Proportion of cancer cases and deaths attributable to potentially modifiable risk factors in Peru.

BACKGROUND: Limited evidence exists on the population attributable fraction (PAF) of cancer cases and deaths in Latin America. In Peru several studies have been published regarding the PAF of various risk factors and their associated diseases. The objective of this study was to estimate the fraction of cancer cases and deaths attributable to potentially modifiable risk factors in Peru in 2018, before the COVID-19 pandemic in the population of 15 years old and older. METHODS: An ecological study was conducted using the prevalence of exposure of the Peruvian population to modifiable risk factors for cancer, the relative risk associated with each factor, and the number of cancer cases and deaths in 2018 as inputs. We used the Parkin formula with a Montecarlo statistical simulation model to calculate the PAF and confidence intervals. The number of new cancer cases and deaths attributed to each risk factor was determined by multiplying the number of cases and deaths in each gender by the PAF of each risk factor. FINDINGS: In Peru, 38.5% of new cases (34.5% in men and 42% in women) and 43.4% of cancer-related deaths (43.4% in men and 43.4% in women) were attributable to modifiable risk factors. The number of cancers attributable was 25,308 (10,439 in men and 14,869 in women) and the number of deaths attributable to cancer was 14,839 (6,953 in men and 7,886 in women). The predominant modifiable risk factors contributing to the highest number of cases and deaths were HPV infection (4,563 cases, 2,409 deaths), current tobacco use (3,348 cases, 2,180 deaths), and helicobacter pylori infection (2,677 cases, 1,873 deaths). Among the risk factors, oncogenic infections constituted the group with the highest PAF (16.6% for cases, 19.2% for deaths) followed by other unhealthy lifestyle factors (14.2% for cases, 16.7% for deaths), tobacco (7.2% for cases, 7.2% for deaths) and ultraviolet radiation (0.5% for cases, 0.3% for deaths). CONCLUSIONS: Prior to the COVID-19 pandemic, 38.5% of cancer cases and 43.4% of cancer-related deaths in Peru were linked to modifiable risk factors in the population of 15 years old and older. Most preventable cancer cases and deaths were related to oncogenic infections, primarily caused by HPV and helicobacter pylori, followed by tobacco and obesity.

Hospitalization, death, and probable reinfection in Peruvian healthcare workers infected with SARS-CoV-2: a national retrospective cohort study.

BACKGROUND: Peru has some of the worst outcomes worldwide as a result of the SARS-CoV-2 pandemic; it is presumed that this has also affected healthcare workers. This study aimed to establish whether occupation and other non-occupational variables were risk factors for possible reinfection, hospitalization, and mortality from COVID-19 in cohorts of Peruvian healthcare workers infected with SARS-CoV-2. METHODS: Retrospective cohort study. Healthcare workers who presented SARS-CoV-2 infection between March 1, 2020, and August 6, 2021, were included. Occupational cohorts were reconstructed from the following sources of information: National Epidemiological Surveillance System, molecular tests (NETLAB), results of serology and antigen tests (SICOVID-19), National Registry of Health Personnel (INFORHUS), and National Information System of Deaths (SINADEF). The incidence of probable reinfection, hospitalization, and death from COVID-19 was obtained in the cohorts of technicians and health assistants, nursing staff, midwives, dentists, doctors, and other healthcare workers. We evaluated whether the occupation and other non-occupational variables were risk factors for probable reinfection, hospitalization, and death from COVID-19 using log-binomial and probit binomial models, obtaining the adjusted relative risk (RRAJ). RESULTS: 90,398 healthcare workers were included in the study. Most cases were seen in technicians and health assistants (38.6%), and nursing staff (25.6%). 8.1% required hospitalization, 1.7% died from COVID-19, and 1.8% had probable reinfection. A similar incidence of probable reinfection was found in the six cohorts (1.7-1.9%). Doctors had a higher incidence of hospitalization (13.2%) and death (2.6%); however, they were also those who presented greater susceptibility linked to non-occupational variables (age and comorbidities). The multivariate analysis found that doctors (RRAJ = 1.720; CI 95: 1.569-1.886) had a higher risk of hospitalization and that the occupation of technician and health assistant was the only one that constituted a risk factor for mortality from COVID-19 (RRAJ = 1.256; 95% CI: 1.043-1.512). CONCLUSIONS: Peruvian technicians and health assistants would have a higher risk of death from COVID-19 than other healthcare workers, while doctors have a higher incidence of death probably linked to the high frequency of non-occupational risk factors. Doctors present a higher risk of hospitalization independent of comorbidities and age; likewise, all occupations show a similar risk of probable reinfection.

