Center Of Lima Research Articles

Anatomical Bases for Aesthetic Costal Surgery: Assessing the Thoracoabdominal Limits.

Knowing the anatomy of the ribs is crucial for understanding various rib procedures. The present study is aimed at describing radiological measurements and ratios of 83 Latin American patients undergoing thoracoabdominal computed tomography (CT). A total of 83 thoracoabdominal computed tomography scans of women aged 18-35 conducted at a medical center in Lima, Peru, were reviewed from January 2022 to January 2023. The resulting measurements and ratios were used to calculate frequency distributions. All data were stored in a Microsoft Excel database and analyzed using statistical analysis software SPSS version 28. Ratios and measures of the tenth, eleventh, and twelfth ribs are shown in the different tables, and costal characteristics with an adequate statistical significance are defined. Using radiological measurements and rib ratios, we were able to find key anatomical relationships with an adequate level of significance, which could help establish objective results in rib procedures.

Analysis of the perception of health professionals regarding the incorporation of emerging technologies in their practice

Introduction: healthcare is currently in the midst of a technology-driven revolution. Emerging technologies (ETs) are disrupting the practice of healthcare professionals in ways that once seemed futuristic, but are now an everyday reality in clinics and hospitals around the world.Objective: to analyze the perception of health professionals regarding the incorporation of emerging technologies in their practice.Methods: it is a quantitative, descriptive, non-experimental, cross-sectional study, whose sample was 107 health professionals who work in different health centers in Lima. The survey technique was used and the instrument was the questionnaire.Results: the participants perceived the incorporation and use of TE in their practice by 63,55 % (68) at a moderate level, 20,56 % (22) reported a high level, while 15,89 % indicated a low level.Conclusions: it was possible to specify a moderate level in the incorporation and use of TE, suggesting an intermediate position in technological adoption in medical care. This provides a solid foundation for future advances and improvements in the implementation of TE in medical practice

About the article entitled "Characteristics and frequency of tuberculosis before and during the COVID-19 pandemic among adults treated in a primary healthcare center in Lima, Peru, 2019-2020"

About the article entitled "Characteristics and frequency of tuberculosis before and during the COVID-19 pandemic among adults treated in a primary healthcare center in Lima, Peru, 2019-2020"

Flow Diversion for the Treatment of Intracranial Aneurysms in a Peruvian Cohort: Experiences from a Limited-Resource Setting and Barriers to Implementation

Stenting with flow diverter devices (FDDs) has increasingly emerged as a treatment for intracranial aneurysms. The use of FDDs in the developing world has not been described. A retrospective review was performed of a cohort of patients who underwent flow diversion at 4 tertiary-care centers in Lima, Peru between January 2017 and June 2021. Demographics, clinical features, and aneurysm morphology were evaluated. Clinical outcomes were observed 3 months after discharge and occlusion rates were assessed 12 months after treatment. Sixty-nine patients (mean age, 46 ±14.5 years; 17% female) were treated with FDDs; 4% (n= 3) of the treated aneurysms were ruptured. Most aneurysms were saccular (n= 65; 94%), <10 mm in maximum size (n= 60; 87%), and located in the anterior circulation (n= 67; 97%). Minor complications, such as groin hematoma, occurred in 7 cases. No serious complications or deaths occurred. Patients' functional status was excellent (modified Rankin Scale score 0-1) in 99% (n= 66) at discharge and 100% (n= 67) at 3 months. Although some patients were lost to follow-up, complete occlusion was seen in 76% (n= 31) of 41 treated patients at 12 months. We report the largest multicenter experience of FDDs for cerebral aneurysm treatment in Peru, with reasonable outcomes that are comparable to other settings despite various challenges, suboptimal circumstances, and lack of resources.

Brief potentially ictal rhythmic discharges on intraoperative electrocorticography predict a good outcome of focal cortical dysplasia after surgical resection: a case report

