ABSTRACT Introduction. This article summarizes the clinical practice guideline (CPG) for the diagnosis and treatment of women with symptomatic endometriosis in the Social Security of Peru (EsSalud). Objective. The aim is to offer evidence-based clinical recommendations for diagnosing and managing women with symptomatic endometriosis in EsSalud. Methods. A guideline development group (GEG), consisting of medical specialists and methodologists, was established to create this CPG. The GEG formulated six clinical questions that guided the development of the CPG. Systematic searches of systematic reviews and -where applicable- primary studies were carried out in PubMed and CENTRAL between December 2021 and February 2022. Relevant evidence was selected to address each clinical question. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Throughout the CPG development process, the GEG held regular meetings to assess the evidence and formulate recommendations, establish points of good clinical practice, and develop flowcharts. The CPG was formally approved through Resolution No. 62-IETSI-ESSALUD-2022. Results. The CPG addressed six clinical questions, categorized into two primary areas: the diagnosis and management of endometriosis. Based on these questions, eight recommendations were developed, comprising one strong recommendation and seven conditional ones. Additionally, 21 good clinical practice points and two flowcharts were created. Conclusion. This article outlines the methodology and evidence-based conclusions of the CPG for the diagnosis and treatment of women with symptomatic endometriosis in EsSalud.

RESUMEN Introducción. Este artículo sintetiza la guía de práctica clínica (GPC) para el diagnóstico y tratamiento de mujeres con endometriosis sintomática en el Seguro Social del Perú (EsSalud). Objetivo. Proporcionar recomendaciones clínicas fundamentadas en la evidencia para el diagnóstico y tratamiento de mujeres con endometriosis sintomática en EsSalud. Métodos. Se constituyó un grupo elaborador de la guía (GEG), compuesto por médicos especialistas y metodólogos. Este GEG formuló seis preguntas clínicas que la GPC debía responder. Se realizaron búsquedas sistemáticas de revisiones sistemáticas y, cuando fue necesario, estudios primarios en las bases de datos PubMed y CENTRAL entre diciembre de 2021 y febrero de 2022. La evidencia relevante se seleccionó para responder a cada una de las preguntas clínicas planteadas. La certeza de la evidencia se evaluó utilizando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Durante reuniones regulares, el GEG empleó esta metodología para revisar la evidencia y desarrollar las recomendaciones, las buenas prácticas clínicas, y los flujogramas. La GPC fue finalmente aprobada mediante la Resolución N° 62-IETSI-ESSALUD-2022. Resultados. Esta GPC respondió a seis preguntas clínicas, distribuidas en dos áreas: diagnóstico y manejo de la endometriosis. A partir de estas preguntas, se elaboraron ocho recomendaciones (una fuerte y siete condicionales), 21 buenas prácticas clínicas, y dos flujogramas. Conclusión. Este artículo presenta un resumen de la metodología y las conclusiones basadas en la evidencia de la GPC para el diagnóstico y tratamiento de mujeres con endometriosis sintomática en EsSalud.

ABSTRACT Introduction. This article provides an overview of the clinical practice guideline (CPG) for breast cancer screening in the Social Security of Peru (EsSalud). Objective. To offer evidence-based clinical recommendations for breast cancer screening within EsSalud. Methods. The CPG for breast cancer screening was developed by establishing a guideline development group (local GDG) consisting of medical specialists and methodologists. The local GDG formulated 5 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and, when it was considered pertinent, primary studies were conducted in Pubmed and Cochrane CENTRAL during 2022. The evidence to answer each of the posed clinical questions was selected. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and the flowchart of screening Finally, the CPG was approved with Resolution No. 68-IETSI-ESSALUD-2022. Results. The CPG examined 5 clinical questions related to physical examination and diagnostic imaging for breast cancer screening. This led to the development of 8 recommendations (2 strong and 6 conditional), 7 best practice points, and 1 flowchart. Conclusion. This article outlines the methodology and evidence-based findings of the CPG for breast cancer screening at EsSalud.