[Undiagnosed arterial hypertension in a Latin American country, 2019 to 2021]. / Hipertensión arterial no diagnosticada en un país de Latinoamérica, 2019 a 2021.

Objective: To determine the factors associated with undiagnosed hypertension. Method: A quantitative, observational, retrospective, cross-sectional and analytical study was carried out in people aged 15 years and over included in the Demographic and Family Health Survey from 2019 to 2021 in Peru. A statistical analysis was carried out using the corrected F test, and crude and adjusted prevalence ratio (aPR), with a 95% confidence interval (95%CI) for inferential analysis, through Poisson regression with robust variance. Likewise, the CSPLAN analysis was carried out for complex samples according to the sample design and taking into account the weighting factor. Results: In the multivariate analysis, a significant association was found between the factors male sex (aPR: 1.22; 95%CI: 1.19-1.26), age from 30 to 49 years (aPR: 0.94; 95%CI: 0.92-0.96), native ethnicity (aPR: 1.07; 95%CI: 1.04-1.10), having health insurance (aPR: 0.91; 95%CI: 0.89-0.93), suffering from some permanent limitation (aPR: 0.83; 95%CI: 0.76-0.91) and diabetes mellitus (aPR: 0.59; 95%CI: 0.55-0.64). No significant association was found with educational level, language, Afro-Peruvian ethnicity, or alcohol or tobacco consumption (p > 0.05). Conclusions: The prevalence of undiagnosed arterial hypertension is high, 69.5%. The associated factors are male sex, native ethnicity, age between 30 and 49 years, having health insurance, suffering from some permanent limitation and having diabetes mellitus.

Objetivo: Determinar los factores asociados a hipertensión arterial no diagnosticada. Método: Estudio de tipo cuantitativo, observacional, retrospectivo, transversal y analítico, en personas de 15 y más años de edad contenidas en la Encuesta Demográfica y Salud Familiar de 2019 a 2021 en Perú. Se realizó un análisis estadístico haciendo uso de la prueba F corregida y la razón de prevalencia cruda y ajustada (RPa), con un intervalo de confianza del 95% (IC95%) para el análisis inferencial, a través de regresión de Poisson con varianza robusta. Asimismo, se realizó el análisis CSPLAN para muestras complejas de acuerdo con el diseño de la muestra y teniendo en cuenta el factor de ponderación. Resultados: En el análisis multivariado se halló una asociación significativa de los factores sexo masculino (RPa: 1.22; IC95%: 1.19-1.26), edad de 30 a 49 años (RPa: 0.94; IC95%: 0.92-0.96), etnia nativa (RPa: 1.07; IC95%: 1.04-1.10), tenencia de un seguro de salud (RPa: 0.91; IC95%: 0.89-0.93), sufrir alguna limitación permanente (RPa: 0.83; IC95%: 0.76-0.91) y diabetes mellitus (RPa: 0.59; IC95%: 0.55-0.64). No se encontró asociación significativa con el nivel de instrucción, el idioma, la etnia afroperuana ni el consumo de alcohol o tabaco (p > 0.05). Conclusiones: La prevalencia de hipertensión arterial no diagnosticada es alta, del 69.5%. Los factores asociados son el sexo masculino, la etnia nativa, la edad entre 30 y 49 años, la tenencia de un seguro de salud, sufrir alguna limitación permanente y tener diabetes mellitus.

Pan-immune-inflammation value and survival in patients with breast cancer from a Peruvian reference hospital.

The pan-immune-inflammation value (PIV), calculated as (neutrophil × platelet × monocyte)/lymphocyte count, may be useful for estimating survival in breast cancer patients. To determine the prognostic value of PIV for overall survival in breast cancer patients in Lima, Peru. A retrospective cohort study was conducted. 97 breast cancer patients diagnosed between January 2010 and December 2016 had their medical records analyzed. The primary dependent variable was overall survival, and the key independent variable was the PIV, divided into high (≥ 310) and low (< 310) groups. Patient data included demographics, treatment protocols and other clinical variables. Statistical analysis involved Kaplan-Meier survival curves and Cox proportional hazards modeling. Patients with a PIV ≥ 310 had significantly lower 5-year survival functions (p = 0.004). Similar significant differences in survival were observed for clinical stage III-IV (p = 0.015), hemoglobin levels < 12 mg/Dl (p = 0.007), histological grade (p = 0.019), and nuclear grade (p < 0.001); however, molecular classification did not show a significant survival difference (p = 0.371). The adjusted Hazard Ratios showed that PIV ≥ 310 was significantly associated with poor outcome (5.08, IC95%: 1.52-16.92). While clinical stage and hemoglobin levels were associated with survival in the unadjusted model. These factors did not maintain significance after adjustment. PIV is an independent predictor of reduced survival in Peruvian breast cancer patients.

