Prevalence of Cognitive Impairment and Dementia in Older Adults Living at High Altitude: A Systematic Review and Meta-Analysis.

INTRODUCTION: Dementia is a chronic disease with a variable prevalence throughout the world; however, this could be higher at high-altitude populations. We aimed to summarize the prevalence of cognitive impairment and dementia in older adults living at high altitude. METHODS: We searched in PubMed, Medline, Scopus, Web of Science, and Embase and included the studies published from inception to July 20, 2020, with no language restriction, which reported the frequency of cognitive impairment or dementia in older adults living at high-altitude populations. Random-effects meta-analyses were performed to calculate the overall prevalence and 95% confidence intervals (95% CI) of cognitive impairment and dementia. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. RESULTS: Six studies were included (3,724 participants), and 5 of the 6 included studies were carried out in Latin America. The altitude ranged from 1,783 to 3,847 m, the proportion of women included varied from 38.7 to 65.6%, and the proportion of participants with elementary or illiterate educational level ranged from 71.7 to 97.6%. The overall prevalence of cognitive impairment was 22.0% (95% CI: 8-40, I2: 99%), and the overall prevalence of dementia was 11.0% (95% CI: 6-17, I2: 92%). In a subgroup analysis according to the instrument used to evaluate cognitive impairment, the prevalence of cognitive impairment was 21.0% (95% CI: 5-42, I2: 99%) in the MMSE group while the prevalence was 29.0% (95% CI: 0-78) in the non-MMSE group. CONCLUSIONS: The prevalence of cognitive impairment and dementia in older adults living at high altitude is almost twice the number reported in some world regions.

Association between depressive symptoms and disability in older adults of 12 high Andean communities from Peru.

OBJECTIVE: Our objective was to evaluate the association between depressive symptoms and disability in older adults residing in 12 high Andean communities in Peru. MATERIAL AND METHODS: We carried out a secondary data analysis of a cross-sectional study that included older adults (60 years or older) from 12 high Andean communities in Peru from 2013 to 2019. Depressive symptoms were defined as a score of two or more in the abbreviated Geriatric Depression Scale, while disability was defined as a score of less than 95 in the Barthel index. We also included sociodemographic characteristics, medical and personal history, and functional and performance-based tests. We used crude and adjusted Poisson regression models to evaluate the association of interest and estimated prevalence ratios (PR) with their respective 95% confidence intervals (95% CI). RESULTS: We included 442 older adults with a mean age of 73 ± 6.9 in the analysis; 63.1% (n = 279) were women, and 79.9% (n = 353) had no education or incomplete primary school. 50.9% (n = 225) of the participants had depressive symptoms, and 49.8% (n = 220) had disability. The adjusted Poisson regression model showed that depressive symptoms increased the probability of disability (adjusted PR = 1.67; 95% CI: 1.34-2.08; p < 0.001) in older adults living at high altitude. CONCLUSIONS: Depressive symptoms was associated with a greater probability of disability in older adults living at high altitude. Longitudinal studies are needed for better understanding of this association in high altitude populations along with timely interventions to reduce the impact of both geriatric syndromes.

[Impact of social support on limited mobility in older people in high Andean communities in PeruImpacto do apoio social na mobilidade reduzida em idosos de comunidades do altiplano andino no Peru]. / Impacto del soporte social sobre la movilidad limitada en personas mayores de comunidades altoandinas peruanas.

OBJECTIVE: To determine whether there is a relationship between physical mobility and lack of social support in elderly people living in high Andean communities in Peru. METHODOLOGY: Observational, analytical, retrospective study using the database of a previous cross-sectional study containing information on 449 people aged 60 years and over, who participated in the ANDES-FRAIL project. The dependent variable was mobility, evaluated using the Short Physical Performance Battery; the independent variable was social support, evaluated using an item from the Edmonton Frail Scale. Sociodemographic parameters, comorbidities, number of drugs commonly used, and scores received from several instruments were used as covariates. These included the Barthel Index to determine functionality in older people and the Yesavage questionnaire to evaluate depression in the elderly. Frequencies and percentages were calculated for the categorical variables. An adjusted model was developed using the variables that were statistically significant in the two-factor logistic regression analysis. RESULTS: The frequency of limited mobility in the studied population was 58.6% (n = 263) and the frequency of inadequate social support was 58.1% (n = 261); 70.7% of participants (n = 186) with inadequate social support had limited mobility. According to the adjusted regression model, inadequate social support would make it 2.5 times more likely (95% CI: 1.3-4.5) to have limited mobility, regardless of the confounding covariates. CONCLUSIONS: Lack of social support is associated with limited mobility in older people living in high Andean communities in Peru.

