Revista Virtual de la Sociedad Paraguaya de Medicina Interna

Prolonged hospital stay: a challenge in hospital management and a public health goal

Jesús Falcón — 2025-01-16

La estancia hospitalaria prolongada representa un problema de múltiples dimensiones que desafía a los sistemas de salud. Este fenómeno no solo incrementa los costos y disminuye la eficiencia operativa, sino que también pone en riesgo la seguridad del paciente y afecta la calidad del servicio prestado ⁽¹⁾.

El estudio publicado en este número aporta evidencia valiosa para tratar de entender los factores asociados a esta problemática y propone un punto de partida para diseñar estrategias efectivas ⁽²⁾.

Demographic and clinical characteristics of adult hospitalized patients with prolonged hospital stay

Laura Carolina Recalde Mello — 2025-01-08

Introduction: Prolonged hospital stay is the time in days of hospitalization additional to that estimated according to the statistical parameters of each institution. It depends on multiple factors and may vary with the study time.

Objectives: To describe the demographic and clinical characteristics of adult patients with prolonged hospital stay admitted to a referral hospital in Asunción, Paraguay, in 2024.

Methodology: An observational, descriptive, cross-sectional design was applied including men and women, over 18 years of age, with a stay of more than 10 days in the Clinical Medicine service from March to October 2024. Data were extracted at discharge. Demographic and clinical variables and causes of prolonged stay were measured. Descriptive statistics were applied. The project was approved by the Ethics Committee of the Universidad Privada del Este, Asunción.

Results: Sixty-seven subjects entered the study: 43 males with a mean age of 70 ± 17 years and 23 females with a mean age of 65 ± 15 years. The median length of stay was 14 days (interquartile range 11 – 22 days). Stroke was the most frequent admission diagnosis (22.39%). Arterial hypertension was the prevalent comorbidity (91.04%). Many patients had various causes of prolonged stay. The most frequent were poor clinical condition (97.01%) and the need for prolonged treatment (88.06%). Mortality was observed in 3 cases (4.48%).

Conclusion: The most frequent causes of prolonged stay in the Clinical Medical service were conditions inherent to the clinical condition of the patients. These conditions could affect the administrative aspects of hospital management.

Prevalence of influenza in patients of the Hospital Regional Instituto de Previsión Social of Ciudad del Este, Paraguay, in 2024

Adryelle Tallita Moreira — 2025-01-08

Introduction: Notifiable diseases are of public health importance due to their epidemic potential, requiring control and prevention strategies. Influenza, in particular, due to its high transmission capacity and global impact, is of great epidemiological importance.

Objectives: To analyze the seasonal distribution and determine the prevalence of influenza among patients aged between 20 and 59 years of age who were seen at the Hospital Regional del Instituto de Previsión Social of Ciudad del Este, Paraguay, in the outpatient, emergency, and inpatient sectors of the internal medical service, between January and August 2024.

Methodology: A retrospective cross-sectional descriptive epidemiological study was carried out using data collected from epidemiological records.

Results: The records of 363 patients were reviewed, 52 (14.3%) tested positive for influenza infection. Of the total number of positive cases, 44 (84.6%) were identified as type A influenza and 8 (15.4%) as type B influenza. An increase in the number of cases was observed from April onwards. It was found that 28.8% of those affected were health care professionals.

Conclusion: The prevalence of influenza was 14.3%, affecting almost one-third of health care professionals.

Satisfaction with care and quality of life of users of a primary care center in Paraguay in 2024

Karen Edith Figueredo Giménez — 2025-01-16

Introduction: User satisfaction is a measure of health care quality. It depends on various factors, including the quality of life of patients.

Objectives: To determine the level of satisfaction and quality of life of users of a primary care center in Paraguay in 2024.

Methodology: An observational, descriptive, cross-sectional, and correlational design was applied. The study population consisted of men and women, aged over 18 years. The level of satisfaction and quality of life were ascertained by the Baker and EQ-5D questionnaires, respectively. The variables were subjected to descriptive statistics and then, the factors associated with dissatisfaction were analyzed using analytical tests. The study was approved by the institutional ethics committee

Results: Of 161 users surveyed, 94 were female with a mean age of 45 years while 67 were men with a mean age of 43 years. Sixty-five subjects (40.4%) were identified as satisfied with the care and 96 (59.7%) were dissatisfied. Poor quality of life was a risk factor of dissatisfaction, although it was not statistically significant: RR 1.2 95% CI 0.9 – 1.6 (p 0.1). No sociodemographic risk factors associated with dissatisfaction were detected.

Conclusion: Sixty-five (40.4%) subjects were satisfied with care and 96 (59.7 %) were dissatisfied. No risk factors associated with dissatisfaction were detected. It is recommended to monitor the opinion of users since it is a parameter of the quality of health care.

Overweight and obesity phenotypes in residents of the Hospital de Clínicas, Paraguay, year 2024

Ignacio Ortiz Galeano — 2025-01-15

Introduction: Obesity is a pathology of global impact, hence the problem and need to study and phenotype this disease.

Objective: To determine the frequency and phenotyping of overweight and obesity in resident physicians of the Hospital de Clínicas, San Lorenzo, Paraguay, in 2024.

Methodology: An observational, descriptive, cross-sectional study was applied. The sampling was non-probabilistic, of consecutive cases, carried out between June and October 2024. The eating behavior phenotypes scale was used to phenotype the subjects in the sample. Sociodemographic variables and cardiovascular risk factors were measured. Eating behavior phenotypes (hedonic, compulsive, emotional, hyperphagic, disorganized) were assessed in those subjects with body mass index ≥ 25 kg/m2. The Epi Info 7™ program was used for the description of the variables. The ethical aspects of the research were respected.

Results: One hundred seventeen residents participated in the study, 50.4% of them presented overweight or obesity, 44% consumed alcohol, 52% were in a sedentary state, and 4% presented hypothyroidism, polycystic ovary syndrome, and dyslipidemia. The predominant eating behavior phenotypes were emotional and hedonic with 34% each.

Conclusions: More than half of the respondents presented overweight or obesity and the predominant eating behavior phenotypes were emotional and hedonic.

Characteristics of metabolic syndrome in a population of northwestern Colombia

Jorge Andrés Hernández — 2025-03-15

Introduction: Metabolic syndrome represents an important public health problem due to its association with chronic noncommunicable diseases such as hypertension, diabetes, and dyslipidemia.

Objective: To describe the characteristics of metabolic syndrome and its associated factors in a population enrolled in a chronic disease control program, identifying opportunities to improve its diagnosis, treatment, and management.

