Edgardo Rebagliati Martins National Hospital Research Articles

FACTORES ASOCIADOS A COMPLICACIONES DESPUÉS DE DUODENOPANCREATECTOMÍA CEFÁLICA (CIRUGÍA DE WHIPPLE) EN UN CENTRO ESPECIALIZADO

Introduction: Whipple procedure, also known as pancreatoduodenectomy (PD), is a widely used procedure for several types of peri-ampullary cancer. Objectives: To establish the factors associated with postoperative complications after PD in the Pancreas Surgery Service of the Edgardo Rebagliati Martins National Hospital in Lima, Peru. Methods: An observational, quantitative, analytical, cross-sectional, and retrospective study was carried out on 81 patients during the period from January 2017 to December 2019, who underwent PD. The dependent variable was postoperative complications and the independent variables were preoperative, perioperative, and postoperative variables. The medical records were reviewed. Logistic regression was performed to find the crude and adjusted ORs. Results: The mean age was 65.97±10.14 and the majority of patients were male. The most common postoperative complication was pancreatic fistula (34.6%). Factors associated with postoperative complications after PD were male sex (aOR: 4.46, 95% CI: 1.35-14.77), ampullary cancer (aOR: 6.92, 95% CI: 1.75-27.48), and soft consistency of the pancreas (aOR: 4.52, 95% CI: 0.07-0.58). Conclusions: The factors associated with postoperative complications after PD were male sex, ampullary cancer, and soft consistency of the pancreas.

Characterization of adverse events to hydroxychloroquine, ivermectin, azithromycin and tocilizumab in patients hospitalized due to COVID-19 in a Peruvian Social Health Insurance hospital.

To characterize the adverse events (AEs) related to the off-label use of hydroxychloroquine (HQ), azithromycin (AZI), tocilizumab (TOB) and ivermectin (IVM) for the treatment of COVID-19 in hospitalized patients. We conducted a secondary cross-sectional analysis of the Peruvian Social Health Insurance (EsSalud) pharmacovigilance system database of AE notifications to HQ, AZI, TOB and IVM in the Edgardo Rebagliati Martins National Hospital from April to October 2020. Information was collected from digital medical records. We estimated AE reporting rates and evaluated their characteristics by drug type, time of occurrence, type by the affected organ-system, severity and causality. We identified 154 notifications describing a total of 183 AE possibly related to HQ, AZI, TOB and IVM; the reporting rate was 8%. The median time of AE occurrence was 3 days (IQR: 2-5). Most were cardiovascular events; prolongation of the QT interval was the most frequent. Hepatobiliary AEs were mainly associated with TOB. Most cases were moderate, however, 10.4% were severe. We found AEs potentially associated with the use of HQ, AZI, TOB and IVM against COVID-19; cardiovascular events were the most frequent. Although AZI, HQ and IVM have known safety profiles, their use against COVID-19 could increase the occurrence of AE due to the risk factors inherent to this infection. Surveillance systems must be improved, especially those for TOB.