OBJETIVO: Determinar se existe relação entre mobilidade física e falta de apoio social em idosos que vivem em comunidades do altiplano andino no Peru. MÉTODOS: Estudo observacional analítico de coorte retrospectiva baseado em dados obtidos em uma pesquisa transversal anterior com 449 participantes, com idade de 60 anos ou mais, como parte do Projeto ANDES-FRAIL. A variável dependente foi a mobilidade, avaliada com o Short Physical Performance Battery, um instrumento que avalia o desempenho físico funcional com uma série curta de testes. A variável independente foi o apoio social, avaliado por um item da Escala de Fragilidade de Edmonton (The Edmonton Frail Scale, EFS). As covariáveis foram parâmetros sociodemográficos, presença de comorbidades, número de medicamentos de uso habitual e pontuação em vários instrumentos de avaliação, como o índice de Barthel de avaliação da independência funcional de idosos e a Escala de Depressão Geriátrica de Yesavage. Foram calculadas as frequências e as porcentagens das variáveis categóricas e elaborado um modelo ajustado com as variáveis com significância estatística na análise de regressão logística bifatorial. RESULTADOS: Na amostra estudada, 58,6% (n = 263) apresentavam mobilidade reduzida e 58,1% (n = 261) recebiam apoio social inadequado. Entre as pessoas com apoio social inadequado, 70,7% (n = 186) apresentavam mobilidade reduzida. De acordo com o modelo de regressão logística ajustado, a chance de ter mobilidade reduzida foi 2,5 vezes maior (IC 95% 1,3­4,5) quando o apoio social era inadequado, independentemente das covariáveis de confusão. CONCLUSÃO: A falta de apoio social está associada à mobilidade reduzida em idosos que vivem em comunidades do altiplano andino no Peru.

Falls Among the Elderly in Peruvian Andean Communities and the Rural far South of Brazil: Prevalence and Associated Factors.

Falls are the fifth leading cause of death and are one of the main causes of hospitalization. The literature about falls prevalence among older adults living in rural/remote communities in South America is scarce. To compare falls prevalence among the elderly in the Andes, Peru, and in the rural area of the municipality of Rio Grande, Rio Grande do Sul state, Brazil. Two separate cross-sectional studies were conducted in Peru, Andes (N = 413), and Brazil, Rio Grande, Rio Grande do Sul state (N = 1029). We stratified all data analysis according to location (Andes/Rio Grande). Characteristics of the samples were compared and the chi square test for proportions was used. Falls prevalence was then calculated for each independent variable and crude and adjusted prevalence ratios were estimated using Poisson Regression with robust variance. Falls prevalence in the last year was much higher in the Andes (64.1%) than in Rio Grande (25.3%). For most characteristics assessed, falls prevalence in Peru was at least double that found in Rio Grande. According to the adjusted analysis for the Andes, age (80 or more), being married, divorced and alcohol intake were significantly associated with falls. In Rio Grande, female gender and being in the 70-79 and 80 or more age ranges were associated with falls as well as those who self-rated their health as poor. This paper contributes to knowledge about falls prevalence among the elderly from rural and remote communities in two South American countries. Longitudinal multicentre studies with standardized methodologies are recommended.

Temporal arteritis, Sjögren's syndrome and mixed pain components as manifestations in a diabetic older adult: systematic review based on a case report.

Temporal arteritis (TA) is an inflammatory vascular disease common in the European population. It is mainly characterized by sudden onset headache. TA is rarely associated with other autoimmune diseases, such as Sjögren's syndrome (SS). We present the case of a Peruvian 71 year-old man with SS history, who was admitted to the emergency department due to severe headache evolved in 4 days, periocular pain and right ptosis. The authors also performed a systematic review of case reports or case series of patients diagnosed with both TA and SS. This temporal arteritis case is an atypical presentation because headache was characterized by mixed nociceptive and neuropathic pain components. Despite the infrequency, new studies should be carried out to identify comorbidities in TA patients.

Vasodilators for women undergoing fertility treatment.

