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

Texto introductorio que da cuenta de los contenidos de la revista 291, enero-abril del 2025, considerando las secciones Doctrina, Análisis de jurisprudencia, Análisis de legislación y Reseñas.

Introduction. Public health emergencies of international concern (PHEIC) are events that constitute a risk to public health due to their international spread. They are declared as such by the World Health Organization (WHO). Objective. To analyze the response to PHEIC and its impact in Peru. Methods. Descriptive study, unit of analysis the PHEIC, which have occurred since the adoption of the International Health Regulations (IHR-2005). Data from publicly available secondary sources were used. Results. Since the adoption of the IHR-2005, WHO declared 08 PHEIC, two of which evolved into pandemics: influenza A H1N1-2009 and COVID-19, two currently in progress: Poliomyelitis-2014 and Monkeypox-2024; in the remaining ones: Ebola-2014, Zika Microcephaly-2015, Ebola-2019 and Monkeypox-2019, the WHO announced their end. In Peru, the 02 pandemics arrived between 15 to 35 days after the PHEIC were announced, affecting all departments causing cases and deaths. Influenza A H1N1-2009 was the first and COVID-19 had the greatest impact in terms of morbidity and mortality, with a cumulative mortality rate of 6.7/1000 inhabitants, the highest in the world. Both viruses currently circulate seasonally. Cases of Monkeypox were also reported throughout the country. All PHEICs involved surveillance and response actions. Conclusion: The PHEICs have had a great impact on our country from an economic, social, political and health point of view, the latter in terms of morbidity and mortality: PHEIC due to influenza AH1N1-2009, COVID-10 and Monkeypox; they have been an opportunity to accelerate the development and implementation of basic capacities established in the RSI-2005.

Introduction: The advancement of artificial intelligence (AI) in medicine has exposed critical challenges, particularly the shortage of high-quality medical data and associated ethical concerns. Frontotemporal dementia (FTD) is a group of neurodegenerative conditions where early diagnosis is crucial. However, the development of AI-assisted diagnostic systems faces challenges due to the scarcity of labeled magnetic resonance imaging (MRI) data. Objective: To develop, compare, and evaluate two Generative Adversarial Network (GAN) models, Deep Convolutional GAN (DCGAN) and Progressive Growing GAN (PGGAN), for generating synthetic brain MRI images suitable for FTD diagnosis. Methods: We trained both models on a limited dataset of FTD brain MRIs. Our evaluation encompassed quantitative and qualitative assessments. We used three metrics for quantitative analysis: Structural Similarity Index (SSIM), Normalized Mutual Information (NMI), and Peak Signal-to-Noise Ratio (PSNR). Results: While both models successfully generated synthetic MRIs, PGGAN consistently outperformed DCGAN. PGGAN-generated images achieved an SSIM of 0.215, NMI of 0.976, and PSNR of 14.900 relative to real images, surpassing DCGAN's scores of 0.216, 0.798, and 12.426, respectively. Qualitative analysis corroborated these findings, with PGGAN producing images featuring enhanced detail. Conclusion: This research contributes to the field of synthetic medical image generation, offering a potential solution to data scarcity while maintaining patient privacy. The demonstrated efficacy of PGGAN holds promise for augmenting limited datasets in neurological research. Furthermore, this study lays the groundwork for developing robust AI-assisted diagnostic tools in neurology, particularly for conditions like FTD, where extensive, diverse datasets are crucial yet challenging.

Introduction: Clinical trials are essential in the fight against cancer, especially in the approach to Leukemias. The characteristics and trends of clinical trials on medical interventions are a relevant point to know due to the need for new treatments for the management of this disease. Objective: To describe the characteristics and trends of clinical trials on leukemia treatments reflected in REPEC. Methods: A descriptive study of the clinical trials of leukemias registered in the REPEC between 1995 and July 2024 was carried out. Data were collected on variables such as sponsor, phase of trial, type of leukaemia, design approach and type of outcome assessed. Results: Of the 2058 clinical trials located, 30 that met the inclusion criteria were included. The most studied type of leukemia was chronic, within this, myeloid had a higher percentage. Most of the studies were sponsored by the pharmaceutical industry, mostly foreign, and most were in phase 2 and 3. The most frequently evaluated outcome was progression-free survival, with most surrogate outcomes. Conclusions: The analysis of clinical trials on leukemias in REPEC reveals a high frequency and tendency to increase clinical studies on chronic leukemias.

