and descriptive study based on a case series. We present a new technique used for surgical repair of bilateral cleft lip in 125 patients. The technique is based in the double advancement and lateral rotation concept which allows lengthening of the shortest lateral lip segment. Most of the incisions are performed on the natural lip landmarks, between the aesthetic subunits of the upper lip. Results were assessed considering the number of failures observed after following up patients for more than one year, performing physical examination and analyzing standardized postoperative pictures. Results: This technique has been used in 125 procedures for repairing cleft lip. We obtained good functional and esthetic outcomes for both nose and lips using this technique. The rate of poor results was 15/125 (12%). These latter procedures had to undergo major secondary surgical revisions. Conclusions: We describe a new technique for surgical repair of asymmetric bilateral cleft lip. This technique led to the elongation of the shortest lateral labial segment, allowing us to achieve good esthetic and functional results on upper lip and nose reconstruction in cases of bilateral asymmetric cleft lip.
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    • The Cocoon Strategy: Does it work for Latin American countries?

      Cáceres Mejía, Brenda; Pereyra Elías, Reneé; Suárez Ognio, Luis; brenda.caceres.mejia@gmail.com (Elsevier B.V., 2014-08-08)
      Cartas al editor
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    • The effect of statins on cardiovascular outcomes by smoking status: A systematic review and meta-analysis of randomized controlled trials

      Ursoniu, Sorin; Mikhailidis, Dimitri P.; Serban, Maria-Corina; Penson, Peter; Toth, Peter P.; Ridker, Paul M.; Ray, Kausik K.; Kees Hovingh, G.; Kastelein, John J.; Hernandez, Adrian V.; Manson, JoAnn E.; Rysz, Jacek; Banach, Maciej; maciejbanach@aol.co.uk (Academic Press, 2017-08)
      Smoking is an important risk factor for cardiovascular disease (CVD) morbidity and mortality. The impact of statin therapy on CVD risk by smoking status has not been fully investigated. Therefore we assessed the impact of statin therapy on CVD outcomes by smoking status through a systematic review of the literature and meta-analysis of available randomized controlled trials (RCTs). The literature search included EMBASE, ProQuest, CINAHL and PUBMED databases to 30 January 2016 to identify RCTs that investigated the effect of statin therapy on cumulative incidence of major CVD endpoints (e.g. non-fatal myocardial infarction, revascularization, unstable angina, and stroke). Relative risks (RR) ratios were calculated from the number of events in different treatment groups for both smokers and non-smokers. Finally 11 trials with 89,604 individuals were included. The number of smokers and non-smokers in the statin groups of the analyzed studies was 8826 and 36,090, respectively. The RR for major CV events was 0.73 (95% confidence interval [CI]: 0.67–0.81; p < 0.001) in nonsmokers and 0.72 (95%CI: 0.64–0.81; p < 0.001) in smokers. Moderate to high heterogeneity was observed both in non-smokers (I2 = 77.1%, p < 0.001) and in smokers (I2 = 51.6%, p = 0.024) groups. Smokers seemed to benefit slightly more from statins than non-smokers according to the number needed to treat (NNT) analysis (23.5 vs 26.8) based on RRs applied to the control event rates. The number of avoided events per 1000 individuals was 42.5 (95%CI: 28.9–54.6) in smokers and 37.3 (95%CI: 27.2–46.4) in non-smokers. In conclusion, this meta-analysis suggests that the effect of statins on CVD is similar for smokers and non-smokers, but in terms of NNTs and number of avoided events, smokers seem to benefit more although non-significantly.
    • The Experiences of Newly Diagnosed Men Who Have Sex with Men Entering the HIV Care Cascade in Lima, Peru, 2015-2016: A Qualitative Analysis of Counselor-Participant Text Message Exchanges