Quality Assessment of Systematic Reviews Performed As An Undergraduate thesis in A Peruvian University: A Systematic Review.

Objective: To determine the quality of systematic reviews submitted as a thesis in the Medical School of Ricardo Palma University. Methods: We conducted a systematic review. We included systematic reviews submitted as theses from Ricardo Palma University, and we excluded narrative reviews, editorials, clinical experiments, and those with incomplete data. We performed a structured search on EMBASE, PubMed, Scopus, and Institutional Repository from the Ricardo Palma University and RENATI. The risk of bias assessment was performed through the AMSTAR-2 and the modified AMSTAR-2 tools. The primary outcome was review quality. A qualitative synthesis of the information was performed. Results: One thousand four hundred eighty-seven theses were identified, and exclusion criteria were applied, whereby 11 theses were selected for review and thorough consultation. Of the 11 selected theses, and through the AMSTAR-2 and modified AMSTAR-2 tools, the findings reached were that 90.9% of the included theses presented critically low quality that was not modified even when the quality was reevaluated after its publication as a scientific article. Conclusion: The systematic reviews presented as undergraduate thesis in the Medical School of Ricardo Palma University showed low and critically low quality. Improvement in systematic review training is required for both students and institutional advisors.

Factors Associated with Symptoms of Depression among People with Obesity: Analysis of a 3-Year-Peruvian National Survey.

INTRODUCTION: Obesity and depression contribute to the global burden of economic cost, morbidity, and mortality. Nevertheless, not all people with obesity develop depression. OBJECTIVE: To determine the factors associated with depressive symptoms among people aged 15 or older with obesity from the National Demographic and Family Health Survey (ENDES in Spanish 2019-2021). METHODS: Cross-sectional analytical study. The outcome of interest was the presence of depressive symptoms, assessed using the Patient Health Questionnaire-9 (PHQ-9). Crude (cPR) and adjusted (aPR) prevalence ratios were estimated using GLM Poisson distribution with robust variance estimates. RESULTS: The prevalence of depression symptoms was 6.97%. In the multivariate analysis, a statistically significant association was found between depressive symptoms and female sex (PRa: 2.59; 95% CI 1.95-3.43); mountain region (PRa: 1.51; 95% CI 1.18-1.92); wealth index poor (PRa: 1.37; 95% CI 1.05-1.79, medium (PRa: 1.49; 95% CI 1.11-2.02), and rich (PRa: 1.65; 95% CI 1.21-2.26); daily tobacco use (PRa: 2.05, 95% CI 1.09-3.87); physical disability (PRa: 1.96, 95% CI 1.07-3.57); and a history of arterial hypertension (PRa: 2.05; 95% CI 1.63-2.55). CONCLUSION: There are several sociodemographic factors (such as being female and living in the Andean region) and individual factors (daily use of tobacco and history of hypertension) associated with depressive symptoms in Peruvian inhabitants aged 15 or older with obesity. In this study, the COVID-19 pandemic was associated with an increase in depressive symptoms.

Ultrastructural skin alterations of healthy subjects with anti-desmoglein 1 antibodies in endemic areas to pemphigus foliaceus: A case series.

Background: Endemic pemphigus foliaceus and endemic pemphigus vulgaris are autoimmune dermatologic disorders endemic to the Peruvian Amazon. Objective: To determine the ultrastructural skin alterations of three healthy subjects with anti DSG-1 antibodies in areas endemic to pemphigus foliaceus and pemphigus vulgaris in the Peruvian Amazon. Patients and methods: Case series carried out from data of three clinically healthy subjects positive to anti DSG-1 antibodies, from Peru. This study consists of a sub-analysis of data gathered in a previous study. Results: Ultrastructural results are presented from the skin biopsies of three clinically healthy patients positive to anti-desmoglein 1 (DSG-1) antibodies. High Resolution Optical Microscopy (HROM) showed the absence of acantholysis. Transmission Electron Microscopy (TEM) showed the widening of intercellular space between keratinocytes, the presence of vacuoles in intercellular space with granular material and cytoplasmic vacuolization, loss of desmosome structure, loss of normal distribution among tonofilaments and lateral separation among cells in the stratum basale. Conclusion: According to our results, healthy subjects that present anti-desmoglein 1 antibodies can develop ultrastructural alterations that are visible through transmission electron microscopy but not through conventional optical microscopy.

