Maternal overweight and obesity before pregnancy as predictors of childhood asthma in children under five years: a retrospective cohort in Peru / Sobrepeso y obesidad materna antes del embarazo como predictores de asma infantil en menores de cinco años: una cohorte retrospectiva en Perú

Abstract Objectives: to estimate the role of maternal overweight and obesity before pregnancy as predictors of childhood asthma in a population of Peruvian children under five years. Methods: we carried out a retrospective cohort study of children aged five years or less and their mothers from the Regional Hospital of Ayacucho and the María Auxiliadora Hospital in Lima, Peru. We included children who were born between 2013 and 2014 and follow them up until 2018 and 2019, respectively. The diagnosis of overweight and obesity of the mother before pregnancy and asthma in the child were registered in their clinical histories. Crude (cRR) and adjusted relative risks (aRR) and 95% confidence intervals (CI95%) were obtained using a generalized lineal model of the Poisson family with link log and robust variances. Results: we evaluated 431 medical records and found that 20.9% of the children had asthma, 26.7% of the mothers were overweight, and 20.2% were obese before pregnancy. In the adjusted regression model, overweight (aRR=2.94; CI95%= 1.54-5.60) and maternal obesity (aRR=5.10; CI95%= 2.73-9.51) were predictors of an increased risk of childhood asthma. Conclusions: maternal overweight and maternal obesity increased the risk of her children developing asthma threeand five-fold, respectively.

Resumen Objetivos: estimar el papel del sobrepeso y la obesidad materna antes del embarazo como predictores de asma infantil en una población de niños peruanos menores de cinco años. Métodos: realizamos un estudio de cohorte retrospectivo de niños de cinco años o menos y sus madres del Hospital Regional de Ayacucho y del Hospital María Auxiliadora de Lima, Perú. Se incluyeron niños nacidos entre 2013 y 2014 y se les dio seguimiento hasta 2018 y 2019, respectivamente. El diagnóstico de sobrepeso y obesidad de la madre antes del embarazo y asma en el niño fueron registrados en sus historias clínicas. Los riesgos relativos crudos (cRR) y ajustados (RRa) y los intervalos de confianza del 95% (IC95%) se obtuvieron mediante un modelo lineal generalizado de la familia de Poisson con log de enlace y varianzas robustas. Resultados: se evaluaron 431 historias clínicas y se encontró que el 20,9% de los niños tenían asma, el 26,7% de las madres tenían sobrepeso y el 20,2% eran obesas antes del embarazo. En el modelo de regresión ajustada, el sobrepeso (aRR=2,94; IC95%= 1,54-5,60) y obesidad materna (RRa=5,10; IC95%= 2,73-9,51) fueron predictores de un mayor riesgo de asma infantil. Conclusiones: el sobrepeso materno y la obesidad materna aumentaron tres y cinco veces el riesgo de que sus hijos desarrollaran asma, respectivamente.

Satisfacción del usuario en consulta externa de Medicina Física y Rehabilitación del Hospital Nacional Edgardo Rebagliati Martins, 2022

Introducción : La satisfacción del paciente es un indicador fundamental de la calidad en los servicios de salud. Sin embargo, encontramos escasos estudios previos en Medicina Física y Rehabilitación (MFyR), especialidad que atiende a pacientes con discapacidad quienes tienen derecho a recibir servicios de salud de la más alta calidad. El objetivo del estudio fue evaluar la satisfacción del usuario en consulta externa de MFyR del Hospital Nacional Edgardo Rebagliati Martins (HNERM) de julio a septiembre del 2022. Métodos : Se realizó un estudio observacional transversal de tipo descriptivo. Se evaluó la satisfacción del usuario de consulta externa con la encuesta SERVQUAL. Asimismo, se incluyeron variables sociodemográficas, relacionadas a la atención brindada, y el tipo de terapia de rehabilitación que recibió. Se realizó el análisis de datos utilizando el paquete estadístico Stata/SE ®. Se realizó el análisis bivariado entre las covariables de interés y la satisfacción. Resultados : Se incluyó a 93 participantes, con una mediana de edad de 43 años, el 49.5 % tuvo un tiempo menor a 6 meses desde la primera atención en consulta externa y el 59.1 % recibía solo terapia física. La satisfacción global fue de 72.4 %. La satisfacción por dimensión fue de 79,6 % para seguridad, 78,5 % para aspectos tangibles, 76,9 % para empatía, 68,8 % para fiabilidad y 58,1 % para capacidad de respuesta. Conclusiones : Hallamos que aproximadamente siete de cada diez participantes presentaron satisfacción global en consulta externa de MFyR del HNERM. Las dimensiones con mayor satisfacción fueron seguridad, aspectos tangibles, y empatía.

