Prognostic factors of progressive fibrotic hypersensitivity pneumonitis: a large, retrospective, multicentre, observational cohort study.

Background: Fibrotic hypersensitivity pneumonitis (fHP) is an immune-mediated interstitial lung disease caused by sensitisation to chronic allergen inhalation. This study aimed to determine prognostic indicators of progression and mortality in fHP. Methods: This was a retrospective, multicentre, observational, cross-sectional cohort study of consecutive patients diagnosed with fHP from 1 January 2012 to 31 December 2021. Multivariate Cox regression analyses were used to calculate hazard ratios (HRs) with 95% confidence intervals for predictors of progression and survival. Results: A total of 403 patients were diagnosed with fHP: median (interquartile range) age 66.5 (14.0) years, 51.9% females and 55.1% never-smokers. The cause of fHP was mainly fungal (39.7%) or avian (41.4%). Lung biopsy was performed in 269 cases (66.7%). In the whole cohort the variables that were related to mortality or lung transplant were older age (HR 1.08; p<0.001), percentage predicted forced vital capacity (HR 0.96; p=0.001), lymphocytosis in bronchoalveolar lavage (BAL) (HR 0.93; p=0.001), presence of acute exacerbation during follow-up (HR 3.04; p=0.001) and GAP (gender, age and lung physiology) index (HR 1.96; p<0.01). In the group of biopsied patients, the presence of fibroblastic foci at biopsy (HR 8.39; p<0.001) stands out in multivariate Cox regression analyses as a highly significant predictor for increased mortality or lung transplant. GAP index (HR 1.26; p=0.009), lymphocytosis in BAL (HR 0.97; p=0.018) and age (HR 1.03; p=0.018) are also predictors of progression. Conclusions: The study identified several prognostic factors for progression and/or survival in fHP. The presence of fibroblastic foci at biopsy was a consistent predictor for increased mortality and the presence of lymphocytosis in BAL was inversely related to mortality.

Higher mortality and intubation rate in COVID-19 patients treated with noninvasive ventilation compared with high-flow oxygen or CPAP.

The effectiveness of noninvasive respiratory support in severe COVID-19 patients is still controversial. We aimed to compare the outcome of patients with COVID-19 pneumonia and hypoxemic respiratory failure treated with high-flow oxygen administered via nasal cannula (HFNC), continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV), initiated outside the intensive care unit (ICU) in 10 university hospitals in Catalonia, Spain. We recruited 367 consecutive patients aged ≥ 18 years who were treated with HFNC (155, 42.2%), CPAP (133, 36.2%) or NIV (79, 21.5%). The main outcome was intubation or death at 28 days after respiratory support initiation. After adjusting for relevant covariates and taking patients treated with HFNC as reference, treatment with NIV showed a higher risk of intubation or death (hazard ratio 2.01; 95% confidence interval 1.32-3.08), while treatment with CPAP did not show differences (0.97; 0.63-1.50). In the context of the pandemic and outside the intensive care unit setting, noninvasive ventilation for the treatment of moderate to severe hypoxemic acute respiratory failure secondary to COVID-19 resulted in higher mortality or intubation rate at 28 days than high-flow oxygen or CPAP. This finding may help physicians to choose the best noninvasive respiratory support treatment in these patients.Clinicaltrials.gov identifier: NCT04668196.

Pancreatitis por citomegalovirus en inmunocomprometidos. Reporte de casos / Cytomegalovirus pancreatitis in inmunocompromised patients: a case report

Se reporta dos casos de pancreatitis secundaria a la infección por citomegalovirus confirmado por reacción en cadena de la polimerasa en tiempo real (PCR-RT) en pacientes portadores del virus de la inmunodeficiencia humana (VIH). Se descartaron otras causas mediante exámenes auxiliares. Ambos pacientes fueron tratados con ganciclovir y se obtuvo una mejoría tanto clínica como en los exámenes auxiliares. Esta patología no debe pasar desapercibida en pacientes VIH positivos a pesar de no presentar la característica clínica de pancreatitis aguda.