Prevalence of SARS-CoV-2 Variants and Disease Outcome of COVID-19 Patients in the Amazonas Region of Peru.

Peru was severely affected by COVID-19 with a fatality rate that reached up to 6%. In this study, the relationship between SARS-CoV-2 variants and COVID-19 disease outcome in Amazonas, a region of northeastern Peru, was evaluated. The variants were determined by genomic sequencing, and clinical-epidemiological data were collected from 590 patients between April 2021 and February 2022. There was no association between mortality and hospitalization with any of the variants, but we did find that Omicron is more likely to infect vaccinated and nonvaccinated people. A significant association was also found between unvaccinated patients and hospitalization. Interestingly, in the indigenous population, there were fewer hospitalizations than in the general population. In conclusion, SARS-CoV-2 variants were not associated with the disease outcome in the Amazonas region, and indigenous population were found to be less vulnerable to severe COVID-19 illness.

The Fruit Intake-Adiposity Paradox: Findings from a Peruvian Cross-Sectional Study.

Due to the increase in obesity worldwide, international organizations have promoted the adoption of a healthy lifestyle, as part of which fruit consumption stands out. However, there are controversies regarding the role of fruit consumption in mitigating this disease. The objective of the present study was to analyze the association between fruit intake and body mass index (BMI) and waist circumference (WC) in a representative sample of Peruvians. This is an analytical cross-sectional study. Secondary data analysis was conducted using information from the Demographic and Health Survey of Peru (2019-2021). The outcome variables were BMI and WC. The exploratory variable was fruit intake, which was expressed in three different presentations: portion, salad, and juice. A generalized linear model of the Gaussian family and identity link function were performed to obtain the crude and adjusted beta coefficients. A total of 98,741 subjects were included in the study. Females comprised 54.4% of the sample. In the multivariate analysis, for each serving of fruit intake, the BMI decreased by 0.15 kg/m2 (ß = -0.15; 95% CI -0.24 to -0.07), while the WC was reduced by 0.40 cm (ß = -0.40; 95% CI -0.52 to -0.27). A negative association between fruit salad intake and WC was found (ß = -0.28; 95% CI -0.56 to -0.01). No statistically significant association between fruit salad intake and BMI was found. In the case of fruit juice, for each glass of juice consumed, the BMI increased by 0.27 kg/m2 (ß = 0.27; 95% CI 0.14 to 0.40), while the WC increased by 0.40 cm (ß = 0.40; 95% CI 0.20 to 0.60). Fruit intake per serving is negatively related to general body adiposity and central fat distribution, while fruit salad intake is negatively related to central distribution adiposity. However, the consumption of fruit in the form of juices is positively associated with a significant increase in BMI and WC.

Perception of risk to COVID-19 and mental health indicators in workers of a Peruvian hospital: An analytical cross-sectional study. / Percepción de riesgo a COVID-19 e indicadores de salud mental en trabajadores de un hospital peruano: estudio transversal analítico.

Introduction: COVID-19 has caused great fear on health professionals and could affect their mental health, therefore it is important to determine the association between the perception of risk to COVID-19 and mental health in workers of a Peruvian hospital. Methods: Analytical cross-sectional study, through virtual survey. The dependent variables were: depression, anxiety and stress; The independent variable was perception of risk to COVID-19 and the covariates: sociodemographic, family, work and clinical data. Crude and adjusted prevalence ratios were found with a 95% confidence interval and a significance level of 5%. Results: There was no association between risk perception and depression (adjusted prevalence ratio: 0.98 95% confidence interval: 0.89 to 1.08), anxiety (adjusted prevalence ratio: 0.94 95% confidence interval: 0.89 to 1.00), stress (adjusted prevalence ratio: 0.89 95% confidence interval 0.76 to 1.04). In the multivariate analysis, an association was found between depression with direct contact with the COVID-19 patient (adjusted prevalence ratio: 2.06, 95% confidence interval: 1.14 to 3.70) and with having a comorbidity (adjusted prevalence ratio: 2.56 95% confidence interval: 1.52 to 4.30); likewise, between anxiety with number of children (adjusted prevalence ratio: 1.09 95% confidence interval: 1.00 to 1.18), with direct contact with COVID-19 patient (adjusted prevalence ratio: 2.67 95% confidence interval 1.46 to 4.85) and having comorbidity (adjusted prevalence ratio: 2.00 95% confidence interval: 1.40 to 2.86); finally, between stress with direct contact with the COVID-19 patient (adjusted prevalence ratio: 2.86, 95% confidence interval: 1.20 to 6.83). Conclusions: No statistically significant association was found between risk perception and depression, anxiety, or stress. However, there was an association between depression, anxiety, and stress, each with direct contact with COVID-19 patients; between anxiety and depression, each with having comorbidities and, finally, anxiety with the number of children.

