Laboratory biomarkers associated with COVID-19 mortality among inpatients in a Peruvian referral hospital.

Aim: To evaluate the biochemical and hematological markers associated with the risk of death due to COVID-19 in a clinical cohort with a severe clinical profile. Methods: A retrospective study was conducted among 215 anonymized inpatient records from the Hospital Nacional Almanzor Aguinaga Asenjo, Peru, between April and June 2020. The association between biomarkers and death due to COVID-19 was assessed using Cox regression, with a multivariable modeling of 1) biochemical and 2) hematological markers. Kaplan-Meier analyses and time-dependent receiver operating characteristic curves were calculated for each associated biomarker (p < 0.05). Results: Data analysis of 215 inpatient records revealed an overall mortality rate of 51.30% (95% CI 44.70-58.50), a mean age of 63.90 ± 14.10 years, and a median oxygen saturation of 88% (interquartile range 82-92%). The best-fitted biochemical model included higher levels of C-reactive protein (CRP), D-dimer, fibrinogen, urea, and lactate dehydrogenase. Similarly, the best-fitted hematological model included higher absolute neutrophil and prothrombin time, and lower absolute platelet counts. The best area under the curve values in both models were found to be CRP and D-dimer values (>0.74) and the absolute neutrophil count (0.63). Conclusions: Some specific biochemical markers outperformed hematological markers. Evaluated hematological counts analyzed in multivariable models proved to be better markers and could be useful to discriminate COVID-19 patients at high risk of death.

[Factors associated with level of knowledge and attitudes toward research among medical students in Peru, 2011]. / Factores asociados con el nivel de conocimientos y la actitud hacia la investigación en estudiantes de medicina en Perú, 2011.

OBJECTIVE: To identify the factors associated with level of knowledge and attitudes toward research among undergraduate medical students in Peru. METHODS: In this analytical cross-sectional study, a validated questionnaire on knowledge, attitudes, and practices related to research was applied to a representative sample of students at 17 Peruvian medical schools. The categorical and quantitative variables were subjected to simple two-factor analysis with adjustment for intraclass correlation. Prevalence ratios were derived on the basis of generalized linear models using bifactorial and multifactorial analysis. RESULTS: Questionnaires from 1 554 students (51.0% women) with an average age of 20.5 ± 2.86 years were analyzed. Only 46.7% of the respondents had a good level of knowledge and 37.7% had appropriate attitudes toward research. The variables that correlated with a good level of knowledge were the respondent having completed at least four years of academic study, belonging to a research group, and having an adviser. Having appropriate attitudes toward research correlated with being a woman and having an adviser. No differences were found between the level of knowledge and attitudes of the students at the universities studied. CONCLUSIONS: In general, the level of knowledge about research was unsatisfactory and the attitudes toward it were inappropriate. In order to change this situation, it will be critical to make changes in the curriculum to ensure that students engage in research from the beginning of their academic careers and develop research skills in their final years of study.

Evidence-based indications for ivermectin in parasitic diseases: An integrated approach to context and challenges in Peru.

Ivermectin has emerged as a therapeutic option for various parasitic diseases, including strongyloidiasis, scabies, lice infestations, gnathostomiasis, and myiasis. This study comprehensively reviews the evidence-based indications for ivermectin in treating parasitic diseases, considering the unique context and challenges in Peru. Fourteen studies were selected from a systematic search of scientific evidence on ivermectin in PubMed, from 2010 to July 2022. The optimal dosage of ivermectin for treating onchocerciasis, strongyloidiasis, and enterobiasis ranges from 150 to 200 µg/kg, while lymphatic filariasis requires a higher dose of 400 µg/kg (Brown et al., 2000). However, increased dosages have been associated with a higher incidence of ocular adverse events. Scientific evidence shows that ivermectin can be safely and effectively administered to children weighing less than 15 kg. Systematic reviews and meta-analyses provide strong support for the efficacy and safety of ivermectin in combating parasitic infections. Ivermectin has proven to be an effective treatment for various parasitic diseases, including intestinal parasites, ectoparasites, filariasis, and onchocerciasis. Dosages ranging from 200 µg/kg to 400 µg/kg are generally safe, with adjustments made according to the specific pathology, patient age, and weight/height. Given Peru's prevailing social and environmental conditions, the high burden of intestinal parasites and ectoparasites in the country underscores the importance of ivermectin in addressing these health challenges.