RESUMEN Introducción. Este artículo presenta un resumen de la guía de práctica clínica (GPC) para el tamizaje de cáncer de mama en el Seguro Social del Perú (EsSalud). Objetivo. Brindar recomendaciones clínicas fundamentadas en la evidencia para el tamizaje de cáncer de mama en EsSalud. Métodos. Se conformó un grupo elaborador de la guía (GEG) compuesto por especialistas médicos y metodólogos. El GEG formuló 5 preguntas clínicas a ser respondidas en esta GPC. Durante 2022, se realizaron búsquedas sistemáticas de revisiones sistemáticas y, cuando fue necesario, de estudios primarios en PubMed y Cochrane CENTRAL. La evidencia fue seleccionada para responder cada una de las preguntas. La certeza de la evidencia fue evaluada mediante la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones periódicas, el GEG utilizó la metodología GRADE para revisar la evidencia y desarrollar las recomendaciones, puntos de buenas prácticas clínicas y el flujograma de tamizaje. La GPC fue aprobada mediante la Resolución N° 98-IETSI-ESSALUD-2022. Resultados. Esta GPC abordó 5 preguntas clínicas relacionadas con el examen físico y el uso de métodos de diagnóstico por imágenes para el tamizaje de cáncer de mama, resultando en la formulación de 8 recomendaciones (2 fuertes y 6 condicionales), 7 puntos de buenas prácticas clínicas, y un flujograma. Conclusión. Este artículo resume la metodología empleada y los hallazgos basados en evidencia de la GPC para el tamizaje de cáncer de mama en EsSalud.

RESUMEN Describir los efectos del parche de lidocaína al 5 % en el alivio sintomático de pacientes peruanos con neuralgia posherpética Reporte de una serie de casos de pacientes adultos con neuralgia posherpética, admitidos y tratados en el Hospital Central de la Fuerza Aérea de Lima, Perú. El alivio sintomático del dolor por neuralgia posherpética fue definido como la diferencia entre la puntuación del dolor especificado antes y después del tratamiento con el parche. La puntuación fue evaluada mediante la escala visual analógica y la escala Pain Assessment in Advanced Dementia para los pacientes con demencia. Se recolectaron 22 casos de pacientes con neuralgia posherpética (edad media de 74,4 ( 12,40 años), 17 de los cuales iniciaron la terapia tópica con lidocaína luego del tratamiento sistémico por vía oral. Las principales razones para el cambio fueron dolor persistente y efectos adversos de la terapia precedente. Se observó una disminución estadísticamente significativa del dolor y de los síntomas colaterales después del uso del parche de lidocaína (p < 0,01). No se reportó reacción adversa alguna al final del seguimiento. Se encontró reducción estadísticamente significativa del dolor posterior al inicio del tratamiento tópico. Se sugiere realizar nuevos estudios que superen las limitaciones de este y de otros previamente publicados.

ABSTRACT To describe the effects of the 5% lidocaine patch on the symptomatic relief of Peruvian patients with postherpetic neuralgia. Case series report of adult patients with post-herpetic neuralgia admitted to and treated at the Air Force Central Hospital in Lima. Symptomatic relief was defined as the difference between the specified pain score before and after patch treatment. The pain score was evaluated by the visual analogue scale and the Pain Assessment in Advanced Dementia scale, for patients with dementia. Twenty-two patients with postherpetic neuralgia (mean age 74.4 ( 12.40 years) were recruited, 17 of whom began topical therapy with lidocaine following oral systemic treatment. The main reasons for the decision to change were a persistent pain and the adverse effects of the preceding therapy. A statistically significant decrease in pain symptoms was observed after the use of the lidocaine patch (p<0.01), and no adverse reactions to the patch were reported during the follow-up period. A statistically significant pain reduction found after the use of topical treatment. New studies that overcome the limitations of this and others previously published, are suggested.