Objetivo: El COVID-19 atemoriza a profesionales sanitarios, pudiendo afectar su salud mental. El objetivo de este estudio fue determinar la asociación entre la percepción de riesgo a COVID-19 y la salud mental en trabajadores de un hospital peruano. Método: Estudio transversal analítico, mediante encuesta virtual. Las variables dependientes fueron depresión, ansiedad y estrés. La variable independiente fue percepción de riesgo a COVID-19 y las covariables fueron datos sociodemográficos, familiares, laborales y clínicos. Se hallaron razones de prevalencia crudas y ajustadas con un intervalo de confianza al 95% y un nivel de significancia del 5%. Resultados: No hubo asociación entre percepción de riesgo y depresión (razón de prevalencia ajustado: 0,98; intervalo de confianza 95%: 0,89 a 1,08), ansiedad (razón de prevalencia ajustado: 0,94; intervalo de confianza 95%: 0,89 a 1,00), estrés (razón de prevalencia ajustado: 0,89; intervalo de confianza 95%: 0,76 a 1,04). En el análisis multivariado se encontró asociación entre depresión con contacto directo con paciente COVID-19 (razón de prevalencia ajustados: 2,06; intervalo de confianza 95%: 1,14 a 3,70) y con tener una comorbilidad (razón de prevalencia ajustados: 2,56; intervalo de confianza 95%: 1,52 a 4,30); entre ansiedad con número de hijos (razón de prevalencia ajustados: 1,09; intervalo de confianza 95%: 1,00 a 1,18), con contacto directo con paciente COVID-19 (razón de prevalencia ajustados: 2,67; intervalo de confianza 95%: 1,46 a 4,85) y con tener comorbilidad (razón de prevalencia ajustados: 2,00; intervalo de confianza 95%: 1,40 a 2,86); entre estrés con contacto directo con paciente COVID-19 (razón de prevalencia ajustados: 2,86; intervalo de confianza 95%: 1,20 a 6,83). Conclusiones: No hubo asociación entre percepción de riesgo y depresión, ansiedad ni estrés. Hubo asociación entre depresión, ansiedad y estrés, cada uno con el contacto directo con pacientes COVID-19; entre ansiedad y depresión, cada uno con tener comorbilidades, y ansiedad con el número de hijos.

Teaching-learning process and the attitude toward scientific research among midwifery students.

BACKGROUND: Research in universities requires systematic and participatory processes that integrate teachers, contents, strategies and tools, and students and their own interests. Therefore, the main objective of this study was to establish the relationship between the perception of the teaching-learning process (TLP) and the attitude toward scientific research among midwifery students. MATERIALS AND METHODS: Descriptive cross-sectional study, conducted on 250 students from second to fourth year of study selected by convenience sampling. The data were collected with two self-administered Likert-type scales that were validated in content and construct, both with high reliability. Descriptive statistics were carried out; the Spearman correlation test was used prior to the application of the Kolmogorov-Smirnov test and Kendall's tau-b test. RESULTS: The favorable perception of the TLP was greater among second-year students (42.6%), in addition, 15.2% agreed that the advice of teachers contributes to the elaboration of the research protocol. The attitude of indifference toward research was more frequent in third-year students (58.2%) and 28.4% were deemed in disagreement to be able to identify and operationalize the variables. In the analysis of dimensions, the role of the student had a moderate relationship with the research design (rho = 0.536; P < 0.001), while a weak relationship was demonstrated between media and techniques with ethical and scientific value (rho = 0.104; P < 0.001). CONCLUSION: The TLP perceived by midwifery students and their attitudes toward scientific research had a direct and significant correlation. The proportion of students with favorable perception was greater among those with a favorable attitude.

Correlation between stress and lifestyle in teachers at some schools in Lima, Peru, during telework in 2020.