Introduction : Patient satisfaction is an important indicator for quality in healthcare services. However, we found scant previous studies on this respect carried out in the Physical and Rehabilitation Medicine (PRM) service, a specialty that takes care of disabled patients entitled to receive best quality medical services. The objective of this study was to evaluate users' satisfaction in the outpatient clinic of the PRM service at Edgardo Rebagliati-Martins National Hospital (ERMNH), from July to September, 2022. Methods : A descriptive cross-sectional observational study was carried out. Outpatient's satisfaction was assessed using the SERVQUAL survey. Also, sociodemographic variables related to healthcare services and the type of rehabilitation therapy these patients received were assessed. Data analysis was performed using the Stata/SE® statistical software. Bivariate analysis for interest covariates and satisfaction was also performed. Results : Ninety-tree participants were included, their mean age was 43 years, nearly half (49.5%) had a less than 6-month time since they were seen for the first time in the outpatient clinic, and 59.1% only received physical therapy. Overall satisfaction was 72.4%. Satisfaction according to different dimensions was as follows> 79.6% for safety, 78.5% for tangible issues, 76.9% for empathy, 68.8% for reliability, and 58.1% for response capacity. Conclusions : We found that approximately seven out of ten patients had overall satisfaction in the PRM outpatient clinic at ERMNH. The dimensions with great satisfaction were safety, tangible issues, and empathy.

Rinitis alérgica asociada al grado de compromiso pulmonar por COVID-19 en pacientes de un hospital general peruano / Allergic rhinitis associated with the degree of pulmonary involvement due to COVID-19 in patients from a peruvian general hospital

Objetivos. Evaluar la asociación entre rinitis alérgica y el grado de compromiso pulmonar en pacientes con COVID-19 y evaluar las frecuencias de las variables principales. Materiales y métodos. Se realizó un estudio de tipo observacional, transversal y analítico mediante la revisión de historias clínicas de pacientes atendidos en el Hospital Nacional Cayetano Heredia entre el año 2020 y 2021 con diagnóstico de COVID-19. Se determinó el antecedente de rinitis alérgica, y el compromiso pulmonar se evaluó mediante una tomografía sin contraste usando el puntaje tomográfico (PT), además de, variables sociodemográficas y clínicas. Se estimaron razones de prevalencias tanto crudas (RP) como ajustadas (RPa) con sus respectivos intervalos de confianza (IC) al 95% y se empleó un modelo lineal generalizado de la familia Poisson con función de enlace logarítmica y varianzas robustas. Resultados. Se evaluaron 434 pacientes predominantemente varones, mayores de 60 años y sin antecedentes médicos relevantes. El 56,2% tenía el antecedente de rinitis alérgica y el 43,1% tuvo un compromiso pulmonar moderado a severo. En el modelo de regresión ajustado, se encontró que el antecedente de rinitis alérgica disminuyó la gravedad de COVID-19 evaluada a través del compromiso pulmonar según el PT (RPa: 0,70; IC 95%: 0,56-0,88; p=0,002). Conclusiones. El antecedente de rinitis alérgica representó una disminución en la gravedad de COVID-19 según el PT score del 30,0% en pacientes hospitalizados.

Objectives. To evaluate the association between allergic rhinitis and the degree of pulmonary involvement in patients with COVID-19 and to determine the frequencies of the main variables. Materials and methods. An observational, cross-sectional and analytical study was carried out by reviewing the medical records of patients diagnosed with COVID-19 from the Cayetano Heredia National Hospital between 2020 and 2021. We obtained information regarding the history of allergic rhinitis; pulmonary involvement was assessed by non-contrast tomography results using the chest computed tomography (CT) score. Data regarding sociodemographic and clinical variables was also obtained. Both crude (PR) and adjusted (aPR) prevalence ratios with their respective 95% confidence intervals (CI) were estimated. We also used a generalized linear Poisson family model with log link function and robust variances. Results. We evaluated 434 patients, who were mostly male, older than 60 years and had no relevant medical history. Of these, 56.2% had a history of allergic rhinitis and 43.1% had moderate to severe pulmonary involvement. The adjusted regression model showed that the history of allergic rhinitis reduced the severity of COVID-19 according to the pulmonary involvement assessed by the CT score (aPR: 0.70; 95%CI: 0.56-0.88; p=0.002). Conclusions. The history of allergic rhinitis resulted in a 30.0% decrease in COVID-19 severity according to the CT score in hospitalized patients.

Informática biomédica: caracterización de la oferta de cursos abiertos masivos en línea / Biomedical informatics: characterization of the offer of massive open online courses

Introducción La informática biomédica ha traído consigo soluciones innovadoras a problemas sanitarios. Sin embargo, el número de profesionales sanitarios capacitados en informática biomédica es bajo. La educación virtual, como los cursos masivos abiertos en línea, brindan la oportunidad de formación en este campo. Objetivo Estimar la oferta global de cursos masivos abiertos en línea sobre informática biomédica y conocer las características de su contenido. Métodos Se realizó una búsqueda de cursos masivos abiertos en línea durante diciembre de 2021 en 25 plataformas que ofertan estos cursos. La estrategia de búsqueda incluyó los descriptores "" y "". Se evaluaron las áreas de aplicación de informática biomédica, la plataforma, la institución, la duración, el tiempo requerido por semana, el idioma y los subtítulos disponibles para cada curso. Se analizaron los datos descriptivamente, reportándose frecuencias absolutas y relativas. Resultados Nuestra estrategia de búsqueda identificó 1333 cursos masivos abiertos en línea. De ellos, solo 79 estaban relacionados con informática de la salud. La mayoría de estos cursos (n = 44; 55,7%) se ofrecieron a través de Coursera. Más de la mitad (n = 55; 69,6%) fueron realizados por instituciones de Estados Unidos y en el idioma inglés (n = 76; 96,2%). La mayor parte de los cursos se centraron en áreas de bioinformática traslacional (n = 27; 34,2%), seguido de informática de la salud pública (n = 23; 29,1%), e informática de la investigación clínica (n = 13; 16,5%). Conclusiones Se encontró una importante oferta de cursos masivos abiertos en línea sobre informática biomédica. Estos cursos favorecen la formación de más profesionales en todas las regiones del mundo, abordando en su mayoría competencias para aplicar la informática en la práctica clínica, la salud pública y la investigación en salud.