LINC-21. PROGNOSTIC FACTORS AND SURVIVAL OF LOW-GRADE GLIOMAS IN CHILDREN AND ADOLESCENTS – A MULTICENTER STUDY IN PERU

BACKGROUND: Low-grade gliomas (LGG) are the most common central nervous system (CNS) tumors in children. Peru is an index country for the Global Initiative for Childhood Cancer (GICC). As part of the Initiative, a multidisciplinary brain tumor team was formed in 2020 that includes five national reference centers: National Institute of Neoplastic Diseases, National Children’s Health Institute-San Borja, National Children’s Health Institute-Breña, Edgardo Rebagliati Martins National Hospital and Guillermo Almenara Irigoyen National Hospital. This multicenter study sought to evaluate the survival and prognostic factors of patients younger than 18 years diagnosed with LGG, an index cancer for the GICC. METHODS: A retrospective study included all patients diagnosed with LGG in the five centers between 2014 and 2018. We analyzed clinical characteristics, histology, and treatment modalities. We used the Kaplan-Meier method for survival. RESULTS: 194 patients were registered; 136 patients were included. M/F ratio was 1.2, mean age 7 years old. The most frequent location was infratentorial (42.2%), supratentorial (34.9%), optic/chiasm/sellar (11%) and brainstem (11.9%). The most frequent histological types were pilocytic astrocytoma (61%), diffuse astrocytoma (10.3%), oligodendroglioma (5.2%), and other low-grade neoplasms (23.5%). Surgery was performed in 109 patients (83.2%). Chemotherapy alone was used in 17 (12.5%), while radiotherapy in 20 (14.7%). Overall survival at 5 years was 82.9% (95% CI 73.3 - 89.4). Age younger than 3 years (p=0.002), diffuse histological type (p=0.04), and location in the brainstem (p=0.001) were factors associated with a worse prognosis. CONCLUSIONS: Within the framework of the GICC, this work is one of the first steps to understand the current context of pediatric CNS tumor care in Peru. Although the reported survival rate is about the GICC goal of 60%, further improvements in care are needed to increase survival to level closer to high-resource setting and decrease long term morbidity.

Factores asociados a Hospitalizaciones inadecuadas de adultos mayores en el Servicio de Emergencia del Hospital Edgardo Rebagliati Martins 2017

Introduction:Inadequate hospitalizations (IH) alter hospital management and much more when they are carried out in the elderly population; therefore, identifying the factors is relevant at the national and local levels. Objective: To determine the factors associated with IH in older adults in the Emergency Service (ES) of the Edgardo Rebagliati Martins National Hospital (HNERM) during 2017. Methods: Observational, analytical, cross-sectional study. A sample of 414 patients randomly selected from 18 250 patients admitted during the study period was selected. Collection forms were used, and medical records were reviewed. With the help of the SPSS 25 program, the Chi-square test was performed, and the simple Prevalence Ratio (PR) and adjusted (Rpa) were calculated. The level of signicance was 5%. Results: The frequency of IH was 11,8%. The epidemiological factors associated with IH were ages from 75 to 84 years RPa=5,80 (2,20-15,27) and from 85 to more years RPa=8,22 (2,76-24,44), the female sex RPa=2,20 (1,11-3,10), the occupation as a housewife RPa=3,39 (1,13-10,17) and the accompaniment of the spouse RPa= 9,16 (2,59-32,38), child RPa= 3,72 (1,14-12,14), parents RPa= 8,50 (1,88-38,44) and siblings RPa=22,42 (5,78-86,97). The organizational factors associated with IH were internist treating physician RPa=2,90 (1,38-6,07) and admisiion morning shift RPa=4,84 (1,67-14,06). Conclusions: There are factors associated with IH in older adults in the SE of HNERM.

Linfoma Hodgkin Clásico en el departamento de anatomía patológica del Hospital Nacional Edgardo Rebagliati Martins durante los años 2015 a 2019.

