Medina Ramirez, Sebastian Andre

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Medina Ramirez, Sebastian Andre
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Medina Ramirez, Sebastian Andre
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Medina-Ramírez, Sebastian A.
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Universidad Peruana Unión
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  • Publicacion
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    Gut microbiota characterization in vegetarian adults from the adventist population living in coastal, highland, and jungle regions of Peru
    (2025-11-27)
    Marcos Carbajal, Pool  
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    Medina Ramirez, Sebastian Andre  
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    Yareta Yareta, José Luis  
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    Otiniano Trujillo, Miguel Angel  
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    Chambi Quispe, Mario Salomón
    Abstract Introduction The gut microbiota plays a crucial role in various physiological processes, and its composition can be influenced by factors such as diet, genetics, age, and health status. Among these, diet is one of the most significant determinants of microbial balance. A well-balanced diet promotes the growth of beneficial bacteria, reducing intestinal inflammation and the risk of chronic diseases. Vegetarian diets have been proposed to confer beneficial effects on gut health; however, many questions remain regarding microbial profiles, their variability, and the potential influence of geographic and cultural factors—particularly within Latin American contexts. This study aims to address this gap by presenting the first characterization of the gut microbiota in vegetarian adults from the Adventist population living in three distinct regions of Peru. Methods Stool samples were used as a proxy to analyze gut microbiota composition through 16S rRNA gene sequencing. Standard descriptive analyses were performed to assess bacterial composition, including diversity and relative abundance across samples. Results The gut microbial communities of Peruvian vegetarians revealed three distinct enterotypes, with distribution varying by region. Enterotype 1 (ET1), predominant in coastal and highland regions, exhibited the highest bacterial richness and diversity. Enterotype 2 (ET2), observed in highland and jungle areas, was characterized by higher levels of Prevotella . Enterotype 3 (ET3), more frequent in the jungle region, showed a greater abundance of Bacteroides and Faecalibacterium . Conclusions Despite all participants adhering to a vegetarian diet, notable diversity in gut microbiota profiles was observed within this population. While three distinct enterotypes were identified, consistent with findings in other populations, the specific profiles differed from those previously reported. This study highlights the importance of incorporating variables that enable greater resolution in future research, allowing better control of within-population variability, such as that observed in Peruvian vegetarians, and ultimately enhancing the accuracy of microbiome-related conclusions.
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    Bibliometric Analysis and Health Evidence Map of Scientific Production on COVID-19 in Peru; Análisis bibliométrico y mapa de evidencia sanitaria de la producción científica sobre COVID-19 en Perú
    (Centro Nacional de Informacion de Ciencias Medicas, 2023)
    De-Los-Rios-Pinto, Abraham
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    Fernandez-Guzman, Daniel
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    Soriano Moreno, David  
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    Benito-Vargas, Raysa M.
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    Caira-Chuquineyra, Brenda
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    Factors Associated with Adequate Breastfeeding: Evidence from the Peruvian Demographic and Health Survey, 2019
    (MDPI, 2022-10-20)
    Yamunaqué-Carranza, Mariela
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    Medina Ramirez, Sebastian Andre  
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    Mamani-García, Carlos S.
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    Caira-Chuquineyra, Brenda
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    Fernandez-Guzman, Daniel
    Objective: To assess the factors associated with adequate breastfeeding (ABF) among Peruvian mothers during 2019. Materials and Methods: We performed a secondary analysis of the 2019 Demographic and Family Health Survey (ENDES) database of Peru. ABF was defined based on the recommendations of the World Health Organization, which defined it as starting breastfeeding within the first hour of life and continuing with exclusive breastfeeding for up to 6 months. To determine the factors associated with ABF, a Poisson generalized linear models with log-link function was used. Adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95% CI) were calculated. Results: A prevalence of ABF of 48.1% was identified among 11,157 women who reported at least one child in the last five years. Most of them were young (68.6%) and lived in urban areas (65.5%). Furthermore, being unemployed (aPR:1.02; 95% CI:1.00–1.04); residing on the coast, except for Metropolitan Lima (aPR:1.08; 95% CI:1.04–1.11), the highlands (aPR:1.14; 95% CI:1.11–1.18), and the jungle (aPR:1.20; 95% CI: 1.16–1.24); having had a vaginal delivery (aPR:1.30; 95% CI:1.27–1.05); and having two children (aPR:1.03; 95% CI:1.01–1.05) or three or more children (aPR:1.03; 95% CI:1.01–1.05) were associated with a higher frequency of ABF. Conclusions: One out of two women between 18–59 with children performed ABF. The factors associated with ABF were the current occupation, region of residence, type of delivery, and parity. Health policies and strategies should be implemented, considering our results, to promote maternal counseling by health personnel in order to increase the prevalence of ABF in the Peruvian population.
