Private University of Trujillo

Ventricular septal defect is a common congenital heart defect. While surgical repair has been the standard, transcatheter and perventricular closures have emerged as minimally invasive alternatives. We conducted a systematic review and network meta-analysis of randomized controlled trials. We searched PubMed, Embase, Cochrane Library, clinicaltrials.gov, and Google Scholar up to February 2026. Risk of bias was assessed using the Cochrane tool, and the certainty of evidence was evaluated with GRADE. We conducted pairwise random-effects meta-analyses for direct comparisons, followed by a frequentist random-effects network meta-analysis to indirectly compare transcatheter and perventricular closure. Seven randomized controlled trials involving 2,126 participants were included. Studies were conducted in China, Egypt, or Russia. No deaths were reported. Transcatheter and perventricular closures may reduce blood transfusion needs compared to surgical repair, but the evidence is very uncertain. Perventricular closure may reduce hospital stay and operative time but may increase tricuspid regurgitation risk, compared to surgical repair. No significant differences were observed in indirect comparisons of transcatheter and perventricular approaches. Certainty of the evidence was low to very low. Current evidence suggests that transcatheter and perventricular approaches may be associated with a lower need for blood transfusion compared with surgical repair, while perventricular closure may also reduce length of hospital stay but may increase tricuspid regurgitation. However, the evidence is uncertain, precluding firm conclusions and highlighting the need for well-designed, adequately powered randomized controlled trials. CRD42024595282

Rheumatoid arthritis (RA) is an autoimmune disease whose treatment has evolved with the introduction of disease-modifying antirheumatic drugs and biological agents such as rituximab (RTX). The objective of this study was to evaluate the efficacy, safety, and treatment adherence of RTX used as monotherapy and in combination with methotrexate (MTX) or leflunomide (LFN) in patients with RA refractory to conventional therapy. A prospective cohort study was conducted including 157 patients, divided into 3 groups: RTX monotherapy (n = 48), RTX + MTX (n = 66), and RTX + LFN (n = 43). Efficacy, safety, and adherence were evaluated at weeks 1, 24, and 48 using the Health Assessment Questionnaire (HAQ), Disease Activity Score in 28 joints (DAS28), American College of Rheumatology 70% response (ACR70), and Treat-to-Target (T2T) criteria. Ethical approval was obtained from the local institutional ethics committee. All 3 therapeutic regimens demonstrated comparable clinical efficacy, with no statistically significant differences in disease activity scores. Adverse events were more frequent in the RTX + LFN group, although not statistically significant. Treatment adherence was highest in the RTX monotherapy group (100%). No significant differences in efficacy or safety were found among the 3 study groups; However, treatment adherence was significantly higher in the RTX monotherapy group (100%).

Background: This investigation compared the efficacy and safety of fexuprazan 40 mg and esomeprazole 40 mg in patients with acid reflux-related disorders, including erosive esophagitis (EE) and laryngopharyngeal reflux disease (LPRD). Methods: A systematic search was conducted across five databases until January 2025. Primary outcomes included esophageal lesion healing, complete resolution of symptoms (CRS), and 24 h symptom-free days. Meta-analyses used random-effects models with the inverse variance method. The Risk of Bias 2.0 tool and the certainty of evidence (CoE) using GRADE methodology were assessed. Results: Three randomized controlled trials (n = 695) conducted in Asian countries were included. Fexuprazan may have little to no effect compared to esomeprazole on EE healing rate at 4 weeks (RR 1.02, 95% CI 0.93 to 1.12, I2 = 0%, n = 2 studies, CoE very low) and 8 weeks. No significant differences were found between treatments regarding CRS at 1 week (RR 1.29; 95% CI: 0.84 to 1.99; I2 = 0%; n = 2 studies; CoE very low) and 8 weeks, or in the 24 h symptom-free days at 1 week (MD 2.67 days, 95% CI -2.76 to 8.10, I2 = 41%, n = 2 studies, CoE very low) and 8 weeks. Fexuprazan also showed little to no effect on treatment-emergent adverse events (RR 1.00, 95% CI 0.83 to 1.20, I2 = 0%, n = 3 studies, CoE very low). Nonetheless, the evidence for all outcomes was rated as very uncertain. Conclusions: Fexuprazan 40 mg may provide similar efficacy compared to esomeprazole 40 mg in EE, with a comparable safety profile to esomeprazole in EE and LPRD patients. However, the evidence is highly uncertain, requiring further studies.

El estudio analiza el síndrome de burnout en docentes de educación básica entre 2019 y 2025 mediante una revisión de literatura de 20 artículos indexados en Scopus y SciELO. Los resultados evidencian que el agotamiento emocional, la despersonalización y la baja realización personal se asocian a sobrecarga laboral, precariedad institucional y falta de reconocimiento profesional. Además, el bienestar psicológico, la resiliencia y la autoeficacia actúan como factores protectores, siendo crucial fortalecer el apoyo institucional y las políticas de salud mental

Oral papilloma is a benign lesion caused by the human papillomavirus (HPV), characterized by an exophytic, vegetative, verrucous, or papular growth in the oral mucosa. This type of lesion can be located in various areas of the oral cavity and represents one of the main clinical manifestations associated with HPV infections. Early diagnosis is crucial to rule out malignant conditions and ensure appropriate treatment. A 59-year-old male patient attended the Odontoestomatology Department at the Regional Teaching Hospital of Trujillo due to an asymptomatic growth in the right soft palate with a 2-year history. Clinical examination revealed an exophytic lesion approximately 5 mm in diameter, with normal coloration, rough texture, and a pedunculated base. An excisional biopsy of the lesion was performed, and histopathological analysis confirmed the presence of oral papilloma with epithelial hyperplasia and koilocytes, confirming the benign nature of the lesion. Surgical excision proved to be an effective and definitive treatment for oral squamous papilloma of the soft palate. Early recognition and appropriate management are crucial to differentiate benign papillomatous lesions from potentially malignant oral pathologies and to prevent unnecessary complications.