Methodology: An observational study was conducted with 2,482 patients enrolled in the 2023 program within the framework of the public chronic disease control program in Bucaramanga, Colombia. Data were collected on demographic characteristics, comorbidities (hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia), and MS diagnostic criteria, including abdominal obesity. Adherence to treatment and adequate control of MS were evaluated using established indicators.

Results: Of the participants, 55.2% were women. Abdominal obesity was the most prevalent diagnostic criterion for metabolic syndrome. The most frequent comorbidities were hypertension, diabetes, hypercholesterolemia, and hypertriglyceridemia. Treatment adherence was 48.5% and adequate MS control was achieved in 44.4% of cases.

Conclusions: The findings underline the need to strengthen primary care with a multidisciplinary approach to improve the diagnosis and management of metabolic syndrome and its complications. Implementing an institutional improvement plan, coordinating efforts with the Ministry of Health, and promoting multicenter studies at the national level are recommended for more effective interventions.

Clinical characteristics of renal transplant patients and frequency of cytomegalovirus infection at the Hospital de Clínicas, period 2006- 2024

Ignacio Ortiz Galeano — 2025-03-15

Introduction: Renal transplantation is the preferred treatment for end-stage chronic kidney disease, improving quality of life and survival. However, the necessary immunosuppression increases the risk of infections, especially cytomegalovirus infections, which can cause serious complications and compromise graft viability and patient survival.

Objective: To identify the clinical characteristics of renal transplant patients and the frequency of cytomegalovirus infection.

Methods: An observational, descriptive, retrospective, and cross-sectional study was carried out with non-probabilistic sampling of consecutive cases, covering renal transplanted patients from the Hospital de Clínicas, 2006-2024. Patients with negative pre-transplant and positive post-transplant serology for cytomegalovirus were included, excluding those who received prophylaxis.

Results: One hundred eighty-nine renal transplant patients were included, of which 22.8% presented positive viral load for cytomegalovirus. The majority were men 66.7%, with a mean age of 38 years, 43.9% did not receive cytomegalovirus prophylaxis, and 88.4% of those treated used ganciclovir and valganciclovir. The main comorbidities were arterial hypertension 65.6% and chronic kidney disease 96.3%. Of the transplants, 51.3% were from living donors, with 84.1% donor+/recipient+ seropositivity. Active cytomegalovirus infection occurred in 7% of patients with detectable viral load.

Conclusion: 22.8% of patients had detectable cytomegalovirus viral load, 7% had active infection and the frequency varied throughout the period. The most frequent comorbidities in renal transplant recipients were arterial hypertension and chronic kidney disease.

Factors associated with vitamin B12 deficiency in older people with type 2 diabetes mellitus treated with metformin

Laura Andrea Dominguez Gallardo — 2025-03-31

Introduction: Metformin is the first-line drug in type 2 diabetes. However, it has been described that it produces a decrease in vitamin B12 plasma levels.

Objective: To determine factors associated with vitamin B12 deficiency in elderly people with type 2 diabetes treated with metformin attending an outpatient clinic in a public center.

Methodology: Observational, descriptive, cross-sectional study, with an analytical component, carried out in elderly people over 60 years of age with type 2 diabetes treated with metformin, in the outpatient clinic of the Santo Domingo Complex, Asuncion, Paraguay, from June to August 2024. Exclusion criteria: gastrectomy or gastric bypass, malabsorption syndrome, alcoholism, B12 supplementation, vegetarian diet, and patients who did not sign the consent form. Non-probability sampling of consecutive cases. The calculated sample size was 158. B12 deficiency was considered at values ≤203 pg/mL.

Results: One hundred fifty-eight people aged 60 to 89 years participated, with a mean age of 73 ± 6 years, 62% were women. Sixty-seven percent met polypharmacy criteria and 21.5% consumed proton pump inhibitors. The duration of metformin use was 7.71 ± 6.53 years, with a daily dose of 1389 ± 746.22 mg. The 38.6% presented B12 deficiency, more frequent in women, polymedicated, without PPI consumption. A total of 86.7% presented hemogram alterations: anemia (18.9%), leukopenia (8.2%) and thrombocytopenia (6.3%). The mean vitamin B12 concentration was 356 ±291.11 pg/mL (range 90 - 2240 pg/mL). Statistical association was found with the time of use and dose of metformin and the use of proton pump inhibitors.

Conclusions: The prevalence of hypovitaminosis B12 was 38.6%. Statistical association was observed with higher daily dose and longer time of metformin use, but not with older age. Based on these findings, it is recommended to actively look for hypovitaminosis B12 in older people treated with metformin.

Prevalence of inadvertent hypoglycemia in patients with diabetes in a referral hospital

Sandra María Soto Valiente — 2025-04-30

Introduction: Inadvertent hypoglycemia is defined as a decreased ability to perceive symptoms of hypoglycemia with glucose values below 70 mg/dL. One of the most widely used methods to measure the perception of inadvertent hypoglycemia is the Clarke questionnaire.

Objective: To determine the prevalence of perception of inadvertent hypoglycemia in a cohort of patients with type 2 diabetes mellitus, insulin users, who undergo check-ups at the Central Police Hospital Rigoberto Caballero, Asuncion, Paraguay, during June 2024.

Methodology: An observational, descriptive, cross-sectional, retrospective, non-probabilistic convenience sampling study was carried out. The accessible population corresponded to male and female patients over 40 years of age, carriers of type 2 diabetes mellitus, insulin users, who underwent check-ups at the aforementioned center. Data recruitment was carried out using a questionnaire developed by the authors, which includes the Clarke questionnaire and other variables of interest.

Results: among the 42 patients studied, 7 (16.6%) presented inadvertent hypoglycemia based on Clarke questionnaire. A total of 85.7% of the patients affirmed that they were hypoglycemic, and 85.7% of the patients reported always having symptoms when hypoglycemia was detected. The mean age was 62 ± 11 years, 54.76% were male, and 54.76% were from the Central Department. The types of insulin used were: U300 glargine 35 patients (83.33%), detemir 2 patients (4.76%), and NPH 5 patients (11.90%).

Conclusion: The prevalence of perception of inadvertent hypoglycemia determined by Clarke's questionnaire in patients with type 2 diabetes mellitus was 16.66%.

Prevalence of type 2 diabetes mellitus in Paraguayan National Police officers

Jorge Alejandro Altemburger Leguizamon — 2025-04-30

Introduction: The prevalence of diabetes mellitus in Paraguay is 10.6%, and it is estimated that it could be higher in police officers.

Objectives: To determine the prevalence of type 2 diabetes mellitus in National Police officers at the Rigoberto Caballero Police Hospital, Asuncion, Paraguay, during 2024.