Concordancia entre las habilidades, conocimientos y labores de médicos peruanos recién egresados con respecto a su propia percepción de las características de un buen médico / Concordance among Peruvian physician’ s skills, knowledge and activities according to their own perception of the characteristics of a good physician

Introducción: Durante el entrenamiento profesional las personas reconocen algunas características que idealmente deberían de ser obtenidas al egreso universitario; sin embargo, no necesariamente todas ellas son alcanzadas. Objetivo: Evaluar la concordancia entre las características propias de los médicos peruanos que realizarán el Servicio Rural Urbano Marginal de Salud con las características idóneas que debería tener un buen médico según el criterio propio de cada encuestado. Materiales y Métodos: Se llevó a cabo un estudio de corte transversal en una muestra de 281 médicos. Se midió la concordancia entre las habilidades, conocimientos y labores que declaraban los participantes y las que debería poseer un buen médico según su propia percepción utilizando un cuestionario estructurado de 26 ítems. Se evaluó la concordancia con el índice Kappa de Fleiss y las diferencias de puntajes con el test de signos y rangos de Wilcoxon. Resultados: El 45,6% fueron varones, 69,6% estudiaban en una universidad privada, 78,9% admiraban a un médico y 27,3% elegiría la misma especialidad que dicha persona. Si bien la puntuación media obtenida en cada ítem fue significativamente menor en la evaluación propia de los participantes frente al puntaje idóneo en la totalidad de ítems evaluados, existió una importante proporción que reconoce haber logrado esas capacidades y en otros casos haber superado lo requerido. Conclusiones: La concordancia encontrada en las diversas características fue de pobre a aceptable. Algunos médicos consideran que aún no han desarrollado aspectos clave como liderazgo, empatía, comunicación y capacidad de escuchar. Se sugiere realizar estudios para evaluar si estas características varían durante los años de práctica tras el egreso.

Introduction: Everyone recognize certain features a good professional should have and every person hopes future professionals would have them. Objective: To evaluate the concordance between recently graduated Peruvian doctors’ characteristics and the features a good doctor should have according to each respondent’s criteria. Methods: A Cross-Sectional study among 318 physicians assessed the concordance of their declared skills, abilities, knowledge and activities (26 items) in comparison with the characteristics a good doctor should possess according to their own perception, using a Likert Scale. Concordance was evaluated applying Kappa index and the difference in scores was assessed using Wilcoxon test. Results: 45.6% of the participants were male and 69.6% studied in a private university. Total score was lower in participants’ self-assessment in comparison to the ideal score in all items studied (p<0.001), Kappa values ranged between 0.11 and 0.34. There were no gender differences (p>0.05). 78.9% admires a doctor and 27.3% would choose the same specialty as that person. Conclusion: A fair concordance was found between the characteristics participants have and those they thought a good doctor should have. Some physicians consider that they have not yet developed important aspects such as leadership, empathy, communication and listening capacity. We suggest carrying out new studies in order to evaluate if these characteristics differ after some years of medical practice.

Publicación de los trabajos presentados a los congresos científicos de estudiantes de medicina, Perú 2002-2009: características y factores asociados. / Publication of summaries presented at the scientific congresses of medical students, Peru 2002-2009: characteristics and related factors.

Objetivos. Determinar la proporción de publicación de los resúmenes presentados a los congresos científicos nacionales de estudiantes de medicina de Perú entre los años 2002 y 2009 y sus factores asociados. Materiales y métodos. Se realizó una cohorte retrospectiva, se evaluó las características de todos los resúmenes presentados y se determinó si habían sido publicados en revistas científicas utilizando una estrategia de búsqueda validada con Google Académico. Se calculó los riesgos relativos (RR), crudos y ajustados mediante la regresión de Poisson con varianza robusta para evaluar asociación con los factores analizados. Resultados. Se analizó 532 resúmenes; 52 (9,8%) fueron publicados en revistas científicas luego de su participación en el congreso; en todos los casos fue en revistas peruanas y en español. La principal revista donde se publicaron fue (CIMEL) (13/52). La mediana del tiempo de publicación fue de 13 meses (rango: 0-75). El que un alumno de la Universidad Nacional Mayor de San Marcos (RR: 5,18; IC95%:2,3-11,6) sea autor del resumen y que el resumen sea de autoría colaborativa entre alumnos de dos universidades (RR: 3,64; IC95%:1,1-11,7) son factores asociados en el análisis multivariado. Conclusiones. La proporción de publicación de resúmenes presentados a los congresos científicos nacionales de estudiantes de medicina de Perú es baja. Se deben implementar nuevas medidas y reforzar las existentes para incentivar una mayor publicación de los trabajos presentados.