ABSTRACT Introduction: This article summarizes the clinical practice guide (CPG) for the surgical management of obesity in adults in the Social Security of Peru (EsSalud). Objective: To provide clinical recommendations based on evidence for the surgical management of patients with obesity in EsSalud. Methods: A CPG for the surgical managmente of patients with obesity in EsSalud was developed. To this end, a guideline development group (local GDG) was established, including medical specialists and methodologists. The local GDG formulated 7 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when it was considered pertinent- primary studies were conducted in Medline and CENTRAL during 2019. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and the flowchart identification of patients with indication for bariatric / metabolic surgery and selection of the type of surgical intervention. The flowchart was designed in the final phase or last meeting based on the recommendations made previously. Finally, the CPG was approved with Resolution No. 115 - IETSI - ESSALUD - 2020. Results: This CPG addressed 7 clinical questions, divided into topics of surgical management of patients with obesity. Based on these questions, 6 recommendations were formulated (3 strong and 3 conditional), 18 BPC, and 2 flow charts. Conclusion: This article summarizes the methodology, recommendations based on evidence, and the points of good clinical practice from the CPG for the surgical management of obesity in EsSalud.

RESUMEN Introducción: El presente artículo resume la guía de práctica clínica (GPC) para el manejo quirúrgico de la obesidad en adultos en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el manejo quirúrgico de la obesidad en adultos en EsSalud. Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 7 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios en Medline y CENTRAL durante el 2019. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas. El flujograma fue diseñado en la fase final o última reunión en base a las recomendaciones formuladas previamente. Finalmente, la GPC fue aprobada con Resolución N° 115 - IETSI - ESSALUD - 2020. Resultados: La presente GPC abordó 7 preguntas clínicas, divididas en a temas de manejo quirúrgico de pacientes con obesidad. En base a dichas preguntas se formularon 6 recomendaciones (3 fuertes y 3 condicionales), 18 BPC, y 2 flujogramas. Conclusión: El presente artículo resume la metodología, las recomendaciones basadas en evidencias, y los puntos de buena práctica clínica de la GPC para manejo quirúrgico de la obesidad en adultos en EsSalud.

Abstract Introduction: Rheumatoid Arthritis (RA) has adverse health consequences, its early diagnosis and optimal management require recommendations based on high quality evidence adapted to each health system. Objective: To provide evidence-based clinical recommendations for the diagnosis and initial management of RA. Methods: A Guideline Development Group (GDG) was established, including medical specialists and methodologists. The GDG formulated 10 clinical questions to be answered by this CPG. Systematic searches of published evidence in PubMed and CENTRAL were performed during December 2017 and July 2019 (including systematic reviews and -when it was considered pertinent- primary studies) were conducted. The evidence of the highest quality for answering each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology which was used in periodic work meetings by the GDG to review the evidence and formulate the recommendations, points of good clinical practice, and flowcharts. Finally, the CPG was approved with Resolution N° 132 - IETSI - ESSALUD - 2019. Results: This CPG addressed 10 clinical questions, divided into two topics: diagnosis and management. Based on these questions, 16 recommendations (5 strong and 11 weak), 28 points of good clinical practice, and 3 flowcharts were formulated. Conclusion: This article summarizes the methodology and evidence-based conclusions from the CPG for the diagnosis and initial management of RA in EsSalud.