Introduction Informatics applied to health sciences has brought cutting-edge solutions to healthcare problems. However, the number of health professionals trained in "Health Informatics" is low. Virtual education, such as massive online open courses, provide the opportunity for training in this field. Objective To estimate the global offer of massive online open biomedical informatics courses and characterize their content. Methods A search for massive online open courses was conducted throughout December 2021 on 25 platforms offering these courses. The search strategy included the terms "health informatics" and "biomedical informatics". The application areas of biomedical informatics, platform, institution, duration, time required per week, language, and subtitles available for each course were evaluated. Data were analyzed descriptively, reporting absolute and relative frequencies. Results Our search strategy identified 1333 massive online open courses. Of these, only 79 were related to health informatics. Most of these courses (n = 44; 55.7%) were offered through Coursera. More than half (n = 55; 69.6%) were conducted by U.S. institutions in english (n = 76; 96.2%). Most courses focused on areas of translational bioinformatics (n = 27; 34.2%), followed by public health informatics (n = 23; 29.1%), and clinical research informatics (n = 13, 16.5%). Conclusions We found a significant supply of massive online open courses on health informatics. These courses favor the training of more professionals worldwide, mostly addressing competencies to apply informatics in clinical practice, public health, and health research.

Autoimmune encephalitis after BBIBP-CorV (Sinopharm) COVID-19 vaccination: a case report.

BACKGROUND: Vaccination is an important public health strategy; however, many neurological adverse effects are associated with COVID-19 vaccination, being encephalitis a rare manifestation. CASE PRESENTATION: We present the case of a 33-year-old woman who received the first dose of the BBIBP-CorV vaccine against COVID-19 on April 4 and the second dose on April 28, 2021. Three days after receiving the second dose, she experienced a subacute episode of headache, fever, insomnia, and transient episodes of environment disconnection. We obtained negative results for infectious, systemic, and oncological causes. Brain magnetic resonance imaging showed lesions in the bilateral caudate nucleus and nonspecific demyelinating lesions at the supratentorial and infratentorial compartments. The results of the neuronal autoantibodies panel were negative. She had an adequate response to immunoglobulin and methylprednisolone; however, she experienced an early clinical relapse and received a new cycle of immunosuppressive treatment followed by a satisfactory clinical evolution. CONCLUSIONS: We report the first case of severe encephalitis associated with BBIBP-CorV (Sinopharm) vaccination in Latin America. The patient had atypical imaging patterns, with early clinical relapse and a favorable response to corticosteroid therapy.

Case Report: Focal leptomeningeal disease, atypical cancer of unknown primary site.

Background: Leptomeningeal metastasis is an infrequent form of cancer expression, and it has a poor prognosis due to its torpid evolution and its challenging diagnosis. Case report: We report the case of a 68-year-old woman with rapidly progressing cognitive decline and focal epilepsy. Brain magnetic resonance imaging showed extensive gyriform hypersignal in the right precentral sulcus region, without mass effect, tenuous contrast uptake, and hydrocephalus with transependymal edema. The body tomographic study was negative for solid cancer and the 18F-FDG PET-CT revealed a severe hypermetabolism in the right lung upper lobe. These findings were suggestive of lung cancer with leptomeningeal metastasis. We performed a brain biopsy, finding atypical cells in the leptomeningeal region with positive immunohistochemical staining for CK7 and negative for CK20 corresponding to lung adenocarcinoma. The patient was evaluated in the oncology service and scheduled for radiotherapy and chemotherapy. Conclusions: Focal leptomeningeal disease is an entity that should be considered as a differential diagnosis in all cases of focal leptomeningitis. Timely diagnosis and adequate cancer management can increase patient survival.

Type 2 diabetes mellitus and hypertension as predictors of community-acquired pneumonia in Peruvian older adults with cancer

Objective: To evaluate DM2 and hypertension as predictors of CAP in older adults with cancer. Material and Methods: We conducted a secondary data analysis of a prospective cohort study in older adults with cancer from the Geriatrics Service of the Centro Médico Naval (CEMENA) of Peru during 2013-2015. T2DM and hypertension diagnosis were obtained from medical records. CAP was defined according to clinical and radiological diagnostic criteria and it was collected from the medical records of the patients up to one year after their inclusion in the study. We used the statistical software STATA v14.0 to develop the analysis. We performed multivariate analysis using crude and adjusted Cox regression models. The reported measure was the hazard ratio (HR) with their respective 95% confidence intervals (95%CI). Results: A total of 231 older adults with cancer were analyzed. The mean age of the participants was 78.6 ± 4.2 (range: 74-92 years) and all of them were men. 33 (14.29%) patients developed CAP during the follow-up, 53 (21.65%) had hypertension, and 56 (22.65%) T2DM. CAP was more frequent in patients with lung cancer and lymphomas. In the adjusted Cox regression models, we found T2DM (aHR=1.49; 95%CI: 1.21-1.79) and hypertension (aHR=1.32; 95%CI: 1.24-1.50) were predictors of CAP incidence. Conclusion: T2DM and hypertension were associated with CAP incidence in oncogeriatric patients. Future intervention studies are needed to improve the functionality and prevent CAP in this vulnerable population.