Introduction: Hodgkin lymphomas are B-cell lymphoid neoplasms histologically characterized by a mixed inflammatory cellular component and few Hodgkin/Reed-Sternberg neoplastic cells. Classical Hodgkin Lymphoma (CHL) represents 10% of all lymphoma cases and 85% of all Hodgkin Lymphomas. According to the current World Health Organization classification, CHL is divided into 4 types: Nodular Sclerosing (NS), Mixed Cellularity (MC), Lymphocyte-Rich (LR), and Lymphocyte-Depleted (LD). Objetive: We reviewed all cases of Classical Hodgkin Lymphoma in the Pathological Anatomy Department at Edgardo Rebagliati Martins National Hospital during 2015 to 2019, in order to determine the most frequent type, the incidence according to age and gender, phenotypical characteristics and relation to Epstein Barr Virus (EBV). Materials and Methods:  We performed a retrospective descriptive case study of Classical Hodgkin Lymphoma and its 4 clinical-pathological types in the Pathological Anatomy Department at Edgardo Rebagliati Martins National Hospital during 2015 to 2019. 72 patients were identified with Classical Hodgkin Lymphoma diagnosis, of which only 64 were selected for the study. The exclusion criteria were the absence of confirmatory immunohistochemical tests and relapse cases. Results: The most frequent type observed was Nodular Sclerosing with 34 cases (53.12%) and the least frequent type was Lymphocyte-Rich with 2 cases (3.12%). Likewise, a predominance in the male gender was observed, with 42 cases, 20 of which were Nodular Sclerosing and 14 not classified, as the most frequent types, and a greater incidence among those 41 to 50 years of age, without detection of the bimodal peak referenced in international literature. The most frequent immunohistochemical profile of Hodgkin/ Reed- Sternberg was CD15 and CD30 positive, with CD45 negative. EBV was present in 36% of cases and is more frequent in the Mixed Cellularity and Lymphocyte-Depleted types. Conclusions: Classical Hodgkin Lymphoma is a group of lymphoid neoplasms with clinical, histological, and phenotypically defined characteristics. It is more frequent in men between 41 and 50 years of age. A complete clinical information and a good biopsy, preferably excisional, is required for an adequate diagnosis. The Nodular Sclerosing type is the most frequent and the Lymphocyte-Rich is the least frequent type. Hodgkin/ Reed- Sternberg cells are usually CD-15 and CD-30 positive and CD-45 negative. The Pax-5 mild positivity allows it to be differentiated from B-cell Non-Hodgkin Lymphomas. EBV is most frequent in Mixed Cellularity and Lymphocyte-Depleted types.

Cross-sectional study of the clinical characteristics and outcomes of children hospitalized with COVID-19 in Lima, Peru

Coronavirus 2019 (SARS-CoV-2) infection in children occurred in Peru as of March 2020, leading to pediatric patients' hospitalization in areas adapted for this purpose at the Edgardo Rebagliati Martins National Hospital. In the beginning, the demand for hospitalization was low, but it increased gradually. Consistent with international reports, the majority of patients presented mild or moderate symptoms. Nonetheless, there were also severe cases, even fatal ones. To describe the characteristics and clinical outcome of pediatric patients with COVID-19 hospitalized in a referral hospital in Lima, Peru, between March and August 2020. A descriptive and inferential cross-sectional study was carried out. The population includes all hospitalized patients in the Department of Pediatrics, with clinical and surgical diagnoses associated with COVID-19. We included 100 patients, with an average age of 83.4 ± 54 months, with a predominance of male patients (55%). Hospitalized patients were grouped into five categories: respiratory failure (17%), multisystemic inflammatory syndrome (MIS-C) (31%), neurological presentation (19%), acute abdomen (20%), and patients with oncological problems (13%). Most of the patients (74%) had comorbidities. Regarding the presenting symptoms, intestinal pain predominated in the appendicitis group (90%, p < 0.001), fever was present in most patients with respiratory failure (64.7%); multisystemic inflammatory syndrome (90.3%), neurological manifestations (15.8%), acute abdomen (50%) and oncological conditions (61.5%) were also present in these patients. Kawasaki symptoms were found in 38.7% of the patients with multisystemic inflammatory syndrome. Mortality was 4%. Respiratory problems (29.4%) and multisystemic inflammatory syndrome (22.6%) required admission to intensive care, more frequently than the other presentations (p = 0.008). We conclude that the vulnerability in the pediatric population is the one that has preexisting conditions. We divided our patients according to presentation, diagnosis, and complications, which were predominantly respiratory. We also had oncological patients with COVID-19.

