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1.
Dengue virus and severe acute respiratory syndrome coronavirus 2 coexist in dengue-endemic countries; therefore, the adoption of preventive measures is essential to control the spread of both viruses. We conducted an ecological study to compare the temporal patterns of the incidence of dengue before and during the Coronavirus disease 2019 (COVID-19) pandemic in Peru. A time-series analysis comparing the incidence of dengue using a Student's t test with variance correction was performed. Poisson regression was applied to determine the incidence rate ratio (IRR) of dengue before and during the COVID-19 pandemic. The incidence of dengue was found to be increased in all endemic regions of Peru during the COVID-19 pandemic, with the highest incidences registered in Ica (IRR = 90.14), Huánuco (IRR = 38.6), and Ucayali (IRR = 23.78), with the exception of Piura (IRR = 0.83). The highest increases in the number of dengue cases per million inhabitants were in Ucayali (393.38), Tumbes (233.19), Ica (166.08), and Loreto (129.93). The gradient of dengue cases was positive in all endemic regions during the COVID-19 pandemic. The number of dengue cases per million increased during the COVID-19 pandemic throughout Peru and in several endemic regions, with the exception of Piura.  相似文献   
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ObjectiveTo evaluate the burden of diabetic foot complications amongst inpatients in Peru.Materials and MethodsCross-sectional multicenter study, performed in public hospitals, in one-day enrollment between October and December 2018.ResultsWe included 8346 patients from 39 national hospitals. Diabetic foot (DF) inpatient point prevalence was 2.8% (CI 95% 2.4–3.1), and DF point prevalence among Diabetes Mellitus (DM) inpatients was 18.9% (CI 95% 16.7–21.1). DF prevalence was higher in jungle and coastal hospitals than highlands ones, and there was no difference according to its care complexity level. Of the 234 patients with DF, 73% were males, age average was 62 ± 12 years, with DM mean time duration of 15 ± 9.9 years. Regarding to DF etiology, 91% and 68% had some degree of peripheral neuropathy and peripheral artery disease, respectively. According to the Infectious Diseases Society of America criteria, 61% presented moderate to severe infections, and 40% had bone involvement. Debridement within 48 h was performed in 36% of sepsis cases.ConclusionPeru has a substantial burden of DF disease, with a greater share of that burden falling on less equipped hospitals in the country’s jungle and coastal regions. Interdisciplinary teams and pathways may improve the time of surgical debridement in the highest risk patients.  相似文献   
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Introduction

The Rural and Urban Marginal Health Service (SERUMS) is a mandatory program at the end of the medical career in Peru. The promotional grade point average (PPP) and the national medical examination (ENAM) grades are used when awarding places.

Materials and methods

An analytical, retrospective study was conducted using the registration of SERUMS in the processes between 2008 and 2015. The differential between the ENAM and PPP grades was evaluated, by an adjudication process and according to the origin of the university. Association statistics were obtained.

Results

From the 21,296 evaluated, the range of grades of the final average in the Peruvian universities was 10.3-12.7 (PPP: 12.7-14.0 and ENAM: 9.3-12.3). In Cubans it was 5.5-12.9 (PPP: 16.9-18.3 and ENAM: 0.0-10.1), in Bolivians it was 3.6-11.2 (PPP: 12.0-13.2 and ENAM: 0.0-10.3), and in other foreign universities it was 4.2-11.7 (PPP: 13.6-17.1 and ENAM: 0.0-10, 6). When calculating the ENAM-PPP differential, a statistically significant discrepancy (P < .001) was found in all cases, and depending on the type of university.

Conclusions

There are statistically significant differences between the final grades of the PPPs and the ENAM according to the origin of the university. This could create inequity in choosing a place in the SERUMS, and could suggest that the acquisition of knowledge models are different, which should be evaluated in order to study their impact during the SERUMS.  相似文献   
5.

Introduction

The National Medical Examination (ENAM) is a mandatory test that students are given to complete after their medical internship. With the changes in law, it now serves as a requirement for the Rural and Urban-Marginal Health Service (SERUMS).

Objective

To determine perceptions of usefulness and preparation for ENAM in ten Peruvian medical faculties.

