Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Objective: To determine the clinical and histopathological characteristics associated to patients with triple negative breast cancer of the Hipolito Unanue National Hospital between June 2012 to June 2018. Methods: Cross-sectional analytical study. Results: 134 patients were included, out of which 36 (26.9%) were TN and 98 No TN. Of the histopathological characteristics, the most frequent CD was III and II for the two groups. The histological type that predominated was the infiltrating ductal type in both groups. The high histological grade was characteristic in NT (58%) unlike non TN. The NTs were larger 5.75 cm in contrast to the TNs with 3 cm, and the Ki 67 was higher in the TN 35% in contrast to the NON TN with 15%. In the bivariate analysis the size (RP: 1.4, CI: 1.17-1.68, p = 0.0001), Ki 67 (RP: 1.05, CI: 1.03-1.07, p = 0.001), BMI ≥25 kg/m2 ( RP: 1.14, CI: 1.23-6.22, p = 0.014), Histological Grade 3 (RP: 3.87, CI: 1.74-8.63, p = 0.001), size ≥5 cm (RP: 2.94, CI: 1.33-6.48, p = 0.008) were significant. In the multivariate analysis it was found that grade 3 (PR: 1.74, CI: 1.01-3, p = 0.0046) and Ki 67 (RP: 1.02, CI: 1.01-1.03, p = 0.0001) were histopathological characteristics associated with CMTN. Conclusion: There are histopathological characteristics associated with triple negative breast cancer particularly high histological grade and Ki67 value.

Introduction: The treatment with carbon dioxide (CO2) laser fractionated in high skin phototypes, can result in pigmentation disorders, persistent erythema, edema, appearance of acne outbreak, among others. Due to this, it is necessary to apply complementary techniques that minimize these adverse effects. Objective: To identify the safety, efficacy and satisfactory synergistic effects after the application of platelet-rich plasma (PRP) after application of fractionated CO2 laser in the face with high phototypes, in order to diminish the adverse effects. Method: Clinical experimental study - open clinical trial - randomized with a universe of 32 hemies with phototypes IV and V of Fitzpatrick. A fractionated CO2 (CO2RE-Syneron Candela) laser was used and immediately autologous PRP was applied in the case hemifields. In controls, betamethasone and petrolatum. The photographic results were compared by showing them to 3 expert doctors without previous information so that they could determine the short, medium and long term findings in a simple scale. This was done at the skin clinic between July 2017 and September 2018 in Lima - Peru. Result: In the short term, satisfactory results were observed in the hemies treated with PRP. There was a decrease in the presence of post-inflammatory hyperpigmentation, erythema, edema and the appearance of acne, as well as an increase in the effect of facial tightening, attenuation of naso-genital grooves and expression lines in the hemias treated with PRP. However, in the long term, these last improvements are not significant in relation to the other control midfaces. Discussion: The fractionated CO2 laser generates histopathological changes similar to the wounds, so that the PRP absorbed at transepidermic level accelerates healing and reduces the possibility of side effects. Important results are seen in the prevention of dyschromias in these phototypes. Laser therapy combined with PRP is associated with greater satisfaction with laser monotherapy. The expected results are in early stages of recovery, while in the long term, there are no significant differences between the two midfaces. Conclusion: These results, in our population of high phototype, suggest that the immediate use of PRP post laser fractionated Co2, is an effective method to improve rehabilitation and healing, reducing the patient's downtime and decreasing the risks of adverse effects - secondary, It should be considered as an effective therapeutic alternative as post laser treatment. The small series of cases presented, leaves open the door to work with greater population and it would be very useful to be able to contrast the results obtained with those of future authors.

Introduction: The infections by bacteria producing b-lactamasas extended spectrum (ESBL) are a serious problem in our country since the beginning of the year 2000 there has been a progressive increase in the frequency of infections caused by these bacteria, especially Escherichia coli and Klebsiella spp. Objective: To determine the comorbidities associated with patients with Urinary Tract Infection caused by e. colli BLEE of the Internal Medicine Service in the Vitarte Hospital in the period 2017-2018. Methods: Observational, case-control study. There was a sample corresponding to 114 divided into 57 cases and 57 controls. The information was collected through the review of medical records and the use of a data collection form. Descriptive statistics were used with measures of central tendency and dispersion, in the bivariate analysis the logistic regression, and in the multivariate analysis generalized linear models. Results: The median age of the population was 66.5 RI: 19-97 years, being 79.82% female (n = 23) and 46.49% mestizo (n = 53). In reference to those who had E. Coli BLEE, their age had a median of 64 years with RI: 19-97, and 43.48% (n = 10) of male sex had it as did 63.64% (n = 4) ) of those who had urinary obstruction, 55.56% (n = 5) of those who had urinary incontinence, 61.02% (n = 36) of those who had diabetes mellitus, 65% (n = 13) of the obese, 57.14% (n = 32) of the hypertensive patients and 62.71% (n = 32) of those who had recurrent UTI. It was determined in the bivariate analysis that DM (OR: 2.53, CI: 1.19-5.39, p = 0.016) and recurrent UTI (OR: 2.94, CI: 1.37-6.3, p = 0.005) were significant. In the multivariate analysis those who had recurrent UTI had 1.61 times the probability of having UTI of E. coli ESBL than those who did not have recurrent UTI with HF: 1.07-2.43, p = 0.022 adjusted for diabetes mellitus. Conclusion: Diabetes mellitus and recurrent UTI were comorbidities independently associated with UTI E. Coli BLEE, with recurrent UTI associated multivariate comorbidity adjusted for diabetes mellitus