BackgroundPeriodontitis can cause systemic alterations associated with various oncological diseases, including colorectal cancer (CRC), with little information on this possible association and its related factors. Objectives: To determine the association between periodontitis severity, CRC, and related factors in adult patients.Material and MethodsThis cross-sectional study was conducted between January and March 2025 at the Trujillo Regional Teaching Hospital and the "Dr. Luis Pinillos Ganoza" Regional Institute of Neoplastic Diseases - North IREN, Trujillo, Peru. A total of 320 adult patients were evaluated: 160 without colorectal cancer (non-CRC) and 160 with colorectal cancer (CRC). Inter- and intra-rater reliability was determined for the diagnosis of periodontitis, bleeding on probing (BOP), and dental plaque control (DPC). The corresponding specialist physician performed the diagnosis of colorectal cancer (CRC). Statistical analysis was performed using the Chi-square test, ordinal logistic regression, and binary logistic regression models, with a significance level of p < 0.05.ResultsNo association was found between the severity of periodontitis and CRC diagnosis in the evaluated population (p=0.068). The most common CRC stages were stage IV (48.1%) and stage III (39.4%), and the most common tumor locations were the rectum (40.0%) and sigmoid colon (36.3%).ConclusionsThere is no association between the severity of periodontitis and CRC diagnosis.

La creciente adopción de la computación en la nube y de entornos digitales ha incrementado la frecuencia de ataques y la probabilidad de accesos no autorizados, frente a los cuales los modelos tradicionales de gestión de identidades y accesos (IAM) resultan insuficientes. En este contexto, el enfoque Zero Trust emerge como una alternativa más sólida que replantea la seguridad. La investigación tuvo como objetivo analizar los modelos de IAM aplicados a la computación en la nube bajo el enfoque Zero Trust, así como identificar sus ventajas y limitaciones. Mediante la metodología PRISMA, se realizó una búsqueda en tres bases de datos y, tras aplicar los criterios de inclusión, se analizaron 22 manuscritos. Los resultados evidencian 15 modelos de IAM basados en Zero Trust que integran inteligencia artificial, blockchain y control de acceso dinámico, ofreciendo mayor seguridad en ámbitos como 5G, IoT, nube y salud. No obstante, persisten limitaciones relacionadas con la complejidad, los costos, la escalabilidad y la privacidad. En conclusión, estos modelos no solo fortalecen la seguridad, sino que también constituyen una línea de investigación y desarrollo orientada a reformular la protección de recursos en diversos sectores.

The purpose of the study was to adapt and validate the Critical Thinking Disposition Scale (CTDS) in the Peruvian context, based on the model developed by Sosu (2013). A total of 1,195 university students (508 men and 687 women) from different professional schools participated in the study during the 2025-I semester. The adaptation followed international standards and was evaluated using exploratory and confirmatory factor analysis, as well as a multigroup analysis that confirmed the equivalence of the scale between men and women, as well as between academic areas. A bibliometric analysis was also performed using Bibliometrix and VOSviewer, which allowed this study to be placed within the context of recent scientific production on critical thinking. The results show that the adapted CTDS is a valid and reliable instrument for use with Peruvian students, and that critical thinking has gone from being a historically neglected topic to becoming a priority in higher education worldwide. Received: 02 September 2025 / Accepted: 17 October 2025 / Published: 05 November 2025

Hyperandrogenism represents a prevalent yet diagnostically challenging endocrine condition in adolescents, with polycystic ovary syndrome (PCOS), non-classic congenital adrenal hyperplasia, and androgen-secreting tumors constituting the most common etiologies. The physiological overlap with normal pubertal development creates significant diagnostic complexity, necessitating evidence-based approaches tailored to this unique population. This narrative review synthesizes evidence from a comprehensive literature search (PubMed/Scopus/Web of Science/EMBASE/Cochrane, 2000-2025) evaluating diagnostic and therapeutic approaches for adolescent hyperandrogenism. We prioritized clinical practice guidelines (including 2023 international PCOS guidelines), randomized controlled trials, and large cohort studies (n ≥ 50), excluding conference abstracts and non-peer-reviewed sources. Data extraction focused on diagnostic accuracy, treatment efficacy, safety profiles, and quality-of-life outcomes across 122 included studies. Current diagnostic frameworks demonstrate critical limitations in adolescent populations, particularly regarding age-specific biochemical cutoffs (testosterone, dehydroepiandrosterone sulphate, and 17-hydroxyprogesterone) and imaging interpretation. While combined oral contraceptives remain first-line therapy, emerging data highlight both metabolic risks (particularly with long-term use) and the potential of insulin sensitizers such as myo-inositol. Psychological comorbidities (anxiety, depression) are prevalent (38%-45% prevalence) yet are frequently under-addressed in clinical management. Key knowledge gaps persist regarding optimal (1) diagnostic thresholds for diverse ethnic groups; (2) longitudinal safety of hormonal therapies; and (3) integrated mental health interventions. Adolescent hyperandrogenism demands multidisciplinary management involving endocrinologic, gynecologic, dermatologic, and psychological expertise. Future research must prioritize (1) validated age- and puberty-stage-specific diagnostic criteria; (2) safety/efficacy data for emerging therapies; and (3) standardized protocols for mental health screening. This synthesis provides a framework for evidence-based, individualized care while highlighting urgent research priorities.