Background: Anthropometry analyzes body dimensions and can serve as a substitute for direct muscle mass measurement. Older adults are particularly susceptible to sarcopenia, a progressive loss of muscle mass. This study aimed to evaluate the efficacy of Lee's formula for estimating muscle mass loss in this population. Methods: This was a secondary, observational, analytical, and cross-sectional study involving older adults receiving ambulatory care who did not have locomotor limitations for the assessment of muscle strength. Descriptive variables included age, sex, marital status, education, number of comorbidities, and body fat percentage. Lee’s formula and appendicular skeletal muscle mass (ASM) measurements were used for comparison. Results: The sample included 35 older adults, of whom 20 (57.14%) were women and 15 (42.86%) were men, with a mean age of 78 years. The most sensitive (94.74%) and most specific (93.75%) cut-off points of Lee’s formula for estimating muscle mass relative to height squared were ≥11.78 and ≥35.91, respectively. A relationship was also observed between smaller calf circumference and reduced muscle mass, particularly among women. Conclusions: The sensitivity and specificity of Lee’s formula were generally low, only exceeding 90% at the extremes of muscle mass values. These findings suggest that equations using anthropometric parameters for muscle mass assessment have limited correlation and may not be reliable for use in the general population. 

There are many definitions of scientific integrity, all of which share the common denominator of developing good research practices to ensure honesty and scientific rigor. According to the National Science and Technology Council of the United States, scientific integrity can be conceptualized as "adherence to professional practices, ethical behavior, and the principles of honesty and objectivity in conducting, managing, using results, and communicating about science and scientific activities" (1). Ciubotariu identifies scientific rigor, reproducibility, and responsibility as fundamental principles for its development (2). Scientific integrity plays a crucial role in preventing biases, data fabrication, plagiarism, and other forms of scientific misconduct. It is involved not only in the development of scientific research but also in its communication and use.

Objective: To compare the efficacy and safety of norepinephrine and etilefrine for the prevention of maternal hypotension during cesarean sections under spinal anesthesia at the National Maternal Perinatal Institute in Lima, Peru. Materials and Methods: A prospective study was conducted with 300 pregnant women, with the respective inclusion and exclusion criteria; of which they were divided into three groups: norepinephrine in continuous infusion (NEI), bolus (NEB), and etilefrine in bolus (EB) until delivery. Maternal hemodynamic variables were evaluated: systolic blood pressure, diastolic pressure, mean arterial pressure, heart rate, use of vasopressor, number of rescue boluses, APGAR score of newborns, use of oxygen in immediate care, criteria for admission to the Neonatal Intensive Care Unit; and other demographic variables such as age group, nutritional status, parity.Results: Norepinephrine infusion significantly reduced episodes of hypotension compared to etilefrine (p < 0.001) and norepinephrine bolus (p < 0.001), with no differences in APGAR scores (p = 0.72). Norepinephrine infusion proved superior, reducing hypotension episodes by 39% compared to etilefrine, and by 47% compared to norepinephrine bolus. In addition, it was observed that in the norepinephrine infusion group, maternal systolic blood pressure remained constant, unlike in the other norepinephrine bolus and ethylephrine bolus groups. Regarding heart rate, it was observed that after administration of the EB group bolus, heart rate increased significantly, even above 80 beats per minute, and remained so for twenty minutes thereafter; unlike the average of the other groups, which ranges from 72 to 77 beats per minute. Conclusions: Norepinephrine administered via continuous infusion was more effective than etilefrine in preventing maternal hypotension, without compromising neonatal safety. n our study, it was demonstrated that norepinephrine infusion better maintains maternal hemodynamic parameters such as systolic pressure, mean pressure and heart rate; without repercussions on the APGAR score, nor neonatal compromise such as stay in the Neonatal Care Unit or the use of oxygen in immediate care. The use of norepinephrine infusion as prophylaxis of hypotension after spinal anesthesia in cesarean section was safe and effective in the population studied and had a more stable hemodynamic pattern compared to the drugs studied.   Key words Anesthesia, Spinal, c-section, local anesthesics, hypotension (Source: MESH, NLM).