Methodology: An observational, descriptive, cross-sectional, retrospective study with non-probabilistic sampling of consecutive cases was carried out. The sample consisted of National Police officers of any age and sex who went to the clinic for physical fitness evaluation for promotion purposes at the aforementioned center.

Results: Eighty-two subjects were studied, being 80.48% male, with a mean age of 38 ± 5 years. A total of 14.63% were carriers of arterial hypertension, and 4.87% were already known carriers of type 2 diabetes mellitus. The mean glycated hemoglobin of the patients was 5.71 ± 0.89%. The prevalence of type 2 diabetes mellitus amounted to 12.2%, including those who were not known carriers of this condition.

Conclusion: The prevalence of type 2 diabetes mellitus in National Police officers competing for promotion who attended designated clinics for aptitude evaluation was 12.2%.

Characterization of patients with type 2 diabetes mellitus under renal replacement therapy in a referral hospital in Asuncion, Paraguay

Sandra María Soto Valiente — 2025-04-30

Introduction: Diabetes is the leading cause of chronic kidney disease and end-stage renal disease, which requires renal replacement therapy. Poor metabolic control, the long duration of diabetes, and the presence of albuminuria and diabetic retinopathy determine the appearance of renal disease in a patient with diabetes.

Objectives: To characterize patients with type 2 diabetes mellitus under renal replacement therapy, followed up at the Central Police Hospital Rigoberto Caballero, Asuncion.

Methodology: An observational, descriptive, cross-sectional, retrospective study with non-probabilistic sampling of consecutive cases was carried out. The accessible population corresponded to male and female patients over 40 years of age, carriers of type 2 diabetes mellitus, under renal replacement therapy, and under follow-up in the Nephrology Service of the mentioned hospital. Demographic and clinical variables were measured. Data were extracted from medical records, and descriptive statistics were applied.

Results: Thirty subjects were evaluated, 73.33% were male, the mean age was 62 ± 9 years. Of these, 73% were on hemodialysis, 56% used jugular catheter, and the mean time since the start of hemodialysis was 21.33 ± 9.62 months. Insulin was used in 56.66% of the patients, mean creatinine clearance was 8.04 ± 4.52 mL/min/1.73 m2, potassium 4.94 ± 0.84 milli mol/L, and phosphorus 5.37 ± 1.75 mg/dL.

Conclusion: Patients with type 2 diabetes mellitus on renal replacement therapy are mostly male, older than 60 years, receiving hemodialysis by jugular catheter, having started therapy 21 months ago, and with creatinine clearance less than 10 mL/min/1.73 m2.

Prevalence of ventilator-associated pneumonia in an adult intensive care unit

Jorge Alejandro Altemburger Leguizamon — 2025-04-30

Introduction: Ventilator-associated pneumonia (VAP) is included among healthcare-associated infections, nosocomial infections, and hospital-acquired infections. It is common in critical patients and can occur in 20 to 25% of those with invasive mechanical ventilation for more than 48 hours. It represents 15-20% of in-hospital infections.

General objective: To determine the prevalence of VAP in adult patients admitted to intensive care at the Rigoberto Caballero Police Hospital, Asuncion, during 2024. The specific objectives were to detail the clinical characteristics of the patients and describe the germs involved.

Methodology: An observational, descriptive, cross-sectional, retrospective design with non-probabilistic sampling of consecutive cases was applied. Patients older than 18 years old admitted with mechanical ventilation for at least 48 hours and with specific clinical, radiological, and microbiological criteria for VAP were included.

Results: Out of 60 patients admitted to the intensive care unit, 55% were women, with a mean age of 62 ±17 years. Intubation was required in 71.66%. The prevalence of VAP was 31.66%. In 5%, germs were isolated, the most frequent being: Acinetobacter baumannii, ESBL Klebsiella pneumoniae, and Serratia marcescens. Overall mortality was 25%, of which 11.66% corresponded to patients with VAP.

Conclusion: The prevalence of VAP was 31.66%, with a mortality of 36.84% in affected patients. The most frequent germs were Acinetobacter baumannii, ESBL Klebsiella pneumoniae, and Serratia marcescens.

Characterization of the patient attending the diabetology clinic at the Central Police Hospital Rigoberto Caballero, Asunción

Jorge Alejandro Altemburger Leguizamon — 2025-05-27

Introduction: Diabetes is a chronic metabolic disease characterized by high blood glucose levels with a high prevalence worldwide; in Paraguay alone, its prevalence is 10.6%. This pathology is associated with multiple comorbidities and complications, among which micro- and macrovascular complications stand out.

Objective: To characterize patients attending the diabetology clinic at the Central Police Hospital Rigoberto Caballero, Asuncion, during 2023 and 2024.

Methodology: An observational, descriptive, cross-sectional, retrospective, non-probabilistic study with convenience sampling was carried out. The study population corresponded to patients of both sexes, over 40 years of age, carriers of type 2 diabetes mellitus, who attended the diabetology office of the aforementioned center. Data were obtained from virtual clinical records by accessing the Health Information System (HIS).

Results: One hundred twenty-three patients were studied, of whom 69 (56.1%) were female with a mean age of 65 ± 10 years, with prevalent comorbidities such as obesity in 87 patients (70.7%), arterial hypertension in 100 patients (81.30%) and chronic kidney disease in 35 patients (28.45%). The mean glycated hemoglobin was 8.54 ± 2.18%. The prevalent therapeutic scheme was the combined treatment of insulin and oral antidiabetics (59.34%), and treatment adherence was 43.04%.

Conclusion: Patients with type 2 diabetes mellitus who attended the diabetology clinic were mostly women, aged 65 years, from the Central Department, with a BMI of 31 kg/m2, with obesity and hypertension, non-adherent to antidiabetic treatment, with suboptimal glycemia, and a combined scheme of oral drugs plus insulin therapy.

Characterization of patients with diabetic foot of the Villarrica Regional Hospital, Paraguay, in the period 2023 - 2024

Fanny Vera Marecos — 2025-05-26

Introduction: Diabetes can develop complications, especially in the feet, a condition favored by the presence of diabetic neuropathy and peripheral arteriopathy, which leads to infection, ulceration, and/or destruction of the deep tissues of the foot.

Objectives: To determine the characteristics of patients with diabetic foot attending the office and hospitalization service at the Regional Hospital of Villarrica, Paraguay, in the period 2023-2024.

Methods: An observational, descriptive, cross-sectional design was applied to patients diagnosed with diabetic foot in the diabetes program of the Villarrica Regional Hospital from 2023 to 2024.

