De Medicina Research Articles

Raptor y la importancia de accidentes de tránsito

Mr. Editor of the Revista de la Facultad de Medicina Humana, Lima, Peru I am writing to you, in relation to the review article "Association between the time of pre-hospital care and hospital mortality in victims of traffic accidents" published in 2020 Volume 20, number 01. In the aforementioned work, by M.J.G. Fernandez Sandoval et al., highlight the existence of a significant association between the time of prehospital care and mortality, with which I agree and express that it is of vital importance, even a good level of prehospital education can be applied in the specific topic of traffic accidents, since it represents an important health problem and is a priority in research.

Alimentos con función antioxidante y sus repercusiones en la retinopatía diabética

Mr. Editor: I had the opportunity to review an article published in the first edition of the journal of the Facultad de Medicina Humana de la Universidad Ricardo Palma this year, which is entitled consumption of foods rich in antioxidants in outpatients with diabetic retinopathy at the hospital la carlota during 2021, identified with DOI n° 10.25176/RFMH.v22i1.4121 and written by Raquel Martínez-Kurata, et al., where they sought to find the amount of antioxidant consumption focusing on vitamins C, E and selenium in patients with diabetic retinopathy (DR), which managed to capture my attention and aroused my curiosity, motivating me to seek more information about it. Let me comment on some points of view in common with the authors.

Dieta deficiente en frutas y riesgo de cáncer colorrectal

Sr. Editor After reading the article by Lobato-Jeri, C et al. which is entitled "Clinical surgical characteristics of patients aged 75 years or older colostomized in the national hospital Edgardo Rebagliati Martins with DOI: 10.25176/RFMH.v16.n2.667, published in 2016, in your prestigious journal of Facultad de medicina humana de la Universidad Ricardo Palma, I must say that it has been a pleasure to have studied it, because it deals with a very relevant topic for the public health of our country. This study covers the characteristics that exist in elderly patients who underwent colostomy surgery. What caught my attention was that, of the patients analyzed in their publication, a large percentage (42.11%) had unresectable colorectal cancer that caused intestinal obstruction, which led them to have a colostomy.

New indexing of Revista de la Facultad de Medicina Humana: Harvard Library and DRJI

The Revista de la Facultad de Medicina Humana de la Universidad Ricardo Palma (RFMH) reaches a momentous career achievement when indexed in the prestigious Harvard Library and the Directory of Research Journals Indexing (DRJI). This indexing reflects the journal's firm commitment to advancing medical science and public health through rigorous, high-quality publication.

The impact of bariatric and metabolic surgery on the morbidity and mortality of patients infected during the COVID-19 pandemic: a retrospective cohort study.

Since the impact of the coronavirus disease 2019 (COVID-19) pandemic in March 2020, several studies have shown a strong relationship between obesity and severe cases of COVID-19. It is imperative to assess whether bariatric surgery exerts a protective effect in such cases. This study aimed to assess the impact of bariatric surgery on the morbidity and mortality in obese patients during the COVID-19 pandemic. A comprehensive search was performed using the PubMed and Cochrane Library databases. Retrospective cohort studies conducted in the Faculdade de Medicina da Universidade Cidade de São Paulo, São Paulo (SP), Brazil. The search comprised the following descriptors: "bariatric, surgery, COVID-19". Current retrospective cohort studies that examined the influence of bariatric surgery on the morbidity and mortality of obese patients during the COVID-19 pandemic were considered eligible. After removing duplicates, 184 studies were obtained from the databases. Of these, 181 were excluded from the analysis as they did not meet the eligibility criteria. Patients undergoing postoperative follow-up of bariatric surgery had a similar probability of SARS-CoV-2 infection compared to the general population, and persistent comorbidities were associated with an increased risk and severity of infection. Bariatric surgery has a protective effect against severe COVID-19 in the obese population, bringing the prevalence of severe disease cases to levels equivalent to those of the nonobese general population, with a positive impact on morbidity and mortality.

