Objetivo: Evaluar la precisión diagnóstica del cociente sFlt-1/PlGF como prueba de cribado para la detección de preeclampsia. Metodología: Se realizó una revisión sistemática y metaanálisis siguiendo las directrices PRISMA DTA. Se registró el protocolo en PROSPERO con el código CRD42024601947. La búsqueda se realizó en las bases de datos Scopus, Web of Science y EBSCO, y en el buscador PubMed hasta octubre de 2024, incluyendo estudios prospectivos que evaluaron el cociente sFlt-1/PlGF en gestantes sin signos o síntomas de preeclampsia en el momento de la prueba. Los datos fueron analizados para calcular sensibilidad, especificidad, razones de verosimilitud y heterogeneidad. La calidad metodológica fue evaluada mediante QUADAS-2 y la certeza de la evidencia con GRADE. Resultados: Se incluyeron seis estudios prospectivos con una sensibilidad estimada de 66% y especificidad de 84%. La heterogeneidad fue significativa, con un I² de 83% para sensibilidad y 99.8% para especificidad. La capacidad predictiva del cociente fue mayor en el tercer trimestre (sensibilidad 65%, especificidad 87%) y mostró mejores resultados en la preeclampsia de inicio temprano (sensibilidad 94.3%, especificidad 81.7%). Conclusiones: El cociente sFlt-1/PlGF tiene una utilidad moderada como prueba de cribado para preeclampsia, con una sensibilidad y especificidad variables entre estudios. Su efectividad es mayor en poblaciones específicas y en preeclampsia de inicio temprano, pero su aplicación como prueba universal de cribado es limitada debido a la heterogeneidad entre los estudios y la variabilidad en los puntos de corte.
Introduction: Puerperal anemia is a public health problem with high prevalence in developing countries. In Peru, it is estimated to affect up to 50% of women in the immediate postpartum period, with regional variations. In Puno (3827 m.a.s.l.),, the department where Carlos Monge Medrano Hospital is located, altitude and socioeconomic conditions may contribute to a higher prevalence. However, no recent studies have assessed its magnitude and risk factors in this area. Objective: To evaluate the risk factors associated with puerperal anemia in immediate postpartum women. Methods: Observational, cross-sectional, and correlational study. A total of 200 immediate postpartum women attended at the hospital in 2023 were analyzed. Data were collected using a structured data collection form and analyzed with Chi-square tests and Poisson regression. Results: The prevalence of puerperal anemia was 79%. Postpartum hemorrhage increased the risk of anemia by 128% (cPR: 1,288; aPR: 1,264), while rural origin increased the risk by 119% (cPR: 1,196; aPR: 1,166). Additionally, 41,3% of the postpartum women had moderate anemia, 37,7% had mild anemia, and 21% had severe anemia. Women with a history of gestational anemia had a significantly higher risk of developing puerperal anemia (cPR: 1,432; aPR: 1,398). Conclusions: Puerperal anemia has a high prevalence in the studied population and is associated with postpartum hemorrhage, rural origin, and a history of gestational anemia.
Introducción: La fatiga por compasión tiene un impacto emocional significativo en los profesionales de la salud, posiblemente por la naturaleza de los escenarios que estos deben presenciar diariamente. Por lo que resulta importante conocer que factores laborales están asociados a dicha problemática. Objetivo: Determinar la relación entre factores laborales y fatiga por compasión en el equipo de cuidados paliativos del Instituto Nacional de Salud del Niño de San Borja, 2024. Material y método: Investigación no experimental y de enfoque cuantitativo, además de diseño observacional, correlacional y prospectivo, cuya población estuvo conformada por 128 profesionales de la salud que laboraron en diversas áreas del Instituto Nacional de Salud del Niño de San Borja, para la recolección de los datos se usó como técnica a la encuesta y al cuestionario como instrumento, mientras que para dar respuesta a los objetivos se aplicó la prueba de correlación Rho de Spearman. Resultados: El 53,1% de profesionales tenían entre 36 y 45 años, además el 86,7% fueron mujeres, el 46,1% no tenían hijos, el 86,7% realizó una especialidad y el 16,4% una maestría. Además, 69,5% presentaron nivel medio de factores laborales estresores y el 58,6% presentaron nivel medio de fatiga por compasión. Se observó relación significativa entre los factores laborales y la fatiga por compasión (p=0,000; Rho=0,326); así como relación entre factores organizativos-relaciones humanas (p=0,000; Rho=0,313) y factores ambientales (p=0,228, Rho=0,010) con la fatiga por compasión. Conclusiones: Existe relación significativa entre los factores laborales y la fatiga por compasión en el equipo de cuidados paliativos.
