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Interatrial septal occlusion devices hinder the transseptal approach for atrial fibrillation ablation, making it necessary to have imaging methods that safely guide transseptal puncture, such as intracardiac echocardiography (ICE). We describe the case of a 49-year-old patient with symptomatic paroxysmal atrial fibrillation, refractory to antiarrhythmic drugs, wearing an interatrial septal occlusion device, with a previous unsuccessful ablation attempt. Atrial fibrillation ablation was performed using the Carto V7 3D mapping system, the transseptal puncture was guided by ICE, and the procedure was successful. This case report highlights the importance of multimodality imaging to achieve successful and effective transseptal puncture for atrial fibrillation ablation in patients with interatrial septal occlusion devices.

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Objetivo: Evaluar la producción científica de los institutos de salud de Perú en Scopus, 2010-2022. Métodos : Estudio bibliométrico realizado en Scopus durante septiembre del 2022, en 14 institutos de salud especializados públicos de Perú. Incluimos estudios originales que tuvieran al menos un autor de alguno de los institutos. Resultados : Los institutos incluidos publicaron entre 0 y 347 artículos originales (H-index entre 0 y 51). Los institutos de la ciudad de Lima fueron los que tuvieron mayor producción. En los siete institutos con mayor producción, el porcentaje de artículos con autor corresponsal del instituto evaluado varió entre 22.3% y 36.7%, y el porcentaje de estudios que declararon ser financiados por el instituto varió entre 0% y 11.6%. Conclusión : La producción científica de los institutos evaluados fue heterogénea, a predominio de aquellos ubicados en Lima. Los institutos raramente participaron en el financiamiento de los estudios publicados.

Objective: To evaluate the scientific production of Peruvian health institutes in Scopus, 2010-2022. Methods: We conducted a Bibliometric study in Scopus during September 2022, in 14 public specialized health institutes of Peru. We included original studies with at least one author from one of the institutes. Results: The institutes included published between 0 and 347 original articles (H-index between 0 and 51). The institutes in the city of Lima were the ones with the highest production. In the seven institutes with the highest production, the percentage of articles with a corresponding author from the institute evaluated ranged from 22.3% to 36.7%, and the percentage of studies that reported being financed by the institute ranged from 0% to 11.6%. Conclusion: The scientific production of the evaluated institutes was heterogeneous, with a predominance of those located in Lima. The institutes rarely participated in the financing of the published studies.

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En Perú, la mayoría de establecimientos de salud, tanto públicos como privados aún se gestionan con formatos de historias clínicas en papel. La migración al sistema de información de historias clínicas electrónicas (SIHCE) es un gran reto en múltiples aspectos. El Complejo Hospitalario San Pablo (CHSP) está conformado por once establecimientos de salud distribuidos en cuatro departamentos del Perú. En el presente artículo relatamos el proceso de implementación del SIHCE en el CHSP mediante el circuito del software, para el cual se siguieron los siguientes pasos: 1) Decisión de implementar un sistema de HCE, 2) Constitución del comité, 3) Benchmarking y evaluación del proveedor, 4) Plan de implementación, 5) Reuniones de coordinación, 6) Pruebas, 7) Capacitaciones, 8) Go Live, y 9) Implementación por réplica. Asimismo, reflexionamos sobre las lecciones aprendidas durante este proceso, las cuales giran en torno a dos ángulos: gestión frente al cambio y modificaciones en los procesos. La experiencia presentada en el presente artículo podría ser de utilidad para otras instituciones prestadoras de salud que deseen o estén en proceso de implementar un SIHCE en un contexto similar al nuestro.

In Peru, the vast majority of health facilities, both public and private, still have medical record formats on paper. Migration to the electronic health records information system (SIHCE) has been seen to be a great challenge in many respects. The San Pablo Hospital Complex (CHSP) is made up of eleven health establishments distributed in four departments of the country. In this article we report the process of implementing the SIHCE in the CHSP through the software circuit, for which the following steps were followed: 1) Decision to implement an EHR system, 2) Constitution of the committee, 3) Benchmarking and evaluation 4) Implementation plan, 5) Coordination meetings, 6) Testing, 7) Trainings, 8) Go Live, and 9) Implementation by replication. Likewise, we reflect on the lessons learned during this process, which revolve around two angles: management versus change and process modifications. The experience presented in this paper could be of use to other healthcare providers that wish or are in the process of implementing an SIHCE system in a context similar to ours.