Methodology

An analytical cross-sectional study was based on 11 questions from a self-administered questionnaire, with a Cronbach Alpha of 0.65. The variables were crossed according to the type of university, year of studies, and if courses were repeated, with the generalised linear models.

Results

Almost all of them (92%) knew what the ENAM is, 82% for what it served, 74% thought they would pass it, and 27% perceived that the knowledge gained in their university was sufficient to pass it. The year of studies was the variable that was most related to the knowledge and perceptions about the ENAM, but some differences were also found according to the type of university and to have failed a previous course.

Discussion

The ENAM is still the most important national medical examination, as it compares the level of teaching between universities, and now serves to work in SERUMS. Most students knew what it was and what it was for, but the minority thought they could pass it or that the knowledge they received was sufficient, being occasionally influenced by the year of studies and to a lesser extent by other variables.  相似文献   
6.
AimTo assess the association between elevated waist circumference (WC) and high waist-to-height ratio (WHtR) with insulin resistance biomarkers.MethodsWe conducted an analytical cross-sectional study in normal-weight adults. Participants were divided in two groups according to WC or WHtR levels. We considered values of WC ≥ 90 in male participants and WC ≥ 80 in adult women as elevated, and values of WHtR≥0.50 as high, for both genders. Our outcomes were high triglycerides to HDL-cholesterol (TG/HDL-C) ratio and elevated triglycerides and glucose index (TGI). We considered values of TG/HDL-C ratio ≥ 3 as high and TGI values ≥ 8.37 as elevated. We elaborated crude and adjusted Poisson generalized linear models to evaluate the proposed associations and explored the gender interaction using stratified models. We reported the prevalence ratio (PR) with their respective 95% confidence intervals (95%CI).ResultsWe analyzed 355 participants. The prevalence of elevated WC and high WHtR was 17.2% (n = 61) and 33.2% (n = 118), respectively, while the prevalence of high TG/HDL-C ratio and elevated TGI was 24.8% (n = 88) and 12.7% (n = 45), respectively. In the adjusted regression model, elevated WC was associated with high TG/HDL-C ratio only in female participants (aPR = 3.61; 95%CI: 1.59–8.20). Similarly, high WHtR was associated with high TG/HDL-C ratio in women (aPR = 2.54; 95%CI:1.08–5.97). We found an association with statistically marginal significance between elevated WC and elevated TGI in women (aPR = 1.54; 95%CI: 0.95–2.50); as well as for the association between high WHtR and elevated TGI in male participants (aPR = 1.87; 95%CI: 1.00–3.50).ConclusionElevated WC and high WHtR were associated with a high TG/HDL-C ratio in women. It is necessary to perform prospective follow-up studies in the Peruvian population in order to corroborate our results.  相似文献   
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Background: Recent studies have shown that genetic alterations are associated with the effect of patient geographiclocation on gallbladder cancer development. Peru has a high incidence of gallbladder cancer, but causative factorshave not yet been identified. We examined the frequency of mutations in TP53 and K-ras genes in Peruvian patientswith gallbladder cancer, and compared this with data from Bolivia, Hungary, Chile, and Japan, which have a highgallbladder cancer incidence. Methods: DNA was extracted from formalin-fixed paraffin-embedded gallbladder tissuesections of 30 gallbladder cancer patients (9 men and 21 women) obtained using microdissection. Mutations in exons5 to 8 of TP53 and codons 12, 13, and 61 of K-ras were examined using direct sequencing. Results: TP53 mutationswere observed in 10 (33.3%) of patients, but K-ras mutations were absent. Nine (90%) TP53 mutations were pointmutations (7 missense and 2 silent mutations), and the most frequent substitution was a G:C to A:T transition. G:C toA:T transitions at the CpG site or G:C to T:A transversions were found in one patient each. No significant differenceswere found in the frequency of TP53 and K-ras mutations among patients in the 5 countries. Conclusions: Our findingssuggest that endogenous mechanisms and exogenous carcinogens may affect the carcinogenic process in Peruviangallbladder cancer patients, similar to that in Bolivian patients. Further studies with a larger sample size are neededto clarify these findings.  相似文献   
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