Results: One hundred thirty-one patients were included, of which 62% were male, with an age range of 40 to 60 years, 57% with primary schooling, and 36% with marital status of free union. The most frequent comorbidities were the use of inadequate footwear 67%, neuropathy 62% and vasculopathy 57%. According to the Wagner scale for diabetic foot disease, 44% had grade 4 (limited gangrene), and 23% grade 3 (deep ulcers). Surgical approach treatments were the most used (53%).

Conclusion: The predominant sex was male, with an age range of 40 to 60 years, with low educational levels. The most frequent comorbidities were inadequate footwear, neuropathy, and vasculopathy. The most frequent grades of diabetic foot were grades 4 and 3. Surgical approach treatments were the most frequently used.

Stroke risk factors in patients of Villarrica Regional Hospital, Paraguay, period 2023 - 2024

Fernando Ariel Romero Paniagua — 2025-05-27

Introduction: Cerebrovascular accidents are pathologies characterized by the destruction of nervous tissue at the intracranial level due to failures in the vascular bed, such as ischemia or hemorrhage. Several risk factors predispose to this pathology.

Objectives: To determine the relationship between risk factors and stroke in patients of the Villarrica Regional Hospital in the period 2023-2024.

Methodology: An observational, descriptive, cross-sectional study with an analytical component was carried out in adults of both sexes with a diagnosis of stroke at the Villarrica Regional Hospital in the period 2023-2024. The relationship between risk factors and the predisposition to have or not have a stroke was hypothesized. The Epi Info 7™ program was used for data description and analysis.

Results: One hundred and fifty patients with stroke and 150 controls were included. Seventy-six percent were male, 75% older than 60 years, 49% with primary education, and 42% were married. The most frequent risk factors were arterial hypertension (88%), diabetes mellitus (67%), and smoking (45%). The predominant type of stroke was ischemic (72%). A statistically significant association was found between the presence of a greater number of risk factors and increased predisposition to stroke: OR 5.62 (95% CI 1.84-17.17; p<0.05). The risk increased as the individual presented more factors: OR 16.31 (95% CI 5.53-48.12; p<0.05).

Conclusion: Stroke predominated in the male sex, over 60 years of age, married, with primary education. The most frequent risk factors were arterial hypertension, diabetes mellitus, and smoking. The most frequent type of stroke was ischemic. A relationship between risk factors and stroke was found.

Diabetic and hypertensive patients and chronic kidney disease in the Regional Hospital of Villarrica, Paraguay, period 2023-2024

Fernando Ariel Romero Paniagua — 2025-06-26

Introduction: Chronic kidney disease (CKD) includes different pathophysiological processes accompanied by abnormalities of renal function and progressive deterioration of the glomerular filtration rate. Hypertension and diabetes are among the main risk factors for CKD.

Objectives: To determine the frequency of chronic kidney disease in patients with hypertension and diabetes in the Villarrica Regional Hospital in 2023-2024.

Methods: An observational, descriptive, cross-sectional design with analytical component was applied in patients diagnosed with diabetes and/or hypertension. The variables studied were: sociodemographic, risk factor (diabetes, hypertension), KDIGO classification of CKD stages. Statistics were applied with the Epi Info 7™ program. The relationship between risk factors (independent variables) and CKD (dependent variable) was analyzed.

Results: Four hundred patients were included. Women predominated (57%), with an age range of 40-60 years, and 46% with a diagnosis of hypertension. The frequency of chronic kidney disease was 34%, with a predominance of KDIGO stages 1 and 2. Patients presenting both pathologies concomitantly had a higher risk of developing chronic kidney disease, OR 8.61 (95% CI 4.83-15.36) (p 0.0000001).

Conclusion: Female patients predominated, with an age range between 40 and 60 years. The frequency of chronic kidney disease according to the KDIGO-CKD scale was 34%, with the highest proportion corresponding to stages 1 and 2. There was a statistically significant relationship between the presence of diabetes and concomitant hypertension and the subsequent development of chronic kidney disease.

Stroke in young adults at a referral hospital in Paraguay

José Carlos Dávalos Ortiz — 2025-07-31

Introduction: Globally, there is an increase in the prevalence of stroke in young adults, with approximately 10 to 20% of ischemic strokes occurring in people aged 18 to 50 years.

Objective: To determine the clinical characteristics of young adult patients hospitalized for stroke at the National Medical Center, Hospital Nacional, Itauguá, Paraguay, in 2023.

Methodology: Observational, descriptive, cross-sectional study with consecutive case sampling. Patients aged 15 to 55 years hospitalized for ischemic and hemorrhagic stroke were included.

Results: One hundred twelve patients were included, with a mean age of 45.6±8.1 years; 52.7% were women. Of the total, 90.2% had at least one comorbidity, with hypertension found in 82.1%. Hemorrhagic stroke occurred in 66.1%. The average length of hospitalization was 23.3±19.1 days, with a mortality rate of 9.8%. Bivariate analysis showed an association between ischemic stroke and male sex (OR 2.2; p 0.045), history of stroke (OR 5.4; p 0.043), diabetes (OR 2.7; p 0.018), and heart failure (OR 19.4; p 0.012). Patients who died had a significantly shorter hospital stay than those who were discharged (4.7 ± 4.6 days vs. 25.3 ± 18.9 days; p < 0.001).

Conclusion: Females predominated, and hypertension was the most prevalent comorbidity. More than half had multiple comorbidities, and the overall mortality rate was 9.8%. Hemorrhagic stroke was the most common type. Male sex, history of stroke, and heart failure were risk factors for ischemic stroke. In addition, deceased patients had a significantly shorter length of stay. These findings emphasize the importance of controlling cardiovascular risk factors in young populations.

Internet addiction and academic achievement among university students in Latin America, 2024: a cross-sectional study

Angela Traba Daviccino — 2025-07-31

Introduction: Internet use is a common tool in the life of university students. However, excessive use can lead to addiction and have biopsychosocial consequences, including poor academic performance.
Objective: To relate internet use and the perception of academic performance in Latin American university students in 2024.
Materials and Methods: A cross-sectional, observational, and correlational design was employed. The study population consisted of university students of both sexes residing in Paraguay, Peru, and Cuba during 2024. The variables were measured using an online questionnaire. Internet use was calculated using Young KS’s Internet Addiction Test, and the perception of academic performance was measured using another 5-question test. The data were subjected to inferential statistics. The study was approved by the institutional ethics committee.
Results: Two hundred seventy-one subjects entered the study, 188 (69.4%) of whom were women with a median age of 19 years, and 83 (30.6%) were men with a median age of 20 years. They were from Peru, Paraguay, and Cuba. The most common degree program was medicine. The internet addiction test found that 82.66% had average internet use, 16.24% had problematic use, and 1.11% had addictive use. In addition, 30.6% of the subjects perceived themselves as having good academic performance, and 69.4% as having poor academic performance. When analyzing both variables, a significant association was found between the two (OR 2.45, CI 95% 1.09 – 5.5).
Conclusions: A significant correlation was detected between problematic and addictive internet use and poor academic performance. It is recommended to monitor excessive internet use among university students and to apply preventive measures and appropriate therapies to those affected, such as motivational interviews and cognitive-behavioral therapy, among others.