Resumen Introducción: La Artritis Reumatoide (AR) tiene adversas consecuencias en la salud su diagnóstico temprano y manejo óptimo requiere recomendaciones basadas en evidencia de alta calidad adaptadas a cada sistema de salud. Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el diagnóstico y manejo inicial de la AR. Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 10 preguntas clínicas a ser respondidas por la presente GPC. Se realizaron búsquedas sistemáticas de la evidencia publicada en PubMed y CENTRAL entre diciembre 2017 a julio 2019 (revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios). Se seleccionó la evidencia de mayor calidad para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE) y en reuniones de trabajo periódicas, el GEG usó dicha metodología para revisar la evidencia y formular las recomendaciones, los puntos de buena práctica clínica y los flujogramas. Finalmente, la GPC fue aprobada con Resolución N° 132 - IETSI - ESSALUD - 2019. Resultados: La presente GPC abordó 10 preguntas clínicas, divididas en dos temas: diagnóstico y manejo. En base a dichas preguntas se formularon 16 recomendaciones (5 fuertes y 11 condicionales), 45 puntos de buena práctica clínica, y 3 flujogramas. Conclusión: El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el diagnóstico y manejo inicial de la AR en EsSalud.

RESUMEN Introducción: El presente artículo resume la guía de práctica clínica (GPC) para el diagnóstico y tratamiento de la infección crónica por el virus de Hepatitis C en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el diagnóstico y tratamiento de la infección crónica por el virus de Hepatitis C en EsSalud. Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas y metodólogos. El GEG formuló 4 preguntas clínicas. Se realizó búsquedas sistemáticas de revisiones sistemáticas y estudios primarios en PubMed y Central de Cochrane durante el 2019. Se seleccionó la evidencia para responder a las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). El GEG usó la metodología GRADE para revisar la evidencia y formular recomendaciones, los puntos de buena práctica clínica y el flujograma de tratamiento. Finalmente, la GPC fue aprobada con Resolución N° 151-IETSI-ESSALUD-2019. Resultados: La presente GPC abordó 4 preguntas clínicas, divididas en cuatro temas: tamizaje, diagnóstico, estadiaje y tratamiento. En base a estas preguntas se formularon 13 recomendaciones (8 fuertes y 5 condicionales), 27 puntos de buena práctica clínica y 1 flujograma de manejo. Conclusión: El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el diagnóstico y tratamiento de la infección crónica por el virus de Hepatitis C en EsSalud.

RESUMEN Introduction: This article summarizes the clinical practice guidelines (CPG) for the diagnosis and treatment of chronic infection of hepatitis viral C of the Peruvian Health Social Security (EsSalud). Objective: To provide clinical recommendations based on evidence for the diagnosis and treatment of chronic infection of hepatitis viral C in EsSalud. Methods: A guideline development group (GDG) was established, including medical specialists and methodologists. The GDG formulated 4 clinical questions to be answered in this CPG. Systematic searches of systematic reviews and primary studies (when pertinent) were conducted in PubMed, and Central (Cochrane) during 2019. The evidence was selected to answer each of the clinical questions. The accuracy of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice and the treatment flowchart. Finally, the CPG was approved with Resolution No. 151-IETSIESSALUD-2019. Results: The present CPG addressed 4 clinical questions of four topics: screening, diagnosis, staging and treatment. Based on these questions, 13 recommendations (8 strong recommendations and 5 weak recommendations), 27 points of good clinical practice, and 1 flowchart were formulated. Conclusion: This paper summarizes the methodology and evidencebased conclusions from the CPG for for the diagnosis and treatment of chronic infection of hepatitis viral C of the EsSalud.

ABSTRACT Objective: To describe the prevention and control practices for the infection to SARS-COV2 in the Peruvian population. Methods: Observational descriptive study. We evaluated a non-probabilistic sample of adult residents in some departments of Peru. Preventive practices were evaluated in people without a history of COVID-19 and control practices in people who had suffered it. Results: We evaluated 3630 Peruvians (mean age 25.4 ± 9.5), of that 3231 don’t have a history of COVID-19 and 399 who had suffered it. The prevention and control practices that were realized often or always, with more frequencies, was the use of a mask when they go out home (97.9% vs 87.7), cover their nose or mouth when they sneeze (95.4% vs 89.9%), save the distance to other people in the street (91.4% vs 74.7%), wash their hands when they came home (92.5% vs 88.7%), and disinfect the objects and personal places (82.6% vs 77.4%). The 22.1% and 83.7%, the 59.7% and 80.2, and the 8.0% and 16.8% consumed some type of medicine, medicinal plant, and chlorine dioxide to prevent and control the infection, respectively. Conclusion In general, less than 50% of the participants performed prevention and control practices against COVID-19 often or always.