      Bayona, Erik; Menacho, Luis; Segura, Eddy R.; Mburu, Gitau; Roman, Fernando; Tristan, Consuelo; Bromley, Elizabeth; Cabello, Robinson (Mary Ann Liebert Inc., 2017-06)
      Mobile phone technology (mHealth) is a promising tool that has been used to improve HIV care in high-risk populations worldwide. Understanding patient perspectives of newly diagnosed men who have sex with men (MSM) in Lima, Peru during linkage and engagement in the HIV care continuum can help close the gaps in care following initial HIV diagnosis and ensure retention in continuous care. From June 2015 to March 2016, as part of a randomized controlled trial, 40 MSM participants were linked to care with an mHealth intervention within 3 months of HIV diagnosis at Via Libre clinic. For 12 weeks, participants agreed to receive weekly predetermined, standardized short message service (SMS), WhatsApp©, and/or Facebook© messages from an assigned HIV counselor. Text messaging was bi-directional, meaning participants could also send messages to their counselor at any time. In this qualitative study, we coded and thematically analyzed 947 SMS, 918 WhatsApp, and 2,694 Facebook bi-directional messages. Mean age of participants was 29.8 years (20-50); with 70 percent reporting some post-high school education and 73 percent self-identifying as homosexual. We identified six recurring themes that emerged from the data: (a) mental health symptoms; (b) coping behaviors; (c) interpersonal support; (d) physical symptoms; (e) HIV knowledge; and (f) care coordination. Participants sent text messages describing depressive symptoms and seeking mental health services during this initial stage of HIV care. For newly diagnosed MSM entering the HIV care continuum, a bi-directional mHealth intervention provided support to facilitate care while eliciting deeply personal mental and emotional states. Future interventions could benefit from using mHealth interventions as ancillary support for clinicians.
    • The fecal virome of South and Central American children with diarrhea includes small circular DNA viral genomes of unknown origin.

      Phan, Tung Gia; da Costa, Antonio Charlys; Del Valle Mendoza, Juana; Bucardo Rivera, Filemon; Nordgren, Johan; O'Ryan, Miguel; Deng, Xutao; Delwart, Eric; delwarte@medicine.ucsf.edu (Springer International Publishing, 2016-04)
      Viral metagenomics of feces collected from 58 Peruvian children with unexplained diarrhea revealed several small circular ssDNA genomes. Two genomes related to sequences previously reported in feces from chimpanzees and other mammals and recently named smacoviruses were characterized and then detected by PCR in 1.7 % (1/58) and 19 % (11/58) of diarrheal samples, respectively. Another three genomes from a distinct small circular ssDNA viral group provisionally called pecoviruses encoded Cap and Rep proteins with <35 % identity to those in related genomes reported in human, seal, porcine and dromedary feces. Pecovirus DNA was detected in 15.5 % (9/58), 5.9 % (3/51) and 3 % (3/100) of fecal samples from unexplained diarrhea in Peru, Nicaragua and Chile, respectively. Feces containing these ssDNA genomes also contained known human enteric viral pathogens. The cellular origins of these circular ssDNA viruses, whether human cells, ingested plants, animals or fungal foods, or residents of the gut microbiome, are currently unknown.
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    • The mortality-incidence ratio as an indicator of five-year cancer survival in metropolitan Lima

      Stenning Persivale, Karoline Andrea; Savitzky Franco, Maria Jose; Cordero-Morales, Alejandra; Cruzado-Burga, José; Poquioma, Ebert; Díaz Nava, Edgar; Payet, Edouardo (Cancer Intelligence, 2018-01-18)
      Introduction: The Mortality–Incidence Ratio complement [1 – MIR] is an indicator validated in various populations to estimate five-year cancer survival, but its validity remains unreported in Peru. This study aims to determine if the MIR correlates directly with five-year survival in patients diagnosed with the ten most common types of cancer in metropolitan Lima. Materials and methods: The Metropolitan Lima Cancer Registry (RCLM in Spanish) for 2004–2005 was used to determine the number of new cases and the number of deaths of the following cancers: breast, stomach, prostate, thyroid, lung, colon, cervical, and liver cancers, as well as non-Hodgkin’s lymphoma and leukaemia. To determine the five-year survival, the five-year vital status of cases recorded was verified in the National Registry of Identification and Civil Status (RENIEC in Spanish). A linear regression model was used to assess the correlation between [1 – MIR] and total observed five-year survival for the selected cancers. Results: Observed and estimated five-year survival determined by [1 – MIR] for each neoplasia were thyroid (66.7%, 86.7%), breast (69.6%; 68%), prostate (64.3%, 63.8%) and cervical (50.1%, 58.5%), respectively. Pearson’s r coefficient for the correlation between [MIR – 1] and observed survival was = 0.9839. Using the coefficient of determination, it was found that [1 – MIR] (X) captures the 96.82% of observed survival (Y). Conclusion: The Mortality–Incidence Ratio complement [1 – MIR] is an appropriate tool for approximating observed five-year survival for the ten types of cancers studied. This study demonstrates the validity of this model for predicting five-year survival in cancer patients in metropolitan Lima.
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    • Titulación por tesis en escuelas de medicina de Lima, 2011: características, motivaciones y percepciones