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The study aimed to investigate the population's perceptions of generic drugs compared to original brand-name drugs in Peruvian hospitals. Participation included 4,914 persons 18 years and older in 13 cities in Peru, categorized as Lima, large cities, and small cities. The study explored socioeconomic and demographic characteristics and perceptions of generics in comparison to brand-name drugs. In determining the associations for each intersection of variables, the authors calculated the prevalence ratios (PR) and 95% confidence intervals (95%CI), using crude and adjusted Poisson regression with robust variance with Stata 14.0. Of the 4,914 participants, 46.7% felt that generics are less effective than brand-name drugs and 49.3% had recommended or would recommend generics to other people; multivariate analysis showed that individuals with income less than PEN 1,000 (USD 300) were prone to recommending a generic drug (PR = 1.36; 95%CI: 1.14-1.63). The results indicate that the Peruvian population still has mistaken concepts and low acceptance of generic drugs, and the study should serve to develop health policies that ensure low cost and quality when choosing medicines.

El objetivo del estudio fue conocer la percepción de la población con respecto a medicamentos genéricos, frente a los medicamentos de marca, en hospitales del Perú. Participaron del estudio 4.914 personas mayores de 18 años, de 13 ciudades del Perú; clasificándolas en Lima, grandes y pequeñas ciudades. Se exploraron características socioeconómicas, demográficas y de percepción de medicamentos genéricos, en comparación con los medicamentos de marca. Determinando las asociaciones para cada cruce de variables, se calcularon razones de prevalencias (RP) y sus intervalos del 95% de confianza (IC95%), usando regresiones de Poisson crudas y ajustadas con varianza robusta con Stata 14.0. De los 4.914 participantes, el 46,7% estaban de acuerdo con que los medicamentos genéricos son menos eficaces que los medicamentos de marca, el 49,3% ha recomendado o recomendaría a otras personas el uso de medicamentos genéricos, además, el análisis multivariado encontró que las personas que tenían un ingreso económico menor a PEN 1.000 estaban predispuestas a recomendar un medicamento genérico (RP = 1,36; IC95%: 1,14-1,63). Los resultados ponen en manifiesto que la población peruana aún tiene conceptos equívocos y baja aceptación a los medicamentos genéricos. El presente estudio debería servir para desarrollar políticas de salud, que velen por el bajo costo y calidad a la hora de escoger un medicamento.

O objetivo do estudo foi conhecer a percepção da população a respeito dos medicamentos genéricos frente aos medicamentos de marca em hospitais do Peru. Participaram 4.914 pessoas maiores de 18 anos, de 13 cidades do Peru; foram classificadas em Lima, além de grandes e pequenas cidades. Foram exploradas as características socioeconômicas, demográficas e de percepção de medicamentos genéricos em comparação com os medicamentos de marca. Determinando as associações para cada intersecção de variáveis, foram calculadas as razões de prevalências (RP) e seus intervalos de 95% de confiança (IC95%), usando regressões de Poisson brutas e ajustadas com variância robusta com Stata 14.0. Dos 4.914 participantes, um 46,7% estavam de acordo com que os medicamentos genéricos são menos eficazes do que os medicamentos de marca, um 49,3% tem recomendado o recomendaria a outras pessoas o uso de medicamentos genéricos, além disso, a análise multivariada encontrou que as pessoas que tinham um ingresso econômico menor a PEN 1.000 eram propensas a recomendar um medicamento genérico (RP = 1,36; IC95%: 1,14-1,63). Os resultados manifestam que a população peruana ainda tem conceitos equívocos e baixa aceitação dos medicamentos genéricos, e o presente estudo deveria servir para desenvolver políticas de saúde, que assegurem o baixo custo e a qualidade na hora de escolher um medicamento.

