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

ABSTRACT The gastropleural fistula is an unusual pathological condition that requires a high index of diagnostic suspicion. A 30-year-old male patient was admitted to the María Auxiliadora Hospital due to a thoracoabdominal trauma opened by a firearm projectile, with an entrance hole in the left anterior hemithorax at the level of the 6th intercostal space and exit orifice in the right posterior hemithorax at the D10 level. When a hemopneumothorax was suspected, a thoracic drainage tube was placed and an exploratory laparotomy was performed after suspicion of gastric perforation. On the ninth day, 400cc of smelly greenish-green discharge with food debris in a thoracic drainage bottle was evident. The diagnosis of gastropleural fistula was made through upper gastrointestinal endoscopy and thoracoabdominal multislice spiral tomography. The treatment was by laparotomy and thoracotomy. Conclusions: Gastropleural fistula due to firearm projectile is an infrequent entity, with multiple diagnosis and surgical treatment. This requires early diagnosis for timely management, which depends on the prognosis of patients. Key words: Thoracic Injury; Gastropleural fistula; Intercostal drainage, Gun injury (source: MeSH NLM) DOI:  10.25176/RFMH.v18.n3.1600

<br class="Apple-interchange-newline"><div></div>   2797/5000   Mr. Editor Clinical trials are characterized by having one of the highest levels of scientific evidence1. A properly designed, executed and reported clinical trial constitutes the gold standard in the evaluation of medical interventions. Therefore, timely dissemination is essential to ensure that the clinical decisions made by physicians and patients reflect the best available evidence2. However, the literature reports that in the last decade only half of clinical trials carried out worldwide have been published3. A study conducted in the United States described that less than 30% of clinical trials were published within 2 years of completion in that country4. In the case of Latin America, only 15% of published clinical trials are reported5. In Peru, information regarding clinical trials conducted in the country is available in an updated virtual platform: Peruvian Registry of Clinical Trials (REPEC). A study that analyzed this platform reported that during 1995-2012 there were a total of 1475 clinical trial protocols, of which 85% were authorized and of these 62% were completed6. The statistics in our country in the year 2005, stated that the number of clinical trials authorized by the Ministry of Health from 1995 to the first quarter of 2003 was 323, highlighting a sustained annual increase in the number of studies approved1 in 1995 to83 in 20027. A study in 2012 reports the number of publications of Peruvian autochthonous clinical trials from 1995 to 2011, which remains constant, showing that the increase in the execution of multinational clinical trials is not related to the execution of clinical trials. native8 On the other hand, despite the fact that there is a virtual platform for the registration of all clinical trials conducted in our country, there is no information about the publication of all of these in biomedical journals. The importance of this is the participation of a Peruvian population in autochthonous or multinational clinical trials, so that their results may be more applicable to patients in the country. However, if these are not published, they will never be used by health professionals. That is why we are currently carrying out a study that delves into the reality of clinical trials in our country beyond just registration. The importance of these results would serve to propose new regulations when registering a clinical trial project in the REPEC. In addition, a model for updating the data collection form may be proposed, including the results and publication of the clinical trial.   DOI:  10.25176/RFMH.v18.n3.1602

Medicine evolves by leaps and bounds and also make the most necessary specialties. A recently published article refers to the 5 new specialties in the USA. UU.: Immunooncology, Lifestyle Medicine, Nocturnists, Clinical Informatics and Virtualist Medicine. The current and future demand for these new specialties is increasing. Why Lifestyle Medicine has come to stay as an attractive new specialty of the present and the future?  About 80% of health care costs are related to chronic diseases, and 80% of chronic diseases are related to lifestyle choices. This is a powerful argument for specialists in lifestyle medicine. The choice of a patient's food and diet, exercise, sleep, stress levels and the ability to relate to others are under the reach of a medical specialist in lifestyle medicine. Lifestyle Medicine deals with all aspects of a person's life. Primary care and family medicine are natural places for life style medicine experts, but it also plays a fundamental role in lifestyle medicine clinics where patients require intensive approaches, when the need is urgent. The American Board of Lifestyle Medicine began offering certification in lifestyle medicine in October 2017, in Tucson, Arizona. The International Board of Lifestyle Medicine together with the regional organizations are in charge of the certification in the 5 continents. In Peru and in Latin America, the Latin American Lifestyle Medicine Association has been working to promote and develop lifestyle medicine as a fundamental pillar in everyday medical practice. In this environment, lifestyle medicine is born, a new concept of treating the person in a holistic way, not just the pathology he or she consults.   DOI 10.25176/RFMH.v18.n4.1724  