BACKGROUND: Stress and unhealthy lifestyle are serious problems in public health and education, particularly due to their significant relevance in the context of the COVID-19 pandemic. OBJECTIVES: To determine the correlation between stress and lifestyle in teachers at some schools in Lima, Peru, during telework in 2020. METHODS: This observational, quantitative, analytical, cross-sectional study was conducted in 217 school teachers from Lima. Lifestyle was measured using the FANTASTIC questionnaire; stress was measured using the Teaching Stress Scale (ED-6), comprised of the anxiety, depression, maladaptive beliefs, work pressure and poor coping dimensions. The Spearman correlation between numerical variables, and the difference of the FANTASTIC score according to the categorical variables, were analyzed with the Mann-Whitney U test or Kruskal-Wallis test, as necessary. Multivariable analysis was done with a multiple linear regression model to find raw and adjusted ß (ßa). RESULTS: The median of the ED-6 scale was 81 (RI: 64-105). Sixty-four percent of the teachers had a good-excellent lifestyle; 27.2%, regular; and 8.49%, bad-dangerous. The FANTASTIC score had an inverse correlation with ED-6 (ßa: -0.16, 95%; CI: -0.20 to -0.12) adjusted for age and cohabitation with children. Likewise, teachers between 40 and 49 years old (ßa: 2.89, 95%; CI: 0.17 to 5.62) had a better lifestyle; and teachers who lived with children (ßa: -5.48, 95%; CI: -7.89 to -3.06), a worse lifestyle. CONCLUSIONS: As stress increased, the lifestyle quality worsened in teachers at some schools in Lima, Peru, during telework in 2020.

Exposure to Atmospheric Ozone Disruption and Altitude Over 3500 m.a.s.l. are Associated with a Higher Prevalence of Photodermatoses in Pediatric Population of High-Altitude in Peru.

Objective: To determine if exposure to atmospheric ozone disruption and other factors are associated with photodermatoses in the high-altitude pediatric population in Peru. Materials and Methods: A cross-sectional study based on data obtained from studies of dermatological diseases among the population exposed to mine tailings in Peru which included children under the age of 18 in 6 population centers located over 2500 meters above sea level (m.a.s.l). We evaluated the presence of photodermatoses and possible associated factors obtaining the adjusted odds ratio (aOR) and confidence intervals (CI). Results: 594 children below the age of 18 participated in this study, 53.0% girls, the average age was 10.4 ± 4.1 years. 51.3% were exposed to a mini hole in the ozone layer, 60.1% resided at an altitude over 3500 m.a.s.l and 51.9% presented cutaneous manifestations of atopy upon physical examination. The prevalence of photodermatoses was 64.8%, of which the most frequent were actinic prurigo (49.3%), pityriasis alba (18.5%) and actinic cheilitis (4.4%). The multivariate analysis found that residing in a region exposed to the mini hole in the ozone layer (aOR = 4.23; CI 95%: 2.32-7.72) and residing at an altitude over 3500 m.a.s.l (aOR = 2.76; CI 95%: 1.57-4.86) were both independent associated factors to photodermatoses. Conclusion: A high prevalence of photodermatoses exists among the pediatric population living at high-altitude in Peru. Residing in a region exposed to a mini hole in the ozone layer and residing over 3500 m.a.s.l constituted associated factors.

Arsenicism by Chronic Exposure to Mine Tailings in Peru: An Analysis of 17 Cases with Lesions on Skin and/or Annexes.

Objective: To characterize the epidemiology and clinical manifestations of arsenicism from chronic exposure to mine tailings in people with lesions on their skin and/or annexes in two mining districts in the highlands of Peru. Materials and Methods: In this case series study, we included 17 people that presented arsenical lesions in skin and annexes which were identified in two prior studies. We evaluated age, occupation, place of exposure, time of exposure, time of disease, manifestations on skin and annexes, location of lesions, severity, and 24-hour urine clearance of arsenic. Results: The average time of exposure was 16.5 ± 14.7 years, and the average length of disease was 9.8 ± 8.1 years. In this study, 70.6% were men, 41.2% were farmers and 17.6% were underage. The most frequent main manifestations in skin and annexes were plantar keratosis (23.5%), palmar (11.8%), palmoplantar (11.8%) and thoracic keratosis (5.9%). Other manifestations were palmoplantar keratosis with thoracic hyperpigmentation (17.6%), Mees' lines (17.6%) and hyper/hypopigmentation in thorax and back (11.8%). With relation to the severity of lesions, 35.3% were grade 1 (mild), 29.4 % were grade 0 (asymptomatic), 29.4 % were grade 2 (moderate), and 5.9% were grade 3 (severe). The median of 24-hour urine clearance of arsenic was 55 µg/L/24 hours. No cases of skin cancer were presented. Conclusion: The studied cases of arsenicism with lesions on skin and/or annexes by exposure to mine tailings present with differential characteristics in comparison to other forms of arsenicism such as less severity, lower urine clearance of arsenic, and absence of skin cancer cases.

Effects of decision aids for depression treatment in adults: systematic review.

