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

This study describes the clinical and obstetric characteristics, use, and outcomes of epidural analgesia in 6,204 pregnant women attended between 2022 and 2024 at the Instituto Nacional Materno Perinatal. It was an observational, retrospective, descriptive study based on electronic records. Most participants were nulliparous (62.3%), overweight or obese (88.4%), and initiated analgesia during the active phase (81.7%); bupivacaine 0.125% was the predominant dose (73.8%). Epidural technique was used in 98.5% of cases, with maintenance mainly through manual bolus (94.8%). At twenty minutes, 97.1% reported mild pain (verbal numerical scale <3), and 78.8% maintained this level during the expulsive phase. The overall incidence of adverse events was 1.8%, mainly dural puncture (0.7%). Newborns achieved an APGAR score ≥7 in 97.4% of cases. Epidural analgesia showed a favorable profile of safety and pain control in this cohort, although analytical studies are needed to confirm its effectiveness.

Introduction: Diffuse large B-cell lymphoma (DLBCL) is an aggressive hematologic malignancy with heterogeneous clinical outcomes. The International Prognostic Index (IPI) remains the main prognostic tool but lacks simple hematologic biomarkers. The Hemoglobin-Platelet Index (HPI) has recently emerged as a potential prognostic alternative. Objective: To assess the prognostic utility of the HPI in patients with DLBCL, NOS, and compare it with the IPI. Methods: Retrospective cohort study of 121 patients with histopathologically confirmed DLBCL treated between 2010 and 2012. Associations between HPI, IPI, and overall survival were analyzed using Kaplan-Meier curves and Cox regression. Results: The IPI and advanced clinical stage were significantly associated with lower overall survival (p < 0.001 and p = 0.002, respectively). Although HPI did not reach statistical significance, a downward trend in survival was observed with higher HPI scores. Conclusions: IPI and advanced clinical stage are independent prognostic factors in DLBCL. HPI showed a trend toward poorer prognosis, suggesting its potential as a complementary tool. Larger studies are needed to validate its clinical utility.

Introduction: Community Health Workers (CHWs) are key actors in communities with poor access to health care, especially characterized by high prevalence of cardiovascular risk factors and acute myocardial infarction. Although cardiopulmonary resuscitation (CPR) is a strategy with known effectiveness, its learning requires extensive training. It is unknown whether simplified CPR training could change the level of knowledge and attitudes in HCWs. Objective: To evaluate changes in the knowledge and attitudes of HCWs after a simplified CPR training program. Methods: A quasi-experimental, multicenter, pre- and post-test study was developed around a simulated training and following AHA recommendations. Results: A total of 119 ACS were included. It was found that at the beginning of the study 74.8% of the participants had low CPR knowledge and less than 40% had positive attitudes towards CPR.  After training, significant increases were found not only in the level of knowledge (p<0.001), but also in the willingness to perform CPR (p<0.001), self-confidence to perform it (p<0.001) and the relevance of knowing how to apply it (p<0.001). Conclusions: Simplified CPR training could be useful to improve the knowledge and attitudes of ACSs, which may be relevant regarding the potential to scale up CPR training and its possible implications for response times to cardiovascular events in communities with limited access to healthcare, where CHWs play a key role in bridging the community and the health system.   Key-words: Cardiopulmonary Resuscitation, CPR, Training, Community Health Workers, Peru.  

Objective: To describe physicians' attitudes toward the management of hypothyroidism. Methodology: Descriptive, cross-sectional, with a convenience sample of 181 physicians. Results: In the prioritization dimension, 66.9% prioritize the management of other chronic conditions, and 90% do not perceive the impact of hypothyroidism on cardiovascular risk. In the diagnosis dimension, 58.6% of physicians do not perform hypothyroidism screening; 76.2% report knowing which tests to order for diagnosis, and 57.5% perceive difficulty interpreting thyroid function tests. In the treatment dimension, 54.7% lack the necessary expertise to prescribe levothyroxine, while 43.1% are fearful of the adverse effects of treatment, and 69.7% prefer to refer patients to a specialist. Conclusions: Physicians' attitudes impact the prioritization, diagnosis, and treatment of hypothyroidism, leading to lower identification and underestimation of cardiovascular risk.