      Inga Berrospi, Fiorella; Mayta-Tristan, Percy; Mejia, Christian R.; christian.mejia.md@gmail.com (Instituto Nacional de Salud (INS), 2014-09-26)
      We surveyed physicians who obtained their medical degree with a thesis in 2011 from the seven medical schools in Lima to know the characteristics of the degree by thesis process, as well as participants’ motivations and perceptions of that process. We included 98 students who did a thesis (87% of total); 99% conducted observational thesis, 30% did so in groups of three. The main motivation was that it was good for their curriculum vitae (94%). At the university where the thesis is compulsory, the process began with the choice of topic and adviser. Perceived “greatest” and “least” difficulty in the process was the completion of administrative procedures (53%) and selection of their advisor (11%), respectively. Administrative timeliness and processes should be reviewed so as not to impede the completion of thesis, since the new University Act requires the completion of a thesis to graduate.
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    • Toxocariosis atípica: reporte de un caso en la costa norte del Perú.

      Terrones-Campos, Cynthia; Andrade, Teresa; Lachira, Arnaldo; Valladolid, Omar; Lanata, Claudio F. (Instituto Nacional de Salud (INS), 2014-03-21)
      We present the case of a 4.5 years old boy with atypic toxocariasis, from La Matanza, Morropon, Piura. The patient had non-specific symptoms during 9 days. Suspicion of Toxocariasis was supported by marked eosinophilia in the cell blood count (15% or 1470 cells/μL). Diagnosis was confirmed by laboratory with ELISA serology demonstrating the presence of IgG and IgM anti-Toxocara antibodies. Symptoms receded before the patient received a five-day treatment with albendazol 15mg/kg/day.
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    • TPM Maintenance Management Model Focused on Reliability that Enables the Increase of the Availability of Heavy Equipment in the Construction Sector

      Palomino-Valles, A.; Tokumori-Wong, M.; Castro-Rangel, P.; Raymundo-Ibañez, C.; Dominguez, F. (Institute of Physics Publishing, 2020-04-06)
      The purpose of this paper is to present a maintenance study focused on total productive maintenance (TPM) and reliability-centered maintenance (RCM). Its approach is based on the first pillars of TPM, preventive and autonomous maintenance, as well as the FMEA analysis of RCM for maintenance analysis, which was conducted in this study. The implementation of TPM was successful in that various preventive maintenance (PM) policies assigned to the assets were implemented and it was demonstrated that TPM application in the construction industry could reduce the excessive accumulation of maintenance with the same effective optimization, and with support from RCM analysis and its heavy equipment systems analysis. Excessive corrective maintenance accounts for high investment and delay rates in work times of the assigned project. Traditional methods of availability guarantee, such as reactive or routine maintenance, are insufficient to satisfy a heavy equipment maintenance plan; therefore, what is called for is the systematic application of RCM and TMP because they allow the selection and application of effective PM tasks. An approach that develops and thoroughly analyzes the strategies of continuous corrective and PM is used with an atmosphere of uncertainty and with operational data limited by criticism. Results show a 90% improvement in availability.
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    • Traditional and Web-Based Technologies to Improve Partner Notification Following Syphilis Diagnosis Among Men Who Have Sex With Men in Lima, Peru: Pilot Randomized Controlled Trial