RESUMEN Objetivo: Describir las prácticas de prevención y control para la infección por SARS-CoV2 en la población peruana. Métodos: Estudio observacional de tipo descriptivo. Se evaluó una muestra no probabilística de adultos residentes en algún departamento de Perú. Las prácticas preventivas fueron evaluadas en personas sin antecedente de COVID-19 y las prácticas de control en personas que lo habían padecido. Resultados: Se evaluó un total de 3630 peruanos (edad media 25,4 ± 9,5) de los cuales el 3231 no indicaban el antecedente de COVID-19 y 399 refirieron haberlo padecido. Las medidas de prevención y control que se realizaron a menudo o siempre con mayor frecuencia fueron el utilizar mascarilla al salir de casa (97,9% vs 87,7), cubrirse su nariz y boca al estornudar o toser (95,4% vs 89,9%), guardar distancia de los demás en la calle (91,4% vs 74,7%), realizar el lavado de manos con agua y jabón al volver a casa (92,5% vs 88,7%), y desinfectar las superficies de objetos y lugares personales (82,6% vs 77,4%). El 22,1% y 83,7%, el 59,7% y 80,2, y el 8,0% y 16,8% consumieron algún tipo de medicamento, planta medicinal y dióxido de cloro para la prevención y control de la infección de COVID-19, respectivamente. Conclusiones En general, menos del 50% de los participantes realizaron prácticas de prevención y control frente a la COVID-19 a menudo o siempre.

ABSTRACT With the objective of analyzing the scientific contribution of measles publications and graphing the collaboration networks between countries during the last 20 years. A bibliometric study was conducted between 1999 and 2018 of journals indexed in Scopus. Annual production data were analyzed and a co-occurrence analysis of production and collaboration between countries using VOSviewer was plotted. 587 documents were registered between 1999 and 2018, with a steady trend, the average of annual publications was 29 documents (range 1-44), being 72.4% were original articles. The countries of Brazil (53.3%) and Mexico (17.5%) had greater productivity and collaboration mainly with the United States and the United Kingdom. Measles research in Latin America presents a stationary trend. Brazil and Mexico were the countries with more publications and have greater networks of scientific collaboration with the United States and the United Kingdom.

RESUMEN Con el objetivo de analizar la contribución científica de las publicaciones sobre sarampión y representar gráficamente las redes de colaboración entre países durante los últimos 20 años, se realizó un estudio bibliométrico entre 1999 y 2018 de revistas indexadas en Scopus. Se analizaron datos de producción anual y se representó gráficamente un análisis de co-ocurrencia de producción y colaboración entre países utilizando VOSviewer. Se registraron 587 documentos entre los 1999 y 2018, con tendencia estacionaria; el promedio de publicaciones anual fue de 29 documentos (rango 13-44), siendo el 72,4 % artículos originales. Los países Brasil (53,3 %) y México (17,5 %) tuvieron mayor productividad y colaboración, principalmente con Estados Unidos y Reino Unido. La investigación sobre sarampión en Latinoamérica presenta una tendencia estacionaria. Brasil y México fueron los países con más publicaciones y tienen mayores redes de colaboración científica con Estados Unidos y Reino Unido.