Presentaciones Clínicas Asociadas Al SARS-CoV-2 En Una Unidad De Cuidados Intensivos Pediátricos Covid De Un Hospital Nacional De Lima

The coronavirus disease 2019 (COVID-19) affects more adults than children. Later, the Pediatric Multisystemic Inflammatory Syndrome (SIMS) associated with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) was described, whose peak incidence was 4 weeks after the maximum peak of infections, so it is postulated that it is a post-infectious entity, and is characterized by affecting several organs and systems. In response to this new need, the Pediatric Intensive Care Unit (PICU) of the Edgardo Rebagliati Martins National Hospital set up a differentiated environment with two beds for the care of children with SARS-CoV-2 infection, to reduce the risk of in-hospital infections.

Diarrea nosocomial por Clostridiodes difficile en un hospital de referencia en Lima, Perú

Objetivo: determinar la frecuencia, incidencia y describir las características clínicoepidemiológicas de los pacientes con diarrea nosocomial por Clostridioides difficile en el Hospital Nacional Edgardo Rebagliati Martins en el período abril a julio de 2019. Materiales y métodos: estudio observacional y transversal realizado en los servicios de medicina interna, cuidados intensivos, hematología, gastroenterología y emergencia. Se realizó una vigilancia activa de los pacientes mayores de 18 años con tres o más deposiciones no formadas en 24 horas luego de 48 horas de admisión hospitalaria. Se empleó un algoritmo diagnóstico, que incluyó la glutamato deshidrogenasa y toxina fecal A y B de C. difficile. En caso de resultados discordantes, se realizó la prueba de amplificación de ácidos nucleicos de los genes productores de toxinas. Resultados: de 107 pacientes con diarrea nosocomial, 12 fueron positivos para C. difficile con una frecuencia de 11,2% (IC 95%: 6,44-18,82). Un paciente fue NAP1-BI-027 positivo. La mayor densidad de incidencia fue en hematología (5,54 x 10 000 pacientes-día). Siete (7/12, 58,3%) fueron varones y la edad fue 64,58 ± 21,34 años. El principal antibiótico indicado previo a la diarrea fue meropenem (9/12, 75%). Solo dos pacientes recibieron clindamicina. La mayoría (8/12, 66,7%) tuvo un episodio inicial no grave. La mortalidad general fue 28% (IC 95%: 20,27-37,38) y cuatro fallecidos tuvieron infección por C. difficile. Conclusiones: la frecuencia de diarrea nosocomial por C. difficile en nuestra institución fue menor al reportado previamente en otro hospital público de Lima. El uso racional de antibióticos y las medidas preventivas explicarían estos hallazgos.

SARS-CoV-2 en la segunda mitad del embarazo: resultados materno – perinatales

Introducción. La pandemia por COVID-19 es una emergencia sanitaria y social mundial. El conocimiento sobre su efecto en las gestantes es todavía limitado. Objetivo. Describir los resultados materno-perinatales de COVID-19 según clasificación de severidad en mujeres hospitalizadas en la segunda mitad del embarazo. Métodos. Estudio observacional, descriptivo, retrospectivo, desde marzo hasta julio del 2020, en el Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú. Se incluyeron a todas las gestantes hospitalizadas con RT-PCR y/o prueba rápida positiva para SARS-CoV-2. Se excluyeron los embarazos menores a 20 semanas y las altas epidemiológicas. Las características maternas al ingreso y los resultados materno-perinatales fueron agrupados según la clasificación clínica de la enfermedad. Las variables cualitativas son presentadas en recuentos y porcentajes; y las cuantitativas, en medianas y rangos. Resultados. Se estudiaron 247 gestantes. La mayoría correspondía al tercer trimestre (76%). La presentación más frecuente de la virosis fue asintomática (83%) y los casos de neumonía severa fueron pocos (3,2%). La tasa de cesárea fue alta (60%), aunque los partos vaginales se duplicaron en el tiempo (0-24% a 44%). Los casos severos tuvieron mayor tasa de cesárea (100%) y parto prematuro iatrogénico (100%). No se reportaron muertes maternas. Se registraron 9 óbitos fetales y 5 neonatos positivos para SARS-CoV-2, ambos entre las asintomáticas y leves. Conclusiones. En nuestra institución, la posibilidad de cesárea y de parto prematuro iatrogénico fue mayor en los casos severos. La tasa de parto vaginal aumentó en los últimos meses. No se identificaron complicaciones perinatales relacionadas al COVID-19.