Introduction: Neonatal sepsis is one of the most important diseases of our country, it is necessary to know its risk factors in our country. Objetive: To determine the risk factors associated with early neonatal sepsis in preterm infants of the National Mother Teaching Hospital San Bartolomé in 2017. Methods: Case-control, observational, analytical, cross-sectional and retrospective study. will work with medical records. The dependent variable was early neonatal sepsis. We worked with a sample size of 62 cases and 124 controls (ratio 1: 2). The data was obtained from the medical records. For inferential statistics, bivariate analysis was used to find the Odds Ratio with their respective 95% confidence intervals. Values p <0,05 wereconsidered statistically significant. Results: Of the 186 patients studied, 53.8% were female. The factors associated with early neonatal sepsis were: low birth weight -ORa: 4,031 (95% CI: 1,743-9,318); age 35 to over -ORa: 2,729 (95% CI: 1,266-5,88); less than 6 prenatal controls -ORa: 3,315 (IC95%: 1,452-7,567); urinary tract infection (UTI) in the 3rd quarter -ORa: 2,947 (95% CI: 1,063-8,174); meconial fluid -ORa: 5,822 (95% CI: 1.92-17.653) and premature rupture of membranes -ORa: 2,789 (95% CI: 1,035- 7,511). Discussion: A significant association has been found between early neonatal sepsis and low birth weight, age 35 to more, fewer than 6 prenatal controls, UTI in the third trimester, meconium fluid and premature rupture of membranes.

Introduction: Surgical site infections (SSI) are part of the most frequent intrahospital infections in the postoperative period of elderly patients. Objective:To determine the agents related to infections of the operative site in the elderly patients after surgery of the Naval Medical Center during January 2013 to December. Methods:An analytical cross sectional study using a secondary data analysis from clinical records of patients older than 65 years post-operated. SSI was studied has outcome, and arterial hypertension, diabetes mellitus, malignant neoplasia, obesity, surgical technique and type of surgery were the agents. Results:Of the 219 older adults, 33.33% (n=73) had SSI. In the bivariate analysis, statistically significant associations were found for diabetes mellitus (PR: 1.49, CI 1.03 - 2.18, p <0.035), type of surgery (PR: 4.63 IC 2.89 -7.42, p <0.05) and surgical technique (PR.0.24, CI 0.13- 0.43, p <0.05). In the multivariate analysis, it was found that emergency type surgery has 4.04 (PR 4.04, IC 2.55 - 6.40, p <0.05) times chance for SSI compared to the programmed surgery, and the laparoscopic technique surgery has 0.29 (PR 0.29, CI 0.17-0.52, p <0.05) chance of SSI compared to the open technique. Conclusion: Laparoscopic operative technique decreases the likelihood of ISO, and emergency surgery increases its likelihood in elderly patients.

Introduction: Patients with chronic terminal disease frequently come to emergency department of reference hospitals. Objectives: To determine frequency of chronic terminal disease in patients admitted to emergency department, identify invasive procedures and compare oncological with non-oncological patients. Methods: Cross-sectional study in patients older than 18 years old, admitted to emergency department of a tertiary hospital, November 2017. Criteria for terminal disease: Clinical stage IV cancer, severe cognitive deterioration or total functional dependence plus diagnosis of dementia, neurological sequelae, dependence of oxygen, glomerular filtration rate <30 ml / min, Child C cirrhosis, or left ventricular ejection fraction <20%. Statistical analysis with Mann-Whitney U and Chi square tests. Results:10.7% (172 of 1604 admissions) of admitted patients presented criteria of chronic terminal disease, with oncological cause 21.5% (37/172) and non-oncological 78.5% (135/172). In oncological patients, the median age was 70 years and was female 59.5%, while in non-oncological 84 years and 57% of women (p <0.01 and 0.79, respectively). 41% (71/172) were admitted by shock-trauma unit, more frequently due to drowsiness and dyspnea. Invasive procedures, probably unnecessary, were identified in 21.5% (37/172 patients), orotracheal intubation and central venous catheter for inotropic were the most frequent. The average stay in emergency department was eight days, with 32% of oncological deaths and 24% of non-oncological deaths in emergency department (p = 0.43). Conclusions: 10% of patients admitted to the emergency department of a tertiary hospital have chronic terminal disease, with a greater frequency of non-oncology, probably performing unnecessary procedures in one fifth of these.

