ACTA MEDICA PERUANA

Editorial practices for preventing scientific fraud and the infiltration of paper mills

Percy Mayta-Tristan — 2024-06-30

Direct cost analysis of renal replacement therapy in a Peruvian hospital

Luis Arellan-Bravo — 2024-06-30

Introduction: Chronic kidney disease (CKD) is a public health problem in Peru. The Peruvian health system spends nearly 4% of its total budget just for paying only hemodialysis therapy. Objective: To determine a comparison of direct costs between kidney replacement therapy options. Materials and methods: This is a descriptive study for cost analysis. Costs for patients when using different modalities of kidney replacement therapy were assessed: renal transplant, hemodialysis, and peritoneal dialysis in Junin Health Network from Peruvian Social Security (EsSalud). Data from 213 patients was analyzed. Mean costs were calculated. Data was taken from the Acquisition and Cost Unit of the Junin Health Network in EsSalud from 2016 to 2021. Results: Renal transplant in the first year costs 70 680 PEN (US$ 18,123.07), and the cost is reduced as years go by. Afterwards, from the second year on the mean annual cost is US$ 6,000. Hemodialysis costs around 39,000 PEN per year (US$ 10,000), and peritoneal dialysis costs 49,680 PEN (US$ 12,738). At five years, peritoneal dialysis is more costly, followed by hemodialysis, and, finally, kidney transplant. Conclusions: Peritoneal dialysis is the most expensive therapy for CKD, followed by hemodialysis and renal transplant.

Risk factors for dengue with warning signs, in the emergency department of a Public Hospital. A case- control study

Lesly García-Vilca — 2024-06-30

Objective: To evaluate the risk factors for dengue with warning signs in patients seen in the emergency department of a Public Hospital located in Trujillo, Perú, during the period from January to October 2023. Materials and methods: A case- control study was conducted at the emergency department of the Hospital Distrital Jerusalén in Trujillo, Perú, between January and October 2023. In the data analysis, chi-square and Fisher tests were used to identify variables associated with warning signs of dengue (p<0.05); subsequently, multivariate logistic regression was performed to calculate the adjusted Odds ratio (ORa) with its respective 95% confidence intervals. Results: We included 92 cases of dengue with warning signs and 184 controls without warning signs. Age, education level, arterial hypertension, obesity and previous infection were significantly associated (p<0.05) to dengue with alarm signs. Logistic regression identified the following as risk factors for dengue with warning signs: arterial hypertension with an ORa of 8.27 (CI 95% 1.20-56.6), obesity with an ORa of 24.4 (CI 95% 7.58-78.9), previous infection with an ORa of 4.99 (CI 95% 1.75-14.2), age ≤ 14 years with an ORa of 5.88 (95% CI 2.08-19.61) and age ≥ 60 years with an ORa of 1.76 (95% CI 1.61-3.00). Conclusion: Arterial hypertension, obesity, previous dengue infection, age ≤ 14 years, and ≥ 60 years are risk factors for dengue with alarm signs.

Prevalence of painful peripheral neuropathy in a screening program looking at risk for developing diabetic foot in a public Peruvian hospital

Luisa S. Rivera-Grimaldo — 2024-06-30

Objective: To determine prevalence of painful asymptomatic peripheral neuropathy (PN) in persons with type 2 diabetes mellitus (DM2) and its associated characteristics. Materials and Methods: This is a cross-sectional descriptive study performed in patients belonging to the program ‘Feet at risk’ at the Endocrinology Service in Maria Auxiliadora National Hospital. Patients with DM2 who were seen between 2015 and 2020 were included. The definition of PN is according to Toronto Consensus, considering the evaluation of three components: symptoms, signs and Achilles reflex, determining certainty as possible and probable, according to the combinations found. For assessing symptoms, the total symptom score (TTS) was used; for signs, monofilament test was used, and vibration sensitivity was assessed using a 128-Hz tuning fork. Prevalence of PN was calculated according to symptoms and certainty of the diagnosis. Also, the clinical characteristics of patient groups were described. Results: One-thousand and six persons were included, their mean age was 60,5 years, and 69,3% were female. In those who had at least one item from Toronto criteria, 60,5% had painful PN, and 21,8% had asymptomatic PN. When using more diagnostic certainty, i.e., two from three criteria being positive, the prevalence of painful PN was 42,2% and for asymptomatic PN, it was 6,5%. Four groups with different distributions with respect to sex, time with diabetes, ulcer history, peripheral arterial disease and glycemic control were established. Conclusion: In patients from the Endocrinology Service at Maria Auxiliadora Hospital 42,2% and 6,5% had more certainty for presenting with probable painful PN and asymptomatic PN, respectively. Further studies are needed for confirming the usefulness of the aforementioned criteria for properly estimating the burden of disease.