Nosocomial anemia: prevalence and clinical characteristics in adult patients

Angela Traba Daviccino — 2025-07-31

Introduction: Nosocomial anemia is defined as any decrease in hemoglobin during hospitalization, considering normal values upon admission. It is assumed that this phenomenon is not associated with objective blood loss.

Objective: To determine the prevalence of nosocomial anemia in adult patients

admitted to the Medical Clinic Service at a referral hospital in Asunción, Paraguay, between April and October 2023.

Methodology: An observational, cross-sectional design was used. The sample consisted of adult men and women. Demographic and clinical variables were measured. The variables were subjected to descriptive statistics.

Results: Forty-four men with a median age of 62 years and 45 women with a median age of 58 years were included in the study. The most frequent diagnoses were community-acquired pneumonia (26.9%), stroke (11.2%), and urinary infection (10.1%). Considering gender, the onset of nosocomial anemia was determined one week after admission in 73% of adult patients who were admitted with normal hematimetric values and in 46.2% of those who were already admitted with anemia. The number of phlebotomies was greater in subjects who developed anemia.

Discussion: The frequency of nosocomial anemia is high and seems to be associated with a high number of phlebotomies.

Conclusions: A decrease in hemoglobin of at least 2 g/dL during the first week of hospitalization was observed in 73% of subjects who were admitted with normal hematimetric values and in 46.2% of those who were already admitted with anemia. It is recommended to evaluate the number and necessity of the number of phlebotomies during hospitalization.

Chronic complications and comorbidities in patients with type 2 diabetes mellitus at the Hospital Regional de Villarrica, Paraguay, in the period 2023–2024

Fernando Ariel Romero Paniagua — 2025-08-14

Introduction: The chronic progression of diabetes mellitus promotes the development of complications such as cardiac, vascular, cerebral, or renal disease.

Objective: To determine the sociodemographic and clinical characteristics of type 2 diabetic patients who attend a diabetes program.

Materials and methods: An observational, descriptive, cross-sectional study was conducted. Adult patients diagnosed with diabetes at the Hospital Regional de Villarrica, Paraguay, were included in the study during the period 2023-2024. The complications and comorbidities presented by the patients were measured.

Results: Three hundred forty-eight patient medical records were processed, 62% were female, 49% were over 60 years of age, 54% had a primary education level, and 33% were married. The most frequent comorbidities were obesity (32%), high blood pressure (25%), and low HDL (16%). Chronic complications occurred in 45% of patients throughout their condition, the most frequent being chronic kidney disease (35%), ischemic heart disease (21%), and diabetic retinopathy (17%).

Conclusion: Females were the most affected, especially those over 60 years of age, with a primary education, and who were married. The most common comorbidities were high blood pressure, obesity, and dyslipidemia. Among chronic complications, the most common were kidney disease, followed by ischemic heart disease and diabetic retinopathy.

Correlation of platelet/spleen index as a predictive factor for esophageal varices in patients with liver cirrhosis

Victor Jonathan Vera Franco — 2025-08-21

Introduction: Liver cirrhosis is the most common cause of blood flow obstruction in the portal venous system. Variceal bleeding is a complication of cirrhosis that defines its decompensation.

Objective: To establish the correlation between the platelet/spleen index as a predictive factor for esophageal varices in patients with liver cirrhosis treated at the Luis Vernaza Hospital between January 2022 and December 2023.

Methodology: A retrospective case analysis design was applied. Population: 108 cases of adults with liver cirrhosis were included, with platelet analysis samples and abdominal ultrasound with spleen measurement. Data analysis: To determine whether the platelet/spleen ratio is a predictor of esophageal varices in cirrhotic patients, univariate and bivariate analyses were performed between the variables, yielding predictive power through logistic regression, with established statistical significance (p < 0.05).

Results: The cutoff point of the platelet/spleen index for predictive value was <909, with a p-value of 0.003, indicating a 3.78 times higher probability of presenting esophageal varices, which in turn increases the hospital stay. The average age was 64 years, with an equal distribution of sexes (50.93% women and 49.07% men), and the most common comorbidity was diabetes mellitus (33.64%). The Child-Pugh C scale was associated with a higher presence of esophageal varices.

Conclusions: The platelet/spleen index with a cutoff point of <909 predicts the presence of esophageal varices and prolongs hospital stay.

Therapeutic inertia in the management of hypertension in older adults: clinical implications

Cindy Julissa Carvajal Oviedo — 2025-03-27

Cardiovascular diseases continue to be the leading cause of morbidity and mortality in the world, generating a significant burden of disease in global health systems. Arterial hypertension (AHT) is one of the most prevalent cardiovascular disorders in the world, with more than 1 billion cases estimated globally. According to data from the World Health Organization, only 2 out of 10 people with HTN are under control, and one of the global health goals for 2030 is to reduce the prevalence of HTN by up to 33%. This may be caused by the omission to intensify drug therapy when necessary (therapeutic inertia). Therapeutic inertia is more frequent in patients at high risk of secondary or adverse events, such as older adults. It is believed that this could be a potential risk factor for cardiovascular outcomes, seeking a change in traditional algorithms and controversial paradigms. However, discrepancies persist in the literature regarding the approach to this topic. Considering its relevance and the need for evidence to meet global health goals, this review aimed to critically analyze the most recent evidence on therapeutic inertia in blood pressure control in older adults.

Monkeypox (Mpox) in men who have sex with men: a systematic review article

Carlos Miguel Rios-González — 2025-04-30

The monkeypox (Mpox) outbreak in 2022 disproportionately affected the men who have sex with men (MSM) community, characterized by anogenital lesions, proctitis, and lymphadenopathy. This article provides a systematic review based on studies published between January 2022 and November 2024, with a specific focus on the MSM population and their particular vulnerability to Mpox. It highlights that transmission in this group occurs mainly through intimate sexual contact, which requires adapting culturally sensitive and specific disease prevention and control strategies for this population. The stigma associated with Mpox and its relationship with the MSM community is a relevant obstacle that must be addressed to ensure equitable access to health services. It is concluded that although there are important advances in diagnosis, prevention, and treatment, significant gaps persist in vaccination coverage and the implementation of adequate education campaigns. For effective control of Mpox, it is essential to develop interventions free of prejudice that promote the integral health of the affected population.