      Clark, Jesse L; Segura, Eddy R.; Oldenburg, Catherine E; Salvatierra, Hector J; Rios, Jessica; Perez-Brumer, Amaya Gabriela; Gonzales, Pedro; Sheoran, Bhupendra; Sanchez, Jorge; Lama, Javier R; jlclark@mednet.ucla.edu (Journal of Medical Internet Research, 2018-07)
      Background: Patient-initiated partner notification (PN) following the diagnosis of a sexually transmitted infection is a critical component of disease control in men who have sex with men (MSM) sexual networks. Both printed and internet-based technologies offer potential tools to enhance traditional partner notification approaches among MSM in resource-limited settings. Objective: This randomized controlled trial aimed to evaluate the effect of 2 different PN technologies on notification outcomes following syphilis diagnosis among MSM in Peru: A Web-based notification system and patient-delivered partner referral cards. Methods: During 2012-2014, we screened 1625 MSM from Lima, Peru, for syphilis infection and enrolled 370 MSM with symptomatic primary or secondary syphilis (n=58) or asymptomatic latent syphilis diagnosed by serology (rapid plasma reagin, RPR, and Microhemagglutination assay for Treponema pallidum antibody; n=312). Prior to enrollment, potential participants used a computer-based self-interviewing system to enumerate their recent sexual partnerships and provide details of their 3 most recent partners. Eligible participants were randomly assigned to one of 4 intervention arms: (1) counseling and patient-initiated Web-based PN (n=95), (2) counseling with Web-based partner notification and partner referral cards (n=84), (3) counseling and partner referral cards (n=97), and (4) simple partner notification counseling (control; n=94). Self-reported partner notification was assessed after 14 days among 354 participants who returned for the follow-up assessment. Results: The median age of enrolled participants was 27 (interquartile range, IQR 23-34) years, with a median of 2 partners (IQR 1-5) reported in the past month. Compared with those who received only counseling (arm 4), MSM provided with access to Web-based partner notification (arms 1 and 2) or printed partner referral cards (arms 2 and 3) were more likely to have notified one or more of their sexual partners (odds ratio, OR, 2.18, 95% CI 1.30-3.66; P=.003 and OR 1.68, 95% CI 1.01-2.79; P=.045, respectively). The proportion of partners notified was also higher in both Web-based partner notification (241/421, 57.2%; P<.001) and referral card (240/467, 51.4%; P=.006) arms than in the control arm (82/232, 35.3%). Conclusions: Both new Web-based technologies and traditional printed materials support patient-directed notification and improve self-reported outcomes among MSM with syphilis. Additional research is needed to refine the use of these partner notification tools in specific partnership contexts.
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    • Traducción del conocimiento: pautas básicas para los profesionales de la salud pública

      Van Der Stuyft, Nina; Soto, Alonso; Solari, Lely; sotosolari@gmail.com (Instituto Nacional de Salud (INS), 2016-08-08)
      Knowledge translation (KT) in Public Health involves the use of scientific evidence by decision makers when generating health policies directed to accelerate the benefits resulting from research and innovation in health system and ultimately people´s health. In this paper we review the definitions and conceptual frameworks related to systematization of KT processes. The different approaches to KT share the concept that KT is composed by two main elements: a product (information) developed through scientific method with a friendly format for the target public and an action devoted to support or promote a health related practice using the aforementioned product. The understanding and application of KT is a key element for effective use of knowledge in decision making.
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    • Transgender Women Living with HIV Frequently Take Antiretroviral Therapy and/or Feminizing Hormone Therapy Differently Than Prescribed Due to Drug–Drug Interaction Concerns

      Braun, Hannan M.; Candelario, Jury; Hanlon, Courtney L.; Segura, Eddy R.; Clark, Jesse L.; Currier, Judith S.; Lake, Jordan E.; School of Medicine, University of California, San Francisco, San Francisco, California.; APAIT, Special Service for Groups, Los Angeles, California.; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.; South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, Los Angeles, California.; South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, Los Angeles, California.; South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, Los Angeles, California.; South American Program in HIV Prevention Research, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, Los Angeles, California.; Jordan.E.Lake@uth.tmc.edu (Mary Ann Liebert Inc., 2017-10)
      Purpose: Both hormone therapy (HT) and antiretroviral therapy (ART) can be lifesaving for transgender women (TW) living with HIV, but each has side effects and potential drug-drug interactions (DDI). We assessed how concerns about HT-ART interactions affect treatment adherence. Methods: This study used a cross-sectional survey of TW (n = 87) in Los Angeles, CA. Results: Fifty-four percent were living with HIV; 64% used HT. Only 49% of TW living with HIV discussed ART-HT DDI with their provider; 40% reported not taking ART (12%), HT (12%), or both (16%) as directed due to DDI concerns. Conclusion: Imperfect HT/ART use and limited provider communication suggests a need for improved HT-ART integration.
    • Transición nutricional en el Perú, 1991 - 2005