AIM AND METHOD: To determine the effect on decisional-related and clinical outcomes of decision aids for depression treatment in adults in randomised clinical trials. In January 2019, a systematic search was conducted in five databases. Study selection and data extraction were performed in duplicate. Meta-analyses were performed, and standardised and weighted mean differences were calculated, with corresponding 95% confidence intervals. The certainty of the evidence was evaluated with GRADE methodology. RESULTS: Six randomised clinical trials were included. The pooled estimates showed that decision aids for depression treatment had a beneficial effect on patients' decisional conflict, patient knowledge and information exchange between patient and health professional. However, no statistically significant effect was found for doctor facilitation, treatment adherence or depressive symptoms. The certainty of the evidence was very low for all outcomes. CLINICAL IMPLICATIONS: Using decision aids to choose treatment in patients with depression may have a a beneficial effect on decisional-related outcomes, but it may not translate into an improvement in clinical outcomes.

Epidemiological Characteristics of Deaths from COVID-19 in Peru during the Initial Pandemic Response.

BACKGROUND AND AIM: Peru is the country with the highest mortality rate from COVID-19 globally, so the analysis of the characteristics of deaths is of national and international interest. The aim was to determine the epidemiological characteristics of deaths from COVID-19 in Peru from 28 March to 21 May 2020. METHODS: Deaths from various sources were investigated, including the COVID-19 Epidemiological Surveillance and the National System of Deaths (SINADEF). In all, 3851 deaths that met the definition of a confirmed case and had a positive result of RT-PCR or rapid test IgM/IgG, were considered for the analysis. We obtained the epidemiological variables and carried out an analysis of time defined as the pre-hospital time from the onset of symptoms to hospitalization, and hospital time from the date of hospitalization to death. RESULTS: Deaths were more frequent in males (72.0%), seniors (68.8%) and residents of the region of Lima (42.7%). In 17.8% of cases, the death occurred out-of-hospital, and 31.4% had some comorbidity. The median of pre-hospital time was 7 days (IQR: 4.0-9.0) and for the hospital time was 5 days (IQR: 3.0-9.0). The multivariable analysis with Poisson regression with robust variance found that the age group, comorbidity diagnosis and the region of origin significantly influenced pre-hospital time; while sex, comorbidity diagnosis, healthcare provider and the region of origin significantly influenced hospital time. CONCLUSION: Deaths occurred mainly in males, seniors and on the coast, with considerable out-of-hospital deaths. Pre-hospital time was affected by age group, the diagnosis of comorbidities and the region of origin; while, hospital time was influenced by gender, the diagnosis of comorbidities, healthcare provider and the region of origin.

Clinical and laboratory factors associated with nosocomial pneumonia in adult patients in the internal medicine department of a national hospital in Peru: A case-control study. / Factores clínicos y de laboratorio asociados a neumonía nosocomial en pacientes adultos en el servicio de medicina interna de un hospital nacional de Perú: estudio de casos y controles.

OBJECTIVE: To determine how clinical and laboratory factors were associated with nosocomial pneumonia in adult patients hospitalized in an internal medicine department. METHODS: We conducted a retrospective unmatched case-control study. We recorded clinical and epidemiological data from patients discharged from an internal medicine department of a Peruvian reference hospital, the Hospital Nacional Arzobispo Loayza, between 2016 and 2018. Bivariate and multivariate analyses (using logistic regression models) were performed to obtain crude and adjusted odds ratios with 95% confidence intervals. A P value < 0.05 was considered significant. We calculated the population attributable fraction of the significant variables. RESULTS: We analyzed 138 cases and 200 controls, with a mean age of 72.6 ± 17.8 years (21 to 104) for cases and 71.7 ± 15.3 years (19 to 98) for controls. The multivariate analysis indicated that severe anemia (adjusted odds ratio 9.0, confidence interval 95% 1.9 to 43.1, P = 0.01), severe hypoalbuminemia (adjusted odds ratio 4.0, confidence interval 95% 1.2 to 13.8, P = 0.03), altered state of consciousness (adjusted odds ratio 3.6, confidence interval 95% 1.6 to 8.2, P = 0.00), and prior use of antibiotics (adjusted odds ratio 6.3, confidence interval 95% 2.7 to 14.5, P = 0.00) were significantly associated with nosocomial pneumonia. The population attributable fraction found were 41.8% for altered state of consciousness, 33.2% for severe anemia, and 36.3% for severe hypoalbuminemia. CONCLUSION: Clinical and laboratory risk factors associated with nosocomial pneumonia development in adult patients hospitalized in an internal medicine department were severe anemia, severe hypoalbuminemia, altered consciousness, and previous use of antibiotics.

