ABSTRACT The objective of the study was to describe the medical interns’ (MI) perceptions about the internship suspension during the COVID-19 quarantine in Peru. A cross-sectional descriptive study was conducted by means of a virtual survey regarding the perception of the internship suspension, return conditions and academic activities during quarantine. A total of 353 MIs participated in the study; 54.9% agreed or totally agreed with returning to their hospital sites if biosecurity measures were guaranteed, more than 90% felt uncertain about the restart and end dates, and 85.6% participated in academic virtual classes. It is concluded that the intention to return to the hospital increases when biosecurity measures are guaranteed. Hospitals should guarantee these measures and ensure health coverage for the MIs, if their return to hospitals is intended.

RESUMEN El objetivo del estudio fue describir las percepciones de los internos de medicina (IM) sobre la suspensión del internado durante la cuarentena por la COVID-19 en el Perú. Se realizó un estudio descriptivo transversal mediante una encuesta virtual sobre la percepción de la suspensión del internado, las condiciones de retorno y las actividades académicas durante la cuarentena. Participaron en el estudio 353IM, el 54,9% estuvo de acuerdo o totalmente de acuerdo con retornar a sus sedes hospitalarias si se garantizaban las medidas de bioseguridad; más del 90% sentía incertidumbre sobre la fecha de reinicio y el fin de internado, y el 85,6% participaba de clases virtuales académicas. Se concluye que la intención de volver al internado aumenta cuando se garantizan las medidas de bioseguridad. Las sedes hospitalarias deberían garantizar estas medidas y la cobertura de salud de los IM si se propone su retorno a los hospitales.

ABSTRACT The objective of the study was to describe the medical interns’ (MI) perceptions about the internship suspension during the COVID-19 quarantine in Peru. A cross-sectional descriptive study was conducted by means of a virtual survey regarding the perception of the internship suspension, return conditions and academic activities during quarantine. A total of 353 MIs participated in the study; 54.9% agreed or totally agreed with returning to their hospital sites if biosecurity measures were guaranteed, more than 90% felt uncertain about the restart and end dates, and 85.6% participated in academic virtual classes. It is concluded that the intention to return to the hospital increases when biosecurity measures are guaranteed. Hospitals should guarantee these measures and ensure health coverage for the MIs, if their return to hospitals is intended.

RESUMEN El objetivo del estudio fue describir las percepciones de los internos de medicina (IM) sobre la suspensión del internado durante la cuarentena por la COVID-19 en el Perú. Se realizó un estudio descriptivo transversal mediante una encuesta virtual sobre la percepción de la suspensión del internado, las condiciones de retorno y las actividades académicas durante la cuarentena. Participaron en el estudio 353IM, el 54,9% estuvo de acuerdo o totalmente de acuerdo con retornar a sus sedes hospitalarias si se garantizaban las medidas de bioseguridad; más del 90% sentía incertidumbre sobre la fecha de reinicio y el fin de internado, y el 85,6% participaba de clases virtuales académicas. Se concluye que la intención de volver al internado aumenta cuando se garantizan las medidas de bioseguridad. Las sedes hospitalarias deberían garantizar estas medidas y la cobertura de salud de los IM si se propone su retorno a los hospitales.

Objective: To describe the perception and uncertainty of medical interns (IM) about the medical internship, academic and extra-academic activities during this COVID-19 pandemic. Methods: Observational descriptive cross-sectional study. IM from Peruvian universities was contacted through the delegates of each university. A virtual survey was applied collecting sociodemographic data, position and uncertainty due to the suspension of the internship, situations of return or not to the internship, academic and extra-academic activities during the quarantine. Results: Data from 353 MI were analyzed, mean age of 25.2 years (standard deviation: 3.1 years), 72.8% had health insurance. 74.8% agreed with the removal of IM from their hospital based. 29.6% agreed or totally agreed with returning in case of collapse of the health system. However, 24.9% of IM would not return to their activities even with biosecurity measures and equipment. More than 90% of IM report feeling uncertainty regarding the restart date of the internship and of the National Medicine Exam (ENAM). 85.6% report using virtual media from ENAM preparation academies. Conclusions: The intention to return to the internship of the surveyed IM increased when the security measures were assured and at the end of the mandatory social immobilization. On the other hand, there is great uncertainty about the dates of return and completion of medical internship and ENAM. Moreover, the majority of respondents invest their time in non-formal education focusing on ENAM.  