Humoral response after a BNT162b2 heterologous third dose of COVID-19 vaccine following two doses of BBIBP-CorV among healthcare personnel in Peru.

Background: The inactivated virus vaccine, BBIBP-CorV, was principally distributed across low- and middle-income countries as primary vaccination strategy to prevent poor COVID-19 outcomes. Limited information is available regarding its effect on heterologous boosting. We aim to evaluate the immunogenicity and reactogenicity of a third booster dose of BNT162b2 following a double BBIBP-CorV regime. Methods: We conducted a cross-sectional study among healthcare providers from several healthcare facilities of the Seguro Social de Salud del Perú - ESSALUD. We included participants two-dose BBIBP-CorV vaccinated who presented a three-dose vaccination card at least 21 days passed since the vaccinees received their third dose and were willing to provide written informed consent. Antibodies were determined using LIAISON® SARS-CoV-2 TrimericS IgG (DiaSorin Inc., Stillwater, USA). Factors potentially associated with immunogenicity, and adverse events, were considered. We used a multivariable fractional polynomial modeling approach to estimate the association between anti-SARS-CoV-2 IgG antibodies' geometric mean (GM) ratios and related predictors. Results: We included 595 subjects receiving a third dose with a median (IQR) age of 46 [37], [54], from which 40% reported previous SARS-CoV-2 infection. The overall geometric mean (IQR) of anti-SARS-CoV-2 IgG antibodies was 8,410 (5,115 - 13,000) BAU/mL. Prior SARS-CoV-2 history and full/part-time in-person working modality were significantly associated with greater GM. Conversely, time from boosting to IgG measure was associated with lower GM levels. We found 81% of reactogenicity in the study population; younger age and being a nurse were associated with a lower incidence of adverse events. Conclusions: Among healthcare providers, a booster dose of BNT162b2 following a full BBIBP-CorV regime provided high humoral immune protection. Thus, SARS-CoV-2 previous exposure and working in person displayed as determinants that increase anti-SARS-CoV-2 IgG antibodies.

Post-vaccination seropositivity against SARS-CoV-2 in peruvian health workers vaccinated with BBIBP-CorV (Sinopharm).

OBJECTIVE: To estimate the prevalence of post-vaccination seropositivity against SARS-CoV-2 and identify its predictors in Peruvian Social Health Insurance (EsSalud) personnel in 2021. METHODS: We conducted a cross-sectional study in a representative simple stratified sample of EsSalud workers. We evaluated IgG anti-SARS-CoV-2 antibodies response (seropositivity) by passive (previous infection) and active immunization (vaccination), and epidemiological and occupational variables obtained by direct interview and a data collection form. Descriptive and inferential statistics were used with correction of sample weights adjusted for non-response rate, and crude and adjusted odds ratio (OR) and geometric mean ratio (GMR) with their respective 95% confidence intervals (95%CI) were estimated. RESULTS: We enrolled 1077 subjects. Seropositivity was 67.4% (95%CI: 63.4-71.1). Predictors of seropositivity were age (negative relation; p < 0.001), previous infection (aOR = 11.7; 95%CI: 7.81-17.5), working in COVID-19 area (aOR = 1.47; 95%CI: 1.02-2.11) and time since the second dose. In relation to antibody levels measured by geometric means, there was an association between male sex (aGMR = 0.77; 95%CI: 0.74-0.80), age (negative relation; p < 0.001), previous infection (aGMR = 13.1; 95%CI:4.99-34.40), non-face-to-face/licensed work modality (aGMR = 0.78; 95%CI: 0.73-0.84), being a nursing technician (aGMR = 1.30; 95%CI: 1.20-1.41), working in administrative areas (aGMR = 1.17; 95%CI: 1.10-1.25), diagnostic support (aGMR = 1.07; 95%CI: 1.01-1.15), critical care (aGMR = 0.85; 95%CI: 0.79-0.93), and in a COVID-19 area (aGMR = 1.30; 95%CI: 1.24-1.36) and time since receiving the second dose (negative relation; p < 0.001). CONCLUSIONS: Seropositivity and antibody levels decrease as the time since receiving the second dose increases. Older age and no history of previous infection were associated with lower seropositivity and antibody values. These findings may be useful for sentinel antibody surveillance and the design of booster dose strategies.