Factores asociados a la presencia de fisura labiopalatina en recién nacidos en un hospital peruano de tercer nivel de atención. Un estudio de casos y controles

Objetivo: identificar los factores asociados a la presencia de fisura labial y/o palatina en recién nacidos en el Hospital Nacional Edgardo Rebagliati Martins, localizado en Lima – Perú, durante el periodo noviembre 2012 - diciembre 2016. Materiales y métodos: estudio observacional, analítico, de casos y controles emparejado, con datos del Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC). Se analizaron 61 casos y 61 controles. La variable dependiente fue la presencia de fisura labial y/o palatina. Se recogieron también variables clínicas, epidemiológicas, obstétricas y prenatales. Resultados: la fisura labiopalatina con extensión completa, en el sexo masculino, fue la forma más frecuente y estuvo presente en 36 neonatos (59%), con cariotipo normal 44 (75,9%) y sin diagnóstico prenatal 40 (65,6%). Las malformaciones observadas con más frecuencia fueron las faciales 27 (44,2%) seguidas de malformaciones cardiacas (29,6%). Se construyó un modelo estadístico mediante análisis multivariado conformado por tres variables: enfermedad crónica durante el embarazo (odds ratio [OR]: 3,8; intervalo de confianza al 95% [IC 95%]: 1,11 - 13,08), edad materna mayor a 35 años (OR: 6,85; IC 95%: 2,69 - 17,43) y antecedente familiar (OR: 14,5; IC 95%: 1,68 - 125,56). Conclusiones: las enfermedades crónicas en el embarazo, la edad materna avanzada y el antecedente familiar fueron factores que aumentaron la presencia de fisura labial y/o palatina.

Operaciones abdominopélvicas de emergencia en pacientes con COVID-19 en el Hospital Edgardo Rebagliati- EsSALUD

Introducción. La pandemia COVID-19 que se declaró el 11 de marzo de este año, se extendió desde China a todo el mundo rápidamente, y la gran cantidad de pacientes infectados ha saturado nuestro precario sistema de salud, lo que ha obligado a restringir la actividad quirúrgica electiva y de emergencia.&#x0D; El objetivo del presente estudio fue describir las características clínicas y quirúrgicas de los pacientes con COVID-19 operados en el servicio de emergencia del Hospital Nacional Edgardo Rebagliati Martins - EsSalud.&#x0D; Método. Se realizó un estudio descriptivo, observacional y retrospectivo, donde se incluyeron los pacientes con diagnóstico de COVID-19 operados por el servicio de emergencia, entre el 6 de marzo y el 8 de junio de 2020. Se analizan las características clínicas, hallazgos en los exámenes diagnósticos y características quirúrgicas.&#x0D; Resultados. Se operaron de emergencia 26 pacientes y se realizaron 17 cesáreas, 4 apendicectomías, 2 resecciones intestinales con ostomía, una herniorrafia inguinal, una rafia vesical y una laparotomía exploradora. Todas tuvieron abordaje abierto. Los síntomas más frecuentes fueron tos y fiebre; 23% los pacientes fueron asintomáticos. El diagnóstico de COVID-19 se confirmó con pruebas rápidas o serológicas. En el grupo de patología abdominal se elevaron la proteína C reactiva y el dímero D más que en el grupo de cesáreas. Se encontró una complicación (infección del sitio operatorio) y no se observó fallecimientos.&#x0D; Conclusión. La adopción de medidas restrictivas en la indicación quirúrgica en los pacientes en emergencia puede explicar la ausencia de complicaciones severas y fallecimientos en esta serie.