The registration of the ethnic variable in health information systems is a key tool for making Indigenous, Native, and Afro-descendant populations visible and for ensuring culturally appropriate healthcare. This study analyzes the progress made in recording this variable in the Peruvian Health Information System (HIS MINSA) between 2019 and 2025. Sustained increases are observed both in the number of individuals served and in the number of services provided with recorded ethnic data. Additionally, the Peruvian case is contextualized within the Latin American framework, highlighting regional advances, challenges, and good practices. The article discusses the implemented strategies, improvement factors, and remaining challenges to strengthen health equity in historically excluded populations.
Introducción: La diabetes mellitus tipo 2 constituye un problema creciente en el Perú; los modelos de estimación de riesgo suelen priorizar factores metabólicos, relegando componentes emocionales como la depresión. El objetivo fue evaluar el desempeño discriminativo del Índice Psicosomático (IPS) para clasificar a la población adulta peruana según el riesgo estimado por el índice de Bang, utilizado como modelo de referencia. Material y métodos: Estudio analítico con datos secundarios de la ENDES 2022–2024 (n= 95 685). Se incluyeron registros con información completa de presión arterial, medidas antropométricas y puntaje PHQ-9. Mediante análisis factorial se construyó un índice compuesto y se evaluó su desempeño discriminativo mediante curvas ROC (AUC), índice de Youden, sensibilidad, especificidad y otras métricas, comparándolo con el índice de Bang. Resultados: El análisis factorial identificó tres componentes: hemodinámico (PAS), antropométrico (IMC) y afectivo (PHQ-9), que conformaron el IPS= (PAS × 0,915 + IMC × 0,971 + PHQ-9 × 0,914). El modelo mostró adecuación estadística (KMO= 0,559; Bartlett: p<0,001). En mujeres, el IPS alcanzó un AUC= 0,849, superior al IMC, perímetro abdominal y PHQ-9. En varones, la relación cintura/altura mostró mayor desempeño (AUC= 0,851). Por edad, el IPS presentó desempeño excelente ≤39 años (AUC= 0,916–0,993) y moderado en ≥40 años (AUC= 0,737–0,836). Conclusiones: El IPS mostró buen desempeño discriminativo para clasificar a población adulta según riesgo estimado por el índice de Bang, especialmente en mujeres y adultos jóvenes, respaldando su utilidad exploratoria como herramienta integrada cardiometabólica-psicoemocional que requiere validación frente a estándares clínicos o bioquímicos.
Introducción. La enfermedad de Castleman (EC) es una neoplasia linfoproliferativa infrecuente que puede asociarse con el pénfigo paraneoplásico (PPN) y, en casos excepcionales, con bronquiolitis obliterante (BO). Reporte del caso. Niña de 12 años con pérdida de peso y lesiones ulceradas orales, diagnosticada con PPN. La tomografía torácica evidenció una masa mediastinal resecada completamente, cuyo estudio histológico confirmó una EC unicéntrica hialino-vascular. Tres meses después de la cirugía desarrolló disnea, tos y sibilancias persistentes, sin respuesta a tratamiento con corticosteroides, metotrexato, azitromicina, montelukast y tocilizumab. La paciente evolucionó a insuficiencia respiratoria crónica y falleció diez meses después del diagnóstico inicial. Conclusión. Este caso ilustra una evolución inusual y fatal de EC unicéntrica asociada a PPN y BO, subrayando la importancia del reconocimiento precoz y el seguimiento multidisciplinario ante posibles complicaciones autoinmunes incluso tras la resección tumoral completa.