Effects of vaccination against COVID-19 on the emotional health of older adults.

Background: The COVID-19 pandemic significantly impacted the mental and emotional health of the elderly, especially those from low to middle-income countries. However, COVID-19 vaccination may reduce this influence. Therefore, we aimed to estimate the effect of vaccination against COVID-19 on the emotional health of older adults. Methods: We selected a national, random, and stratified sample of non-hospitalized adults aged 60 to 79 years from Peru who intended to receive or had already received the COVID-19 vaccine during recruitment. During June and July 2021, the assessed outcomes were the fear, anxiety, and worry about COVID-19, general anxiety, and depression at baseline and after a month. We estimated the adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for each altered emotional health outcomes in those who had one and two doses, compared with those who were not vaccinated using multilevel logistic regression with mixed effects. Results: We recruited 861 older adults with 20.8% of loss to follow-up. At baseline, 43.9% had received only one dose of the vaccine, and 49.1% had two doses. In the analysis during follow-up, those who had two doses had less fear (aOR: 0.19; CI 95%: 0.07 to 0.51) and anxiety to COVID-19 (aOR: 0.45; CI 95%: 0.22 to 0.89), compared to unvaccinated. We observed no effects in those with only one dose. Conclusions: Two doses of COVID-19 vaccination in older adults improves their perception of COVID-19 infection consequences. This information could be integrated into the vaccination campaign as an additional beneficial effect.

Clinical-epidemiologic variation in patients treated in the first and second wave of COVID-19 in Lambayeque, Peru: A cluster analysis.

OBJECTIVES: To identify differences in the clinical and epidemiologic characteristics of patients during the first and second waves of the COVID-19 pandemic at the EsSalud Lambayeque health care network, Peru. METHODS: An analytical cross-sectional study of 53,912 patients enrolled during the first and second waves of COVID-19 was conducted. Cluster analysis based on clustering large applications (CLARA) was applied to clinical-epidemiologic data presented at the time of care. The two pandemic waves were compared using clinical-epidemiologic data from epidemiologic surveillance. RESULTS: Cluster analysis identified four COVID-19 groups with a characteristic pattern. Cluster 1 included the largest number of participants in both waves, and the participants were predominantly female. Cluster 2 included patients with gastrointestinal, respiratory, and systemic symptoms. Cluster 3 was the "severe" cluster, characterized by older adults and patients with dyspnea or comorbidities (cardiovascular, diabetes, obesity). Cluster 4 included asymptomatic, pregnant, and less severe patients. We found differences in all clinical-epidemiologic characteristics according to the cluster to which they belonged. CONCLUSION: Using cluster analysis, we identified characteristic patterns in each group. Respiratory, gastrointestinal, dyspnea, anosmia, and ageusia symptoms were higher in the second COVID-19 wave than the first COVID-19 wave.

Female orgasmic dysfunction and severe climacteric symptomatology in women aged 40 to 59 years: an independent association from an analysis of a multicenter Latin American study.

OBJECTIVE: To evaluate the association between the severity of climacteric symptoms (CS) and orgasmic dysfunction (OD), controlled by demographic, clinical, and partner variables. METHODS: We carried out a secondary analysis of a multicenter Latin American cross-sectional study that surveyed sexually active women 40 to 59 years old. We assessed CS (global, somatic, psychological, or urogenital domains) and OD. Also, we explored clinical variables and partner sexual conditions. We performed logistic regression models with nonparametric bootstrap resampling to estimate crude and adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: We included data of 5,391 women in the analysis. Regarding CS, 24.8%, 10.8%, 28.4%, and 32.9% had respectively severe symptoms according to total, somatic, psychological, and urogenital domain scores of the Menopause Rating Scale. OD was found in 25.4% of women. The adjusted model (including menopausal status and partner sexual dysfunction) showed that severe CS increased the odds of OD (aOR = 2.77; 95% CI: 2.41-3.19 [total Menopause Rating Scale score]; aOR = 1.65; 95% CI: 1.37-2.00 [somatic domain]; aOR = 2.02; 95% CI: 1.76-2.32 [psychological domain] and aOR = 3.89; 95% CI: 3.40-4.45 [urogenital]). CONCLUSIONS: Severe CS were associated with OD independently of demographic, clinical, and partner variables. Severe urogenital symptoms had the strongest association.