Características materno perinatales de gestantes COVID-19 en un hospital nacional de Lima, Perú

Introducción. La pandemia por coronavirus 2019 (COVID-19) se ha extendido en más de 100 mil países. La información específica sobre su comportamiento en el embarazo y parto sigue siendo limitada. Objetivo. Describir las características materno perinatales de pacientes gestantes con COVID-19 en un hospital terciario. Métodos. Estudio descriptivo. Se seleccionó todas las gestantes hospitalizadas por el servicio de emergencia de gineco-obstetricia entre el 24 de marzo y el 07 de mayo del 2020 y que tuvieron diagnóstico de infección por SARS-CoV-2, mediante la prueba rápida o la prueba RT-PCR. Se revisó la historia clínica y registros hospitalarios buscando variables sociodemográficas, antecedentes, manifestaciones clínicas, serología materna, complicaciones obstétricas, vía de parto y aspectos perinatales. Resultados. Se encontró 41 casos de pacientes con diagnóstico de SARS-CoV-2. Un 9,2% tuvo resultado de prueba rápida positiva, Los síntomas más comunes fueron tos en 84,6%, fiebre en 76,9% y dolor de garganta en 61,5%. Un 68.2% estuvo asintomática, 19,5% tuvo enfermedad leve y 7,3% moderada. Dos casos de neumoníasevera requirieron ventilación no invasiva. No se registró muerte materna. 21,7% de los partos fue vía vaginal y 78,3% por cesárea. Hubo un caso de neonato por parto vaginal con PCR positivo al octavo día de vida. Conclusiones. Hubo un alto porcentaje de pacientes gestantes PCR positivas asintomáticas. Es necesario implementar el tamizaje universal en parturientas en el protocolo de flujo de gestantes en cada institución.

Autologous fascia lata grafting in scleromalacia perforans

Ocular perforating is the most dreaded scenario to confront in patients with scleromalacia perforans. Despite its low prevalence, the progression of scleral necrosis to exposed uvea represents one of the ophthalmic emergencies with a high risk of loss of ocular content whose surgical treatment is performed autologous or heterologous tissue patches. This study describes six patients referred to the ophthalmology service of the Edgardo Rebagliati Martins National Hospital in Lima with a clinic history of autoimmune diseases and scleromalacia perforans >10 mm size, treated with autologous fascia lata grafting in addition to topical and systemic immunosuppressive treatment.

Factors associated with survival at one year of life in neonates with severe congenital cardiopathy in A National Hospital in Peru

To determine factors associated with survival in the first year of life in neonates with severe congenital heart disease treated in a national hospital in Peru. 160 children born between 2012 and 2015 with a diagnosis of severe congenital cardiopathy were studied and admitted to the Neonatology Service of the Edgardo Rebagliati Martins National Hospital of the Peruvian Social Security. The Kaplan-Meier method and the Log-Rank test were used in the survival analysis. Crude and adjusted analyses were performed using Cox regression models. Fifty-two, point 5 percent (52.5%) of patients were male and the most frequent severe congenital cardiopathy was pulmonary atresia (26.3%). Thirty-three, point seven percent (33.7%) of patients died, with a 66.3% (IC95% 58.4-73.0) one-year survival. Prenatal diagnosis improved survival (HRa 0.54, 95% CI 0.30-0.98) while cyanotic cardiopathies (HRa 2.93, 95% CI 1.36-6.34) and the presence of another congenital anomaly (HRa 3.28, 95% CI 1.79-6.01) decreased it; these factors were also significant in a second model stratified by surgical treatment with the exception of the stratified model by complications where a prenatal diagnosis ceased to be significant. Prenatal diagnosis increases survival from severe congenital heart disease. However, cyanotic heart diseases and other congenital anomalies, which decrease this chance, should be considered, if surgery is performed or complications occur.