INTRODUCCIÓN: La neumonía nosocomial es la infección intrahospitalaria más frecuente y es responsable de alta morbimortalidad en todo el mundo, por lo que su estudio es muy importante. OBJETIVO: Determinar cómo los factores clínicos y de laboratorio se asociaron a neumonía nosocomial en pacientes adultos hospitalizados en un servicio de medicina interna. MÉTODOS: Se realizó un estudio retrospectivo de casos y controles no pareado. Se recolectaron los datos clínicos epidemiológicos de pacientes egresados del departamento de medicina interna durante el periodo 2016 a 2018 de un centro de referencia en Perú: el Hospital Nacional Arzobispo Loayza. Se realizó análisis bivariado y multivariado, usando el método de regresión logística, para obtener Odds ratio crudos y ajustados, con un intervalo de confianza de 95%. El valor p < 0,05 fue considerado significativo. Se calculó la fracción atribuible poblacional de las variables significativas. RESULTADOS: Se analizaron 138 casos y 200 controles, la media de edad fue de 72,6 ± 17,8 años (21 a 104) para los casos y 71,7 ± 15,3 años (19 a 98) para los controles. En el análisis multivariado la anemia severa (Odds ratio ajustado: 9,0; intervalo de confianza 95%: 1,9 a 43,1; p = 0,01), hipoalbuminemia severa (Odds ratio ajustado: 4,0; intervalo de confianza 95%: 1,2 a 13,8; p = 0,03), trastorno de conciencia (Odds ratio ajustado: 3,6; intervalo de confianza 95%: 1,6 a 8,2; p = 0,00) y el uso previo de antibióticos (Odds ratio ajustado: 6,3; intervalo de confianza 95%: 2,7 a 14,5; p = 0,00) se asociaron independientemente con la neumonía nosocomial. La fracción atribuible poblacional encontrada fue 41,8% para trastorno de conciencia, 33,2% para anemia severa y 36,3% para hipoalbuminemia severa. CONCLUSIONES: Los factores de riesgos clínicos y de laboratorio asociados al desarrollo de neumonía nosocomial en pacientes adultos hospitalizados fueron la anemia severa, la hipoalbuminemia severa, el trastorno de conciencia y el uso previo de antibióticos.

Detection of Viral and Bacterial Respiratory Pathogens Identified by Molecular Methods in COVID-19 Hospitalized Patients and Its Impact on Mortality and Unfavorable Outcomes.

PURPOSE: The purpose of this study is to evaluate the frequency of viral and bacterial respiratory pathogens detected by molecular methods in sputum samples of patients hospitalized for COVID-19 and to evaluate its impact on mortality and unfavorable outcomes (in-hospital death or mechanical ventilation). PATIENTS AND METHODS: The prospective cohort included patients with diagnosis of COVID-19 hospitalized at Hospital Nacional Hipólito Unanue. Sociodemographic and clinical data were collected from clinical records. Sputum samples were analyzed with the Biofire Filmarray Pneumonia plus® respiratory panel. Crude and adjusted associations with unfavorable outcomes were evaluated using logistic regression models. RESULTS: Ninety-three patients who were able to collect sputum samples were recruited between September 8 and December 28, 2020. The median age was 61.7 years (IQR 52.3-69-8) and 66 (71%) were male. The most frequent symptoms were dyspnea, cough, fever, and general malaise found in 80 (86%), 76 (82%), 45 (48%), and 34 (37%) patients, respectively. Fifty-three percent of patients had comorbidities. Seventy-six (82%) patients received antibiotics prior to admission and 29 (31%) developed unfavorable outcome. Coinfection was evidenced in 38 (40.86%) cases. The most frequently found bacteria were Staphylococcus aureus, Streptococcus agalactiae, Haemophilus influenzae and Klebsiella pneumoniae in 11 (11.83%), 10 (10.75%), 10 (10.75%), and 8 (8.6%) cases, respectively. Streptococcus pneumoniae was found in one case (1.08%). We neither identify atypical bacteria nor influenza virus. No association was found between the presence of viral or bacterial microorganisms and development of unfavorable outcomes (OR 1.63; 95% CI 0.45-5.82). CONCLUSION: A high frequency of respiratory pathogens was detected by molecular methods in patients with COVID-19 pneumonia but were not associated with unfavorable outcomes. No atypical agents or influenza virus were found. The high use antibiotics before admission is a concern. Our data suggest that the use of drug therapy against atypical bacteria and viruses would not be justified in patients hospitalized for COVID-19.