Objetivo: Evaluar la DM2 y la hipertensión como predictores de NAC en adultos mayores con cáncer. Materiales y métodos: Se realizó un análisis de base secundaria de una cohorte prospectiva en adultos mayores con diagnóstico de cáncer del Servicio de Geriatría del Centro Médico Naval (CEMENA) del Perú durante 2013-2015. Los diagnósticos de DM2 e hipertensión se obtuvieron de las historias clínicas. La NAC se definió según criterios diagnósticos clínicos y radiológicos y se recogió de las historias clínicas de los pacientes hasta un año después de su inclusión en el estudio. Utilizamos el software estadístico STATA v14.0 para desarrollar el análisis. Realizamos un análisis multivariante utilizando modelos de regresión de Cox crudos y ajustados. La medida reportada fue la razón de hazards (HR) con sus respectivos intervalos de confianza del 95% (IC95%). Resultados: Se analizaron un total de 231 adultos mayores con cáncer. La edad media de los participantes fue de 78,6 ± 4,2 (rango: 74-92 años) y todos ellos eran hombres. 33 (14,29%) pacientes desarrollaron NAC durante el seguimiento, 53 (21,65%) tenían hipertensión y 56 (22,65%) DM2. La NAC fue más frecuente en pacientes con cáncer de pulmón y linfomas. En los modelos de regresión de Cox ajustados se encontró que tener DM2 (HRa=1,49; IC95%: 1,21-1,79) o hipertensión arterial (HRa=1,32; IC95%: 1,24-1,50) fueron predictores para la incidencia de NAC. Conclusiones: La DM2 y la hipertensión se asociaron con la incidencia de NAC en pacientes oncogeriátricos. Son necesarios futuros estudios de intervención para mejorar la funcionalidad y prevenir la NAC en esta población vulnerable.

Post-Vaccinal Encephalitis with Early Relapse after BNT162b2 (COMIRNATY) COVID-19 Vaccine: A Case Report.

We describe the case of a 72-year-old man who received the first dose of the BNT162b2 (COMIRNATY) vaccine against COVID-19 on 18 May 2021, and the second dose on 9 September 2021. One day after receiving the first dose, he cursed with malaise, headache, fever, confusion, aggressiveness, and gait alterations. We performed serum and cerebrospinal fluid (CSF) tests (finding elevated proteins in CSF) with negative results for infectious, systemic, and neoplastic causes. We performed brain nuclear magnetic resonance imaging (MRI), finding circumscribed encephalitis at the anterior frontal and bilateral temporal lobes. We were unable to perform a panel of antineuronal antibodies. The patient was readmitted due to early clinical relapse four days after receiving his second dose. We found sequelae lesions at the frontal level but with new demyelinating lesions at the left temporal level in brain MRI. We indicated methylprednisolone, and he presented a favorable improvement. We report an encephalitis case of probable autoimmune etiology after vaccination with BNT162b2, which presented early clinical relapse after receiving the second dose and presented a favorable response to methylprednisolone.

Spontaneous resolution of intussusception after COVID-19 infection found at laparoscopy in a 6-year-old.

The incidence of intussusception is 2.5 per 1000 live births, and infants between 4 and 10 months of age represent the highest frequency peak. Cases of intussusception with acute COVID-19 infection have been reported in infants under one year of age and with one death associated with MIS-C. However, we have not found reports of intussusception in schoolchildren. We report the case of a 6-year-old male with two days of illness that began with a sensation of temperature rise, headache, abdominal pain, liquid stools with mucus and no blood, hyporexia, chills, and food vomiting. He presented a negative result for the detection of SARS-CoV-2 antigen, negative SARS-CoV-2 IgM/IgG serology positive (lateral flow immunochromatography test), in addition to total IgM/IgG antibodies in 11.88 COI by means of a test of electrochemiluminescence. An abdominal ultrasound was performed that concluded invagination, for which an exploratory laparoscopy was performed and the patient evolved favorably. 13 cases of intussusception associated with acute COVID-19 infection have been described in this group. However, no reports of intussusception have been described after COVID-19 infection in school age. We recommend ruling out active or past SARS-CoV-2 infection in children with gastrointestinal symptoms and, if it exists, ruling out invagination by means of abdominal ultrasound.

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.

Diagnóstico situacional de los Comités Institucionales de Ética en Investigación de la Seguridad Social en Perú / Situational diagnosis of the Institutional Research Ethics Committees in Social Security in Peru

Introducción: Aunque el Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) ha impulsado la conformación de Comités Institucionales de Ética en Investigación (CIEI) en la Seguridad Social de Salud del Perú (EsSalud), pueden existir aspectos perfectibles. Se describen las características de los CIEI de EsSalud y sus miembros durante el 2021. Material y Métodos: Se realizó un estudio descriptivo y observacional que empleó una base de datos secundaria. Se encuestó a los miembros de los CIEI de EsSalud mediante un formulario virtual confeccionado por IETSI. Resultados: Se incluyó a 114 miembros pertenecientes a 18 redes prestacionales de EsSalud. El 52,6% de los participantes era de sexo masculino, la media de edad fue de 50,6 ± 11,9 años y el 42,1% tenía función científica. El 38,8% de los CIEI evaluó más de cinco ensayos clínicos en los últimos dos años y el 72,2% más de cinco estudios observacionales en el mismo periodo de tiempo. Los miembros refirieron limitaciones para la realización de reuniones o supervisiones virtuales, falta de tiempo para la realización de sus labores debido a la alta carga laboral y necesidad de capacitaciones sobre metodología de la investigación y bioestadística. Conclusión: Es necesario mejorar el soporte administrativo y el plan de capacitaciones a los miembros de los CIEI de EsSalud, para el logro de competencias metodológicas, éticas y regulatorias que aseguren una mejora en los procesos de evaluación y monitoreo ético de las investigaciones con seres humanos a su cargo.