Objectives. To determine the publication rate of abstracts submitted at the national scientific meetings of medical students in Peru between 2002 and 2009, and associated factors. Materials and methods. A retrospective cohort was performed; the characteristics of overall abstract submitted were assessed. In addition, whether they were published in scientific journals was determined by way of a search strategy validated using Google Scholar. Crude and adjusted relative risks (RR) were calculated using Poisson regression with robust variance to assess association with the analyzed factors. Results. 532 abstracts were analyzed, 52 (9.8%) of which were published in scientific journals after their presentation at a scientific meeting. All of them were published in Peruvian journals written in Spanish. The most important journal in which they were published was Ciencia e Investigación Médica Estudiantil Latinoamericana (CIMEL) (13/52). The median of publication time was 13 months (range: 0-75). The fact that a student from the Universidad Nacional Mayor de San Marcos (RR: 5.18; CI95%:2.3-11.6) is the author of the abstract and that the abstract was collaboratively written by students from two universities (RR: 3.64; CI95%:1.1-11.7) are associated factors in the multivariate analysis. Conclusions. The publication rate of abstract submitted at national scientific meetings of medical students in Peru is low. New strategies should be taken, and the existing ones should be reinforced in order to increase the publication rate of the abstract submitted.

[Publication of summaries presented at the scientific congresses of medical students, Peru 2002-2009: characteristics and related factors]. / Publicación de los trabajos presentados a los congresos científicos de estudiantes de medicina, Perú 2002-2009: características y factores asociados.

OBJECTIVES: To determine the publication rate of abstracts submitted at the national scientific meetings of medical students in Peru between 2002 and 2009, and associated factors. MATERIALS AND METHODS: A retrospective cohort was performed; the characteristics of overall abstract submitted were assessed. In addition, whether they were published in scientific journals was determined by way of a search strategy validated using Google Scholar. Crude and adjusted relative risks (RR) were calculated using Poisson regression with robust variance to assess association with the analyzed factors. RESULTS: 532 abstracts were analyzed, 52 (9.8%) of which were published in scientific journals after their presentation at a scientific meeting. All of them were published in Peruvian journals written in Spanish. The most important journal in which they were published was Ciencia e Investigación Médica Estudiantil Latinoamericana (CIMEL) (13/52). The median of publication time was 13 months (range: 0-75). The fact that a student from the Universidad Nacional Mayor de San Marcos (RR: 5.18; CI95%:2.3-11.6) is the author of the abstract and that the abstract was collaboratively written by students from two universities (RR: 3.64; CI95%:1.1-11.7) are associated factors in the multivariate analysis. CONCLUSIONS: The publication rate of abstract submitted at national scientific meetings of medical students in Peru is low. New strategies should be taken, and the existing ones should be reinforced in order to increase the publication rate of the abstract submitted.

Factors associated with anti-tuberculosis medication adverse effects: a case-control study in Lima, Peru.

BACKGROUND: Long-term exposure to anti-tuberculosis medication increases risk of adverse drug reactions and toxicity. The objective of this investigation was to determine factors associated with anti-tuberculosis adverse drug reactions in Lima, Peru, with special emphasis on MDR-TB medication, HIV infection, diabetes, age and tobacco use. METHODOLOGY AND RESULTS: A case-control study was performed using information from Peruvian TB Programme. A case was defined as having reported an anti-TB adverse drug reaction during 2005-2010 with appropriate notification on clinical records. Controls were defined as not having reported a side effect, receiving anti-TB therapy during the same time that the case had appeared. Crude, and age- and sex-adjusted models were calculated using odds ratios (OR) and 95% confidence intervals (95%CI). A multivariable model was created to look for independent factors associated with side effect from anti-TB therapy. A total of 720 patients (144 cases and 576 controls) were analyzed. In our multivariable model, age, especially those over 40 years (OR = 3.93; 95%CI: 1.65-9.35), overweight/obesity (OR = 2.13; 95%CI: 1.17-3.89), anemia (OR = 2.10; IC95%: 1.13-3.92), MDR-TB medication (OR = 11.1; 95%CI: 6.29-19.6), and smoking (OR = 2.00; 95%CI: 1.03-3.87) were independently associated with adverse drug reactions. CONCLUSIONS: Old age, anemia, MDR-TB medication, overweight/obesity status, and smoking history are independent risk factors associated with anti-tuberculosis adverse drug reactions. Patients with these risk factors should be monitored during the anti-TB therapy. A comprehensive clinical history and additional medical exams, including hematocrit and HIV-ELISA, might be useful to identify these patients.