RESUMEN Introducción: Los médicos residentes que laboran más horas diarias son propensos a sufrir problemas de salud mental como la depresión, tema que se ha estudiado poco. Por ello, el presente estudio tiene por objetivos determinar la prevalencia de los síntomas depresivos y evaluar la asociación entre el número de horas diarias laboradas y la presencia de síntomas depresivos en residentes del Perú. Métodos: Estudio transversal analítico que usó la base de datos de la Encuesta Nacional para Médicos Residentes-2016, una encuesta voluntaria realizada virtualmente por el Consejo Nacional de Residentado Médico de Perú a médicos que realizaban su residencia en este país. Se consideró presencia de síntomas depresivos una puntuación ≥ 3 con la escala Patient Health Questionnaire-2. Las horas laboradas diariamente se tomaron mediante una pregunta directa. Para evaluar la asociación de interés, se calcularon razones de prevalencia (RP) y sus intervalos de confianza del 95% (IC95%) usando regresiones de Poisson brutas y ajustadas con varianza robusta. Resultados: Se evaluaron las respuestas de 953 residentes (el 41,3% mujeres; media de edad, 32,5 arios), de los que el 14,6% tenía síntomas depresivos. En el análisis ajustado, se encontró que la prevalencia de síntomas depresivos aumentaba por cada hora laborada adicional (RP = 1,11; IC95%, 1,04-1,17). Conclusiones: Uno de cada 7 residentes presentó síntomas depresivos. Por cada hora laborada diariamente extra, la frecuencia de síntomas depresivos aumentó un 11%.

ABSTRACT Introduction: Resident physicians who work more hours a day are prone to suffer mental health problems such as depression, a subject that has been little studied. In this regard, the aim of this study was to determine the prevalence of depressive symptoms and to evaluate the association between the number of daily working hours and depressive symptoms in Peruvian residents. Methods: Analytical cross-sectional study that used the database of the National Survey for Resident Physicians-2016, a voluntary survey issued virtually by the National Council of Medical Residency of Peru to physicians who were undertaking their residency in Peru. The presence of depressive symptoms was considered as having obtained a score ≥3 with the Patient Health Questionnaire-2 scale. The number of hours worked each day was collected through a direct question. To assess the association of interest, prevalence ratios (PR) and their 95% confidence intervals (95% CI) were calculated using crude and adjusted Poisson regressions with robust variance. Results: The responses of 953 residents (41.3% women, mean age: 32.5 years) were evaluated, 14.6% of which presented depressive symptoms. In the adjusted analysis, it was found that the prevalence of depressive symptoms increased for each additional hour worked (PR = 1.11; 95% CI, 1.04-1.17). Conclusions: One in seven residents had depressive symptoms. For every extra daily working hour, the frequency of depressive symptoms increased by 11%.

RESUMEN El presente artículo resume recomendaciones clínicas basadas en evidencia para la evaluación y el manejo de pacientes con Leucemia Linfoblástica Aguda (LLA) en EsSalud. Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 8 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios en PubMed y CENTRAL durante el 2019. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y el flujograma de evaluación y manejo. La presente GPC abordó 8 preguntas clínicas, divididas en cuatro temas: diagnóstico, medidas generales, manejo quimioterápico de LLA, y trasplante. En base a dichas preguntas se formuló 5 recomendaciones (3 recomendaciones fuertes y 2 recomendaciones condicionales), 20 puntos de buena práctica clínica, y 3 flujogramas.

ABSTRACT This paper summarizes the evidence-based clinical recommendations for the assessment and management of patients with acute lymphoblastic leukemia (ALL) in Peruvian Social Security (EsSalud). A guide writing team (GWT) was convened, which included specialized physicians and methodologists. The GWT asked 8 clinical questions to be responded by the Clinical Practice Guidelines (CPG). Detailed searches of systematic reviews and - when it was considered as pertinent - primary studied featured in PubMed and CENTRAL during 2019 were performed. Evidence for responding each of the proposed clinical questions was selected. Certainty of the evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In scheduled workshops, the GWT used the GRADE methodology for reviewing the evidence and propose recommendations, the points for good clinical practice, and the assessment and management flowcharts. This CPG worked on 8 clinical questions, which were divided in 4 topics: diagnosis, general measures, chemotherapy management for ALL, and transplantation. On the basis of these questions, 5 recommendations were formulated (3 strong recommendations and 2 conditional recommendations), 20 points for good clinical practice, and 3 flow charts.