Background:Although the Instituto de Evaluación de Tecnologías e Investigaciones en Salud (IETSI) has promoted the formation of Institutional Research Ethics Committees (IRECs) in the social security of Peru (EsSalud), there may be perfectible aspects. The characteristics of the IREC of EsSalud and its members during 2021 are described. : Adescriptive and observational study was Material and Methodscarried out using a secondary database. IREC members were surveyed using a virtual form created by IETSI. 114 members belonging to 18 EsSalud networks were included. Results:52.6% of the participants were male, the mean age was 50.6 ± 11.9 years, and 42.1% had a scientific role. In 38.8% of the IREC were evaluated more than five clinical trials in the last two years and 72.2% more than five observational studies in the same period. The members reported limitations for holding virtual meetings or supervisions, lack of time to carry out their tasks due to the high workload and the need for training on research methodology and biostatistics. it is Conclusion:necessary to improve the administrative support and the training plan for the members of the IREC of EsSalud, to achieve methodological, ethical, and regulatory competencies that ensure an improvement in the processes of evaluation and ethical monitoring of human research.

Factores asociados al resultado citológico positivo en pruebas de Papanicolau en mujeres atendidas en la Liga peruana de lucha contra el cáncer / Factors associated with a positive cytological result in Papanicolau tests in women attended In the Liga Peruana de Lucha contra el Cancer

Objetivo: Evaluar los factores asociados a un resultado de citología cervical positiva en la prueba de Papanicolau en una muestra de mujeres peruanas en Lima, Perú - 2013. Material y métodos: Se realizó un estudio transversal analítico que incluyó a mujeres con edades entre 21 a 64 años y empleó la prueba de Papanicolaou para evaluar la citología cervical. Se incluyó factores sociodemográficos y antecedentes de la mujer obtenidos de la historia clínica de las pacientes. Se realizaron modelos lineales generalizados de familia Poisson con varianzas robustas para evaluar los factores asociados a la citología positiva. La medida de asociación reportada fue la razón de prevalencia (RP) con sus respectivos intervalos de confianza al 95% (IC95%). Resultados: Se incluyeron a 11110 mujeres en el análisis con una edad media de 41,5±10,9 años y la prevalencia de un resultado positivo en la prueba de Papanicolau fue de 2,8%. En el modelo ajustado, se halló que tener entre 21 a 30 años (RPa=1,97;IC95%:1,30-3,00), 31 a 40 años (RPa=2,56;IC95%:1,76-3,72) y 41 a 50 años (RPa=2,16;IC95%:1,47-3,17), ser soltera (RPa=1,41;IC95%:1,10-1,83), viuda o divorciada (RPa=1,90;IC95%:1,27-2,87), haber tenido inicio de vida sexual antes de los 16 años (RPa=1,30;IC95%:1,01-1,68) o entre los 16 a 19 años (RPa=1,69;IC95%:1,22-2,36) se asoció a una mayor probabilidad de presentar un resultado de citología cervical positivo. Conclusiones: El cáncer de cuello uterino representa un problema de salud pública en Perú, por lo que identificar sus factores asociados es útil para mejorar las estrategias de tamizaje, priorizando grupos de mayor riesgo.

Objetive:To evaluate the factors associated with a positive cervical cytology result in the Pap smear test in a sample of Peruvian women from Lima, Peru - 2013. : We conducted an analytical cross-sectional Material and Methodsstudy including women from 21 to 64 years and we used the Pap smear test to evaluate cervical cytology. We included sociodemographic and medical history variables obtained from medical records of the patients. We elaborated generalized linear models from Poisson family with robust variances to evaluate the factors associated with positive cytology. The association measure reported was the prevalence ratio (PR) with their respective 95% confidence intervals (95%CI). We analyzed 11110 women with a mean age of 41.5 ± 10.9 Results: years and a prevalence of a positive Pap smear test of 2.8%. In the adjusted model, we found that women between 21 and 30 years old (aPR=1.97; 95%CI:1.30-3.00), 31 to 40 years (aPR=2.56; 95%CI:1.76 -3.72) and 41 to 50 years (aPR=2.16; 95%CI:1.47-3.17), single (aPR=1.41; 95%CI:1.10-1.83), widowed or divorced (aPR=1.90; 95%CI:1.27-2.87), with a sexual life onset before 16 years (aPR=1.30; 95%CI:1.01- 1.68) or between 16 and 19 years (aPR=1.69; 95%CI:1.22-2.36) had a greater prevalence of a positive cervical cytology result. Cervical cancer is a public health problem in Peru, then, identifying the factors associated will allow us to Conclusions:improve screening strategies and prioritize groups at higher risk.