Introduction:Ventilator-associated pneumonia (VAP) increases the risk of mortality by 2 to 3 times. Objectives: To know characteristics of VAP, determining VAP infection rates, analyze related factors, isolatedgerms, antibiotic sensitivity and mortality. Methods:Descriptive, retrospective study in patients with VAP2015-2018. The data was obtained from the Rikchary program of a pediatric intensive care unit, analyzed withSPSS 24.00. Results:There were 60 cases of VAP, with average annual rates of 9.8 per 1000 days of mechanicalventilation (MV). 65% of the VAPs were late diagnosed after 5 days of MV, the average MV days were 15, 25%of the patients were re-admitted to MV. The average hospitalization was 31 days. The most frequent germswere Stenotrophomona maltophilia sensitive 81% to Cotrimoxazol and Pseudomona aureginosa sensitive80% to cefepime, 90% to Amikacin and between 50% to 60% to carbapenemens. The mortality was 15%.Conclusion:The average annual rate of VAP in the evaluated service is within international standards, themost frequent type is late, was more frequent in children under 6 months and male. Malnutrition, congenitalheart disease, mechanical ventilation time, days of hospitalization and surgeries were found in a greaterproportion in patients with VAP. The most frequent negative gram and 15% mortality.

Objective: To determine the perception on the general competences of nursing teachers by specialist nurses in the intensive care area at the Guillermo Almenara Irigoyen Hospital in 2018. Key words: general competences, nurse, intensive care. Methods: Prospective study and design with qualitative-quantitative approach. Thirty-eight nurses were surveyed using a general skills perception scale, and 7 nurses were interviewed with an interview guide, all intensive care specialists. The perception was categorized into good, fair and bad. Descriptive statistics was used, using absolute and relative frequencies, as well as mean and standard deviation. Results: The average age was 41.39 ± 7.92 years, 92.1% being female. The general competencies of nursing teachers in the intensive care area reached a regular perception of 55.3% and good perception in 44.7%. The aspects with the highest degree of agreement were adaptation to the different situations that occur in daily practice (65.8%), the empathy shown to students (57.9%) and the ability to solve emergency problems (50%). The years of experience were the most relevant referred to the adequate capacity and execution of the nurses. Conclusion: The perception about the general competences of the nursing teachers of the intensive care area of the Guillermo Almenara Irigoyen Hospital in the year 2018 was regular.

Objective:To Assess the impact of the capitated payment mechanism, implemented by the ComprehensiveHealth Insurance (SIS), in the execution of resources from the source of financing, donations and transfers,during the years 2012 to 2016, Peru. Methods:Assessment of the execution percentages of the regions, thenumber of preventive benefits versus the number of recuperative benefits and the impact on the increaseof preventive care in the pilot regions versus the counterfactual regions was measured. A retrospectivedescriptive study was carried out pre post and difference of differences between the pilot regionsApurímac, Amazonas, Ayacucho, Callao and Huancavelica compared with a counterfactual paired by theHuman Development Index; In addition, the regions of Moquegua, Loreto, Puno, Cajamarca and Huánucowere considered. Results:An increase in the average percentage of execution was observed, prior to thecapitated mechanism, from 68.5% in 2012 to 92.3% in 2016; likewise, the increase at the national levelof preventive benefits versus recuperative benefits, with the specific weight of preventive benefits beinginvested in favor of them and, using the difference in differences method, it was evident that the pilotregions had a positive difference of 1551 preventive benefits for every 10,000 insured persons versus thecounterfactual regions.

Objective: To determine the prevalence of infection due to atypical microorganisms in cases of communityacquired pneumonia in adult inmunocompetent patients seeking attention in the Hospital Nacional Hipolito Unanue. Methods: Adult inmunocompetent patients seeking medical attention in the emergency ward of Hospital Hipolito Unanue with diagnosis of community-acquired pneumonia were evaluated between september 2008 and january 2009. Blood samples were drawn for Mycoplasma pneumoniae and Chlamydia pneumoniae serology, by the detection of M Inmunoglobulin by ELISA technique. Results: We recruited 85 patients. The average age was 65.33 ± 21.43 years. We found 3 cases with positive IgM serology against M. pneumoniae and 1 case positive against C. pneumoniae. The antibody titers against M. pneumoniae had a highly significant correlation with the age (r=-0.28; p<0.01). We also found a statistically significant difference between the titers of antibodies against M. pneumoniae and those correspondent to C. pneumoniae (r=0.29; p<0.01). Conclusion: Infection due to atypical microorganisms doesn’t seem to be a frequent condition in inpatients with diagnosis of community-acquired pneumonia. Research in larger populations, including outpatients should be done, in order to define the role of atypical pathogens in cases of pneumonia at a national level.