Impact of mechanical ventilation in the management of severe traumatic brain injury: An updated review

Milagros Tatiana Jaco-Yupanqui — 2025-05-27

Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability, especially in young people, with a high social impact due to care costs and lost productivity. Mechanical ventilation (MV) is essential in treating patients with severe TBI. Still, its prolonged use in intensive care units (ICU) can lead to complications such as ventilator-associated pneumonia (VAP). This article reviews the impact of MV in severe TBI, analyzing management strategies, benefits, risks, and treatment options to improve the prognosis of these critical patients.
Methodology: A systematic review was performed by electronic search of studies indexed in “PubMed”, “Scielo”, and “Google Scholar”.
Results: Of the 42 articles found in the review, 30 were excluded because they did not meet the inclusion criteria or because they met some exclusion criteria, leaving 13 articles for this review.
Conclusions: MV is crucial in the management of severe TBI by providing essential respiratory support. However, its prolonged use increases the risk of complications such as VAPM and other pulmonary infections. An individualized approach and more prospective studies are needed to optimize management, prevent respiratory complications, and improve clinical outcomes.

Chromoblastomycosis due to Fonsecaea monophora

Elvis Javier Ibáñez Franco — 2025-01-16

Chromoblastomycosis is an implantation mycosis of worldwide distribution caused by saprophytic dematiaceous fungi, mainly from the genera Fonsecaea, Phialophora, Cladophialophora and Rhinocladiella. It manifests as slowly growing erythematous, scaly, verrucous plaques, especially on the extremities.

We present the case of a 61-year-old female patient who presented erythematous plaques on upper limbs that started after trauma.

The mycological study and pathological anatomy led to the diagnosis of chromoblastomycosis due to Fonsecaea, and molecular techniques identified Fonsecaea monophora, the first confirmed case of this species in our country.

She was treated with itraconazole 200 mg/day associated with cryotherapy, showing a good response.

Symptomatic myocardial bridging

Francisco Javier Suárez-Guzmán — 2025-01-16

Myocardial bridging (MB) is a frequent congenital anatomical alteration in which a coronary artery segment takes an intramyocardial pathway. A clinical case of a 56-year-old male athlete is presented who experienced sleep apnea syndrome, episodes of atrial fibrillation, dizziness on mild/moderate exertion, increased chest tightness and shortness of breath, diagnosed with angina concerning MB and milking effect. Its prevalence is estimated at more than 30% of the population. Although most patients are asymptomatic, they may experience exertional angina, acute coronary syndrome, cardiac arrhythmia, syncope, or sudden death. There is no gold standard diagnostic test and both invasive and non-invasive tests are used. The general practitioner should be familiar with these pathologies to take early and accurate action, given their possible lethal complications in case of delay or error in diagnosis.

Familial acne conglobata in indigenous population

Elvis Javier Ibáñez Franco — 2025-01-16

Acne conglobata is a severe form of acne that appears infrequently and may run in families. Timely treatment with specific therapy avoids sequelae such as scars and deformities that can occur with an erroneous or late diagnosis.

We present the cases of 2 twin brothers, from an ethnic group of native people of Paraguay, with onset of the disease at puberty, accompanied by other pathologies in the first case. Both received systemic treatment with antibiotics and retinoids, with good response until their second month of control.

Orbital cellulitis due to Neisseria sp in a patient with HIV and syphilis

Dalila Magdalena Benítez García — 2025-01-16

Orbital cellulitis is a serious infection of the periocular tissues that may be associated with complications such as abscesses or loss of vision. It is usually caused by common pathogens such as Staphylococcus aureus or Streptococcus spp. however, the involvement of Neisseria sp. is extremely rare. HIV, particularly with low CD4 count and high viral load, increases the risk of atypical infections, and coinfection with late latent syphilis may aggravate immunosuppression, facilitating opportunistic infections.

In this case report, we describe an HIV-positive patient with a diagnosis of late latent syphilis who develops orbital cellulitis secondary to Neisseria sp.

Acute generalized hydroxychloroquine-induced exanthematous pustulosis

Jaqueline Paola Tipas – Cuaspud — 2025-01-16

Acute generalized exanthematous pustulosis (AGEP) is an uncommon skin reaction characterized by the presence of sterile pustules on an erythematous base, generally associated with drugs. We present the case of a 56-year-old female patient who developed a dermatologic clinical picture consisting of pustular lesions on the scalp, face, extremities, and genitals, accompanied by pruritus and fever after 22 days of treatment with 200 mg/day of hydroxychloroquine for the management of Sjögren's syndrome. Initially, it was diagnosed as varicella. However, as the lesions and fever persisted, a dermatologic evaluation was performed which led to the diagnosis of hydroxychloroquine-induced AGEP.

Post -infectious acute cerebelitis in young patient

Cecilia Rosmary Méndez Fernández — 2025-01-16

The case of a 20-year-old male with a history of treated pulmonary tuberculosis is presented, who had headache, dizziness, and ataxia. Imaging studies and lumbar puncture were normal but among the serological studies, IgM antibody against Epstein-Barr viruses was positive, suggesting postinfectious cerebelitis. Bacterial infections were ruled out and the patient was treated with intravenous methylprednisolone, improving rapidly. He was discharged in stable condition with neurological follow-up.

Severe skin and soft tissue infection in a patient with metastatic Hodgkin lymphoma under palliative management

Jorge Andrés Hernández Navas — 2025-01-16

Severe skin and soft tissue infections are common complications in patients with Hodgkin lymphoma (HL), especially those in the advanced stages of the disease who are receiving palliative treatment. HL is a type of lymphoma characterized by the proliferation of abnormal lymphocytes, and its treatment, which includes chemotherapy and immunotherapy, involves significant immunosuppression, which increases the risk of infections. Infections can evolve rapidly in these patients and present atypical features, complicating diagnosis and management.

The objective of this report is to describe the case of a 73-year-old patient with metastatic HL on palliative treatment who developed a severe skin and soft tissue infection, which evidenced the challenge in the management of infections in immunocompromised patients. Despite receiving targeted antimicrobial therapy and surgical drainage, the patient presented a progressive clinical deterioration due to persistent infection and refractory sepsis, culminating in multiorgan failure. This case highlights the importance of a multidisciplinary approach that considers both antimicrobial management and comprehensive patient care, prioritizing symptomatic management and communication with family members in poor prognostic scenarios.