Intestinal Barrier and Intestinal Permeability The "Intestinal Barrier" (BI) covers an area of approximately 400 m2 and requires about 40% of theenergy expenditure of the body. Among its functions are to avoid the loss of water and electrolytes and the entry of antigens and microorganisms to the human organism1. At the same time, the BI must allow the exchange of molecules between the body and the environment, as well as the absorption of nutrients from food consumed. The specialized adaptations of the intestinal mucosa of the mammal perform two functions apparently opposite: first, allow a peaceful coexistence with the intestinal microbiota without cause chronic inflammation and, secondly, provide a defensive inflammatory and response measure according to the threat of pathogens    DOI 10.25176/RFMH.v18.n4.1725

ABSTRACT 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:  10.25176/RFMH.v18.n3.1599

Pseudomembranous colitis is a serious digestive disease that develops in a context clinical-epidemiological quite predictable and most of the time, fatal. We present the case of a Elderly patient suffering left hip fracture, enters the hospital center and develops infection urinary, receiving broad-spectrum antibiotic therapy. Progressively, complications are installed respiratory, digestive and septic, being operated surgically to correct a clinical picture of intestinal obstruction, performing a sigmoidectomy. The macro and microscopic findings corresponded to a typical pseudomebranous colitis. The patient dies five days after the surgery. The entity is reviewed, with emphasis on the pathological findings, in order to make diagnoses safer and faster in future cases.   DOI 10.25176/RFMH.v18.n4.1739

II LATIN AMERICAN CONGRESS OF LIFE STYLE MEDICINE 2018  We are pleased to direct you to invite you to the region's premium Lifestyle Medicine event, the “Second Latin American Congress of Lifestyle Medicine”, which will take place in Lima, Peru on 06 and 07 November 2018, at the Sheraton Hotel & amp; Convention Center. This international event is organized byLatin American Lifestyle Medicine Association: LALMA and has the strategic participation of universities and national and international companies.La Asociación Latinoamericana de Medicina de Estilo de Vida: LALMA (https://www.lalma.co) is the scientific medical professional organization that represents doctors and health professionals in the countries of Latin America and the Caribbean dedicated to the advancement and practice of Lifestyle Medicine; focused on the prevention, treatment and even the reversion of most chronic diseases, specifically addressing the true underlying causes.La Asociación Latinoamericana de Medicina de Estilo de Vida, it is a similar organization of American College of Lifestyle Medicine ACLM: (https://www.lifestylemedicine.org), de la Organización Europea de Medicina del Estilo de Vida EULM: (https://eulm.org) y forma parte de la Alianza Global de Instituciones de Medicina de Estilo de Vida LMGA:(https://lifestylemedicineglobal.org), counting in this way with all the scientific support of these structures. POST CONGRESS IMAGES

Hepatocarcinoma is the second cause of death in the world related to cancer and in our country we find patients with large liver tumors that are unresectable and are only tributaries of palliative treatments with little survival, however with an adequate selection of patients in teams multidisciplinary we can offer an extended hepatectomy to many of these patients, so we present the case of a young adult patient with hepatitis B and giant hepatocarcinoma to which we performed an extended left hepatectomy is disease free survival at 14 months after surgery.   DOI 10.25176/RFMH.v18.n4.1738  

Cervical cancer is the most frequent type of cancer in Peruvian women and in the population general. Cerebral metastases of the cervix are extremely rare with an incidence of 0.4 to 2.3% and only approximately 100 case reports in the medical literature. We report a case of a 52-year-old woman with a history of cervical cancer who after 14 months of this diagnosis presents headache, vomiting and upheaval of conscience. In the brain MRI study, evidence a contrast-enhancing lesion in the right parieto-occipital region. Craniotomy is performed minimal parietal with stereotactic assistance and complete resection of the tumor. According to the report of the Pathology service indicated metastasis of endocervical adenocarcinoma. The patient had a good postoperative evolution with remission of neurological symptoms.     DOI 10.25176/RFMH.v18.n4.1740

The nutritional support of the critical pediatric patient directly influences their morbimotality. Various conditions make the child particularly vulnerable to malnutrition when he has serious illnesses. The metabolic response to stress is mainly protein hypercatabolism that causes a negative nitrogen balance. It is important to adopt strategies to provide adequate and timely nutrition, making a good nutritional assessment, calculating the expenditure of energy requirements, prioritizing the contribution of proteins as the most relevant macronutrient, initiating early nutritional support, through the correct route and performing the monitoring and timely follow-up. In conclusion, nutritional support should be an important part of the therapeutic strategy in every critical child.     DOI 10.25176/RFMH.v18.n4.1737