The recent and historic adoption of the WHO Pandemic Agreement by the 78th World Health Assembly—concluded after three years of intense negotiations—represents a crucial step toward addressing the deficiencies and inequities exposed by the COVID-19 pandemic. This agreement aims to establish principles of equity, solidarity, and shared responsibility—elements that proved to be significant challenges during the recent global crisis and that revealed deep disparities in the distribution of vaccines, treatments, and diagnostic resources. Such inequities must not be allowed to recur. One of the most salient aspects, which requires clear public understanding, is the condition for its entry into force. Document A78/10 specifies that the WHO Pandemic Agreement “shall enter into force on the thirtieth day following the date of deposit of the respective instrument of ratification, acceptance, approval, or accession” by at least 30 Member States. This means its effectiveness is directly tied to the sovereign commitment of nations. The speed and universality with which countries adopt this instrument will be decisive for its success.

Gene editing in medicine has become one of the most disruptive innovations in contemporary biomedicine. This tool not only opens up opportunities for the development of new therapeutic options for monogenic and polygenic diseases, but is also transforming the way genetic pathologies are diagnosed. Its appeal lies in the progressive reduction in costs and increasingly accessible technical feasibility, which explains its expansion in clinical and preclinical research worldwide.

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This article contributes an additional perspective to the successful case described on radiofrequency ablation of thyroid nodules by considering the use of adjustable electrodes as an alternative to conventional ones.

Objective: Determine if pregestational obesity is a risk factor for preterm birth in pregnant women attended at the National Maternal Perinatal Institute during the period 2021-2022. Methods: Observational, quantitative, analytical, retrospective study of cases and controls.The sample size was 544 pregnant women, of which 272 were the cases and 272 were the controls. The bivariate analysis was conducted using Pearson's Chi square test and the multivariate analysis using logistic regression.Results: The average age was 28.4 years (SD:6.6) and the median pregestational Body Mass Index was 25.7kg/m2, with a range of 17.7 to 45.2kg/m2. 14.1% of pregnant women with preterm delivery were obese compared to pregnant women with full-term delivery (8.2%). In the multivariate analysis, pregestational obesity (aOR:1.75;95%CI:1.08-2.83), having <6 prenatal check-ups (aOR:2.99;95%CI:1.99-4.49), preeclampsia (aOR:13.15;95%CI:5.61-30.81), premature rupture of membranes (aOR:3.23;95%CI:2.05-5.10), intrauterine growth restriction (aOR:2.64;95%CI:1.27-5.47) and placenta previa (aOR:5.96;95%CI:1.60-22.17) were significantly associated with preterm delivery. Conclusion: There is an association between pregestational obesity and preterm birth, while having <6 prenatal check-ups, preeclampsia, premature rupture of membranes, intrauterine growth restriction and placenta previa were also found to be associated.

Gallbladder adenomyomatosis is a benign lesion, characterized by hyperplasia of the gallbladder epithelium alternating with hypertrophy of the smooth muscle layer, in whose thickness there are epithelial projections that can reach the subserosa/adventitia of the organ, causing thickening of the gallbladder wall and possible confusion with neoplasia. The entity has been detected in 2 to 8% of all cholecystectomies and up to 5% of necropsies. It is usually asymptomatic and when it does generate symptoms, they are usually those of coexisting cholecystitis/cholelithiasis. It is more common in adults and very rarely in the pediatric population. An interesting factor is its probable relationship with gallbladder cancer. We present 7 cases of vesicular adenomyomatosis, one of them with epithelial dysplasia, considered a precursor lesion to cancer. Keywords: Adenomyomatosis, gallbladder, dysplasia, gallbladder cancer.