BACKGROUND: The rate of successful pregnancies brought to term has barely increased since the first assisted reproductive technology (ART) technique became available. Vasodilators have been proposed to increase endometrial receptivity, thicken the endometrium, and favour uterine relaxation, all of which could improve uterine receptivity and enhance the chances for successful assisted pregnancy. OBJECTIVES: To evaluate the effectiveness and safety of vasodilators in women undergoing fertility treatment. SEARCH METHODS: We searched the following electronic databases, trial registers, and websites: the Cochrane Gynaecology and Fertility Group (CGF) Specialised Register of controlled trials, the Cochrane Central Register of of Controlled Trials, via the Cochrane Register of Studies Online (CRSO), MEDLINE, Embase, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Knowledge, the Open System for Information on Grey Literature in Europe (OpenSIGLE), the Latin American and Caribbean Health Science Information Database (LILACS), clinical trial registries, and the reference lists of relevant articles. We conducted the search in October 2017 and applied no language restrictions. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing vasodilators alone or in combination with other treatments versus placebo or no treatment or versus other agents in women undergoing fertility treatment. DATA COLLECTION AND ANALYSIS: Four review authors independently selected studies, assessed risk of bias, extracted data, and calculated risk ratios (RRs). We combined study data using a fixed-effect model and assessed evidence quality using Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) methods. Our primary outcomes were live birth or ongoing pregnancy and vasodilator side effects. Secondary outcomes included clinical pregnancy, endometrial thickness, multiple pregnancy, miscarriage, and ectopic pregnancy. MAIN RESULTS: We included 15 studies with a total of 1326 women. All included studies compared a vasodilator versus placebo or no treatment. We judged most of these studies as having unclear risk of bias. Overall, the quality of evidence was low to moderate for most outcomes. The main limitations were imprecision due to low numbers of events and participants and risk of bias due to unclear methods of randomisation.Vasodilators probably make little or no difference in rates of live birth compared with placebo or no treatment (RR 1.18, 95% confidence interval (CI) 0.83 to 1.69; three RCTs; N = 350; I² = 0%; moderate-quality evidence) but probably increase overall rates of side effects including headache and tachycardia (RR 2.35, 95% CI 1.51 to 3.66; four RCTs; N = 418; I² = 0%; moderate-quality evidence). Evidence suggests that if 236 per 1000 women achieve live birth with placebo or no treatment, then between 196 and 398 per 1000 will do so with the use of vasodilators.Compared with placebo or no treatment, vasodilators may slightly improve clinical pregnancy rates (RR 1.45, 95% CI 1.19 to 1.77; 11 RCTs; N = 1054; I² = 6%; low-quality evidence). Vasodilators probably make little or no difference in rates of multiple gestation (RR 1.15, 95% CI 0.55 to 2.42; three RCTs; N = 370; I² = 0%; low-quality evidence), miscarriage (RR 0.83, 95% CI 0.37 to 1.86; three RCTs; N = 350; I² = 0%; low-quality evidence), or ectopic pregnancy (RR 1.48, 95% CI 0.25 to 8.69; two RCTs; N = 250; I² = 5%; low-quality evidence). All studies found benefit for endometrial thickening, but reported effects varied (I² = 92%) and ranged from a mean difference of 0.80 higher (95% CI 0.18 to 1.42) to 3.57 higher (95% CI 3.01 to 4.13) with very low-quality evidence, so we are uncertain how to interpret these results. AUTHORS' CONCLUSIONS: Evidence was insufficient to show whether vasodilators increase the live birth rate in women undergoing fertility treatment. However, low-quality evidence suggests that vasodilators may slightly increase clinical pregnancy rates. Moderate-quality evidence shows that vasodilators increase overall side effects in comparison with placebo or no treatment. Adequately powered studies are needed so that each treatment can be evaluated more accurately.

Cognitive impairment and hypertension in older adults living in extreme poverty: a cross-sectional study in Peru.

BACKGROUND: Previous studies have shown that hypertension is a risk factor for cognitive impairment, but whether this association is also present in extremely poor populations in Low Middle Income Countries settings remains to be studied. Understanding other drivers of cognitive impairment in this unique population also merits attention. METHODS: We performed a secondary analysis using data from the "Encuesta de Salud y Bienestar del Adulto Mayor", a regional survey conducted in an extremely poor population of people older than 65 years old from 12 Peruvian cities in 2012. The outcome variable was cognitive impairment, determined by a score of ≤7 in the modified Mini-Mental State Examination. The exposure was self-reported hypertension status. Variables such as age, gender, controlled hypertension, education level, occupation, depression and area of living (rural/urban) were included in the adjusted analysis. We used Poisson regression with robust variance to calculate prevalence ratios (PR) and 95% confidence interval (95% CI) adjusting for confounders. RESULTS: Data from 3842 participants was analyzed, 51.8% were older than 70 years, and 45.6% were females. The prevalence of cognitive impairment was 1.7% (95% CI 1.3%-2.1%). There was no significant difference on the prevalence of cognitive impairment between the group of individuals with hypertension in comparison with those without hypertension (PR = 0.64, 95% CI 0.33-1.23). CONCLUSIONS: The association described between hypertension and cognitive impairment was not found in a sample of extremely poor Peruvian older adults.