Glycemic control and HbA1c variations in patients with diabetes mellitus seen in live consultation and in remote consultation in a Peruvian hospital

Eddy López-Huamanrayme — 2024-06-30

Objective: To assess glycemic control in patients with diabetes mellitus (DM) seen in live consultation or remote consultation, and to identify factors associated with variations in glycated hemoglobin (HbA1c) values. Materials and methods: We did a retrospective cohort study that included patients >18 years old who were seen in live consultation or remote consultation because of DM in Alberto Sabogal-Sologuren National Hospital, during June 2021. Clinical data from electronic clinical records were obtained, including baseline and at 11-month follow-up HbA1c values. We used Poisson regression with robust variance for calculating relative risk (RR) and 95% confidence intervals (CI), for identifying factors associated with ≥0.5 HbA1c variations during follow-up. Results: Four-hundred and sixteen patients were included, their mean age was 62 years, 57.2% were female, and 68.5% had remote consultation. The percentage of patients with HbA1C <7% increased from 21,7 to 27,4% during follow-up, while in those with HbA1C ≥10%, there was a reduction, from 38,2 to 19,1%. Amongst patients with baseline HbA1c ≥7%, having baseline HbA1c ≥10% was associated with ≥0,5% reduction in HbA1c values (adjusted RR: 2,97; 95% CI: 1,61-5,50). The consultation modality (live or remote) was not associated with significant variations in HbA1c levels. Conclusions: One fifth of patients had optimum glycemic control at baseline, and this rate increased during follow-up. Those who had baseline HbA1C ≥10% had greater frequency in HbA1c level reduction, although the consultation modality (live or remote) was not associated with variations in HbA1c levels.

Perception of Afro-Peruvians on primary healthcare in the first level of attention

Pavel J. Contreras — 2024-06-30

Objective: To describe perception of compliance with primary healthcare requisites in Afro-Peruvian population during the COVID-19 pandemic. Materials and Methods: This is an observational and cross-sectional study, which was performed in six Peruvian cities, which included adult Afro-Peruvian subjects who were selected using intentional sampling. An online survey was administered, using the Primary Care Assessment Tool (PCAT), which was harmonized for an Ibero-American context, assessing attributes of primary care, such as service accessibility, continuing care, community participation, and cultural suitability; and these characteristics were assessed using a descriptive analysis. Additionally, related factors, such as sociodemographic and clinical characteristics were assessed using hypothesis tests. Results: Most interviewed persons perceived compliance limitations with primary healthcare attributes (94.8%). Particularly, community participation and continued care were troublesome areas, reaching 92.3% and 92.1%, respectively. No significant correlation was found between compliance perception for primary healthcare and sociodemographic and clinical factors, with the exception of a history of having had COVID-19, in which less compliance with attributes of primary healthcare were also observed. Global reliability of PCAT was 0.93 using Cronbach alpha test. Conclusions: There is a generally low perception of primary healthcare services in Afro-Peruvian population. Further investigation is required for exploring the underlying causes for such perception, and efforts must be made for improving compliance with primary healthcare attributes that are perceived as insufficient, particularly accessibility and continued care.