BackgroundFocal cortical dysplasia (FCD) is a common cause of drug-resistant epilepsy. Electroencephalography (EEG) biomarkers that predict good postoperative outcomes are essential for identifying patients with focal epilepsies.Case presentationWe report the case of a 21-year-old female with seizure onset at the age of 9, characterized by left-hand dystonic posturing and impaired awareness, which evolved to bilateral tonic-clonic seizures, evaluated in a neurological referral center in Lima, Peru. During 6-h video-EEG, interictal EEG revealing focal brief potentially ictal rhythmic discharges (BIRDs) over the right frontal central region, lasting less than 10 s. The ictal features were characterized by low-voltage fast activity over the same area. Brain magnetic resonance imaging (MRI) demonstrated a focal lesion of focal cortical dysplasia type II in the right frontal lobe. The patient underwent a lesionectomy guided by electrocorticography, which showed continuous polyspikes. BIRDs showing a brief burst of spikes lasting longer than 0.5 s, were also identified on intraoperative electrocorticography (ECoG) and helped define the extent of resection. The patient obtained an Engel Outcome Class IA at 6 years of follow-up.ConclusionsThe atypical BIRDs on ECoG can be used as a prognostic biomarker for prolonged seizure-freedom outcome in patients with epilepsy. Additional reports are needed in developing countries with and without brain MRI lesions to advance outpatient presurgical evaluations despite limited resources.

Abstract P4-06-12: Decision of Neoadjuvant Therapy in Younger vs. Older Breast Cancer Patients: A Real-World Data Analysis

Abstract Background: The incidence of breast cancer among younger patients (age ≤ 40) is higher in Latin America than in other regions. The multidisciplinary approach of breast cancer cases has been related with better survival, and the knowledge about specific clinicopathological features of this population is needed to optimize the therapeutic approach. The aim of our study was to describe the clinicopathological characteristics of breast cancer in younger (Y) compared with older patients (O), and to determine which characteristics were associated with the use of primary systemic therapy. Methods: A retrospective cohort study was designed. Clinicopathological data of consecutive invasive non-metastatic breast cancer patients diagnosed between Jan 2015 to Dec 2019 in two private oncological centers in Lima, Perú were collected. Logistic regression analysis was performed to obtain models to predict primary systemic therapy as first treatment. Results: We included 503 cases (mean age 49.8 years [SD 11.8]), 30.6% younger (n = 109) and 69.4% O (n = 394). No significant differences were found for ductal histology (89% Y vs. 87.7% O, p = 0.49) and HER2-overexpression (28.4% Y vs. 23.9% O, p = 0.39). Significant differences were found for stage III (37.6% Y vs. 20% O, p &amp;lt; 0.01), grade 3 (44.4% Y vs 33% O, p = 0.04) and HR-positive (64.2% Y vs. 75.1% O, p = 0.03). Univariate analysis showed significant OR = 2.1 to receive primary systemic therapy for Y (95%CI 1.37 – 3.24; p &amp;lt; 0.01), however, multivariate analysis adjusted for age, hormone receptors (HR), HER2, grade and stage showed non-significant OR = 1.5 to receive primary systemic therapy for Y (95%CI 0.90 – 2.50; p = 0.12) as detailed in the table below: Conclusions: In our series we found a greater proportion of young breast cancer patients than previously reported. Clinical-pathological characteristics of breast cancer were different between younger and older patients, showing more aggressive phenotypes for younger patients with greater proportion of stage III, grade 3 and non-expression of hormone receptors. Decision of using primary systemic therapy in our series was based on anatomic and biologic characteristics and not on age. Citation Format: Enrique Alanya, Silvia Falcon-Lizaraso, Sebastian Aldecoa-Falcon, Franklin Aldecoa-Bedoya. Decision of Neoadjuvant Therapy in Younger vs. Older Breast Cancer Patients: A Real-World Data Analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-06-12.

A new surgical technique for left atrial reduction in giant left atrium.

The study objective was to evaluate the safety and clinical and echocardiographic outcomes of a new surgical technique in adult patients diagnosed with a giant left atrium. We analyzed a cohort of patients who underwent left atrium reduction surgery between January 2016 and June 2020 performed by a specialized surgical team in 2 national reference centers in Lima, Peru. We assessed the major adverse valvular-related events and the New York Heart Association functional class as primary clinical outcomes. Also, our primary echocardiographic endings were the diameter, area, and volume of the left atrium. We assessed these variables at 3 time periods: baseline (t0), perioperative period (t1), and extended follow-up (t2: 12±3.4months). We carried out descriptive and bivariate exploratory statistical analysis for dependent measures. We included 17 patients, 70.6% of whom were women. Rheumatic mitral valve disease (76.5%) was the main etiology. We performed 14 (82.4%) mitral valve replacements and 3 repairs. Major adverse valvular-related events occurred in 1 patient (5.9%) (hemorrhagic stroke) at t1. A significant reduction in the size of the left atrium was observed: diameter (77mm vs 48mm, P<.001), area (75cm2 vs 31cm2, P<.001), and volume (332cm3 vs 90cm3, P<.001). Compared with t0 and t1, these echocardiographic findings remained without significant changes during t2. Our surgical left atrium reduction technique was associated with improved clinical functionality and reduced left atrium measures in patients with a giant left atrium undergoing mitral valve surgery.