Objetivo: Describir la percepción e incertidumbre de los internos de medicina (IM) sobre el internado médico, actividades académicas y extraacadémicas durante esta pandemia de COVID-19. Métodos: Estudio observacional descriptivo transversal. Se contactó a IM de universidades peruanas a través de sus respectivos delegados. Se aplicó una encuesta virtual durante la quinta semana de emergencia nacional. Se recolectó datos sociodemográficos, posición e incertidumbre por la suspensión del internado, situaciones de retorno o no, actividades académicas y extraacadémicas durante la cuarentena. Resultados: Se analizó datos de 353 IM, edad media de 25,2 años (desviación estándar: 3,1 años), 72,8% contaron con un seguro de salud. 74,8% estuvo de acuerdo con el retiro de los internos de sus sedes. 29,6% estuvo de acuerdo o totalmente de acuerdo con retornar en caso de colapso del sistema de salud. Sin embargo, 24,9% de los internos no retornarían a sus actividades aun con medidas y equipos de bioseguridad. Más del 90% de IM refieren sentir incertidumbre respecto a la fecha de reinicio del internado y del Examen Nacional de Medicina (ENAM). 85,6% reporta usar medios virtuales de academias de preparación ENAM. Conclusiones: La intención de volver al internado de los IM encuestados aumentaba cuando se aseguraban las medidas de seguridad y al finalizar la inmovilización social obligatoria. Por otro lado, existe una gran incertidumbre sobre las fechas de regreso y finalización de internado médico y del ENAM. Además, que la mayoría de los encuestados invierten su tiempo en educación no formal enfocándose en el ENAM.

RESUMEN Introducción: Las consecuencias de la homofobia pueden afectar a la integridad y la salud mental y física de los individuos homosexuales en la sociedad. En Perú hay escasos estudios que hayan evaluado la homofobia en la población médico-estudiantil. Objetivo: Determinar los factores sociales, educativos y culturales asociados con la homofobia entre estudiantes de Medicina peruanos. Métodos: Se realizó un estudio de tipo transversal analítico en 12 sedes de Medicina humana peruanas. Se definió homofobia según un test validado, que se asoció con otras variables. Se obtuvieron estadísticos de asociación. Resultados: Las 4 universidades de Lima obtuvieron menores porcentajes de alumnos homofóbicos (15-20%) que las universidades del interior del país (22-62%). Al realizar el análisis multivariable, disminuyeron la frecuencia de homofobia: ser mujer (RPa = 0,74; IC95%, 0,610,92; p = 0,005), estudiar en una universidad de Lima (RPa = 0,57; IC95%, 0,43-0,75; p < 0,001), profesar la religión católica (RPa = 0,53; IC95%, 0,37-0,76; p < 0,001), conocer a un homosexual (RPa = 0,73; IC95%, 0,60-0,90; p = 0,003) y haber atendido a un paciente homosexual (RPa = 0,76; IC95%, 0,59-0,98; p = 0,036); en cambio, ser machista aumentó la frecuencia de homofobia (RPa = 1,37; IC95%, 1,09-1,72; p = 0,007), ajustado por 4 variables. Conclusiones: La homofobia fue menos frecuente entre las mujeres, los que estudiaban en la capital, los que profesan el catolicismo y los que conocen/han atendido a un homosexual; por el contrario, los machistas fueron más homofóbicos.

ABSTRACT Background: The consequences of homophobia can affect the integrity, mental and physical health of homosexual individuals in society. There are few studies in Peru that have evaluated homophobia in the medical student population. Objective: To establish the social, educational and cultural factors associated with homophobia among Peruvian medical students. Methods: A cross-sectional analytical study was conducted in 12 medicine schools in Peru. Homophobia was defined according to a validated test, which was associated with other variables. Statistical associations were identified. Results: The lowest percentages of homophobic students (15-20%) were found in the four universities in Lima, while universities in the interior of the country had the highest percentages (22-62%). Performing a multivariate analysis, we found that the frequency of homophobia was lower for the following variables: the female gender (PRa=0.74; 95% CI, 0.61-0.92; p=0.005), studying at a university in Lima (PRa=0.57; 95% CI, 0.43-0.75; p<0.001), professing the Catholic religion (PRa=0.53; 95% CI, 0.37-0.76;p<0.001), knowing a homosexual (PRa=0.73; 95% CI, 0.60-0.90; p=0.003) and having treated a homosexual patient (PRa=0.76; 95% CI, 0.59-0.98; p=0.036). In contrast, the frequency of homophobia increased in male chauvinists (PRa=1.37; 95% CI, 1.09-1.72; p=0.007), adjusted by four variables. Conclusions: Homophobia was less common in women, in those who study in the capital, those who profess Catholicism and those who know/have treated a homosexual. In contrast, male chauvinists were more homophobic.