Introduction: Diabetes mellitus (DM) requires complementary therapies. Objectives: To determine the hypoglycemic effect of Blechnum asplenioides extract and its interaction with metformin in albino rats with induced DM. Methods: A controlled preclinical experimental study was conducted in a murine model using 72 Holtzman albino rats, randomly assigned to nine groups of eight animals each. Hyperglycemia was induced with alloxan 180 mg/kg. Treatments included metformin at 100 and 200 mg/kg, hydroalcoholic extract of Blechnum asplenioides at 250 and 500 mg/kg, and the respective combinations. Blood glucose (mg/dL) was measured by tail puncture at 1, 2, 6, and 24 hours. Means were compared using ANOVA with Tukey’s post hoc test. Results: Significant differences among groups were observed at all time points (p<0.05). At one hour, groups treated with Blechnum asplenioides 250 and 500 mg/kg, and the combination of Blechnum asplenioides 250 mg/kg plus metformin 100 mg/kg, showed reduced glucose levels compared with the untreated group. At two and six hours, most regimens produced significant decreases versus the untreated group. At 24 hours, Blechnum asplenioides 500 mg/kg, 250 mg/kg plus metformin 100 mg/kg, 250 mg/kg plus metformin 200 mg/kg, and 500 mg/kg plus metformin 200 mg/kg showed significant reductions compared with the untreated group (p<0.05); the last two were lower than the metformin 200 mg/kg group (p<0.05). No differences were observed compared with metformin 100 mg/kg at any measurement time. Conclusion: The hydroalcoholic extract of Blechnum asplenioides exerts hypoglycemic activity and, in combination with metformin, enhances glucose reduction, suggesting an additive effect.

Introduction: Preoperative systemic inflammation may predict surgical site infection (SSI) after primary inguinal hernioplasty. Objective: To evaluate the relationship between preoperative systemic immune-inflammation index (SII) and SSI. Methods: An analytical observational case–control study of patients undergoing primary inguinal hernioplasty was conducted at the Hospital Nacional Hipólito Unanue (HNHU) between 2019 and 2023. Cases were defined as those with SSI within 30 days, and controls as those without SSI. The sample, obtained through simple random sampling, included 429 patients (86 with SSI; 343 without SSI). The exposure was SII, calculated as (platelets × neutrophils)/lymphocytes. Receiver operating characteristic (ROC) curve analysis and logistic regression were applied to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Results: SII showed an area under the curve (AUC)=0.830; 95% CI: 0.765–0.895; p<0.001. The optimal cutoff point was 536.82, with 72/86 positive cases and 133/343 positive controls. At this threshold, sensitivity was 83.72%, specificity 61.22%, positive likelihood ratio 2.159, and negative likelihood ratio 0.265. In logistic regression, SII≥536.82 was associated with SSI (adjusted OR=6.180; 95% CI: 3.207–11.911; p<0.001), and male sex showed lower odds (adjusted OR=0.150; 95% CI: 0.082–0.275; p<0.001). Conclusion: Preoperative SII was a useful marker for predicting SSI and may therefore facilitate risk stratification.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease in patients with type 2 diabetes mellitus (T2DM). Its prevalence is strongly associated with factors such as obesity, dyslipidemia, and insulin resistance, highlighting the need for effective diagnostic, therapeutic, and preventive strategies at the clinical level.   Objectives: To evaluate the pharmacological treatment of patients with T2DM and its association with NAFLD, considering metabolic factors and sociodemographic characteristics.   Methods: An analytical cross-sectional study was conducted on 109 patients with T2DM at a medical unit of the Mexican Social Security Institute (IMSS) in Morelos, Mexico. Clinical, biochemical, and ultrasound characteristics were analyzed. Patients aged 18 years or older with a confirmed diagnosis of T2DM under pharmacological treatment were included. Those with hepatitis C, HIV, or chronic alcoholism were excluded. Descriptive statistical analyses and logistic regression were applied to identify factors associated with NAFLD.   Results: Of the participants, 67.89% were women, with a mean age of 56 years. Obesity was present in 51.38% of participants, and 55% had dyslipidemia. Factors such as elevated body mass index (BMI), high triglycerides, and increased waist circumference were significantly associated with a higher risk of NAFLD (p<0.000). The use of statins significantly reduced the likelihood of developing hepatic steatosis by 99% (p<0.000).   Conclusions: Elevated BMI and dyslipidemia are significant predictors of NAFLD in patients with T2DM. Statins demonstrated a protective role, emphasizing their importance not only in lipid control but also as a potential tool for the comprehensive management of NAFLD.