KAWASAKI DISEASE IN A INFANT

Kawasaki disease is an acute febrile illness of childhood characterized by vasculitis of the middle-sized, extraparenchymal arteries with a predilection for the coronary arteries. The etiology remains obscure, which hinders efforts to develop a diagnostic test and targeted treatments. We present the case of a 9-month-old female patient admitted to the Edgardo Rebagliati Martins National Hospital due to fever, polymorphous rash on the thorax and lower limbs with central progression, associated with pruritus, conjunctival injection and edema of the hands and feet. Taking into account the physical examination and the results of the complementary studies carried out, Kawasaki disease was diagnosed, for which intravenous immunoglobulin (3 doses) and acetylsalicylic acid were indicated. Key words: Kawasaki disease; Pharmacotherapy; Vasculitis; Immunoglobulin. (source: MeSH NLM) DOI:&nbsp; 10.25176/RFMH.v18.n3.1599

NEW STANDARDS IN THE TREATMENT OF AN OLD PATHOLOGY: MIOGENIC TORTICOLIS

Introduction: The diagnosis and timely treatment of congenital muscular torticollis with physiotherapy can avoid their sequence of craniofacial asymmetry, which is difficult to correct once they have been established1. Cases that do not respond to initial medical treatment benefit from surgery. Objectives: To identify the clinical and surgical characteristics of the pediatric population with surgical treatment for congenital torticollis. Methods: Descriptive and retrospective study, carried out in the Pediatric Unit of the Head and Maxillofacial Surgery Service of the Edgardo Rebagliati Martins National Hospital. The sample consisted of 30 pediatric patients, with surgical treatment for congenital muscular torticollis during the last 15 years, who fulfilled the inclusion and exclusion criteria, the patients' clinical histories were reviewed. The statistics used were descriptive. Results: The age range of patients&nbsp; was from 2 months to 10 years of age, the&nbsp; sex predominated was male , the most affected side was the right side, the surgical treatment consisted of myotomies of sternocleidomastoid muscle insertions through direct approach by small transverse incisions, the correction amount had no correlation with age or with the severity of the deformity, good results were obtained even in severe deformities. Conclusion: In all cases we achieved substantial improvement, without complications and with acceptable scars; The lateral column of the neck at the site of the sectioned muscle recovered its continuity, without perception of abrupt cut, depression or subsidence. We did not observe a correlation between the improvement achieved and the severity of the deformity, nor with the age of the patient at the time of surgery. Key words: Congenital torticollis; Myogenic torticollis; Myotomy. (source: MeSH NLM) &nbsp; DOI: 10.25176/RFMH.v18.n2.1281

Molecular characterization of pathogenic bacteria of the respiratory tract in peruvian patients with cystic fibrosis

To molecularly characterize the pathogenic bacteria of the respiratory tract isolated from patients with cystic fibrosis (CF) in Peru. Bacterial communities cultured from sputum samples of pediatric and adult patients with CF admitted to the Edgardo Rebagliati Martins National Hospital and the National Institute of Child Health were characterized. Standard microbiological techniques were used for bacterial culture, and gene sequencing of 16S rRNA and matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry and tandem MALDI-TOF mass spectrometry (MALDI TOF/TOF) were used for molecular characterization. Seventeen bacterial strains were characterized by 16S rRNA sequencing, and the identified pathogenic bacteria were Pseudomonas aeruginosa (31.5%), Staphylococcus aureus (12.6%), Pseudomonas spp. (11.8%), and Klebsiella oxytoca (3.1%). MALDI-TOF analysis generated a series of spectra representative of each isolated bacterial species, whereas MALDI TOF/TOF analysis identified the peptides and proteins of the most common strains and provided data on pathogenicity and sensitivity to antibiotics. The primary pathogenic microorganisms found in the respiratory tract of patients with CF in Peru were the same as those found in other countries. This study is the first to perform 16S rRNA sequencing as well as MALDI-TOF and MALDI-TOF/TOF analysis of the bacterial pathogens circulating in Peru. The inclusion of proteomic analysis further allowed for the identification of native microorganisms involved in CF.