RESUMO: Objetivo: Determinar a associação entre a discriminação percebida e o recebimento de tratamento adequado para doenças crônicas em migrantes venezuelanos. Métodos: Foi realizado um estudo transversal. Esta é uma análise secundária da pesquisa nacional Venezuelan Population Residing in the Country Survey do Peru. A associação entre discriminação percebida e receber tratamento adequado para doenças crônicas foi avaliada por meio de um modelo de regressão de Poisson, considerando o efeito ajustado da amostra em múltiplos estágios. Resultados: Foram avaliados 865 migrantes (idade: 36,6 ± 0,7 anos e 58,2% mulheres). Destes, 54,8% perceberam discriminação e 89,2% não receberam tratamento para a doença crônica. A discriminação percebida foi significativamente associada à menor prevalência de receber adequado tratamento para doenças crônicas (razão de prevalência ajustada — RPa = 0,49, intervalo de confiança de 95% — IC95% 0,25 – 0,97). Conclusão: Este estudo mostrou que a discriminação percebida diminui a prevalência de receber adequado tratamento para doenças crônicas em 50%, em comparação com aqueles que não percebem a discriminação.

ABSTRACT: Objective: To determine the association between perceived discrimination and receiving adequate treatment for chronic diseases in Venezuelan migrants. Methodology: A cross-sectional study was performed. This is a secondary analysis of the ENPOVE national survey from Peru. The association between the perceived discrimination and receiving adequate treatment for chronic diseases was evaluated using a Poisson regression model, considering the adjusted effect of the multistage sampling. Results: A total of 865 migrants were evaluated (age: 36.6 ± 0.7 years and 58.2% women). Of these, 54.8% perceived discrimination, and 89.2% did not receive adequate treatment for chronic diseases. Perceived discrimination was significantly associated with a lower prevalence of receiving adequate treatment for chronic diseases (PRa = 0.49; 95%CI 0.25 – 0.97). Conclusion: This study evidenced that perceived discrimination decreases the prevalence of receiving adequate treatment for chronic diseases by approximately 50% compared with those who did not perceive discrimination.

RESUMO: Objetivo: Determinar a associação entre a discriminação percebida e o recebimento de tratamento adequado para doenças crônicas em migrantes venezuelanos. Métodos: Foi realizado um estudo transversal. Esta é uma análise secundária da pesquisa nacional Venezuelan Population Residing in the Country Survey do Peru. A associação entre discriminação percebida e receber tratamento adequado para doenças crônicas foi avaliada por meio de um modelo de regressão de Poisson, considerando o efeito ajustado da amostra em múltiplos estágios. Resultados: Foram avaliados 865 migrantes (idade: 36,6 ± 0,7 anos e 58,2% mulheres). Destes, 54,8% perceberam discriminação e 89,2% não receberam tratamento para a doença crônica. A discriminação percebida foi significativamente associada à menor prevalência de receber adequado tratamento para doenças crônicas (razão de prevalência ajustada — RPa = 0,49, intervalo de confiança de 95% — IC95% 0,25 – 0,97). Conclusão: Este estudo mostrou que a discriminação percebida diminui a prevalência de receber adequado tratamento para doenças crônicas em 50%, em comparação com aqueles que não percebem a discriminação.