Background: Functional constipation (FC) is common in pediatrics, and its management includes polyethylene glycol (PEG) along with adequate intake of fluids and dietary fiber. Pectin, a highly fermentable soluble fiber, may influence the symptoms of this condition. Objective:To evaluate the effect of restricting pectin-rich foods in children with FC treated with PEG. Material and Methods: A quasi-experimental study without a concurrent control group was conducted in a pediatric gastroenterology clinic in northern Peru. Sixty-six children older than 4 years with a diagnosis of FC according to ROME IV criteria were included, excluding organic causes. All participants received PEG (1 g/kg/day for disimpaction and 0.5 g/kg/day for maintenance). Participants followed two weeks of a habitual diet and then two weeks with restriction of pectin-rich foods. Stool consistency and frequency, abdominal pain, flatulence, and abdominal circumference were evaluated. Statistical analysis was performed using the Wilcoxon test. Results: No significant differences were observed between the two periods. Stool consistency was similar (4.03 [IQR: 0.93] vs 4.04 [IQR: 0.68]; p=0.783), and defecation frequency was 15.5 (IQR: 9) versus 18 (IQR: 10) stools over two weeks (p=0.458). Days with abdominal pain were 1 (IQR: 3) versus 0 (IQR: 2) (p=0.412), and days with flatulence were 4 (IQR: 8) versus 2 (IQR: 9) (p=0.712). Abdominal circumference was also comparable between periods (p=0.057). Conclusions: Pectin restriction was not associated with clinical improvement in children with FC treated with PEG. Controlled studies that quantify fiber intake are needed to confirm these findings.
Introduction: Pediatric intensive care units (PICUs) are essential services in the management and treatment of critically ill children; however, mortality rates remain very high in these services in low- and middle-income countries. Objective: To describe the clinical characteristics of patients admitted to the PICU of a referral hospital in Peru and to determine the factors related to mortality. Methods: A retrospective observational study with time-to-event analysis was conducted in the PICU of a tertiary hospital, including patients aged 0 to 17 years who were admitted between July 2022 and July 2023. Patients who stayed in the PICU for less than 24 hours and those with missing information were excluded. Various sociodemographic and clinical variables were analyzed. A bivariate analysis (chi-square, Student's t-test) and multivariate logistic regression were performed to determine predictors of mortality, and a Kaplan-Meier survival analysis was performed. Results: A total of 503 patients were included (53.1% male; median age 28 months). The main causes of admission were postoperative status (32.8%) and acute respiratory failure (25.2%). Invasive mechanical ventilation was required in 76.5% of patients. The mortality rate was 9.94%. In the multivariate regression analysis, mechanical ventilation (ORaj: 2.41; 95% CI: 1.01–5.77; p=0.047) and healthcare-associated infections (HCAIs) (ORaj: 3.16; 95% CI: 1.28–7.81; p=0.012) were identified as independent predictors of mortality. Survival analysis showed that most deaths occurred between days 7 and 10. Conclusion: Invasive mechanical ventilation and HAIs were independent predictors of mortality in this PICU. Early detection of high severity and strict control of nosocomial infections are recommended.
Objetivo: Este estudio tuvo como objetivo determinar si los niveles de hematocrito y creatinina al ingreso son predictores independientes de mortalidad en pacientes críticamente enfermos admitidos en la Unidad de Cuidados Intensivos (UCI). Materiales y Métodos: Este estudio fue aprobado por el Comité de Ética en Investigación local. Se realizó un estudio de cohorte retrospectivo que incluyó a 158 pacientes admitidos en la UCI entre 2021 y 2023. Se recopilaron variables demográficas, clínicas y de laboratorio. Se utilizó la regresión de riesgos proporcionales de Cox para identificar predictores independientes de mortalidad intrahospitalaria. Resultados: La mortalidad fue del 38,6%. La causa más frecuente de ingreso fue la insuficiencia respiratoria (34,8%) y el 60,8% de los pacientes eran hombres. La hipertensión arterial (44,9%) y la diabetes mellitus (29,8%) fueron las comorbilidades más comunes. Un hematocrito ≥ 40% (HRa: 1,87; p = 0,028), creatinina ≥ 1,2 mg/dL (HRa: 1,73; p = 0,039) y una presión arterial media < 65mmHg (HRa: 2,24; p=0.003) se identificaron como predictores significativos de mortalidad. Las puntuaciones APACHE II y SOFA, aunque comúnmente asociadas con el pronóstico, no fueron significativas en esta muestra. En el análisis de discriminación, la creatinina y el hematocrito mostraron una capacidad predictiva moderada para mortalidad, con áreas bajo la curva (AUC) de 0,644 y 0,591, respectivamente. Conclusión: Los niveles elevados de hematocrito y creatinina al ingreso en la UCI son predictores independientes de mortalidad en pacientes críticamente enfermos. Estos parámetros pueden constituir herramientas accesibles y rentables para la evaluación temprana del riesgo.