Prevalencia y factores asociados a la intención de vacunarse contra la COVID-19 en el Perú / Prevalence and factors associated with the intention to be vaccinated against COVID-19 in Peru

RESUMEN Objetivos: Estimar la prevalencia y los factores asociados a la intención de vacunación (IDV) contra la COVID-19 en el Perú. Materiales y métodos: Estudio transversal analítico utilizando una encuesta realizada por la Universidad de Maryland, EUA, en Facebook. La variable dependiente fue la IDV. Se calcularon razones de prevalencia (RP) crudas y ajustadas, con sus intervalos de confianza al 95% (IC95%), mediante modelos lineales generalizados de la familia Poisson para evaluar la asociación de variables sociodemográficas, el cumplimiento de estrategias comunitarias de mitigación, los síntomas de la COVID-19, la salud mental y la aceptación de la vacunación ante la recomendación (AVR) por diversos actores y autoridades sanitarias. Resultados: Se analizaron los datos de 17 162 adultos. La prevalencia general de la IDV fue del 74,9%. Se asociaron a una menor prevalencia de la IDV ser de sexo femenino (RP=0,95; IC95%:0,94-0,97), vivir en un pueblo (RP=0,95; IC95%:0,91-0,99) o en una aldea u otra área rural (RP=0,90; IC95%:0,86-0,93) y la AVR de políticos (RP=0,89; IC95%: 0,87-0,92). Contrariamente, tener síntomas de COVID-19 (RP=1,06; IC95%:1,03-1,09), inseguridad económica (RP=1,04; IC95%: 1,01-1,06), miedo a enfermar o que un familiar enferme de COVID-19 (RP=1,49; IC95%: 1,36-1,64) y la AVR de familiares y amigos (RP=1,10; IC95%: 1,08-1,12), trabajadores de la salud (RP=1,29; IC95%: 1,26-1,32), la Organización Mundial de la Salud (RP=1,34; IC95%: 1,29-1,40) y funcionarios del gobierno (RP=1,18; IC95%: 1,15-1,22) se asociaron con mayor prevalencia de IDV. Conclusiones: Tres cuartas partes de los encuestados manifiestan IDV. Existen factores potencialmente modificables que podrían mejorar la aceptación de la vacuna.

ABSTRACT Objectives: To estimate the prevalence and factors associated with the intention to be vaccinated (ITV) against COVID-19 in Peru. Materials and methods: Analytical cross-sectional study using the survey conducted by the University of Maryland, USA, on Facebook. The dependent variable is the ITV. Crude and adjusted prevalence ratios (PR) were calculated, with their 95% confidence intervals (95% CI) using generalized linear models of the Poisson family, in order to evaluate the association of sociodemographic variables, compliance with community mitigation strategies, symptoms of COVID-19, mental health and acceptance of vaccination before the recommendation (AVR) by various actors and health authorities, with the ITV. Results: Data from 17,162 adults were analyzed. The overall prevalence of the ITV was 74.9%. A lower prevalence of the ITV was associated with the female sex (PR=0.95; 95% CI: 0.94-0.97), living in a town (PR=0.95; 95% CI: 0.91-0.99) or village or other rural area (PR=0.90; 95% CI: 0.86-0.93) and the AVR of politicians (PR=0.89; 95% CI: 0.87-0.92). Conversely, having COVID-19 symptoms (PR=1.06; 95% CI: 1.03-1.09), economic insecurity (PR=1.04; 95% CI: 1.01-1.06), fears of becoming seriously ill or that a family member becomes seriously ill from COVID-19 (PR=1.49; 95% CI: 1.36-1.64) and the AVR of family and friends (PR=1.10; 95% CI: 1.08-1.12), healthcare workers (PR=1.29; 95% CI: 1.26-1.32), World Health Organization (PR=1.34; 95% CI: 1.29-1.40) and government officials (PR=1.18; 95% CI: 1.15-1.22) was associated with a higher prevalence of the ITV. Conclusions: Three-quarters of the respondents had the ITV. There are potentially modifiable factors that could improve vaccine acceptance.

Factors Associated with Nutritional Deficiency Biomarkers in Candidates for Bariatric Surgery: A Cross-Sectional Study in a Peruvian High-Resolution Clinic.

Previous studies have described multiple nutritional deficiencies after bariatric surgery (BS). However, few studies have evaluated these deficiencies prior to BS, specifically in Latin America. This study aimed to determine the factors associated with nutritional deficiency biomarkers in candidates for BS in Peru. We included adults of both sexes, aged 18 to 59 years, admitted to a Peruvian clinic with a body mass index (BMI) ≥30 kg/m2; they were candidates for BS from 2017 to 2020. We considered the serum levels of hemoglobin and albumin (in tertiles) as the nutritional deficiency biomarkers. In order to assess the associated factors, we calculated crude (cPR) and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95%CI). We analyzed 255 patients: 63.1% were males, with a mean age of 37.1 ± 10.3 years and mean hemoglobin and albumin values of 14.0 ± 1.5 g/dL and 4.6 ± 0.4 g/dL, respectively. We found that males (aPR = 1.86; 95%CI: 1.26-2.73; p = 0.002), participants between 30 and 49 (aPR = 2.02; 95%CI: 1.24-3.28; p = 0.004) or 50 years or more (aPR = 2.42; 95%CI: 1.35-4.35; p = 0.003), participants with a BMI ≥40 kg/m2 (aPR = 1.68; 95%CI: 1.09-2.60; p = 0.018), participants with impaired high-density lipoprotein levels (aPR = 1.43; 95%CI: 1.01-2.05; p = 0.049) and individuals in the high tertile of C-reactive protein (aPR = 6.94; 95%CI: 3.37-14.32; p < 0.003) had a higher probability of being in the lower tertile of albumin. In addition, we found that the male sex (aPR = 6.94; 95%CI: 3.37-14.32; p < 0.001) and elevated cholesterol levels (aPR = 0.71; 95%CI: 0.52-0.97; p = 0.034) were associated with the lowest hemoglobin tertile. In our setting, nutritional deficiency biomarkers were associated with sociodemographic, anthropometric and laboratory markers. The pre-bariatric surgery correction of nutritional deficiencies is essential, and can prevent major complications after surgery.