Synchronous papillary and medullary thyroid carcinoma: about a case

Edgar Fermín Yan-Quiroz — 2024-06-30

The synchronous existence of papillary and medullary carcinoma is infrequent, and they can have a discrete or mixed presentation. About its pathogenesis, it is not entirely clear, however, various theories have currently been proposed where genetic mutations and local and environmental factors involved in its appearance are involved. According to their histological characteristics, these are highly variable, presenting different structural patterns. The therapeutic approach differs in both histopathological types, so it is important to know about the synchronous existence of these tumors.

Low-grade multicentric glioma: a rare entity

John Vargas-Urbina — 2024-06-30

Multiple gliomas (multifocal and multicentric) are rare in low-grade gliomas. In multicentric gliomas, their etiology is poorly understood, and their management is controversial. A 27-year-old female patient, with two lesions compatible with low-grade glioma, confirmed by pathological study, for which; she received chemotherapy and radiotherapy, maintaining stable disease after one year of follow-up; she could not undergo surgery because the lesions were located in eloquent areas. For this type of patient, the standard of care is surgery whenever feasible based on eloquence and vascular involvement, followed by chemotherapy and radiotherapy like treatment given in single gliomas. Low-grade multicentric gliomas are a rare pathology that must be managed by a multidisciplinary team where surgery is the standard of care whenever feasible, followed by chemotherapy and radiotherapy.

Cavernous sinus hemangioma: a rare entity

John F. Vargas Urbina — 2024-06-30

Cavernous sinus hemangioma is considered as a vascular malformation or as a vascular tumor. It is usually extra-axially located, but it is histologically different from cavernomatous cerebral malformations. Clinical features may include headache, visual alterations or cranial nerve palsy. Diagnostic methods include CT scans, but the best is contrast-enhanced magnetic resonance imaging (MRI). Therapy may be microsurgery or radiotherapy. We present the case of a 30-year-old male, with no relevant past history, who had suffered with headache for three years, and diplopia for the last seven months, due to paresis affecting the sixth cranial nerve. Contrast-enhanced MRI showed an expansive lesion in the right cavernous sinus, with regular borders, T1 hypointense, with significant contrast uptake, T2 and FLAIR hyperintense, with no diffusion restriction. A craniotomy plus total resection of the tumor with hemostatic matrix support for controlling bleeding was performed. This patient developed complete ophthalmoparesis that improved over time. It was concluded that cavernous sinus hemangioma is an unusual condition, with high associated morbidity and mortality rates, but good results may be achieved with an adequate surgical technique.

Scrotal myasis with multiple inoculation: case report

Leonidas Carrillo-Ñañez — 2024-06-30

Myasis is an ectoparasitic infection caused by human (as well as some domestic and wild animals) tissue and cavity infestation by _Diptera_ larvae, generally flies. This condition is more frequent in tropical areas, and it may also occur in places with deficient sanitary conditions. We present the case of a patient from a tropical area, a farmer who reported exposure to dead animals, wild animals, and flies, in whom forunculoid type cutaneous myasis in the scrotum region was diagnosed, which also had superimposed infection. This patient received therapy with intravenously administered antibacterial agents, a single dose of oral ivermectin. Locally, orifices were occluded with basil. This was followed by the forceps-aided extraction of 20 larvae in two sessions. The patient had good progression. We consider this case is an original contribution, given that genitalia infection by fly larvae is unfrequently reported, even in endemic areas. Two cases of genital myasis have been reported in the national literature: one in a young woman, and the other in an elderly woman. Nonetheless, as far as we know, scrotal myasis has never been reported in Peru.

Melanonychia due to hydroxyurea

Oscar G. Pamo-Reyna — 2024-06-30

We present the case of an 85-year-old woman who was diagnosed with essential thrombocytosis; and, who, after six months receiving therapy with hydroxyurea, she noticed her fingernails turned dark. The exact mechanism for this occurrence is still unknown. We should pay attention to this unusual complication that may lead to interrupt or modify therapy.

The need for adequate evaluation of suspected cases of methanol poisoning

José Valencia-Rodríguez — 2024-06-30

Response to a comment on: Methanol poisoning: analysis of a case series in two public hospitals

Yanissa Venegas-Justiniano — 2024-06-30