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BACKGROUND: A high number of vaginal examinations (VEs) may lead to a higher risk of infections, as well as discomfort/dissatisfaction with intrapartum care. OBJECTIVE: To determine the frequency of potential excess of vaginal examinations (PEVE) during the management of labor and identify its associated factors, in Peruvian hospitals. METHODS: Secondary analysis of the data collected in the DisrespEct and abuse during ChIlDbirth in pEru (DECIDE) study, held between April and May 2016. In this study, women hospitalized in Peruvian hospitals right after giving birth were surveyed by trained personnel. PEVE, the main outcome, was considered as five or more vaginal examinations (VEs) performed during the management of labor. Poisson regression models with robust variance were performed to calculate crude and adjusted prevalence ratios (cPR and aPR) as well as their 95% confidence intervals (95% CI). RESULTS: One thousand four hundred twenty registries of 13 hospitals from 8 Peruvian cities were evaluated. The number of women studied at each hospital ranged between 100 and 129. The median age was 26 years (interquartile rank: 22-31). The median number of VEs was 3 (interquartile rank: 2-5). The proportion of women who underwent PEVE was 33.9%, this ranged from 0.9 to 69.9% at the studied hospitals. The frequency of PEVE was higher in women who attended > 2 obstetric psychoprophylaxis sessions, compared to those who attended ≤ 2 sessions (aPR: 1.78 95% CI: 1.01-3.12); and among women who gave birth between 18:00 h and 23:59 h, compared to those who did it between 7:00 and 17:59 h (aPR: 1.28 95% CI: 1.04-1.57). CONCLUSION: Around one in three women underwent a PEVE, although this frequency varied widely across the evaluated hospitals. Women with more psychoprophylaxis sessions, and who gave birth between 18:00 h and 23:59 h, had a higher PEVE frequency. Future studies should assess in depth the causes and consequences of this high frequency.

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Resumen: El objetivo del estudio fue conocer la percepción de la población con respecto a medicamentos genéricos, frente a los medicamentos de marca, en hospitales del Perú. Participaron del estudio 4.914 personas mayores de 18 años, de 13 ciudades del Perú; clasificándolas en Lima, grandes y pequeñas ciudades. Se exploraron características socioeconómicas, demográficas y de percepción de medicamentos genéricos, en comparación con los medicamentos de marca. Determinando las asociaciones para cada cruce de variables, se calcularon razones de prevalencias (RP) y sus intervalos del 95% de confianza (IC95%), usando regresiones de Poisson crudas y ajustadas con varianza robusta con Stata 14.0. De los 4.914 participantes, el 46,7% estaban de acuerdo con que los medicamentos genéricos son menos eficaces que los medicamentos de marca, el 49,3% ha recomendado o recomendaría a otras personas el uso de medicamentos genéricos, además, el análisis multivariado encontró que las personas que tenían un ingreso económico menor a PEN 1.000 estaban predispuestas a recomendar un medicamento genérico (RP = 1,36; IC95%: 1,14-1,63). Los resultados ponen en manifiesto que la población peruana aún tiene conceptos equívocos y baja aceptación a los medicamentos genéricos. El presente estudio debería servir para desarrollar políticas de salud, que velen por el bajo costo y calidad a la hora de escoger un medicamento.

Abstract: The study aimed to investigate the population's perceptions of generic drugs compared to original brand-name drugs in Peruvian hospitals. Participation included 4,914 persons 18 years and older in 13 cities in Peru, categorized as Lima, large cities, and small cities. The study explored socioeconomic and demographic characteristics and perceptions of generics in comparison to brand-name drugs. In determining the associations for each intersection of variables, the authors calculated the prevalence ratios (PR) and 95% confidence intervals (95%CI), using crude and adjusted Poisson regression with robust variance with Stata 14.0. Of the 4,914 participants, 46.7% felt that generics are less effective than brand-name drugs and 49.3% had recommended or would recommend generics to other people; multivariate analysis showed that individuals with income less than PEN 1,000 (USD 300) were prone to recommending a generic drug (PR = 1.36; 95%CI: 1.14-1.63). The results indicate that the Peruvian population still has mistaken concepts and low acceptance of generic drugs, and the study should serve to develop health policies that ensure low cost and quality when choosing medicines.

Resumo: O objetivo do estudo foi conhecer a percepção da população a respeito dos medicamentos genéricos frente aos medicamentos de marca em hospitais do Peru. Participaram 4.914 pessoas maiores de 18 anos, de 13 cidades do Peru; foram classificadas em Lima, além de grandes e pequenas cidades. Foram exploradas as características socioeconômicas, demográficas e de percepção de medicamentos genéricos em comparação com os medicamentos de marca. Determinando as associações para cada intersecção de variáveis, foram calculadas as razões de prevalências (RP) e seus intervalos de 95% de confiança (IC95%), usando regressões de Poisson brutas e ajustadas com variância robusta com Stata 14.0. Dos 4.914 participantes, um 46,7% estavam de acordo com que os medicamentos genéricos são menos eficazes do que os medicamentos de marca, um 49,3% tem recomendado o recomendaria a outras pessoas o uso de medicamentos genéricos, além disso, a análise multivariada encontrou que as pessoas que tinham um ingresso econômico menor a PEN 1.000 eram propensas a recomendar um medicamento genérico (RP = 1,36; IC95%: 1,14-1,63). Os resultados manifestam que a população peruana ainda tem conceitos equívocos e baixa aceitação dos medicamentos genéricos, e o presente estudo deveria servir para desenvolver políticas de saúde, que assegurem o baixo custo e a qualidade na hora de escolher um medicamento.