Impact of the Delayed Initiation of Adjuvant Chemotherapy in the Outcome of Triple Negative Breast Cancer.

BACKGROUND: Adjuvant chemotherapy decreases the recurrence risk and improves survival rates; however, it is unclear whether a delayed initiation is associated with adverse outcomes, especially in triple negative breast cancer (TNBC). In this study, we evaluated the influence of the time to start adjuvant chemotherapy (TTC) in the outcomes of TNBC. PATIENTS AND METHODS: We retrospectively analyzed 15 years of data from patients with TNBC who received adjuvant chemotherapy at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru). TTC was categorized into 4 groups: ≤ 30, 31 to 60, 61 to 90, and ≥ 91 days. We evaluated overall survival (OS) and distant recurrence-free survival (DRFS). Cox proportional hazard models were used to identify prognostic factors. RESULTS: In total, 687 patients were included. The mean age at diagnosis was 49.1 years (SD, 11.8 years), and most (62.6%) patients had pathologic stage T2. The median TTC was 48.1 days (SD, 27.4 days); 189 (27.5%) received chemotherapy ≤ 30 days; 329 (47.9%), between 31 and 60 days; 115 (16.7%), between 61 and 90 days; and 54 (7.9%) in ≥ 90 days. In the multivariate analysis, a TTC between 31 and 60 days (hazard ratio [HR], 1.78; 95% confidence interval [CI], 1.17-2.72), 61 and 90 days (HR, 2.38; 95%CI, 1.43-3.97), and ≥ 91 days (HR, 2.45; 95% CI, 1.32-4.55) was associated with an increased mortality in contrast with a TTC < 30 days. Although a TTC between 31 and 60 days, 61 and 90 days, and ≥ 91 days was associated with an increased risk of DRFS (HR, 1.86; 95% CI, 1.24-2.79; HR, 2.34, 95% CI, 1.42-3.867; and HR, 3.16; 95% CI, 1.78-5.61, respectively). CONCLUSION: A delaying in TTC ≥ 30 days was associated with poorer outcomes. Our data suggest that several efforts should be conducted to avoid a delayed TTC in patients with TNBC.

Impact of the COVID-19 pandemic on general surgery residency program in Peru: A cross-sectional study.

BACKGROUND: General surgey is a specialty of high demand and relevance. We aimed to collect the opinions of the residents and their tutors and heads of department, regarding the impact that this COVID-19 pandemic is having - and will probably have - on the training of future general surgeons in Peru. METHODS: We conducted a cross-sectional study in Lima, Peru. We surveyed residents of general surgery, as well as their tutors and heads of surgery departments from 14 Peruvian hospitals. RESULTS: The impact of COVID-19 was considered severe in approximately 60% of first-year residents, 100% of second-year residents, 40% of third-year residents and about 80% of attending physicians. The 68.8% of the residents considered that the loss of surgical training opportunities during the pandemic would negatively affect their job performance. In addition, as of 03/16/2020, no residents had performed more than 25 elective surgeries, trauma surgeries or laparoscopic procedures. All the participants (including tutors and heads of departments) highlighted the need to extend the residency period. CONCLUSION: The COVID-19 pandemic has affected the training of the general surgery residents. Deficiencies need to be identified in order to evaluate extending the period of the medical residency program in Peru.

Association between knowledge about cervical cancer and having a Papanicolaou test in peruvian women. / Asociación entre conocimientos acerca del cáncer de cuello uterino y realizarse una prueba de Papanicolaou en mujeres peruanas.

OBJETIVES: To estimate the association between having knowledge about cervical cancer (CC) and having a Pap test (PAP) in Peruvian women over 30 years old. MATERIALS AND METHODS: A secondary analysis of the Demographic and Family Health Survey of the years 2015 to 2017 was carried out. The level of knowledge was evaluated using the questions, do you think that cancer can be prevented?, Have you ever heard of CC?, Have you ever heard of human papillomavirus (HPV)? And do you think HPV can cause CC? The dependent variable was the realization of a PAP in the last two years. To estimate the association, generalized linear models of the raw and adjusted Poisson family were used. The measure of association was the adjusted prevalence ratio (aPR) with its respective 95% confidence intervals (95% CI). RESULTS: Data from 21 563 women were analyzed. The prevalence of having performed a PAP in the last two years was 52.4%. It was found that, those who responded that cancer can be prevented (aPR = 1.09; 95% CI: 1.01-1.17), who had heard of CC (aPR = 1.27; 95% CI: 1.14-1 , 40) or HPV (aPR = 1.20; 95% CI: 1.13-1.28) or who responded that HPV could cause CC (aPR = 1.21; 95% CI: 1.11-1.33) had a higher prevalence of having performed a PAP in the last two years. CONCLUSIONS: Having knowledge about CC and HPV has been associated with having performed a PAP in the last two years.