Correlation between Instrumental Activities of Daily Living and muscle mass in older adults: impact of comorbidities.

Background: There is evidence that sarcopenia and functionality are closely related. However, the association between geriatric syndromes, such as dependence, on instrumental activities and sarcopenia could be affected by the presence of certain comorbidities, such as overweight, obesity, diabetes, and chronic obstructive pulmonary disease (COPD). Therefore, the present study aimed to determine the association between instrumental activities of daily living and muscle mass in the elderly and evaluate the impact of certain comorbidities on this association. Methods: This was a retrospective analytical observational study, including 1897 patients. Muscle mass was measured with calf circumference, and instrumental activities were measured with the Lawton index. Results: Among different parameters studies, a statistical correlation was found in a stratified regression analysis between the Lawton index score and muscle mass in patients who were overweight (p value:0.001 ;beta coefficient: 0.08), obese (p value: 0.001 ; beta coefficient: 0.05), had diabetes (p value: 0.012 ;beta coefficient: 0.03), and had COPD (p value:0.001 ;beta coefficient:0.03). Conclusion: The correlation between muscle mass and instrumental activities of daily living should be evaluated individually according to the needs of each participant and according to their comorbidities, promoting patient-centered geriatric medicine.

Acute abdomen following COVID-19 vaccination: a systematic review.

Purpose: Conduct a systematic review of case reports and case series regarding the development of acute abdomen following coronavirus disease 2019 (COVID-19) vaccination, to describe the possible association and the clinical and demographic characteristics in detail. Materials and Methods: This study included case report studies and case series that focused on the development of acute abdomen following COVID-19 vaccination. Systematic review studies, literature, letters to the editor, brief comments, and so forth were excluded. PubMed, Scopus, EMBASE, and Web of Science databases were searched until June 15, 2023. The Joanna Briggs Institute tool was used to assess the risk of bias and the quality of the study. Descriptive data were presented as frequency, median, mean, and standard deviation. Results: Seventeen clinical case studies were identified, evaluating 17 patients with acute abdomen associated with COVID-19 vaccination, which included acute appendicitis (n=3), acute pancreatitis (n=9), diverticulitis (n=1), cholecystitis (n=2), and colitis (n=2). The COVID-19 vaccine most commonly linked to acute abdomen was Pfizer-BioNTech (messenger RNA), accounting for 64.71% of cases. Acute abdomen predominantly occurred after the first vaccine dose (52.94%). All patients responded objectively to medical (88.34%) and surgical (11.76%) treatment and were discharged within a few weeks. No cases of death were reported. Conclusion: Acute abdomen is a rare complication of great interest in the medical and surgical practice of COVID-19 vaccination. Our study is based on a small sample of patients; therefore, it is recommended to conduct future observational studies to fully elucidate the underlying mechanisms of this association.

Evaluation of Factors Influencing Handgrip Strength Asymmetry in Older Peruvian Adults.

BACKGROUND: Sarcopenia is a musculoskeletal disease involving the reduction of muscle mass, strength, and performance. Handgrip strength (HGS) measurements included in frailty assessments are great biomarkers of aging and are related to functional deficits. We assessed the association between potential influencing factors and HGS asymmetry in older Peruvian adults. METHODS: We used a database of the Peruvian Naval Medical Center "Cirujano Santiago Távara" located in Callao, Peru. All the patients included were ≥60 years old and had an HGS measurement in the dominant and non-dominant hand. RESULTS: From a total of 1,468 patients, 74.66% had HGS asymmetry. After adjustment, calf circumference weakness (adjusted prevalence ratio [aPR]=1.08; 95% confidence interval [CI], 1.01-1.15), falls risk (aPR = 1.08; 95% CI, 1.02-1.16), and an altered Lawton index (aPR=0.92; 95% CI, 0.84-0.99) were associated with HGS asymmetry. CONCLUSION: Our findings suggest that HGS asymmetry should be measured along with other geriatric assessments used to evaluate health outcomes in the elderly to enhance health promotion and prevention aimed at preserving muscle strength to curb functional limitations in the elderly.