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INTRODUCTION: Health professionals performing their social health service (SHS) in rural communities could be at risk of developing depression. Moreover, those who migrate from farther places to perform their SHS could have an increased risk. The objective of this study was to evaluate the association between place of origin and the presence of depressive symptoms, in health professionals performing rural social health service (SHS) in Ancash, Peru. METHODS: This was a cross-sectional study. During April 2015, a survey was applied to health professionals performing SHS in the Peruvian Ministry of Health (MINSA) facilities in Ancash. The main outcome was the presence of depressive symptoms, defined as a score ≥2 points in the Patient Health Questionnaire-2. The main exposure was the place of origin, defined as the place where the subjects completed their undergraduate professional studies (Ancash, Lima city or others). Poisson regressions with robust variance were performed to calculate crude and adjusted prevalence ratios (PR and aPR) and their 95% confidence interval (95%CI). RESULTS: From 573 health professionals performing their SHS in MINSA in Ancash, 347 were included in the study. The mean age was 27.2±4.5 years, 78.7% were women, and 14.7% scored positive for depressive symptoms. Those who had completed their undergraduate professional studies in Lima city had a higher prevalence of presence of depressive symptoms compared to those who did in Ancash (aPR=2.59, 95%CI=1.23-5.45). CONCLUSIONS: Those who completed their undergraduate professional studies in Lima had a higher prevalence of depressive symptoms than those who did in Ancash. Possible explanations include the difficulty in visiting family and friends, acculturation, and lack of Quechua language proficiency.

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OBJECTIVE: To assess the prevalence of disrespect and abuse during childbirth and its associated factors in Peru. METHODS: In an observational cross-sectional study, women were surveyed within 48 hours of live delivery at 14 hospitals located in nine Peruvian cities between April and July 2016. The survey was based on seven categories of disrespect and abuse proposed by Bowser and Hill. To evaluate factors associated with each category, prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using adjusted Poisson models with robust variances. RESULTS: Among 1528 participants, 1488 (97.4%) had experienced at least one category of disrespect and abuse. Frequency of abandonment of care was increased with cesarean delivery (PR 1.27, 95% CI 1.03-1.57) but decreased in the jungle region (PR 0.27, 0.14-0.53). Discrimination was associated with the jungle region (PR 5.67, 2.32-13.88). Physical abuse was less frequent with cesarean than vaginal delivery (PR 0.23, 0.11-0.49). The prevalences of abandonment of care (PR 0.42, 0.29-0.60), non-consented care (PR 0.70, 0.57-0.85), discrimination (PR 0.40, 0.19-0.85), and non-confidential care (PR 0.71, 0.55-0.93) were decreased among women who had been referred. CONCLUSION: Nearly all participants reported having experienced at least one category of disrespect and abuse during childbirth care, which was associated with type of delivery, being referred, and geographic region.

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RESUMEN Introducción y objetivos: En el Perú, un país en vías de desarrollo, las cifras de partos domiciliarios en zonas rurales incrementan las tasas de mortalidad materna y neonatal, por tal razón el objetivo del trabajo fue: Determinar la prevalencia y características de los partos domiciliarios en la provincia de Ocongate, zona rural del departamento de Cusco en la sierra del Perú, 2015-2016. Materiales y Métodos: Se realizó un estudio observacional, de diseño de casos y controles, donde se incluyó 46 casos, de mujeres con parto domiciliario y 100 controles con partos institucionales registrados en los años 2015 y 2016, se exploraron resultados descriptivos de características sociodemográficas y Gineco-Obstétricas. Realizando análisis bivariado con la prueba estadística del chi cuadrado, calculando los Odds Ratio e intervalos de confianza al 95% (IC95%) con Regresión Logística Múltiple. Resultados: De 558 partos registrados 49 (8,7%) fueron partos domiciliarios, donde la edad promedio fue de 25,3 ± 6,4 años; en el análisis multivariado encontró que: no tener ningún control prenatal [OR=12,2; IC95% 4,6-64,9]; tener antecedente de parto domiciliario [OR=4,5; IC95% 1,01-20,5]; vivir a una distancia > de 90 minutos [OR=3,2; IC95% 1,08-10,2]; y tener una captación tardía de a gestante, ser factores de riesgo para tener un parto domiciliario. Conclusiones: En la mayoría de mujeres que tuvieron partos domiciliarios influyó negativamente la captación tardía de la gestante, un mayor tiempo de viaje al centro de salud, antecedente de parto domiciliario, y no tener ningún control prenatal, siendo necesario diseñar estrategias para disminuir los partos domiciliarios en zonas rurales del Perú.