OBJETIVOS: Estimar la asociación entre tener conocimientos acerca del cáncer de cuello uterino (CaCu) y re alizarse una prueba de Papanicolaou (PAP) en mujeres peruanas mayores de 30 años. MATERIALES Y MÉTODOS: Se realizó un análisis secundario de la Encuesta Demográfica y de Salud Familiar de los años 2015 al 2017. El nivel conocimiento fue evaluado utilizando las preguntas: ¿considera usted que el cáncer se puede prevenir?, ¿alguna vez ha oído hablar del CaCu?, ¿alguna vez ha oído hablar del virus del papiloma humano (VPH)? y ¿considera que el VPH puede causar CaCu? La variable dependiente fue la realización de un PAP en los dos últimos años. Para estimar la asociación se utilizaron modelos lineales generalizados de la familia Poisson crudos y ajustados. La medida de asociación fue la razón de prevalencia ajustada (RPa) con sus respectivos intervalos de confianza al 95% (IC 95%). RESULTADOS: Se analizaron datos de 21 563 mujeres. La prevalencia de haberse realizado un PAP en los últimos dos años fue 52,4%. Se encontró que, quienes respondieron que se puede prevenir el cáncer (RPa = 1,09; IC 95%: 1,01-1,17), que habían oído hablar del CaCu (RPa = 1,27; IC 95%: 1,14-1,40) o del VPH (RPa = 1,20; IC 95%:1,13-1,28) o que respondieron que el VPH podía causar CaCu (RPa = 1,21; IC 95%: 1,11 1,33) tuvieron una mayor prevalencia de haberse realizado un PAP en los últimos dos años. Conclusiones: Tener conocimientos sobre CaCu y VPH se asoció con haberse realizado un PAP en los últimos dos años.

Asociación entre conocimientos acerca del cáncer de cuello uterino y realizarse una prueba de Papanicolaou en mujeres peruanas / Association between knowledge about cervical cancer and having a Papanicolaou test in peruvian women

Resumen Objetivos: Estimar la asociación entre tener conocimientos acerca del cáncer de cuello uterino (CaCu) y re alizarse una prueba de Papanicolaou (PAP) en mujeres peruanas mayores de 30 años. Materiales y métodos: Se realizó un análisis secundario de la Encuesta Demográfica y de Salud Familiar de los años 2015 al 2017. El nivel conocimiento fue evaluado utilizando las preguntas: ¿considera usted que el cáncer se puede prevenir?, ¿alguna vez ha oído hablar del CaCu?, ¿alguna vez ha oído hablar del virus del papiloma humano (VPH)? y ¿considera que el VPH puede causar CaCu? La variable dependiente fue la realización de un PAP en los dos últimos años. Para estimar la asociación se utilizaron modelos lineales generalizados de la familia Poisson crudos y ajustados. La medida de asociación fue la razón de prevalencia ajustada (RPa) con sus respectivos intervalos de confianza al 95% (IC 95%). Resultados: Se analizaron datos de 21 563 mujeres. La prevalencia de haberse realizado un PAP en los últimos dos años fue 52,4%. Se encontró que, quienes respondieron que se puede prevenir el cáncer (RPa = 1,09; IC 95%: 1,01-1,17), que habían oído hablar del CaCu (RPa = 1,27; IC 95%: 1,14-1,40) o del VPH (RPa = 1,20; IC 95%:1,13-1,28) o que respondieron que el VPH podía causar CaCu (RPa = 1,21; IC 95%: 1,11 1,33) tuvieron una mayor prevalencia de haberse realizado un PAP en los últimos dos años. Conclusiones: Tener conocimientos sobre CaCu y VPH se asoció con haberse realizado un PAP en los últimos dos años.

Abstract Objetives: To estimate the association between having knowledge about cervical cancer (CC) and having a Pap test (PAP) in Peruvian women over 30 years old. Materials and Methods: A secondary analysis of the Demographic and Family Health Survey of the years 2015 to 2017 was carried out. The level of knowledge was evaluated using the questions, do you think that cancer can be prevented?, Have you ever heard of CC?, Have you ever heard of human papillomavirus (HPV)? And do you think HPV can cause CC? The dependent variable was the realization of a PAP in the last two years. To estimate the association, generalized linear models of the raw and adjusted Poisson family were used. The measure of association was the adjusted prevalence ratio (aPR) with its respective 95% confidence intervals (95% CI). Results: Data from 21 563 women were analyzed. The prevalence of having performed a PAP in the last two years was 52.4%. It was found that, those who responded that cancer can be prevented (aPR = 1.09; 95% CI: 1.01-1.17), who had heard of CC (aPR = 1.27; 95% CI: 1.14-1 , 40) or HPV (aPR = 1.20; 95% CI: 1.13-1.28) or who responded that HPV could cause CC (aPR = 1.21; 95% CI: 1.11-1.33) had a higher prevalence of having performed a PAP in the last two years. Conclusions: Having knowledge about CC and HPV has been associated with having performed a PAP in the last two years.