Characteristics and frequency of tuberculosis before and during the COVID-19 pandemic among adults treated in a primary healthcare center in Lima, Peru, 2019–2020

Objective: To determine the characteristics and frequency of patients aged over 18 years with tuberculosis (TB) before (2019) and during (2020) the COVID-19 pandemic in a healthcare center (CS) in Lima, Peru. Materials and methods: A descriptive retrospective study that included medical records of 100 patients aged &gt; 18 years enrolled in the TB program at CS Los Libertadores (SMP-Lima, Peru) from 2019 to 2020. Sociodemographic (sex, origin, age), clinical (admission/discharge status, body mass index, comorbidities, TB infection site, type of resistance, treatment regimen) and laboratory (smear microscopy, culture, drug susceptibility testing) variables were analyzed. Patients who did not have all the variables were excluded. An Excel database was prepared and a descriptive statistical analysis of the qualitative variables, expressed in frequencies, and quantitative variables, expressed in measures of central tendency (mean) and standard deviation, was performed using IBM SPSS Statistics. TB prevalence per year was determined, according to the population assigned to the healthcare center. Said information was obtained through the Tuberculosis Management Information System (SIGTB). Results: TB prevalence was 0.0015 % (49 patients) in 2019 and 0.075 % (51 patients) in 2020. In both years, the male sex and the age group between 18 and 29 years prevailed, and the most common site of infection were the lungs. In 2020, an increase in HIV comorbidity and mortality rate (0.074) was observed, as well as more positive smear microscopy cases. Conclusions: TB prevalence was higher in 2020, the first year of the COVID-19 pandemic, due to a reduced approach to TB programs as a result of the situation imposed by the pandemic. In addition, TB mortality rates raised in the same year, probably due to an increase in treatment dropouts or HIV and diabetes comorbidity rates.

Phenotypic Characteristics and Clonal Relationships of Stenotrophomonas maltophilia Isolates in Hospitalized Adults from a Private Center in Lima, Peru.

Stenotrophomonas maltophilia is an opportunistic pathogen, often associated with nosocomial infections. Ten S. maltophilia were isolated from clinical samples during the period January 2021 and June 2022. Eight (80%) patients had cancer as a background disease and 2 patients had coronavirus disease 2019. A fatal outcome was recorded in 4 cases (40% of patients). All the isolates were susceptible to minocycline and levofloxacin. Trimethoprim/sulfamethoxazole and ceftazidime resistance rates were 20% and 40% respectively. Eight different patterns were observed by Pulsed-Field Gel Electrophoresis, only two isolates being clonally identical. The isolation of S. maltophilia in clinical settings requires the implementation of infection prevention measures.

Impact of Teleworking on the Health and Well-Being of Peruvian Workers in Times of Pandemic

The objective of this study was to establish the impact of teleworking on the health and well-being of Peruvian workers in times of pandemic. In this study, two questionnaires were applied to the selected sample made up of 428 workers from three organizations dedicated to the field of services: telecommunications, telephony and call centers in Lima. The findings indicate that, in the teleworking variable, the regular level prevailed at 41.12% due to weaknesses such as improvisation in the coordination to carry out the tasks, while the health and well-being variable was located at a moderate level at 35.28% reflecting that some workers were affected by COVID-19 and other illnesses related to it. It was possible to establish the incidence of health and well-being in teleworking carried out by Peruvian workers in times of pandemic; which led to results in the Telework dimension considered by the workers within the regular line of the survey; and the dimension of health and well-being was estimated within the moderate line of the survey. The conclusions of the study allow the creating of precedents to generate policies aimed at improving the conditions of this type of work, as well as generating new lines of research on the subject of teleworking.