Association between gait speed and balance disorders in older adults from 12 high Andean Peruvian communities, 2013-2019.

Background: Gait speed is associated with a higher prevalence of balance disorders in older adults residing at high altitudes. This study investigated this association in older adults from 12 high-altitude Andean Peruvian communities. Methods: We performed a secondary data analysis from an analytical cross-sectional study of adults >60 years of age, residing in 12 high-altitude Andean Peruvian communities, enrolled between 2013 and 2019. The exposure and outcome variables were gait speed (categorized in tertiles), and balance disorders (defined as a functional reach value of ≤20.32 cm), respectively. We built generalized linear models of the Poisson family with a logarithmic link function and robust variances, and estimated crude prevalence ratios (cPR) and adjusted prevalence ratios (aPR) with 95% confidence intervals (CIs). Results: We analyzed 418 older adults; 38.8% (n=162) were male, and the mean age was 73.2 ± 6.9 years. The mean gait speed and functional reach were 0.66 ± 0.24 m/s and 19.9 ± 6.48 cm, respectively. In the adjusted regression model, the intermediate (aPR=1.88; 95% CI: 1.39-2.55; p<0.001) and low (aPR=2.04; 95% CI: 1.51-2.76; p<0.001) tertiles of gait speed were associated with a higher prevalence of balance disorders. Conclusions: The intermediate and low tertiles of gait speed were associated with a higher prevalence of balance disorders among older adult residents of 12 high-altitude Andean communities. We recommend further research on the behavior of this association to propose interventions for these vulnerable groups and reduce the impact of geriatric conditions.

Sarcopenia and sarcopenic obesity among community-dwelling Peruvian adults: A cross-sectional study.

INTRODUCTION: Sarcopenia and sarcopenic obesity (SO) have emerged as significant contributors to negative health outcomes in the past decade. We aimed to estimate the prevalence of probable sarcopenia, sarcopenia, and SO in a community-dwelling population of 1151 adults aged ≥55 years in Lima, Peru. METHODS: This cross-sectional study was conducted between 2018 and 2020. Sarcopenia was defined as the presence of low muscle strength (LMS) and low muscle mass (LMM) according to European (EWGSOP2), US (FNIH) and Asian (AWGS2) guidelines. We measured muscle strength by maximum handgrip strength and muscle mass using bioelectrical impedance analyzer. SO was defined as a body mass index ≥ 30 kg/m2 and sarcopenia. RESULTS: The study participants had a mean age of 66.2 years (SD 7.1), age range between 60 to 92 years old, of which 621 (53.9%) were men. Among the sample, 41.7% were classified as obese (BMI ≥30.0 kg/m²). The prevalence of probable sarcopenia was estimated to be 22.7% (95%CI: 20.3-25.1) using the EWGSOP2 criteria and 27.8% (95%CI: 25.2-30.4) using the AWGS2 criteria. Sarcopenia prevalence, assessed using skeletal muscle index (SMI), was 5.7% (95%CI: 4.4-7.1) according to EWGSOP2 and 8.3% (95%CI: 6.7-9.9) using AWGS2 criteria. The prevalence of sarcopenia based on the FNIH criteria was 18.1% (95%CI: 15.8-20.3). The prevalence of SO, considering different sarcopenia definitions, ranged from 0.8% (95%CI: 0.3-1.3) to 5.0% (95%CI: 3.8-6.3). CONCLUSION: Our findings reveal substantial variation in the prevalence of sarcopenia and SO, underscoring the necessity for context-specific cut-off values. Although the prevalence of SO was relatively low, this result may be underestimated. Furthermore, the consistently high proportion of probable sarcopenia and sarcopenia point to a substantial public health burden.

Discontinuation of Antihypertensive Drug Use Compared to Continuation in COVID-19 Patients: A Systematic Review with Meta-analysis and Trial Sequential Analysis.