Introduction: Previous studies have associated exposure to fine particulate matter (PM2.5) with higher rates of tuberculosis (TB), especially among men. Likewise, a causal relationship between TB and lung cancer (LC) has been demonstrated. On the other hand, residential radon gas (222Rn) is a well-known carcinogen and the leading cause of LC among non-smokers. Objective: To evaluate the ecological association between PM2.5 and/or 222Rn levels and tuberculosis (TB) and lung cancer (LC) rates in adults over 60 years of age of both sexes, in the 43 districts of Metropolitan Lima, during the period 2019-2022. Materials and Methods: A cross-sectional observational study using secondary data analysis. TB and LC data were obtained from the Ministry of Health, PM2.5 estimates were derived using the WRF-Chem model, and 222Rn concentrations were measured with G2 diffusion chambers. For the associative analysis, negative binomial regression models were constructed using STATA statistical software version 18.0. Results: A positive association was observed between lung cancer (LC) and the top tertile of TB rates (IRR: 1.61; 95%CI: 1.12-2.29), although there was no evidence of an inverse relationship. Exposure to PM2.5was associated with PC in males (IRR: 1.02; 95% CI: 1.00-1.02), while exposure to 222Rn showed a significant association with PCa in both sexes (female IRR: 1.44; Male IRR: 1.34). In women, only 222Rn was associated with PC; in males, independent associations with PM2.5, TBC, and 222Rn were identified. Conclusions: The results suggest a possible sexual dimorphism in the ecological relationship between the exposure factors evaluated and lung cancer (LC) rates, with the districts with the highest rates being more frequently associated with males.
Introduction: Guillain-Barr & eacute; syndrome (GBS) is an acute inflammatory neuropathy that can cause respiratory paralysis and require mechanical ventilation. Diaphragmatic ultrasound is useful for assessing respiratory function in these patients and guiding ventilator weaning. Case report: We present the case of a 16-year-old adolescent with GBS and progressive respiratory failure, admitted to the Intensive Care Unit on mechanical ventilation and vasoactive support. Chest CT revealed left atelectasis, confirmed by fiberoptic bronchoscopy. Subsequently, diaphragmatic ultrasound showed excursion less than 10 mm, indicating muscle dysfunction. A tracheostomy and respiratory rehabilitation were initiated, with progressive clinical and functional improvement. Conclusion: Diaphragmatic ultrasound allowed for early identification of diaphragmatic dysfunction, facilitating key therapeutic decisions such as tracheostomy. Its use in critically ill patients with Guillain-Barr & eacute; syndrome represents a valuable, noninvasive, and safe tool for optimizing ventilatory management and improving clinical outcomes.
Digital literacy represents a key challenge in closing the gaps in access to and use of technologies among Amazonian Indigenous, Andean, and Afro-Peruvian populations in Peru. This article analyzes the evolution of access to and use of digital technologies within these groups using data from the National Household Survey (ENAHO) between 2019 and 2024. Significant progress is evident, such as the increase in internet use and the expansion of mobile telephony; however, challenges to digital inclusion persist, linked to geographic, socioeconomic, cultural, and linguistic factors. The main initiatives implemented by the Peruvian State to promote more equitable access to information and public services are also reviewed. Finally, the findings reveal that populations whose mother tongue is Amazonian exhibit the lowest levels of digital connectivity, with internet access 35-40% lower than Andean populations and more than 50% lower compared to other groups, reflecting persistent inequalities in access and appropriation of technology. Achieving true digital equity requires strengthening infrastructure, developing content in Indigenous languages, and closing digital skills gaps under a framework of sustainability, interculturality, and equity.
Subjective benign paroxysmal positional vertigo (sBPPV) is a clinical variant of BPPV in which patients present with typical vestibular symptoms but without evidence nystagmus during the Dix-Hallpike maneuver. Subjective benign paroxysmal positional vertigo accounts for approximately 20% of all BPPV cases and is frequently underdiagnosed in primary care settings. Our findings indicate that the Epley maneuver is equally effective in patients with subjective and objective BPPV, enabling timely intervention without the need for instrumental diagnostic methods. Objective: evaluate the short-term effectiveness of the Epley maneuver in patients with sBPPV treated at Centro M & eacute;dico ISSEMyM Toluca, as well as to analyze potential correlations with age, gender, and comorbidities. Methods: A quasi-experimental study conducted in 49 patients diagnosed with sBPPV. The effectiveness of the Epley maneuver was assessed using the Dizziness Handicap Inventory (DHI) questionnaire at the initial consultation and at a 7-day follow-up. Results: 85.7% of patients achieved complete resolution of symptoms. The mean DHI score significantly decreased from 40.12 (+/- 14.43) to 24.48 (+/- 15.68) (p = 0.026). A negative correlation was observed between and improvement in DHI scores (r =-0.32, p = 0.023). Discussion: The Epley maneuver proved to be highly effective. Its simplicity, accessibility, and zero cost make it a valuable tool in various clinical settings. The negative correlation between age and improvement highlights the need for closer follow-up in older patients to prevent falls. Conclusions: The Epley maneuver is an effective intervention for the management sBPPV. While it is essential to rule out central pathology, once the diagnosis established, addressing the patient's needs is crucial to optimize their quality of life prevent complications.