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    Green space exposure and type 2 diabetes mellitus incidence: A systematic review
    (Elsevier Ltd, 2023-05-07)
    Ccami-Bernal, Fabricio
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    Soriano Moreno, David  
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    Fernandez-Guzman, Daniel
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    Tuco, Kimberly G.  
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    Castro Diaz, Sharong Dayan  
    Introduction Epidemiological studies have suggested that exposure to green spaces is associated with a lower prevalence of diabetes. The aim of this systematic review was to summarize the evidence on green spaces and diabetes mellitus II (T2DM) in longitudinal studies. Methods We searched PubMed, SCOPUS, Web of Science (WoS)/Core Collection, WoS/MEDLINE, and EMBASE until February 2023. We included cohort studies that assessed the incidence of T2DM according to the level of exposure to green spaces. Two authors independently performed study selection, data extraction, and analysis of risk of bias. No meta-analysis was performed due to clinical heterogeneity between studies. Results We included 13 cohort studies with a sample size ranging from 1700 to 1 922 545 participants. Studies presented different ways of defining (quartiles, percentages) and measuring (tools, buffers) green spaces. Similarly, the definition of T2DM was heterogeneous (self-reports, medical records, clinical criteria). Twelve studies showed that individuals with higher exposure to green spaces had a decreased incidence of T2DM. Out of these 12 studies, 10 revealed statistically significant differences. All studies were of high methodological quality, except for one. Conclusion Our findings suggest that exposure to green space could be a protective factor for the development of T2DM. Promoting policies to preserve and increase green space could help to reduce T2DM at the community level. More standardization of green space exposure definition is needed in studies on green space and T2DM.
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    Online academic satisfaction during the COVID-19 pandemic in medical students: role of sleep, psychological issues, college adjustment, and digital skills
    (2022-10-24)
    Medina Ramirez, Sebastian Andre  
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    Rojas Humpire, Ricardo Josue  
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    Canaza, Josue F.
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    Hernandez, Fiorella
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    Huancahuire Vega, Salomon  
    Background: The measures taken to contain the COVID-19 pandemic, led to significant changes in university education, resulting in the new normal standard of virtual teaching in many undergraduate medical schools worldwide. Therefore, the aim of this paper was to determine the factors related to academic satisfaction with virtual teaching in medical students during the COVID-19 pandemic. Methods: A cross-sectional-analytical study was conducted on medical students at a private university in Peru, through self-reported questionnaires divided into sociodemographic data and variables of interest that could influence academic satisfaction during the pandemic. To evaluate possible factors related to academic satisfaction, stepwise regression models were performed for both sexes. Results: In total, data from 310 medical students, 117 males and 193 females, were analyzed. Academic satisfaction reached a score of 11.2 ± 2.9, which was similar in both sexes. The best regression model for males (AIC: 544.32; RMSE: 2.42; R 2 : 0.30) showed that adaptation to university life (favorable change) and depression (unfavorable change) explained 30% of changes in students' academic satisfaction. While in females (AIC: 907.59; RMSE: 2.49; R 2 : 0.22) the model integrated favorable factors such as adjustment to college life and anxiety; while depression and poor sleep quality were unfavorable factors. Conclusion: Factors that contributed to academic satisfaction in medical students were determined in this study, which differed by gender. Thus, it is important to take into account the particularities of male and female medical students in order to improve their academic satisfaction during their university careers.
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    Effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis: a systematic review
    (2023-09-01)
    Flores-Lovon, Kevin
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    Soriano‐Moreno, David R.