INTRODUCTION: COVID-19 related mortality is about 2%, and it increases with comorbidities, like hypertension. Regarding management, there is debatable evidence about the benefits of continuation vs. discontinuation of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEI/ARB). AIM: We performed a systematic review to assess the effects and safety of in-hospital discontinuation compared to continuation of ACEI/ARB in COVID-19 patients. METHODS: We systematically searched on PubMed, Scopus, and EMBASE from inception to June 19, 2021. We included observational studies and trials that compared the effects and safety of continuing ACEI/ARB compared to discontinuing it in COVID-19 patients. Effects sizes for dichotomous variables were expressed as risk ratios (RR) and 95% confidence intervals. For continuous variables, effects were expressed as mean difference (MD). We used random effect models with the inverse variance method. We assessed certainty of evidence using the GRADE approach. RESULTS: We included three open-label randomized controlled trials and five cohort studies. We found that the continuation group had lower risk of death compared with the discontinuation group only in the cohort group (RR: 0.46, 95% CI: 0.24-0.90), but not in the RCT group (RR: 1.22, 95% CI: 0.75-2.00). The ICU admission rate was significantly lower in the continuation group (RR: 0.46, 95% CI: 0.31-0.68) in the cohort group, but not in RCT group (RR: 1.03, 95% CI: 0.67-1.59). We did not find significant differences between groups regarding hospitalization length, hypotension, AKI needing renal replacement therapy, mechanical ventilation, new or worsening heart failure, myocarditis, renal replacement therapy, arrhythmias, thromboembolic events and SOFA AUC. The GRADE approach revealed that the certainty ranged from moderate to high level. CONCLUSIONS: There is no significant difference in mortality and other outcomes between continuation and discontinuation groups.

Factors associated with mortality in patients hospitalized for COVID-19 admitted to a tertiary hospital in Lambayeque, Peru, during the first wave of the pandemic.

INTRODUCTION: COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spread worldwide, becoming a long-term pandemic. OBJECTIVES: To analyze the factors associated with mortality in patients hospitalized for COVID-19 in a tertiary hospital in the Lambayeque region of Peru. METHODS: A retrospective cohort study of patients with a diagnosis of COVID-19, hospitalized in a hospital in northern Peru, was conducted from March to September 2020. RESULTS: Of the 297 patients studied, 69% were women, the mean age was 63.99 years (SD = ±15.33 years). Hypertension was the most frequent comorbidity (36.67%), followed by diabetes mellitus (24.67%) and obesity (8.33%). The probability of survival at 3 days of ICU stay was 65.3%, at 7 days 24.2%, and 0% on day 14. Risk factors associated with mortality in patients hospitalized for COVID-19 are age, male sex, tachypnea, low systolic blood pressure, low peripheral oxygen saturation, impaired renal function, elevated IL-6 and elevated D-dimer. CONCLUSIONS: Mortality in hospitalized patients with COVID-19 was 51.18 per 100 persons, Mortality was found to be associated with hypertension, type of infiltrating, and sepsis.

[Frequency of food allergy in students of human medicine of a private university]. / Frecuencia de alergia alimentaria en estudiantes de medicina humana de una universidad privada.

OBJECTIVE: Determine the frequency of total food allergy, and to Peruvian products, in Human Medicine students. METHODS: A study design is observational, descriptive and retrospective was made. Human medicine students, aged 18-25 from a private Peruvian university were included in a type of snowball sampling via electronic messaging. The sample size was calculated using the OpenEpi v3.0 program and the prevalence formula. RESULTS: We registered 355 students, with a mean age of 20.87 years (SD ± 5.01). A frequency of food allergy was also found in 9.3% of the total participants in terms of native products and common in other countries, the highest percentage are seafood 2.24%, spices and condiments 2.24%, allergy to fruits 1.4%, milk 1.4%, red meat 0.84%. CONCLUSIONS: The frequencies of self-reported food allergy produced was 9.3% by native Peruvian products and commonly consumed nationwide.

OBJECTIVO: Determinar la frecuencia de alergia alimentaria en general, y de productos de consumo común oriundos del Perú, en estudiantes de medicina humana. MÉTODOS: Estudio observacional, descriptivo y retrospectivo, al que se incluyeron estudiantes de medicina humana de 18-25 años, de una universidad privada del Perú, seleccionados mediante muestreo tipo "bola de nieve" a través de mensajería electrónica. El tamaño de la muestra se calculó con el programa OpenEpi v3.0 y la fórmula de prevalencia. RESULTADOS: Se registraron 355 estudiantes, con edad media de 20.9 años (SD ± 5,01). La frecuencia de alergia alimentaria fue de 9.3% del total de la muestra; y la frecuencia de alergia a productos de consumo común (oriundos del país) reportó: mariscos 2.24%, especias y condimentos 2.24%, frutas 1.4%, leche 1.4% y carnes rojas 0.84%. CONCLUSIONES: Existe una frecuencia de 9.3% de alergia alimentaria autorreportada, producida por productos de consumo común (oriundos del Perú) a nivel nacional.