O.22.4 - (WIP) Simulated patients' dramatic performance: perceived impact on clinical communication training: Presenter(s): Margarida Figueiredo-Braga, Faculdade de Medicina da Universidade do Porto, Portugal

O.22.4 - (WIP) Simulated patients' dramatic performance: perceived impact on clinical communication training: Presenter(s): Margarida Figueiredo-Braga, Faculdade de Medicina da Universidade do Porto, Portugal

Maternal visceral adiposity and fetal biometry in women with obesity and diabetes.

The aim of this study was to compare the correlation of maternal visceral adiposity with sonographic variables related to fetal biometry in the second trimester of pregnancy in mothers who were previously obese versus nonobese and gestational diabetic versus nondiabetic. This cross-sectional study included 583 pregnant women who received prenatal care between October 2011 and September 2013 at the Instituto de Medicina Integral Prof. Fernando Figueira, northeast of Brazil. Maternal visceral adiposity was measured by ultrasound examination at the same time as fetal biometry. Gestational age was 14.9±3.2 weeks. The correlation between maternal visceral adiposity and fetal biometric variables was evaluated using Pearson's correlation coefficient. Among the groups, the correlation coefficients were compared using Fisher's Z-test. This test was also used to evaluate the null hypothesis of correlation coefficients between pairs of variables. Maternal visceral adiposity positively correlated with fetal abdominal circumference, estimated fetal weight, head circumference, femur length, and biparietal diameter in pregnant women with obesity, nonobesity, gestational diabetes, and nondiabetes, but the correlation coefficients were statistically similar among the groups. Maternal visceral adiposity positively correlated with fetal biometry in the second trimester of pregnancy in the same manner in pregnant women previously obese and nonobese, as well as in pregnant women with gestational diabetes and nondiabetes.

Epipericardial fat necrosis: a case report of an underdiagnosed disease.

Epipericardial fat necrosis: a case report of an underdiagnosed disease.

An initial investigation of the role of depressive and anxious syndromes in Problematic Internet Use in adolescence and young adults

Depressive and anxious syndromes have been proposed as risk factors and as consequences of Problematic Internet Use (PIU). There has been no study relating affective symptoms in subjects with Problematic Internet Use and those with major depressive and anxious syndromes. In this study, three samples were collected: two from ambulatory clinical settings of the North Lisbon Hospital Centre (1. Centre for PIU and 2. Out-patient psychiatry consultation for adolescents and young adults) and a control group from Faculdade de Medicina da Universidade de Lisboa. Internet use profile and affective psychopathology were assessed and socio-demographic characteristics were controlled. The results revealed that both the PIU group and the clinical group presented significantly higher depression and anxiety scores than the control group while there was no significant difference between them. Also, Problematic Internet Users, similarly to the clinical group, tend to live in less functional families. We speculate that the similitude between samples and yet such different clinical presentations could be explained if Internet acted as a buffer to affective psychopathology. These findings warrant exploring the possibility of PIU as new (and generation biased) psychopathology of depressive or anxious states.

Indicadores de gestión en investigación 2022

Given the importance of the research component to respond to phenomena and problems demanded by society, At Universidad Ricardo Palma, research has been fostered and promoted as an institutional policy. The Instituto de Investigación en Ciencias Biomédicas, which reports to the Rectorate and is integrated into the Facultad de Medicina Humana, has been working to contribute substantially to this growth in research. The research is directly related to the quality processes of higher education, innovation, extension, linking, licensing, accreditation, and finally, the ranking of universities. As is evident, the research is linked to the present and the future of universities. Therefore, measuring the impact of research is essential because educational institutions are and must be permanent generators of intellectual property, knowledge and human resources, which impact the educational, scientific, economic and social sectors.