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    Medina Ramirez, Sebastian Andre  
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    Fernandez‐Guzman, Daniel
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    Caira‐Chuquineyra, Brenda
    OBJECTIVES: To evaluate the efficacy of antituberculosis therapy on pregnancy outcomes in infertile women with genital tuberculosis. DESIGN: Systematic review. DATA SOURCES: We searched in PubMed/MEDLINE, CENTRAL and EMBASE up to 15 January 2023. Additionally, we manually search the reference lists of included studies. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCT), non-RCTs (non-RCT) and cohort studies that evaluated the effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis compared with not receiving antituberculosis treatment or receiving the treatment for a shorter period. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data. We used Cochrane Risk of Bias 1.0 and Risk Of Bias In Non-randomised Studies tools for risk of bias assessment and meta-analysis was not performed. We used Grading of Recommendations, Assessment, Development and Evaluations approach to assess the certainty of the evidence. RESULTS: Two RCTs and one non-RCT were included. The antituberculosis regimens were based on isoniazid, rifampicin, pyrazinamide and ethambutol for 6-12 months. In women without structural damage, very low certainty of evidence from one RCT showed that the antituberculosis treatment may have little to no effect on pregnancy, full-term pregnancy, abortion or intrauterine death and ectopic pregnancy, but the evidence is very uncertain. In women with structural damage, very low certainty of evidence from one non-RCT showed that the antituberculosis treatment may reduce the pregnancy rate (297 fewer per 1000, 95% CI -416 to -101), but the evidence is very uncertain. In addition, very low certainty of evidence from one RCT compared a 9-month vs 6-month antituberculosis treatment regimen showed similar effects between the schemes, but the evidence is very uncertain. Two RCTs reported that no adverse events of antituberculosis treatment were noted or were similar in both groups. CONCLUSION: The effect of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis is very uncertain. PROSPERO REGISTRATION NUMBER: CRD42022273145.
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    Conservative Treatment of HAV‐Associated Acalculous Acute Cholecystitis in an Adult: A Case Report
    (2025-01-01)
    Medina Ramirez, Sebastian Andre  
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    Arones-Santayana, Camila A.
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    Carcausto, Eduardo
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    Diaz Reyes, Nelson Fidel  
    Hepatitis A virus (HAV) is a viral infection that can present with a wide range of clinical manifestations, including rare complications such as acute acalculous cholecystitis (AAC). We present the case of a 31-year-old woman who arrived at the emergency department with severe epigastric pain, fever, early satiety, nausea, and vomiting. Physical examination revealed a positive Murphy's sign, hepatomegaly, and epigastric tenderness, suggesting obstructive acute cholecystitis. Imaging studies showed reactive changes in the gallbladder and mild dilation of the intrahepatic bile ducts. Laboratory tests indicated elevated bilirubin levels and a cholestatic pattern with markedly increased transaminases. Magnetic resonance cholangiopancreatography confirmed AAC and ruled out biliary obstruction. Positive serology for Hepatitis A led to the definitive diagnosis of AAC secondary to Hepatitis A. Treatment focused on supportive care with intravenous hydration and symptomatic management, avoiding antibiotics due to the self-limiting nature of the viral infection. The patient showed a favorable clinical course, with a progressive decrease in gallbladder diameter and normalization of liver parameters. This case highlights the importance of considering rare viral infections as a cause of AAC and demonstrates that a conservative approach can be effective in managing this condition. This case underscores the importance of considering viral etiologies, particularly HAV, in the differential diagnosis of AAC in adults. It further demonstrates that, in carefully selected patients, conservative management can be both safe and effective, thereby avoiding unnecessary antibiotic use or surgical intervention in the context of a self-limiting viral infection.
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    Metabolic Syndrome and Risk of Peripheral Arterial Disease: A Systematic Review and Meta-Analysis
    (2022-09-21)
    Soriano‐Moreno, David R.
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    Fernandez-Morales, Jared
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    Medina Ramirez, Sebastian Andre  
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    Coico-Lama, Abdiel H.
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    Soriano Moreno, Anderson Nelver Elías  
    This systematic review aimed to evaluate metabolic syndrome as a risk factor for the development of peripheral arterial disease (PAD). We searched in four databases: (1) PubMed, (2) Web of Science, (3) Scopus, and (4) Embase until March 2021. We included cohort studies that evaluated the risk of PAD in patients with and without metabolic syndrome. Study selection, data extraction, and risk of bias analysis were performed independently by 2 authors. We used a random-effects model to conduct a meta-analysis of effect measures [hazard ratio (HR), risk ratio (RR), and odds ratio (OR)]. Individual analyses were performed according to the diagnostic criterion used for metabolic syndrome. We included 7 cohort studies with a total of 43 824 participants. Most of the studies were performed in the general adult population. The metabolic syndrome and PAD diagnostic criteria used in the individual studies were heterogeneous. Almost all studies using RR found an association between metabolic syndrome and the development of PAD (RR: 1.31; confidence interval 95%: 1.03-1.59; I 2 : 15.6%). On the other hand, almost all the studies that used HR found no association between the two variables. All studies had a low risk of bias. In conclusion, available evidence on the association between metabolic syndrome and the risk of developing PAD is inconsistent. However, given the high prevalence of risk factors that patients with metabolic syndrome have, testing to rule out PAD could be recommended. Future studies should analyze each component of the metabolic syndrome separately and according to the severity of PAD.