The impact of the COVID-19 pandemic on patients’ experiences obtaining a tuberculosis diagnosis in Peru: a mixed-methods study

BackgroundThe COVID-19 pandemic disrupted TB services worldwide, leading to diagnostic delays. There have been few published reports describing how the pandemic affected people’s pathway to diagnosis from their own perspectives. We sought to evaluate the impact on the pandemic on people’s experiences obtaining a TB diagnosis.MethodsWe performed a mixed-methods study, enrolling newly diagnosed TB patients from 12 health centers in Lima, Peru. We used structured surveys to quantify diagnostic delay, defined as the time between symptom onset and diagnosis, and in-depth interviews to understand the ways in which the pandemic affected the pathway to care. We compared diagnostic delay between patients enrolled during the first year of the pandemic to those diagnosed after using a Wilcoxon rank-sum test. We used an inductive content analysis approach to analyze interview content related to the pandemic.ResultsWe enrolled 51 patients during November 2020–April 2021 (during the first year of the pandemic) and 49 patients during October 2021–February 2022. Median diagnostic delay was longer for patients diagnosed during the first year of the pandemic (median 15 [IQR 5–26] weeks compared to 6 [IQR 3–18] weeks, p = 0.027). Qualitative analysis of 26 interviews revealed that the pandemic affected participants’ care-seeking behavior and their ability to access to TB diagnostic services, particularly for those diagnosed in the first year of the pandemic. Many participants initially had their symptoms attributed to COVID-19, resulting in delayed TB evaluation and additional costs for COVID-19 treatment.ConclusionsThe COVID-19 pandemic impacted multiple steps in the pathway to care for TB patients in Lima, causing delays in TB diagnosis. These findings demonstrate how the shifting of health care resources to prioritize COVID-19 can lead to collateral damage for people with TB and other conditions.

Hearing Loss due to Noise Exposure and its Relationship with Hypertension in Peruvian Workers

Introduction: Noise-induced hearing loss has been implicated in the genesis of several chronic conditions; however, its behavior concerning hypertension still raises doubts about it.&#x0D; Objective: to determine the association between hearing loss due to exposure to noise and the presence of hypertension in a sample of Peruvian workers.&#x0D; Methods: Cross-sectional analytical study. Secondary analysis of the occupational database of a Medical center in Lima, Peru. hypertension was measured by self-report and clinical method. Hearing loss was classified as none, mild, moderate and severe. For the regression analysis, Poisson was performed with robust variance, obtaining crude (PRc) and adjusted (PRa) prevalence ratios.&#x0D; Results: We worked with a total of 1987 participants. The prevalence of hypertension was 15.40% and hearing loss was 36.39%. For the multivariate regression analysis, a statistically significant association with hypertension was found in those with mild hearing loss (PRa=1.52; CI95% 1.06–2.10), moderate (PRa=2.70; CI95% 1,93–3.76) and severe (PRa=3.82; 95% CI 2.56–5.96), compared to those without hearing loss.&#x0D; Conclusions: Hearing loss due to exposure to occupational noise was associated with the presence of hypertension. Although this study is only a first overview of the relationship that both variables could have, it is recommended to continue promoting policies and awareness campaigns to prevent hearing loss in workers, and thus avoid complications related to it in the long term.

Chronic hepatitis C in hemodialysis patients: Prevalence and liver fibrosis impact in the National Center for Renal Health in Peru

Hepatitis C (HCV) remains a serious public health problem in high-risk persons such as patients on chronic hemodialysis. We aimed to estimate the serological prevalence of HCV, the HCV viral load and genotype, and liver fibrosis stage among patients on chronic hemodialysis at the National Renal Health Center in Lima, Peru. From June 2019 to March 2021, all patients who received chronic hemodialysis were invited to participate. Subjects who provided written informed consent were enrolled. Patients with HCV-positive serology underwent determination of HCV viral load. Samples from subjects with detectable viral load, underwent determination of HCV genotype. Then, HCV infected subjects underwent determination of liver fibrosis using transitional elastography (Fibroscan 402): Metavir score: F0–F1: 2.5–7.5 kPa, F2: 7.6–9.5 Kpa, F3: 9.6–12 Kpa, F4 (Cirrhosis): 12.1–75 Kpa. Of the 303 subjects invited to participate, 174 (57.4%) subjects gave their written consent. Mean age was 52 years (range 22–91) and 116 (66.6%) were male. HCV serology was positive in 35.1% of patients (61/174); however, the prevalence of positive serology with detectable viral load was 20.11% (35/174). Genotype 1a was the most prevalent (85%). The majority (83.6%) of subjects with detectable viral load had values lower than 800.000 IU/mL. Twenty-nine of those 35 subjects underwent elastography evaluation, and 13 (44.8%) of them were found to have stage F2–F4 fibrosis. The prevalence of HCV at the largest reference center for hemodialysis in Lima remains high, with GT1a predominance, viral load usually below 800,000 IU/mL and significant liver fibrosis.

The Effectiveness of Pap and Visual Inspection With Acetic Acid (VIAA) Tests in Cervical Dysplasia Screenings During the COVID-19 Pandemic.