Apendicitis aguda en la gestación y puerperio.

0BJETIV0: Revisar los casos de apendicitis aguda que ocurren en la gestación y el puerperio. SUJETOS: Trece pacientes gestantes o puérperas atendidas por apendicitis aguda en los servicios de emergencia de obstetricia y cirugía. LUGAR: Hospital Nacional Edgardo Rebagliati Martins. DISEÑO: Estudio descriptivo de 13 casos de apendicitis aguda, confirmados por estudio anatomo-patológico, que ocurrieron durante la gestación y el puerperio en el período de enero de 1995 a marzo de 1996 (15 meses). En el mismo lapso se atendió 10626 partos y se realizó 1271 apendicectomías. RESULTADOS: Se encontró una incidencia de apendicitis aguda de 1/817 partos (0,12%),), y un porcentaje de 1,02% de apendicitis en gestantes, con predominio en el segundo trimestre y mayor frecuencia en primíparas y multíparas, con una edad promedio de 30,7 años (DS 4,22). Se registró dos casos de apéndice sin alteraciones significativas (15,38%), dos muertes fetales y ningún caso de muerte materna. Se discute el cuadro clínico y los efectos de la enfermedad apendicular y del acto operatorio sobre el curso de la gestación.

Uso de la prostaglandina E-1 en obstetricia.

0BJETIVO: Estudio de la prostagilandina E-1 en la evacuación uterina, como alternativa al uso de la oxitocina y la histerotomía. MATERIAL: 176 casos de pacientes tratadas con prostaglandina E-1, para producir la evacuación uterina, realizado en el Departamento de Obstetricia del Hospital Nacional «Edgardo Rebagliati Martins&gt;, del Instituto Peruano de Seguridad Social. MÉTODO: Se administró el medicamento vías vaginal y oral, combinadas. RESULTADOS: Se obtuvo éxito en 168 casos (95,5016) y falló en 8 (4.5%). Los efectos secundarios fueron mínimos. Su uso acortó la estancia hospitalaria y facilitó otros tratamientos complementarios. CONCLUSIONES: El porcentaje bajo de casos fallidos y la rara presentación de efectos secundarios hacen que este producto sea indispensable en el arsenal terapéutico de nuestra especialidad.

La emergencia ginecoobstétrica en el hospital Nacional Edgardo Rebagliati Martins del IPSS

Objetivo: Comunicar la actividad de una emergencia especializada en ginecoobstetricia. Lugar. Emergencia de obstetricia del Hospital Nacional Edgardo Rebagliati Martins (HNERM) del IPSS. Pacientes e intervenciones. 19 856 pacientes atendidas, 13 486 hospitalizadas y 4 064 intervenidas quirúrgicamente durante 1994. Resultados: El promedio de atención fue de 57 pacientes por día, de las que el 68% requirió hospitalización. La paciente promedio tuvo 31,7 años de edad y 2,4 gestaciones. Las 3 200 cesáreas representaron un promedio de 8,8 cesáreas diarias y el 69,5% de las intervenciones quirúrgicas totales. La prevalencia de cesáreas en el HNERM fue 35,4% en 1994, de las que el 90% fueron atendidas por la Emergencia. La primera causa de cesárea fue la cesárea anterior (26%). Las razones principales de las 75 laparotomías fueron el quiste de ovario (45%) y el embarazo ectópico (36%); y de las 25 histerotomías, la rotura prematura de membranas, el óbito fetal y el desprendimiento prematuro de la placenta. La causa principal de histerectomía fue la atonía uterina, en 7 de los 17 casos (41%). Conclusiones: La presente revisión muestra que la Emergencia de Obstetricia en HNERM desarrolla una intensa actividad, con casos delicados y muchas veces complejos, actividad que merece el apoyo más decidido a su personal médico, brindándole las facilidades de tecnología y equipos para un diagnóstico más precoz y preciso.