Advanced nasal neuroendocrine carcinoma: response to treatment and management of anemia in a palliative patient

Jorge Andrés Hernández — 2025-03-27

Advanced nasal neuroendocrine carcinoma is a rare malignant tumor originating in the nasal cavity and paranasal sinuses. It is characterized by its high aggressiveness and tends to present in advanced stages, with infiltration of underlying bone structures. Diagnosis is confirmed by biopsy and histology, which usually shows poor neuroendocrine differentiation. Treatment is usually multimodal, including chemotherapy, radiotherapy, and in some cases, surgery. Neoadjuvant chemotherapy with cisplatin and etoposide improves survival in these patients.

We present the case of a 54-year-old female patient with stage IV A nasal neuroendocrine carcinoma, in palliative treatment with chemotherapy based on cisplatin and etoposide, and management of associated iron deficiency anemia. The patient showed a positive response to treatment, with scheduled follow-up to monitor her hematologic status and adjust supportive treatment.

Granulomatosis with polyangiitis: an atypical presentation of a complex vasculitic disease

Jorge Andrés Hernández — 2025-04-30

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis that mainly affects small and medium-sized vessels, with clinical manifestations including pulmonary involvement. The lungs are one of the most involved organs, and typical lesions include cavitary nodules, infiltrates, and alveolar hemorrhage. Early diagnosis and proper management are essential to avoid serious complications.

We present the case of a 51-year-old female patient with a history of rheumatoid arthritis, fibromyalgia, Sjögren's syndrome, arterial hypertension, and latent tuberculosis. She presented with headache, polyuria, asthenia, and neuropsychiatric symptoms. A pituitary adenoma was identified by MRI and a cavitated lung lesion, possibly due to fungal superinfection or sequelae of tuberculosis. Hormonal profile showed hypothyroidism and adrenal insufficiency. The antineutrophil cytoplasmic antibodies (c-ANCA) result was 1:320. She received treatment with hydrocortisone, levothyroxine, desmopressin, and cyclophosphamide. The patient showed significant improvement, and outpatient follow-up with endocrinology and rheumatology was planned for therapeutic adjustments and control of comorbidities.

Primary adrenal insufficiency associated with systemic mycosis

Viviana Raquel Ruiz Cano — 2025-05-27

Primary adrenal insufficiency, or Addison's disease, is a rare and usually progressive disorder caused by hypoperfusion of the cortex. In the past, tuberculosis was considered the main infectious cause of this entity. However, at present, autoimmunity represents the main etiology.

We describe the case of a 50-year-old male patient with arterial hypertension and a history of pulmonary, lymph node, and meningeal tuberculosis, who completed his anti-bacillary treatment 7 years ago.

He presented with 2 months of vomiting with progression to oral intolerance, accompanied by weight loss and asthenia. Computed tomography showed irregular enlargement of both adrenals. A CT-guided biopsy was performed, and a histopathological study reported Histoplasma.

Pituitary apoplexy: sudden manifestation of a silent macroadenoma

Valeria Rosalba Valdez Martínez — 2025-06-26

Pituitary apoplexy is a rare neuroendocrine emergency, usually caused by hemorrhage or ischemia in a previously existing pituitary adenoma. This report presents the case of a 69-year-old male patient who, after being diagnosed with a silent pituitary macroadenoma without symptoms at onset, suddenly presented with a pituitary apoplexy. The clinical picture included severe headache, visual disturbance, and hormonal deficit. Despite the absence of relevant clinical manifestations before the event, the diagnosis was confirmed by neuroimaging studies and hormonal evaluation. The therapeutic approach, which included surgical intervention, enabled partial recovery of visual and hormonal function. This case highlights the importance of surveillance of patients with pituitary macroadenomas, even when they are clinically silent, as they can present acute and severe complications such as pituitary apoplexy.

Phytophotodermatitis: sun and lemon, a bad combination. Presentation of 4 cases

Regina Beatriz Espínola Espínola — 2025-06-26

Phytophotodermatitis is a condition caused by direct phototoxicity resulting from contact with botanical substances containing furocoumarins or psoralens. It is generally benign and self-limiting, although the lesion may persist for months. To prevent it, it is necessary to avoid contact with triggers and use sunscreen.

We present the cases of four adults who came to the clinic with skin lesions on different parts of the body, characteristic of phototoxicity induced by plant-based irritants.

Thrombolysis in ischemic stroke during the window period at the Ciudad del Este Regional Hospital of the Instituto de Previsión Social in 2023, Paraguay

Fabián Franco — 2025-07-17

A cerebrovascular accident (CVA) is a sudden-onset neurological emergency classified as ischemic (80% of cases) or hemorrhagic, with a high incidence in low- and middle-income countries. Risk factors include high blood pressure (the main modifiable factor), advanced age, diabetes mellitus, and male gender.

We present a clinical case of a 60-year-old man with ischemic stroke at the IPS Regional Hospital in Ciudad del Este, Paraguay, who was admitted with severe headache, right hemiplegia, dysarthria, and hypertension. Although he denied a history of hypertension, his type 2 diabetes mellitus and age placed him at high risk. Computed tomography ruled out hemorrhage, allowing the administration of alteplase (0.9 mg/kg) within the therapeutic window (0-3 hours), with notable improvement in neurological deficit.

Considering the high annual incidence of cases and the critical importance of timely treatment—which reduces mortality during the acute phase by 20% and disabling sequelae by 30%—the existing gap in care in our setting is alarming. This situation means that many patients do not receive therapeutic intervention, which, when applied appropriately as in this case, offers optimal results in terms of functional recovery and survival.

Uncommon coinfection: cerebral toxoplasmosis and neurosyphilis in an immunocompromised individual

Karina Raquel Acosta Colman — 2025-07-21

We present the case of a young adult patient diagnosed with HIV in 2017 who had not received treatment or medical follow-up. He was admitted to the emergency department due to tonic-clonic seizures. A series of laboratory and imaging studies were performed, and magnetic resonance imaging revealed lesions suggestive of cerebral toxoplasmosis. A lumbar puncture was performed, which yielded a reactive VDRL test result. During his hospital stay, he received specific treatment and was discharged in improved condition with follow-up by the infectious disease service.

Primary progressive multiple sclerosis in a young adult

Francisco Javier González — 2025-08-23

Multiple sclerosis is a condition known as the “disease with a thousand faces” due to the wide variety of clinical presentations it exhibits throughout its course. It is a disease that affects the central nervous system, causing demyelination of different areas of the nervous system, with symptoms depending on the specific area affected.

We present the clinical case of a 35-year-old male patient who was diagnosed with primary progressive MS after meeting the current diagnostic criteria. Despite treatment with natalizumab, indicated under the initial diagnosis of MS, the patient presented a gradual progression of his neurological deficit, which retrospectively allowed the identification of a primary progressive form of the disease.

The aim is to emphasize the need for physicians who are not specialists in clinical neurology to be able to recognize the neurological condition for correct referral to a trained professional, timely diagnosis, and early treatment.