EVALUATION OF KNOWLEDGE OF BIOSAFETY OF HEALTH PROFESSIONALS OF MULTIPROFESSIONAL RESIDENCE OF A HOSPITAL

The recent concept of biosafety encompasses the set of actions aimed at preventing, minimizing or eliminating risks inherent to research, production, teaching, technological development and service provision activities, aiming to preserve the health of man, animals and the environment . In this context, awareness and permanent education of professionals are also essential, which provides them with conditions to carry out safe work, critical discussions and reflections, update and adoption of correct preventive measures. The objective of the research was to evaluate the knowledge of health professionals from the Multiprofessional Residency of the Instituto de Medicina Integral Professor Fernando Figueira, about biosecurity in the hospital premises. The study was of the descriptive observational epidemiological type through the application of a questionnaire on the topic addressed. The sample consisted of a multidisciplinary population, effectively enrolled in the first and second years of residency (n=83). Of the participants, 89.2% reported being aware of the risks of biosafety, 81.9% walk around the hospital’s internal and external areas wearing the lab coat, 96.4% usually use the lab coat in restaurants and only 34.9% correctly clean the hands in a hospital environment. Insufficient biosafety practices are notorious, which demonstrates a lack of awareness on the part of professionals. Thus, basic and consensual measures are necessary to remedy and/or reduce risks and contamination vectors in hospital sectors by health professionals.

ИНФИНИТИВЫ ПЕРФЕКТА В МЕДИЦИНСКИХ РЕКОМЕНДАЦИЯХ ТРАКТАТА ЦЕЛЬСА «О МЕДИЦИНЕ»

ИНФИНИТИВЫ ПЕРФЕКТА В МЕДИЦИНСКИХ РЕКОМЕНДАЦИЯХ ТРАКТАТА ЦЕЛЬСА «О МЕДИЦИНЕ»

The use of bedside echocardiography in the care of critically ill patients - a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência and Sociedade Brasileira de Medicina Hospitalar. Part 2 - Technical aspects.

Echocardiography in critically ill patients has become essential in the evaluation of patients in different settings, such as the hospital. However, unlike for other matters related to the care of these patients, there are still no recommendations from national medical societies on the subject. The objective of this document was to organize and make available expert consensus opinions that may help to better incorporate echocardiography in the evaluation of critically ill patients. Thus, the Associação de Medicina Intensiva Brasileira, the Associação Brasileira de Medicina de Emergência, and the Sociedade Brasileira de Medicina Hospitalar formed a group of 17 physicians to formulate questions relevant to the topic and discuss the possibility of consensus for each of them. All questions were prepared using a five-point Likert scale. Consensus was defined a priori as at least 80% of the responses between one and two or between four and five. The consideration of the issues involved two rounds of voting and debate among all participants. The 27 questions prepared make up the present document and are divided into 4 major assessment areas: left ventricular function, right ventricular function, diagnosis of shock, and hemodynamics. At the end of the process, there were 17 positive (agreement) and 3 negative (disagreement) consensuses; another 7 questions remained without consensus. Although areas of uncertainty persist, this document brings together consensus opinions on several issues related to echocardiography in critically ill patients and may enhance its development in the national scenario.

Intoxicação por ureia em bovinos: breve revisão e abordagem diagnóstica

ABSTRACT: Urea is an organic compound characterized as a white, solid, and hygroscopic substance. It is recognized as a source of non-protein nitrogen (NPN) and is widely used as a partial replacement for protein in cattle diets due to the ability of the ruminal microbiota to convert it into microbial protein. Despite the advantages of using urea, it also has limitations, particularly the proximity between metabolizable and toxic or fatal doses. Furthermore, for safe use, a period of adaptation is necessary for the animals. Poisoning is characterized by rapid and generally fatal development, which is frequent in non-adapted animals but can also occur in those with previous adaptations. The aim of this study was to characterize the clinical, epidemiological, and pathological aspects of urea poisoning through a brief review and a retrospective study. In addition, interviews were conducted with veterinarians who frequently send diagnostic material to the Laboratory of Anatomic Pathology of the “Faculdade de Medicina Veterinária e Zootecnia” (LAP-FAMEZ) to assess their perception of the outbreaks of urea poisoning. The objective was to obtain a comparative scenario between published cases and those received by the laboratory while considering the real situation of this condition in the field. During this retrospective study, only four outbreaks were investigated; in one, the diagnosis was possible through experimental reproduction. Of 35 interviewees, 88.9% said they had seen more than one case compatible with urea poisoning, but 87.5% did not perform a necropsy and/or send material to confirm the diagnosis. The results show that the reality of urea poisoning may be very distant from that reported in previous studies due to the difficulty often observed in the diagnostic approach, so we developed a flowchart aiming to provide a useful guide for field veterinarians.