ABSTRACT: Objective: To determine the association between perceived discrimination and receiving adequate treatment for chronic diseases in Venezuelan migrants. Methodology: A cross-sectional study was performed. This is a secondary analysis of the ENPOVE national survey from Peru. The association between the perceived discrimination and receiving adequate treatment for chronic diseases was evaluated using a Poisson regression model, considering the adjusted effect of the multistage sampling. Results: A total of 865 migrants were evaluated (age: 36.6 ± 0.7 years and 58.2% women). Of these, 54.8% perceived discrimination, and 89.2% did not receive adequate treatment for chronic diseases. Perceived discrimination was significantly associated with a lower prevalence of receiving adequate treatment for chronic diseases (PRa = 0.49; 95%CI 0.25 – 0.97). Conclusion: This study evidenced that perceived discrimination decreases the prevalence of receiving adequate treatment for chronic diseases by approximately 50% compared with those who did not perceive discrimination.

ABSTRACT This paper summarizes the clinical practice guide (CPG) for the screening and management of mild depressive episode at the first level of care in the Social Security of Peru (EsSalud). A guideline development group (GDG) was established for develop this CPG, which included clinical and methodology specialists, who formulated 06 clinical questions. Systematic searches were conducted in Pubmed and GPC repositories to answer each question, and relevant evidence was selected. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GDG used the GRADE methodology for reviewing the evidence and for developing recommendations. At the end, this CPG formulated 07 recommendations (03 strong and 04 conditional), 28 points of good clinical practice, and 02 flow charts were formulated.

RESUMEN El presente artículo resume la guía de práctica clínica (GPC) para el tamizaje y el manejo del episodio depresivo leve en el primer nivel de atención en el Seguro Social del Perú (EsSalud). Para el desarrollo de esta GPC, se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas clínicos y metodólogos, el cual formuló 06 preguntas clínicas. Para responder cada pregunta se realizó búsquedas sistemáticas en PubMed y en repositorios de GPC, y se seleccionó la evidencia pertinente. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones periódicas, el GEG usó la metodología GRADE para revisar la evidencia y emitir las recomendaciones. Se emitieron siete recomendaciones (tres fuertes y cuatro condicionales), 28 puntos de buena práctica clínica, y dos flujogramas.

Abstract Lymphangioma is a rare and understudied pathology that is usually detected in the first decade of life, and its appearance in adults is rare. This report details a 51-year-old man with morbid obesity who presented, for the last eight months, multiple asymmetric tumor lesions with extension to the scrotal region. The diagnosis of circumscribed lymphangioma with associated infection was confirmed. This case report demonstrates an unusual presentation of the characteristics of the lymphangioma that are seldom described in the literature.

ABSTRACT Acute appendicitis is the most common pathology from acute abdomen during pregnancy, which has a difficult diagnosis because of the physiological changes during pregnancy which results in confusing clinical presentations. We reported the case of a multiparous woman of 27 years with 22 3/7 weeks diagnosed with acute appendicitis, undergoing surgery without complications and with a necrosed appendix that was evidenced through pathological examination. It is important to emphasis the role of the anamnesis with the physical examination guided by the physiological pregnancy changes related to the appendix. A timely diagnosis and treatment with an interdisciplinary approach would significantly reduce the maternal-fetal risks related to this pathology, the appendix removal and the continuation of the pregnancy.

RESUMEN La apendicitis aguda es una patología de abdomen agudo quirúrgico frecuente en el embarazo, siendo de difícil diagnóstico debido a los cambios fisiológicos del embarazo que ocasionan cuadros clínicos confusos. Reportamos el caso de una gran multigesta de 27 años de 22 semanas 3/7 en el cual se diagnosticó clínicamente apendicitis aguda, siendo intervenida quirúrgicamente sin complicaciones, encontrándose un apéndice necrosado corroborado posteriormente con anatomía patológica. Es importante enfatizar el rol de la anamnesis dirigida aunado al examen clínico orientado por los cambios fisiológicos del embarazo. Un diagnóstico oportuno junto al manejo interdisciplinario permitirá reducir significativamente los riesgos materno y fetales relacionados a esta patología, y tanto la extirpación del apéndice como la continuación del embarazo.