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    Insulin Resistance Indexes as Biomarkers of Lifetime Cardiovascular Risk among Adults from Peru
    (2021-03-25)
    Rojas Humpire, Ricardo Josue  
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    Olarte Durand, Mely Alexandra  
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    Medina Ramirez, Sebastian Andre  
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    Gutierrez-Ajalcriña, Rosmery
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    Canaza, Josue F.
    BACKGROUND: Cardiovascular disease (CVD) is the most prevalent cause of death from disease and disability in the world. Reliable markers are needed to assess and reduce cardiovascular risk. This study aimed to determine if insulin resistance indexes, triglycerides to HDL-cholesterol ratio (TG/HDL-C), and triglyceride glucose index (TyG) are biomarkers for lifetime cardiovascular risk (CVR). METHODS: This analytical cross-sectional study was performed on health personnel from Huaycan Hospital in Peru. The QRISK model was used to measure lifetime CVR. The association and diagnostic accuracy for TyG calculated as Ln (TG (mg/dL) × glucose (mg/dL)/2) and TG/HDL-C ratio were determined using Poisson regression models and ROC curves with Youden index. RESULTS: In total, 291 adults (207 women and 84 men) were analyzed. In the adjusted Poisson models, each unit of TG/HDL-C increased 1.22-fold and 1.16-fold the probability of high lifetime CVR in men and women, respectively. However, each unit of TyG increased 1.98-fold in men and 3.25-fold in women the probability of high lifetime CVR. The optimal cutoff values of TG/HDL-C were 2.64 (AUC: 0.77), 3.90 (AUC: 0.80), and 2.64 (AUC: 0.74) for the overall population, men, and women, respectively. Likewise, the optimal cutoff values of TyG were 9.04 (AUC: 0.80), 8.95 (AUC: 0.79), and 9.04 (AUC: 0.80) for the overall population, men, and women, respectively. CONCLUSION: TG/HDL-C and TyG presented a significant association with lifetime CVR. However, TyG presented a stronger association than TG/HDL-C. Both TG/HDL-C and TyG are shown to be reliable markers for CVR in adults.
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    Fecal Microbiota Transplantation for People Living with Human Immunodeficiency Virus: A Scoping Review
    (2022-04-22)
    Caira‐Chuquineyra, Brenda
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    Fernandez‐Guzman, Daniel
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    Soriano‐Moreno, David R.
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    Fernandez-Morales, Jared
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    Flores-Lovon, Kevin
    The aim of this scoping review was to determine the characteristics of studies evaluating fecal microbiota transplantation (FMT), as well as its effects and safety as a therapeutic intervention for people living with human immunodeficiency virus (HIV). We conducted a scoping review following the methodology of the Joanna Briggs Institute. We searched the following databases: PubMed, Web of Science, Scopus, Embase, Cochrane Library, and Medline until September 19, 2021. Studies that used FMT in people living with HIV and explored its effects on the health of these people were included. Two randomized and 2 uncontrolled clinical trials with a total of 55 participants were included. Participants were well-controlled HIV-infected people. Regarding microbiota changes, three studies found significant post-FMT increases in Fusobacterium, Prevotella, α-diversity, Chao index, and/or Shannon index, and/or decreases in Bacteroides. Regarding markers of intestinal damage, one study found a decrease in intestinal fatty acid binding protein post-FMT, and another study found an increase in zonulin. Other outcomes evaluated by the studies were as follows: markers of immune and inflammatory activation, markers of immunocompetence (CD4+, and CD8+ T lymphocytes), and HIV viral load; however, none showed significant changes. Clinical outcomes were not evaluated by these studies. Regarding the safety of FMT, only mild adverse events were appreciated. No serious adverse event was reported. The clinical evidence for FMT in people living with HIV is sparse. FMT appears to have good tolerability and, no serious adverse event has been reported so far. Further clinical trials and evaluation of clinically important biomedical outcomes for FMT in people living with HIV are needed.
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