Characterization and maintenance of hospital equipment:a case study on the institute of molecular medicine JoãoLobo Antunes

Objective:The objective of this study was to conduct a study on the characterization and maintenance ofequipment in a hospital environment and apply it in the case study conducted as part of an internship at theInstituto de Medicina MolecularJoão Lobo Antunes (iMM), with a duration of 11 months. This work contributed tothe identification of improvements to be applied in theSafety and Compliance Department, in the maintenance,calibration, and monitoring of medical-hospital equipment (MHE), to improve their reliability and efficiency, thereduction of costs and downtime, and the probability risk to the patient, engineer, or user associated with theequipment.Materials and methods:This is an MHE study of the iMM, also monitoring the maintenance and calibration ofdifferent equipment by technicians and engineers responsible internally and externally.Discussion and Practical Results:A maintenancesoftwarefor the iMM was chosen to help the institute to haveall the equipment information in a more organized way. Monitoring of some iMM equipment was conducted.Conclusion:It was found that the safety of patients, engineers, or users who manage MHE is an extremely principalfactor. For this factor not to be harmed, constant monitoring, maintenance, and calibration of the equipment arenecessary, ensuring the safety of the user and their proper functioning.

Brief History of Oral and Maxillofacial Pathology in Colombia: Milestones and Current State.

Oral and maxillofacial pathology, the branch of dentistry concerning clinical and histopathological diagnosis of pathologies of the oral and maxillofacial region, started to develop in Colombia in the mid- 19th century. Since 1950s, dedicated dental clinicians from different dental schools played an important role in its inception and subsequent development. The first significant wave of progress occurred in the 1970s with the appearance of the first formally trained oral pathologists. It was sometime in the late 1980s and early 1990s that dentists Ines Velez and Benjamin Herazo had separate initiatives and created the first oral pathology postgraduate programs in Bogotá. It was in the late 80's and early 90's that dentists Ines Velez and Benjamin Herazo had their own initiatives and created the first oral pathology postgraduate programs in the city of Bogotá. A concomitant of their achievements was the establishment of the first on-site oral pathology biopsies units and registers at Colegio Odontãlogico Colombiano, Pontificia Universidad Javeriana and Escuela Colombiana de Medicina dental schools. The programs have trained many dentists in the field over the years and two of them remain active and fully accredited. The past and present contributions and leaderships of some academic figures and graduates have allowed a steady evolution of the specialty nationwide. Currently, the ability to manage and overcome educational and professional challenges is necessary to advance the growth of this specialty in this country.

Morphological characteristics of the left gastric, common hepatic and splenic arteries. A descriptive study in human cadaveric specimens.

to evaluate the morphology of the branches of celiac trunk (CT), left gastric (LGA), common hepatic (CHA), and splenic (SA) arteries in cadaveric specimens from a sample of a Colombian population. descriptive cross-sectional study of 26 blocks from the abdominal upper segment of human cadavers who underwent forensic autopsies at the Instituto de Medicina Legal at Bucaramanga, Colombia. The vascular beds of the celiac trunk were, subsequently, perfused with a semi-synthetic resin. the diameters of LGA, CHA, and SA were 3.6±0.8mm, 5,2±1.2mm, and 5.9±1.0mm, respectively. Statistically, LGA and SA were different (p=<0.001). SA followed a linear trajectory in 8 (31%) samples, slightly tortuous in 4 (15%), and tortuous in 14 (54%). The tortuosity index was 1.25±0.18. Of the branches of CHA, the proper hepatic artery (PHA) had 4.8±1.2mm in diameter and 18.8±9.1mm in length, whereas the gastroduodenal artery (GDdA) had 4.1±0.8mm. In 2 cases (7.7%), an accessory hepatic artery from the LGA was found to supply perfusion to the left hepatic lobe. Finally, in 2 cases (7.7%) the SA came independently from the abdominal aorta. the observed emergence incidence of the CT branches from the same level as reported in the literature is lower. The characterization, along with their variants, of LGA, CHA, and SA must be considered in surgical procedures in the upper abdominal segment, to avoid iatrogenic complications.