ABSTRACT Introduction and objectives: In Perú, Maternal and neonatal mortality rates are increased by the non-institutional births in rural areas. This is why the study's objective was to determine the prevalence and characteristics of non-institutional births in the province of Ocongate, a rural area located in Cusco, in the highland of Peru, 2015-2016 Methods and materials: An observational case-control study was conducted, which included 46 cases of noninstitutional births and 100 controls of institutional births between 2015 and 2016. Gynecological, Obstetric and sociodemographic characteristics are described and analyzed by a bivariate analysis, which was performed with chi square statistical test calculating the Odds Ratio and 95% confidence intervals (95% CI) with Multiple Logistic Regression. Results: Forty-nine (8.7%) of the total registered deliveries were non-institutional births. The average age was 25.3 ± 6.4 years. In the multivariate analysis, it was found that: not having any prenatal control [OR = 12.2; 95% CI 4.6-64.9]; having a history of home birth [OR = 4.5; 95% CI 1.01-20.5]; living at a distance of> 90 minutes [OR = 3.2; 95% CI 1.08-10.2]; and having a late uptake of a pregnant woman, are all risk factors for having a noninstitutional birth. Conclusions: The majority of women who had non-institutional births was negatively affected by the late pregnancy uptake, a longer travel time to the nearest health center, a previous non-institutional birth and no prenatal control. It is necessary to design strategies to reduce non-institutional births in rural areas of Perú.

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Objetivo: describir la opinión de estudiantes de medicina de Perú sobre la legalización del aborto por violación y evaluar sus factores asociados. Material y Métodos: estudio observacional, transversal y analítico, en estudiantes de Medicina Humana que asistieron a alguna de las dos asambleas estudiantiles nacionales realizadas en la ciudad de Trujillo durante el 2015. Se aplicó una encuesta de 25 preguntas que recolectó variables sociodemográficas e información sobre la opinión de los estudiantes sobre la legalización del aborto. Los factores asociados a estar a favor de la legalización del aborto en casos de violación se evaluaron mediante la regresión de Poisson con varianza robusta, obteniendo razones de prevalencia (RP) y sus intervalos de confianza al 95% (IC95%). Resultados: se encuestó a 142 estudiantes de Medicina Humana. El 53,5% fueron mujeres, el 62,7% se encontraban estudiando en universidades fuera de Lima y el 44,0% se encontraban entre quinto y octavo semestre. El 57,5% estuvieron de acuerdo con la legalización del aborto en casos de violación, lo cual estuvo asociado a mayor compromiso religioso (RP=0,50; IC95%=0,30-0,84) y a la aprobación familiar de la legalización del aborto (RP=1,39, IC95%=1,08-1,80). Conclusiones: aproximadamente la mitad de los encuestados estuvo de acuerdo con la legalización del aborto en casos de violación. Esto estuvo asociado a tener un menor compromiso religioso y a que su familia apruebe la legalización del aborto, lo cual resalta la importancia del entorno familiar y religioso en este tema.

Objective: to describe the opinion of Peruvian medical students about the legalization of abortion in cases of rape, and to address its associated factors. Material and Methods: an observational, cross-sectional and analytical study was performed in medical students who attended any of the two national student assemblies that took place in the city of Trujillo during 2015. A 25-question survey was administered, which included socio-demographic variables and information regarding the students’ opinion about abortion legalization. Factors associated with favoring abortion legalization in cases of rape were assessed using Poisson regression with robust variance, obtaining prevalence ratios (PR) and 95% confidence intervals (CI). Results: we surveyed 142 medical students. Fifty-three and a half per cent were women, 62.7% were studying in universities outside Lima and 44.0 % were between fifth and eighth semester. Fifty-seven and a half percent of the students agreed with legalizing abortion in cases of rape, which was associated with religious commitment (PR = 0.50, 95% CI = 0.30-0.84) and with the approval of such legalization by their relatives (PR = 1.39, 95% CI = 1.08 to 1.80). Conclusions: Half of the participants agreed that abortion should be legalized in cases of rape. This was associated with having a more relaxed religious commitment and with the approval of abortion legalization by their relatives, which highlights the importance of the family and religious environment in this issue.

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