Introduction: The evaluation of the homeostatic model gives results close to the gold standard (hyperinsulinemic-euglycemic clamp). Objective: To develop an equation to determine the homeostatic model of insulin resistance. Material and methods: Analytical and cross-sectional study of secondary databases of 2004 Venezuelan adults and another of 4363 Mexicans. The variables were: homeostatic model of insulin resistance (HOMA-2), basal insulin, basal glucose. Multiple linear regression, scatter plot, and student t test were used. Results: The regression equation was-0.694+(0.138*basal insulin)+(0.009*basal glucose), where HOMA2-IR increases 0.138 for each U/mL of insulin and increases 0.009 for each mg/dL of basal glucose. The R2 value was 0.983 (Venezuelan database), indicating that 98% of the change in HOMA2-IR can be explained by the model based on basal insulin and glucose. The equation was applied to the Mexican adult database (n=4363), obtaining a coefficient of determination R2 of 0.897, implying that 90% of the variation in HOMA2-IR from the clinical calculator can be explained by HOMA2-IR from the regression equation. With a HOMA2-IR cut-off point of 2, lipid, glycemia, insulinemia, waist circumference, BMI, and blood pressure values were higher in the presence of HOMA2-IR levels >= 2 in the Venezuelan and Mexican databases. Conclusions: The regression equation to determine HOMA2-IR based on basal insulin and glucose is close to the HOMA2-IR clinical calculator.
Objectives: The implementation of the updated monovalent vaccine for the high-risk population in Peru, such as healthcare workers (HW's), has occurred without an adequate communication campaign by the central government, which has raised many doubts about its efficacy and safety. This study aimed to investigate the perceptions and factors associated with uptake of monovalent XBB.1.5 BNT162b2 COVID-19 vaccine among HW's in Peru. Methods: We conducted a cross-sectional study based on an online survey from March 22 to May 1, 2024. HW's (physicians, nurses, etc.) living and practicing in Peru were included. We calculated crude and adjusted prevalence ratios with 95% confidence intervals to determine the associated factors and perceptions using Poisson regression with robust variance. Results: We included 393 HW's, predominantly women (55.2%) and physicians (63.9%), almost half at 30-49 years of age (50.9%). The majority (72.8%) reported not having been vaccinated with the updated vaccine, but 65% of them intended to do it. Regarding perceptions, more than 70% of respondents thought the updated vaccine was necessary and protective against severe COVID-19 and mortality, but only 16.5% believed it caused severe adverse events. Only 24.7% felt the Peruvian Ministry of Health was adequately informing about the vaccines. In the adjusted multivariate analysis, the uptake of this vaccine was significantly higher among those who lived in the northern macroregion (aPR: 1.96; 95% CI: 1.15-3.34), had received six or more vaccine doses (aPR: 2.18; 95% CI: 1.06-4.51), were previously hospitalized due to COVID-19 (aPR: 2.18; 95% CI: 1.37-3.49), in those who received the bivalent vaccine (aPR: 1.88; 95% CI: 1.17-3.04), and in participants who believed that the monovalent updated vaccine should be mandatory for healthcare workers (aPR: 1.76; 95% CI: 1.08-2.86). The uptake was lower in those who believed that the monovalent vaccine should not be mandatory (aPR: 0.39; 95% CI: 0.17-0.92) and in participants who felt that the Ministry of Health was not adequately informing about the vaccines (aPR: 0.63; 95% CI: 0.40-0.97). Conclusions: The present study showed that uptake of the XBB.1.5 vaccine was low among HW's in Peru. Living in the northern macroregion, previous hospitalization due to COVID-19, and having received six or more vaccine doses were identified as the main factors associated with higher uptake. Our findings underscore the importance of targeted interventions and effective communication strategies to improve vaccination against COVID-19 among HW's.