Coronary Artery Bypass Grafting: A Comparative Exercise between Patients from the BYPASS Registry and Patients from a University Hospital.

The coronary artery bypass grafting (CABG) data provided by the Brazilian Registry of Cardiovascular Surgeries in Adults (BYPASS) Registry is a Brazilian reality. To carry out a comparative exercise between the BYPASS Registry published data and data from patients operated on in a randomly chosen period (2013-2015) at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP). This is a retrospective study reviewing 173 electronic medical records of CABG patients from the HCFMRP-USP. These data were compared with the BYPASS Registry published data. Chi-square test was used to verify the changes within the prevalence of adequate/inadequate biochemical tests before and after surgery. The sample was divided into groups consistent with cardiopulmonary bypass (CPB) time (CPB ≤ 120 minutes and CPB > 120 minutes). For the complications, prevalence by the chi-square test was adopted. Significant P-values are < 0.05. The comparative operative data of the BYPASS Registry and the HCFMRP-USP patients were quite similar, except for the isolate use of only arterial grafts, which was more frequent on HCFMRP-USP patients (30.8% vs. 15.9%), and the use of radial artery, also more frequent on HCFMRP-USP patients (48.8% vs. 1.1%). The comparative study suggested that the BYPASS Registry should be a reference for CABG quality control.

Characterization of the normal fetal circulatory system of the ductus venosus using sound complexity parameters.

The aim of this study was to characterize the normality of the fetal circulatory system through the time between ventricular systoles of the ductus venosus in the three gestational trimesters in healthy fetuses using nonlinear methods of the complexity of the signal. A prospective cohort study was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) from December 2019 to May 2020. Pregnant women between 11 and 14 weeks, with intrauterine pregnancy and healthy fetus were included. Patients with multiple gestation, positive screening for congenital malformation, including heart disease, and under 18 years of age were excluded. Doppler velocimetry ultrasonography of the ductus venosus was performed between the 11th and 14th weeks, 20th and 24th weeks, and 28th and 32nd weeks of gestation, and then the sound signal was extracted and segmented from the videos. To compare the means between the gestational trimesters of the approximate entropy (ApEn) and Lempel-Ziv complexity (CLZ) of the time between ventricular systoles, the Friedman test was used, with a significance level of 5%. No statistically significant difference was found between the 1st, 2nd, and 3rd trimesters regarding the mean ApEn (P=0.281) and CLZ (P=0.595) of the time between ventricular systoles of the ductus venosus. Ductus venosus systolic time was not sensitive to differentiate fetal cardiovascular dynamics between gestational trimesters. This study pioneered the characterization of cardiovascular normality by nonlinear parameters of the fetal ductus venosus in all three trimesters.

Patient’s Medical Records in Brazil: Legal and Regulatory Considerations

This work aimed to research medical records' legal and regulatory definitions as found in force not only in the Brazilian normative systems but also at the Federal and Regional Councils of Medicine (Conselho Federal e Conselhos Regionais de Medicina), particularly their completeness to be accepted by the judicious system. This empirical retrospective documentary research recovered norms, legislations, resolutions, and professional opinions about medical records and some of its parameters, such as content, legibility, and accountability using official legal and regulatory digital platforms. No period limitation was set for document recovery; however, only current ones (still in force) were analyzed in full. Documents that dealt with the content of the medical record per se were included; those that dealt with custody, confidentiality, digitization, and access to third parties were excluded. The Brazilian legislation does not provide a clear definition of medical records or their core content. Nonetheless, its collective nature is recognized. The Federal and Regional Councils of Medicine have issued numerous resolutions and opinions on the matter, clarifying its completeness in nature. Medical Records are a collection of health documents of a patient, which should be readily available upon court request as a complete medical dossier, and must contain legible and signed copies, including all the procedures a person underwent while under care.