Prevalencia y factores asociados con síntomas depresivos en estudiantes de ciencias de la salud de una Universidad privada de Lima, Perú 2010 / Prevalence and asociated factors WITH depresive symptoms in Health Sciences students from a private university in Lima, Peru 2010

Introducción. Los síntomas depresivos en estudiantes de ciencias de la salud son comunes y podrían ser potencialmente perjudiciales. Objetivos. Determinar la prevalencia de síntomas depresivos y sus factores asociados en los estudiantes de la Facultad de Ciencias de la Salud de la Universidad Peruana de Ciencias Aplicadas, Lima (Perú), junio 2010. Materiales y métodos. Estudio analítico transversal; se realizó una encuesta previo consentimiento informado a 590/869 estudiantes. Para medir la variable de respuesta (síntomas depresivos) se usó la escala de Zung abreviada. Se empleó la regresión logística múltiple para evaluar los factores asociados, considerando un nivel de significancia de p<0,05. Resultados. La edad media fue 18,97 ± 2,45 años; 71,1 por ciento fueron mujeres; 19,6 por ciento fueron migrantes y 62,5 por ciento fueron de la carrera de medicina. La prevalencia de síntomas depresivos fue 31,2 por ciento en la población y de 33,6 por ciento en estudiantes de medicina. No se encontró asociación en el análisis bivariado con el sexo, carrera de estudio, si ha repetido cursos, si vive solo o si es migrante (p>0,05). En el análisis multivariado, se encontró asociación con la inconformidad de su rendimiento académico (OR=2,13; IC95 por ciento:1,47-3,08), inconformidad con la situación económica actual (OR=1,93; IC95 por ciento:1,24-2,99) y vivir con un familiar externo a la familia nuclear (OR=1,62; IC95 por ciento:1,07-2,45). Conclusión. Existe una alta prevalencia de síntomas depresivos en la población estudiada, especialmente en los alumnos de la carrera de medicina, siendo la inconformidad con el rendimiento académico, con su economía y vivir con un familiar externo a la familia nuclear, factores asociados que podrían tomarse en cuenta para trabajar programas preventivos.

Introduction. Depressive symptoms in health sciences students are common, these might be potentially detrimental. Objectives. To determine the prevalence of depressive symptoms and its associated factors in students from the Health Sciences Faculty of the Universidad Peruana de Ciencias Aplicadas in Lima (Peru), June 2010. Materials and methods. Cross-sectional analytic study; a pre-consented survey was applied to the population 590/869 students. Zung’s abbreviated scale was used to measure depressive symptoms. To evaluate de associated factors, logistic regression was used, p<0.05 was considered statistically significant. Results. The mean age was 18.97 ± 2.45 years and 71.1 percent were women, 19.6 percent were migrants and 62.5 percent were medical students. The prevalence of depressive symptoms was 31.2 percent in the whole population and in medical students was 33.6 percent. Depressive symptoms were not associated in bivariate analysis with sex, career, having failed a course, living alone or being a migrant (p>0.05). In the multivariate analysis, significant statistical association was found between depressive symptoms and dissatisfaction with the own academic performance (OR=2.13 CI95 percent1.47-3.08), dissatisfaction with the current economic status (OR=1.93 CI95 percent1.24-2.99) and living with a relative external to the nuclear family (OR=1.62 CI95 percent1.07-2.45). Conclusion. A high prevalence of depressive symptoms was found, especially in medical students; being dissatisfaction with academic performance, economic status and living with a relative external to the nuclear family associated factors that could be taken into account in order to build preventive programs.

[Prevalence and associated factors with depressive symptoms in Health Sciences students from a private university in Lima, Peru 2010]. / Prevalencia y factores asociados con síntomas depresivos en estudiantes de ciencias de la salud de una Universidad privada de Lima, Perú 2010.

INTRODUCTION: Depressive symptoms in health sciences students are common, these might be potentially detrimental. OBJECTIVES: To determine the prevalence of depressive symptoms and its associated factors in students from the Health Sciences Faculty of the Universidad Peruana de Ciencias Aplicadas in Lima (Peru), June 2010. MATERIALS AND METHODS: Cross-sectional analytic study; a pre-consented survey was applied to the population 590/869 students. Zung's abbreviated scale was used to measure depressive symptoms. To evaluate de associated factors, logistic regression was used, p<0.05 was considered statistically significant. RESULTS: The mean age was 18.97 ± 2.45 years and 71.1% were women, 19.6% were migrants and 62.5% were medical students. The prevalence of depressive symptoms was 31.2% in the whole population and in medical students was 33.6%. Depressive symptoms were not associated in bivariate analysis with sex, career, having failed a course, living alone or being a migrant (p>0.05). In the multivariate analysis, significant statistical association was found between depressive symptoms and dissatisfaction with the own academic performance (OR=2.13 CI95%1.47-3.08), dissatisfaction with the current economic status (OR=1.93 CI95%1.24-2.99) and living with a relative external to the nuclear family (OR=1.62 CI95%1.07-2.45). CONCLUSION: A high prevalence of depressive symptoms was found, especially in medical students; being dissatisfaction with academic performance, economic status and living with a relative external to the nuclear family associated factors that could be taken into account in order to build preventive programs.