      Mispireta, Mónica L.; Rosas, Ángel M.; Velásquez, José E.; Lescano, Andrés G.; Lanata, Claudio F.; mmispireta@iin.sld.pe (Instituto Nacional de Salud (INS), 2014-08-11)
      Nutrition transition is a process including changes in the nutritional profile of populations. Many developing countries, including Peru, are in transition. Objectives: The aim of this study was to describe the variation of the nutritional profile of Peruvian children, mothers in reproductive age and families between 1991 and 2005. Material and methods: using available information from databases from Peruvian Health and Demographic National Surveys, between 1991 and 2005, we described the prevalence of malnutrition in Peruvian children less than 5 years of age, mothers in reproductive age, and families, at the national, regional, and socioeconomic level, and by residence area (urban/rural). Results: Stunting in children has been high and constant since 1996. Overweight in children has increased, mainly in Lima and the Coast. Overweight and obesity are the main nutritional problems of mothers in reproductive age, which have increased in Lima and the Coast. Coexistence of child stunting and maternal obesity at the family level has been low and without specific trend. Conclusions: The Peruvian nutritional profile is in transition. The main components are the high prevalence of stunting in children and the increase of maternal overweight and obesity. This findings show that Peruvian population is posed at a high risk of developing diseases related to both extremes of nutrition.
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    • Translation, cultural adaptation and validation of the Kidney Disease Knowledge Survey (KiKS) to Spanish

      Mota Anaya,Evelin; Wright Nunes, Julie; Mayta-Tristan, Percy; evelinmota@hotmail.com (2016-10-03)
      Introduction—Chronic kidney disease (CKD) affects 50 million people globally. Several studies show the importance of implementing interventions that enhance patients' knowledge about their disease. In 2011, the Kidney Disease Knowledge Survey (KiKS) was developed, a questionnaire that assesses the specific knowledge about CKD in pre-dialysis patients. Objective—To translate to Spanish, culturally adapt and validate the questionnaire KiKS in a population of patients with pre-dialysis CKD. Methods—The translation and cultural adaptation of KiKS was performed. Subsequently, its validity and reliability were determined. The validity was evaluated by construct validity; and the reliability by its internal consistency and its intra-observer reliability (test-retest). Results—A good internal consistency was found (Kuder-Richardson = 0.85). Regarding intraobserver reliability, the intraclass correlation coefficient with a value of 0.78 (95% CI: 0.5–1.0) indicated a good reproducibility; the mean difference of −1.1 test-retest S.D. 6.0 (p = 0.369) confirm this.
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    • Trauma and traumatic stress in a sample of pregnant women.

      Gelaye, Bizu; Zhong, Qiu-Yue; Basu, Archana; Levey, Elizabeth J; Sanchez, Sixto; Koenen, Karestan C; Henderson, David C; Williams, Michelle A; Rondón, Marta B. (Elsevier B.V., 2017-11)
      OBJECTIVE: To examine the construct validity of the 9 item Traumatic Events Questionnaire (TEQ) and to evaluate the extent to which experiences of trauma assessed using the TEQ are associated with symptoms of psychiatric disorders among 3342 pregnant women in Lima, Peru. METHODS: Symptoms of depression were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) while the PTSD Checklist-civilian (PCL-C) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess symptoms of PTSD and generalized anxiety. Hierarchical logistic regression procedures were used to evaluate relations between TEQ and symptoms of psychiatric disorders. RESULTS: The majority of participants (87.8%) experienced at least one traumatic event (mean = 2.5 events). The trauma occurrence score was moderately correlated with symptoms of PTSD (PCL-C: rho = 0.38, P-value < 0.0001), depression (EPDS: rho = 0.31, P-value < 0.0001; PHQ-9: rho = 0.20, P-value < 0.0001), and GAD (GAD-7: rho = 0.29, P-value < 0.0001). Stronger correlations were observed between the trauma intensity score with symptoms of psychiatric disorders (PCL-C: rho = 0.49, P-value < 0.0001; EPDS: rho = 0.36, P-value < 0.0001; PHQ-9: rho = 0.31, P-value < 0.0001; GAD-7: rho = 0.39, P-value < 0.0001). CONCLUSION: Given the high burden of trauma experiences and the enduring adverse consequences on maternal and child health, there is an urgent need for integrating evidence-based trauma informed care programs in obstetrical practices serving Peruvian patients.
    • Trauma exposure and post-traumatic stress disorder in a cohort of pregnant Peruvian women.