ObjectiveThis study was aimed at analyzing the validity and reliability of the Papanicolaou (Pap) test and visual inspection with acetic acid (VIAA) tests for cervical dysplasia screenings during the COVID-19 pandemic.Material and methodsThis was a retrospective study of patients 21 years or older seen at the Luis Negreiros Primary Care Center in Lima, Peru between 2020 and 2021, who underwent cervical dysplasia screening (Pap or VIAA). Relevant information regarding patient age, date of service, and Pap and VIAA results were collected. Parallel form reliability was analyzed with chi-square tests, and phi, contingency and Cramer's V coefficients. The validity of these tests was analyzed through the calculation of the sensitivity, specificity, and positive and negative predictive values with confidence intervals. A p-value less than 0.05 indicated statistical significance.ResultsFrom 4,503 records, the sensitivity, specificity, and positive and negative predictive values for Pap were 0.87 (0.81-0.92), 1.0 (1.0-1.0), 1.0 (1.0-1.0) and 0.99 (0.98-0.99), respectively, and those for VIAA were 0.22 (0.14-0.31), 0.10 (0.10-0.10), 0.53 (0.38-0.69) and 0.10 (0.10-0.10), respectively. Test validity varied slightly according to patient age and the year of testing. The correlation, although significant, was inverse; chi-square = 39.18, p <0.001, phi = -0.60, contingency = 0.51 and Cramer’s V = -0.59.ConclusionThe validity and reliability of Pap testing and VIAA for cervical dysplasia screening significantly decreased during the COVID-19 pandemic. The correlation between these tests, although significant, was inverse. More larger-scale studies are needed to confirm these findings and understand the reasons underlying the decreased effectiveness of these tests.

Biochemical failure and toxicity in treatment with brachytherapy and external beam radiotherapy compared with radical prostatectomy in localized prostate cancer.

BackgroundLocalized prostate cancer (T1–3N0M0) has therapeutic options such as radical prostatectomy (RP), external beam radiation therapy (EBRT) and brachytherapy (BT). However, the evidence of the outcome of these treatments is limited and no studies have been conducted comparing biochemical failure (BF) and toxicity associated with surgical treatment and EBRT + high-dose brachytherapy (HDBT) in the region.Materials and methodsRetrospective cohort study, clinical records of patients diagnosed with localized prostate cancer between 2014 and 2018 were reviewed at one of the main private neoplasm centers in Lima, Peru; Cox regression was used for both the BF outcome and the grade 2 toxicity outcome, calculating the hazard ratio (HR) with 95% confodence interval (CI).ResultsOf 549 patients, 76.3% (419) received RP as primary treatment, and 72% were between 50 and 70 years old at the time of diagnosis. The patients treated with EBRT + HDBT presented worse characteristics. The EBRT + HDBT group had a 40% lower risk of presenting BF (HR = 0.6; 95% CI: 0.4–0.9), and also a 50% greater risk of presenting toxicity greater than or equal to grade 2 (HR = 1.5; 95% CI: 1.0–2.0) than the group treated with RP.ConclusionOur results show that when comparing patients treated with EBRT + HDBT and RP, BF was greater in RP, and post-treatment toxicity was greater in EBRT + HDBT.

Aortic valve replacement through minithoracotomy. Results from the Peruvian experience.

To assess mortality, major valve-related events (MAVRE), and other complications in the perioperative period and follow up in patients with aortic valve replacement (AVR) through mini-thoracotomy (MT). We retrospectively analyzed patients aged <80 who underwent AVR through MT between January 2017 and December 2021 in a national reference center in Lima, Peru. Patients undergoing other surgical approaches (mini-sternotomy, etc.), other concomitant cardiac procedures, redo, and emergency surgeries were excluded. We measured the variables (MAVRE, mortality, and other clinical variables) at 30 days and a mean follow-up of 12 months. Fifty-four patients were studied, the median age was 69.5 years, and 65% were women. Aortic valve (AV) stenosis was the main indication for surgery (65%), and bicuspid AV represented 55.6% of cases. At 30-days, MAVRE occurred in two patients (3.7%), with no in-hospital mortality. One patient had an intraoperative ischemic stroke, and one required a permanent pacemaker. No patient underwent reoperation due to prosthesis dysfunction or endocarditis. In a mean follow-up of one year, MAVRE occurrence did not show variations with the perioperative period, most patients remained in NYHA I (90.7%) or II (7.4%) compared to the preoperative period (p<0.001). AV replacement through MT is a safe procedure in our center for patients under 80 years.