Self-Medication Practices, Use of Brand-Name, and Over-the-Counter Medicines by Peruvian Older Adults.

Background: Older adults are a particularly vulnerable group to drug use and self-medication. The aim of the study was to evaluate self-medication as a factor associated with the purchase of brand-name and over-the-counter (OTC) drugs in older adults in Peru. Methods: A secondary analysis was performed using an analytical cross-sectional design of data from a nationally representative survey from 2014 to 2016. The exposure variable was self-medication, defined as the purchase of medicines without a prescription. The dependent variables were purchases of brand-name and OTC drugs, both as a dichotomous response (yes/no). Information of sociodemographic variables, health insurance, and the types of drugs purchased by the participants was collected. Crude prevalence ratios (PR) were calculated and adjusted using generalized linear models of the Poisson family, considering the complex sample of the survey. Results: In this study, 1,115 respondents were evaluated, with a mean age of 63.8 years and a male proportion of 48.2%. The prevalence of self-medication was 66.6%, while the proportions of purchases of brand-name and OTC drugs were 62.4% and 23.6%, respectively. The adjusted Poisson regression analysis revealed an association between self-medication and the purchase of brand-name drugs (adjusted PR [aPR]=1.09; 95% confidence interval [CI]: 1.01-1.19). Likewise, self-medication was associated with the purchase of OTC medications (aPR=1.97; 95%CI: 1.55-2.51). Conclusions: This study evidenced a high prevalence of self-medication in Peruvian older adults. Two-thirds of the surveyed people bought brand-name drugs, whereas one-quarter bought OTC drugs. Self-medication was associated with a greater likelihood of buying brand-name and OTC drugs.

Sarcopenia and sarcopenic obesity among community-dwelling Peruvian adults: A cross-sectional study.

Background: Sarcopenia and sarcopenic obesity (SO) have emerged as significant contributors to negative health outcomes in the past decade. However, there remains a lack of consensus on the criteria and cut-off thresholds for assessing sarcopenia and SO. Moreover, limited data are available on the prevalence of these conditions in Latin American countries. To address this evidence gap, we aimed to estimate the prevalence of probable sarcopenia, sarcopenia, and SO in a community-dwelling population of 1151 adults aged ≥ 55 years in Lima, Peru. Methods: Data collection for this cross-sectional study was conducted between 2018 and 2020 in two urban low-resource settings in Lima, Peru. Sarcopenia was defined as the presence of low muscle strength (LMS) and low muscle mass (LMM) according to European (EWGSOP2), US (FNIH) and Asian (AWGS) guidelines. We measured muscle strength by maximum handgrip strength; muscle mass using a whole-body single-frequency bioelectrical impedance analyzer, and physical performance using the Short Physical Performance Battery and 4-meter gait speed. SO was defined as a body mass index ≥ 30 kg/m2 and sarcopenia. Results: The study participants had a mean age of 66.2 years (SD 7.1), of which 621 (53.9%) were men, and 41.7% were classified as obese (BMI ≥ 30.0 kg/m2). The prevalence of probable sarcopenia was estimated to be 22.7% (95%CI: 20.3-25.1) using the EWGSOP2 criteria and 27.8% (95%CI:25.2-30.4) using the AWGS criteria. Sarcopenia prevalence, assessed using skeletal muscle index (SMI), was 5.7% (95%CI: 4.4-7.1) according to EWGSOP2 and 8.3% (95%CI: 6.7-9.9) using AWGS criteria. The prevalence of sarcopenia based on the FNIH criteria was 18.1% (95%CI: 15.8-20.3). The prevalence of SO, considering different sarcopenia definitions, ranged from 0.8% (95%CI: 0.3-1.3) to 5.0% (95%CI: 3.8-6.3). Conclusions: Our findings reveal substantial variation in the prevalence of sarcopenia and SO when using different guidelines, underscoring the necessity for context-specific cut-off values. Nevertheless, regardless of the chosen guideline, the prevalence of probable sarcopenia and sarcopenia among community-dwelling older adults in Peru remains noteworthy.

Never Thought I was Going to be Placed in a Situation Like This: In the Shoes of the Doctor Responsible for Municipal Health, Back in My Country, Perú.