      Levey, Elizabeth J; Gelaye, Bizu; Koenen, Karestan; Zhong, Qiu-Yue; Basu, Archana; Sanchez, Sixto E.; Henderson, David C; Williams, Michelle A; Rondón, Marta B. (Springer-Verlag Wien, 2017-09-13)
      Women have a higher prevalence of post-traumatic stress disorder (PTSD) than men, with a peak during the reproductive years. PTSD during pregnancy adversely impacts maternal and infant health outcomes. The objectives of this study were to estimate the prevalence of antepartum PTSD symptoms in a population of pregnant Peruvian women and to examine the impact of number of traumatic events and type of trauma experienced. The Traumatic Events Questionnaire was used to collect data about traumatic exposures. The Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C) was used to assess PTSD. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Three thousand three hundred seventy-two pregnant women were interviewed. Of the 2920 who reported experiencing one or more traumatic events, 41.8% met criteria for PTSD (PCL-C score ≥ 26). A quarter of participants had experienced four or more traumas, and 60.5% of those women had PTSD. Interpersonal trauma was most strongly associated with PTSD (aOR, 3.20; 95% CI, 2.74-3.74), followed by unspeakable trauma (aOR, 2.87; 95% CI, 2.35-3.50), and structural trauma (aOR, 1.39; 95% CI, 1.15-1.67). These findings indicate the high prevalence of PTSD during pregnancy in the Peruvian population, which is relevant to other countries suffering from terrorism, war, or high rates of violence. This underscores the importance of screening for PTSD in pregnancy.
    • Tumor de Leydig simulando una neoplasia germinal

      Gamboa Acuña, Brenda Adriana; Guillén Zambranoa, Rayza; Lizzetti Mendozaa, Grecia; glizzetti@gmail.com (Elsevier B.V., 2016-06-22)
      Hallazgos principales Reportamos un caso de neoplasia de células de Leydig en un paciente varón de 25 años, sin factores de riesgo clásicos con evolución tórpida. Se analizó la histopatología de la masa tumoral y se encontró malignidad por lo que se decide realizar orquiectomía derecha, seguida de quimioterapia. Luego del tratamiento se halla metástasis pulmonar, adenopatías perihepáticas e hidronefrosis, falleciendo 2 meses después de su último ingreso hospitalario. Hipótesis del caso El tumor de células de Leydig representa entre el 1-3% de todos los tumores testiculares. Se presentan a cualquier edad; sobre todo en la infancia y en la 3.a-6.a década de la vida. Aproximadamente el 90% son de curso benigno y el 10% son malignos, presentándose sobre todo entre la 5.a y la 6.a década de la vida, y están asociados con un tamaño > 5 cm y ginecomastia. Finalmente, es difícil predecir el comportamiento en términos histológicos. Repercusiones a futuro A pesar que los tumores de células no germinales son poco frecuentes, es importante considerarlos como diagnóstico para brindar el tratamiento óptimo y evitar resultados desafortunados.
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    • Tumor mucoso apendicular

      Diego Ángeles, Pedro; Vega, Ximena; Palacios, José; ximenavegaarias@gmail.com (Asociación Colombiana de Cirugía, 2016-03)
      Los tumores mucosos apendiculares tienen baja incidencia y comúnmente se diagnostican en el estudio anatomo-patólogico después de la apendicectomía. Se reporta el caso de una mujer de 41 años de edad, con un cuadro clínico de ocho meses de evolución, caracterizado por dolor abdominal de tipo opresivo, difuso y de gran intensidad en el hemiabdomen inferior, acompañado de náuseas. Después de cinco meses de iniciado este cuadro clínico, se evidenció una masa en la fosa iliaca derecha; el dolor se agudizó e intensificó, y las náuseas continuaron, por lo cual fue remitida al hospital. En los exámenes practicados se observó una masa quística compleja abdomino-pélvica de origen indeterminado, y la tomografía computadorizada de abdomen fue sugestiva de mucocele apendicular. Con estos hallazgos, se optó por el tratamiento quirúrgico por laparotomía, consistente en hemicolectomía derecha, con resección parcial de íleon, epiplectomía, histerectomía y salpigooforectomía bilateral.
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