Resumo Objetivo: Avaliar a associação entre distúrbios do sódio ou do cloro e mortalidade hospitalar de pacientes com insuficiência renal aguda (IRA) ou doença renal crônica (DRC) submetidos a hemodiálise aguda. Métodos: O presente estudo de coorte retrospectiva incluiu pacientes adultos submetidos a hemodiálise aguda com diagnóstico de IRA ou DRC em um hospital público de Lima, Peru. Os distúrbios do sódio foram classificados como hiponatremia (Na < 135mmol/L) ou hipernatremia (Na > 145mmol/L), enquanto os distúrbios do cloro foram classificados como hipocloremia (Cl < 98 mmol/L) ou hipercloremia (Cl > 109mmol/L). O desfecho de interesse foi mortalidade hospitalar. Utilizamos modelos de Poisson da família de modelos lineares generalizados com bootstrap não-paramétrico e correção de viés acelerado para estimar os riscos relativos na análise bruta (RR) e ajustada (RRa) para sexo, idade, HCO3 (para todos os pacientes) e escore de Liaño (apenas para IRA) com IC 95%. Resultados: Foram incluídos 263 pacientes (idade média 54,3 anos; 43% do sexo feminino), 191 com DRC e 72 com IRA. A mortalidade foi mais elevada nos pacientes com IRA (59,7%) do que nos indivíduos com DRC (14,1%). No geral, os pacientes com hipernatremia tiveram mortalidade hospitalar mais elevada do que os indivíduos com valores normais de sódio (RRa: 1,82; IC 95%: 1,17-2,83). Os pacientes com hiponatremia não apresentaram mortalidade diferente (RRa: 0,19; IC 95%: 0,69-2,04). Também identificamos que hipercloremia (RRa: 1,35; IC 95%: 0,83-2,18) e hipocloremia (RRa: 0,66; IC 95%: 0,30-14,78) não elevaram a mortalidade em comparação a indivíduos com níveis normais de cloro. Não foi encontrada associação entre distúrbios do sódio ou do cloro e mortalidade hospitalar nos subgrupos com DRC e IRA. Conclusões: Em nossa análise exploratória, apenas hipernatremia apresentou associação com mortalidade hospitalar em pacientes com IRA ou DRC submetidos a hemodiálise aguda.

Abstract Objective: To evaluate the association between dysnatremias or dyschloremias and mortality during hospitalization in patients with acute kidney injury (AKI) or chronic kidney disease (CKD) undergoing acute hemodialysis. Methods: We carried out a retrospective cohort study on adult patients undergoing acute hemodialysis with AKI or CKD diagnosis at a public hospital in Lima, Peru. Dysnatremias were categorized as hyponatremia (Na < 135mmol/L) or hypernatremia (Na > 145mmol/L), and dyschloremias were defined as hypochloremia (Cl < 98 mmol/L) or hyperchloremia (Cl > 109mmol/L). The outcome of interest was mortality during hospitalization. We performed generalized lineal Poisson family models with bias-corrected and accelerated non-parametric bootstrap to estimate the risk ratios at crude (RR) and adjusted analysis (aRR) by gender, age, HCO3 (for all patients) and Liaño score (only for AKI) with CI95%. Results: We included 263 patients (mean age: 54.3 years, females: 43%): 191 with CKD and 72 with AKI. Mortality was higher in patients with AKI (59.7%) than in patients with CKD (14.1%). In overall, patients with hypernatremia had a higher mortality during hospitalization compared to those who had normal sodium values (aRR: 1.82, 95% CI: 1.17-2.83); patients with hyponatremia did not have different mortality (aRR: 0.19, 95% CI: 0.69-2.04). We also found that hyperchloremia (aRR: 1.35, 95% CI: 0.83-2.18) or hypochloremia (aRR: 0.66, 95% CI: 0.30-14.78) did not increase mortality in comparison to normal chloride values. No association between dysnatremias or dyschloremias and mortality during hospitalization was found in CKD and AKI subgroups. Conclusions: In our exploratory analysis, only hypernatremia was associated with mortality during hospitalization among patients with AKI or CKD undergoing acute hemodialysis.