The COVID-19 pandemic changed the way of living on the planet and, in my case, revealed the fragility of primary care services to respond to a health emergency that mainly affected older adults. Upon obtaining my medical degree, I felt guaranteed to have the skills to be a primary care physician; however, the coronavirus gave me "a reality bath with the aroma of impotence, bewilderment, and abandonment." Contradictory provisions and regulations, absence of a continuous policy, poor leadership, insufficient resources, and mismanagement by the Ministry of Health. Scandals of possible corruption and vices in the processes of research studies on vaccines. Anti-vaccine strategies, screening tests without evidence. The reference hospitals without oxygen, intensive care beds, and the outpatient consultations of specialist doctors closed. A community that is organized and wants to help but does not have a clear technical guide. These are some of the things I have had to deal with as head of a municipal health program. Meanwhile, I watched helplessly as members of my community continued to die and become disabled. Learning from mistakes and horrors is our duty. I narrate this experience to contribute to being prepared for the next time.

Cognitive Frailty as a Predictor of Mortality in Older Adults: A Longitudinal Study in Peru.

Objective: To evaluate the role of cognitive frailty and its components as risk factors of mortality in older adults of the Centro Médico Naval (CEMENA) in Callao, Peru during 2010-2015. Methods: We performed a secondary analysis of data from a prospective cohort that included older adults (60 years and older) treated at the CEMENA Geriatrics service between 2010-2015. Frailty was defined as the presence of three or more criteria of the modified Fried Phenotype. Cognitive impairment was assessed using the Peruvian version of the Mini Mental State Examination (MMSE), considering a score <21 as cognitive impairment. Cognitive frailty was defined as the coexistence of both. In addition, we included sociodemographic characteristics, medical and personal history, as well as the functional evaluation of each participant. Results: We included 1,390 older adults (mean follow-up: 2.2 years), with a mean age of 78.5 ± 8.6 years and 59.6% (n = 828) were male. Cognitive frailty was identified in 11.3% (n = 157) and 9.9% (n = 138) died during follow-up. We found that cognitive frailty in older adults (aHR = 3.57; 95%CI: 2.33-5.49), as well as its components, such as sedentary behavior and cognitive impairment (aHR = 7.05; 95%CI: 4.46-11.13), weakness and cognitive impairment (aHR = 6.99; 95%CI: 4.41-11.06), and exhaustion and cognitive impairment (aHR = 4.51; 95%CI: 3.11-6.54) were associated with a higher risk of mortality. Conclusion: Cognitive frailty and its components were associated with a higher risk of mortality in older adults. It is necessary to develop longitudinal studies with a longer follow-up and that allow evaluating the effect of interventions in this vulnerable group of patients to limit adverse health outcomes, including increased mortality.

Gait speed as a predictor of mortality in older men with cancer: A longitudinal study in Peru.

BACKGROUND: Given the increase in incidence and mortality from cancer in recent years in Latin America and Peru, it is necessary to identify frailty older adults at higher risk of disability, hospitalizations and mortality. However, its measure is complex and requires time. For this reason, it has been proposed that frailty can be evaluated by a single measure, as gait speed. We aimed to evaluate the role of gait speed as a predictor of mortality in older men with cancer in Peru. METHODS: A prospective cohort study was carried out that included military veterans (aged 60 years and older) with an oncological diagnosis evaluated at the Centro Médico Naval in Peru during the period 2013-2015. Slow gait speed was defined as <0.8 m/s. All-cause mortality was recorded during a 2-year follow-up. Sociodemographic characteristics, medical and personal history, and functional assessment measures were collected. We performed Cox regression analysis to calculate hazard ratios with their respective 95% confidence intervals. RESULTS: 922 older men were analyzed from 2013 to 2015, 56.9% (n = 525) of whom were >70 years of age. 41.3% (n = 381) had slow gait speed with a mortality incidence of 22.9% (n = 211) at the end of follow-up. The most frequent types of cancer in the participants who died were of the lung and airways (26.1%), liver and bile ducts (23.2%), and lymphomas and leukemias (16.6%). In the adjusted Cox regression analysis, we found that slow gait speed was a risk factor for mortality in older men with cancer (adjusted hazard ratio = 1.55; 95% confidence interval: 1.21-2.23). CONCLUSIONS: Slow gait speed was associated with an increased risk of mortality in older men with cancer. Gait speed could represent a simple, useful, inexpensive, rapidly applicable marker of frailty for the identification of older men at higher risk of mortality. Gait speed could be useful in low- and middle-income countries, and in rural areas with limited access to health services.