[Factors associated with dropout in outpatient clinic in a Peruvian Social Security hospital]. / Factores asociados a deserción en consulta externa en hospital del Seguro Social del Perú.

BACKGROUND: dropout is considered a problem because attention is interrupted, causing in many cases, complications and important sequelae. The prevalence and factors associated with outpatient referral (DECE) in a national hospital in Peru, 2014-2015, were evaluated. METHODS: analytical cross-sectional design. The DECE is that medical appointment by external office that was not specified. Demographic factors related to the medical appointment were collected. To assess the factors associated with DECE, a generalized linear model of the Poisson family with robust standard errors (crude and adjusted) was used. RESULTS: Of 592160 medical appointments granted, the prevalence of DECE was 20.2%. The average age was 51.10 ± 23.23 years and 59.6% were women. The factors associated with a greater probability of DECE were: being a woman, being under 18 years of age or adult, programming schedule, type of patient of the service and the hospital; and have more than 15 days of deferral in the appointment. CONCLUSIONS: Conclusions: One out of every five patients did not make an appointment in the outpatient clinic. There were demographic and health system factors associated with a higher prevalence of DECE, which could be considered to propose strategies to reduce it.

INTRODUCCIÓN: se considera la deserción un problema debido a que interrumpe la atención, ocasionando, en muchos casos, complicaciones y secuelas importantes. Se planteó valorar la prevalencia y los factores asociados a la deserción en consulta externa (DECE) en un hospital nacional de Perú, 2014-2015. MÉTODOS: diseño transversal analítico. La DECE es aquella cita médica por consultorio externo que no fue concretada. Se recolectaron factores demográficos y relacionados a la cita médica. Para valorar los factores asociados a la DECE se utilizó un modelo lineal generalizado de la familia Poisson con errores estándares robustos (crudo y ajustado). Se reporta como medida de asociación a la razón de prevalencias (RP) con sus IC95%. RESULTADOS: de 592 160 citas médicas otorgadas, la prevalencia de DECE fue de 20.2%. La edad promedio fue 51.1 ± 23.2 años, y el 59.6% fueron mujeres. Los factores asociados a una mayor probabilidad de DECE fueron: ser mujer, ser menor de 18 años de edad, horario de programación (tarde), tipo de paciente (continuador y de reingreso) del servicio y del hospital y tener más de 15 días de diferimiento en la cita. En contraste, los factores que disminuyeron la probabilidad de DECE fueron: tener cita adicional, horario de programación (noche) y si fueron horas extras u horas de régimen de prestaciones complementarias de trabajo. CONCLUSIONES: uno de cada cinco pacientes no concretó su cita en consulta externa. Se evidenciaron factores demográficos y del sistema de salud asociados a una mayor prevalencia de DECE que podrían ser tomados en cuenta para plantear estrategias para disminuirla.

Retos y perspectivas de las agencias de evaluación de Tecnologías en Salud en el Perú / Challenges and perspectives of the Health Technology evaluation agencies in Peru