ALK-negative anaplastic large cell lymphoma, primary presentation in the skin

Erika Ayelen Adorno Villalba — 2025-08-23

ALK-negative anaplastic large cell lymphoma with primary cutaneous presentation is part of the spectrum of CD30+ lymphoproliferative diseases, along with lymphomatoid papulosis. It is a rare entity, accounting for a minimal proportion of non-Hodgkin lymphomas.

We present the case of a 63-year-old male patient who consulted for the presence of multiple exophytic skin lesions with poorly defined edges and a tendency to coalesce, some with ulcerations and a necrotic center, which were painless. The lesions involved the extremities, trunk, and lower limbs. The patient did not present with fever, weight loss, or other systemic symptoms. Laboratory and imaging studies were normal. A skin biopsy with immunohistochemistry was performed on one of the lesions on the left forearm, where a diagnosis of ALK-negative anaplastic large cell lymphoma with primary presentation in the skin was made.

Calciphylaxis with fatal outcome in a patient undergoing chronic hemodialysis

Miguel Angel Montiel Alfonso — 2025-08-23

Calciphylaxis is a rare but devastating complication of end-stage renal disease (ESRD), especially in patients undergoing hemodialysis. It is characterized by calcification of the middle layer of the arteries, leading to ischemia, necrosis, and an increased risk of sepsis and death. We present the case of a 65-year-old woman with ESRD secondary to hypertensive nephropathy, on chronic hemodialysis, who developed extensive necrotic skin lesions on her lower limbs. Severe alterations in bone mineral metabolism were documented, including severe hyperparathyroidism, hypercalcemia, and hyperphosphatemia. The diagnosis of calciphylaxis was confirmed by biopsy. Despite planned medical and surgical treatment, the patient developed superinfection, vascular access thrombosis, pulmonary thromboembolism, sepsis, and death from multiple organ failure. This case illustrates the clinical aggressiveness of calciphylaxis, its difficult management, and the need for early, multidisciplinary intervention.

Urinary chromatic duality in an elderly adult with advanced bladder cancer: partial manifestation of purple urinary bag syndrome

Milagros Damián-Mucha — 2025-08-24

Purple urinary bag syndrome (PUBS) is a rare condition associated with chronic urinary tract infections in patients who use catheters, particularly older adults. We present the case of a 79-year-old woman with advanced bladder cancer and double urinary diversion (Bricker-type urostomy and right nephrostomy), who developed PUBS exclusively in the urostomy, showing a striking urinary chromatic duality. This observation suggests a predominant pathophysiological role of the bladder reservoir, influenced by the local microbiome, urinary pH, collection material, and exposure to oxygen. Urine culture isolated Escherichia coli, with a favorable response to ceftriaxone. This case broadens the understanding of PUBS from a geriatric, oncological, and microbiological perspective and proposes an in vivo model for studying the local factors that determine its expression. Recognizing this condition in palliative care allows for proportionate interventions, avoiding unnecessary treatments and prioritizing the comfort of the frail patient.

Alterations in the liver profile and other markers of asymptomatic patients who attend routine examinations in an urban area of Lima, Perú

Miguel Jesus Bardales Fierro — 2025-01-16

Señor Editor

Quisiéramos expresar nuestros comentarios sobre el artículo titulado Alteraciones en el perfil hepático y otros marcadores de pacientes asintomáticos que acuden a exámenes de rutina en un área urbana de Lima, Perú ⁽¹⁾. Este estudio evalúa biomarcadores hepáticos en pacientes asintomáticos y utiliza un corte de 40 años para dividir a la población en dos grupos. Aunque este criterio se justifica con la referencia de Izquierdo Martínez, quien describe la adultez media a partir de los 40 años desde un enfoque psicológico, considero que dicho corte etario podría no capturar de manera óptima los cambios fisiológicos graduales observados en biomarcadores como la bilirrubina, las transaminasas y la albúmina. Estos biomarcadores no necesariamente se ven afectados por una etapa específica en la adultez, sino por un proceso continuo de envejecimiento.

Respuesta a Carta al Editor

Quisiera agradecer y aceptar las valiosas sugerencias presentadas en la carta Alteraciones en el perfil hepático y otros marcadores de pacientes asintomáticos que acuden a exámenes de rutina en un área urbana de Lima, Perú. Aprecio profundamente los comentarios y las referencias adicionales proporcionadas, que sin duda enriquecen la discusión sobre la evaluación de biomarcadores hepáticos en pacientes asintomáticos.

Importance of epidemiology in the management of rheumatoid arthritis

Jhan Sebastian Saavedra Torres — 2025-04-30

To the Editor,

Reviewing the study entitled "Activity Level in Patients with Rheumatoid Arthritis at the National Hospital of Itauguá," published in the Rev Soc Parag Med Interna in 2020 (1), highlights its relevance for understanding rheumatoid arthritis (RA) activity. This analysis offers a detailed view of the status of outpatients, revealing that 45% have a moderate activity level and only 31% achieve remission. This research enriches the existing literature and underscores the need for more personalized approaches to disease management.

Artificial intelligence in rheumatology: advances, challenges and ethical considerations

Jorge Andrés Hernández — 2025-05-27

Señor Editor

La inteligencia artificial (IA) ha experimentado un crecimiento exponencial en la medicina en las últimas décadas, con aplicaciones que van desde el análisis automatizado de imágenes médicas hasta la predicción de respuestas terapéuticas en enfermedades crónicas. En el campo de la reumatología, esta revolución tecnológica está generando un impacto significativo al mejorar la precisión diagnóstica, optimizar la estratificación de riesgos y personalizar los tratamientos en pacientes con enfermedades autoinmunes. Sin embargo, junto con estos avances, emergen desafíos críticos en términos de interpretabilidad de los modelos, equidad en su aplicación y consideraciones éticas que requieren atención inmediata por parte de la comunidad médica y científica ^(1,2).

Association between the SERPINA1 gene and susceptibility to the development of COPD

Jorge Andrés Hernández Navas — 2025-08-23

La enfermedad pulmonar obstructiva crónica (EPOC) representa una de las principales causas de morbimortalidad en el mundo y, aunque el tabaquismo es ampliamente reconocido como su principal factor de riesgo, no todos los fumadores desarrollan la enfermedad, lo que sugiere la existencia de elementos genéticos moduladores de la susceptibilidad individual. En este contexto, el gen SERPINA1 ha emergido como uno de los determinantes más relevantes en la patogénesis de la EPOC, particularmente por su papel en la codificación de la alfa-1 antitripsina (AAT), una proteína inhibidora de la elastasa de neutrófilos.