Diagnosis of Guillain-Barré syndrome and use of Brighton criteria in Peruvian hospitals.

Guillain-Barré syndrome (GBS) is an autoimmune disease of the peripheral nervous system that caused multiple epidemiological outbreaks in Peru during 2018 and 2019. It is usually diagnosed using the Brighton criteria (BC). We aimed to determine the performance of Peruvian neurologists in diagnosing GBS based on the BC, along with its associated factors. This was a retrospective multicenter cohort study. We included patients diagnosed with GBS between 2007 and 2018 in three public hospitals in Lima, Peru. We collected data regarding demographic, clinical and management characteristics. We evaluated the use of the BC for confirmatory diagnosis of GBS and developed a logistic regression model to identify factors associated with its use. Out of 328 cases, we reviewed 201 available charts. The median age was 48 years, with male predominance. Over half of the patients presented an inadequate motor examination according to their Medical Research Council (MRC) score. Additional testing included lumbar puncture and electrophysiological testing, in over 70% of the cases. The BC showed certainty level 1 in 13.4% and levels 2 and 3 in 18.3%. Neither the quality of the motor examination nor the type of institution showed any association with the BC. Level 1 diagnostic certainty of the BC was met in less than one quarter of the cases with a GBS diagnosis in three centers in Lima, Peru, between 2007 and 2018. This level was not significantly associated with being treated in a specialized institute, rather than in a general hospital.

119P Impact of magnetic resonance imaging in the surgical treatment of early breast cancer in two private cancer care centers in Lima, Peru

The impact of preoperative magnetic resonance imaging (MRI) in newly diagnosed breast cancer patients is matter of debate. Our study's major goal was to investigate the influence of MRI on the primary surgical treatment of early breast cancer: type of surgery, time to surgery, rate of reoperations.

The effects of telenutrition in overweight and obese adults in a nutritional center in Lima, Peru.

Background: COVID-19 pandemic has been challenging for health services and systems around the world, including Peru. A viable alternative in the telemedicine field to guarantee patient nutritional care is telenutrition. Telenutrition involves the interactive use of electronic information and telecommunications technologies to implement the nutrition care process with patients at a remote location. Information regarding the experience with this methodology and its potential effect on patients’ nutritional goals, does not exist in Peru. The aim of the study was to report the effect of the evaluation type (telenutrition vs. in-person) on weight, body mass index (BMI), waist circumference (WC) and relative fat mass (RFM) in overweight and obese adult patients. Methods: This retrospective study included 100 eligible patients in a single nutritional center, from January 2019 to March 2021. Telenutrition and in-person continuous variables were compared with independent sample t-test or U Mann-Whitney test. Results: There were significant differences in weight, BMI, WC and RFM by the end of follow-up period, in both evaluation modalities. Patients on the telenutrition group had a mean decrease of 6.80 ± 4.87 cm in WC, whereas the mean difference observed for the in-person group was 6.74 ± 4.55 cm. There were no significant differences in the changes of any anthropometric parameters when comparing both systems. Reductions were observed in weight (5.93 ± 3.88 kg vs. 4.92 ± 3.29 kg), BMI (2.23 ± 1.39 kg/ m2 vs. 1.83 ± 1.23 kg/ m2), WC (6.80 ± 4.87 cm vs. 6.74 ± 4.55 cm) and RFM (2.43 ± 1.78 vs. 2.63 ± 1.73) in telenutrition and in-person evaluation, respectively by the end of the follow-up period. Conclusions: Telenutrition may be regarded as an alternative to in-person evaluation offering anthropometric changes and nutritional goals similar to those reported through the in-person modality, in overweight and obese adult people.

Third molar impaction position in Peruvian adults

Objective. To determine the position of the third molars in patients treated in a diagnostic imaging center in Lima during the period 2017-2020. Methodology. An observational, descriptive, cross-sectional and retrospective research was carried out; which consisted of a sample of 253 panoramic radiographs of patients treated in a private radiological center. The position of the lower third molars, the depth of impact, and their impaction position in relation to the mandibular ramus were evaluated using the Pell and Gregory classification; as well as the Winter classification. The data were analyzed in the statistical package SPSS vs. 26. Outcome. It was observed that the vertical and mesioangular position were the most common with 14.6% and 13.2%; respectively. Type I and II according to Pell and Gregory was the most common with values of 15.4% and 14.4%; as well as, class B with 15.4%. Conclusion. The vertical and mesioangular impaction position, type B and class II were the most frequent for the lower third molars.