RESUMEN Las Tecnologías Sanitarias (TS) son importantes para tomar decisiones adecuadas en el ámbito de la salud. Se destaca la necesidad de estandarizar las evaluaciones de las TS, ya que actualmente existen diferencias en los métodos y recomendaciones utilizados. Además, se menciona la falta de recursos humanos capacitados para llevar a cabo estas evaluaciones, así como los tiempos prolongados que pueden tomar. Por lo tanto, es fundamental priorizar las tecnologías a evaluar para maximizar los recursos disponibles. En América Latina, el proceso de priorización de tecnologías sanitarias presenta diversas barreras, como la falta de un proceso explícito y formal de priorización en la mayoría de los países. Estas barreras incluyen la fragmentación de los servicios de salud, el desacuerdo de los actores involucrados y el temor a una reducción de la discrecionalidad en la toma de decisiones. A pesar de estas dificultades, se han desarrollado procesos de priorización basados en diferentes marcos metodológicos, que deben ser transparentes, sistemáticos, eficientes, explícitos y consensuados. Por lo tanto, es necesario contar con marcos referenciales para evaluar el impacto de estas tecnologías en la atención sanitaria. Se destaca la importancia de declarar los conflictos de interés en la evaluación de tecnologías sanitarias y cómo la influencia de la industria puede afectar el proceso de evaluación. Además, se resalta la necesidad de estandarizar metodologías e instrumentos de evaluación para mejorar la calidad y comparabilidad de las ETS.

ABSTRACT Health Technologies (HT) are important to make appropriate decisions in the field of health. The need to standardize TS evaluations is highlighted, since there are currently differences in the methods and recommendations used. In addition, the lack of trained human resources to carry out these evaluations is mentioned, as well as the long times they can take. Therefore, it is essential to prioritize the technologies to be evaluated to maximize available resources. In Latin America, the health technology prioritization process presents various barriers, such as the lack of an explicit and formal prioritization process in most countries. These barriers include fragmentation of health services, disagreement among stakeholders, and fear of reduced discretion in decision-making. Despite these difficulties, prioritization processes have been developed based on different methodological frameworks, which must be transparent, systematic, efficient, explicit and consensual. Therefore, it is necessary to have reference frameworks to evaluate the impact of these technologies on healthcare. The importance of declaring conflicts of interest in the evaluation of health technologies and how industry influence can affect the evaluation process is highlighted. Furthermore, the need to standardize evaluation methodologies and instruments is highlighted to improve the quality and comparability of STDs.

Letalidad por COVID-19 en adultos hospitalizados durante las dos primeras olas pandémicas: Una experiencia del sector privado en Perú

Introducción: La letalidad por COVID-19 en Perú fue 9.1 % en 2020-2021, una de la más altas en el mundo. Objetivos: describir la letalidad por COVID-19 en adultos hospitalizados en una clínica privada en Lima, Perú, durante las primeras dos olas pandémicas y evaluar sus factores asociados. Materiales y métodos: Estudio trasversal analítico en abril-septiembre 2020 (primera ola) y enero-mayo 2021 (segunda ola), en pacientes mayores de 18 años atendidos por COVID-19 en una clínica privada del Perú, obtenidos por muestreo aleatorio simple. Se aplicó pruebas estadísticas considerando p<0,05, usando IBM SPSS 27.0. Resultados: La muestra de 263 y 235 pacientes en la primera y segunda ola, la mediana de edad fue 51 y 49 años en cada periodo y en ambos momentos el sexo masculino predominó con72.9 % y 63.2 %. La letalidad fue de 7.7 % y 6 % en cada ola pandémica. Entre ambas olas se encontró diferencia respecto al sexo y frecuencia respiratoria. Los factores asociados a letalidad en ambas olas fueron la edad, SatO/FiO y lactato deshidrogenasa (LDH). Conclusiones: La letalidad por COVID-19 en pacientes adultos hospitalizados en una clínica privada, durante las primeras dos olas pandémicas fue baja y los factores asociados fueron edad, SatO/FiO y LDH.

Introduction: The fatality rate from COVID-19 in Peru was 9.1% in 2020-2021, the adults hospitalized in a private clinic in Lima, Peru during the first two pandemic waves and to evaluate its associated factors. Materials and methods: Analytical cross-sectional study in April-September 2020 (first wave) and January-May 2021 (second wave), in patients over 18 years of age treated for COVID-19 in a private clinic in Peru, obtained by simple random sampling. Statistical tests were applied considering p<0,05, using IBM SPSS 27.0. Results: The sample was 263 and 235 patients in the first and second wave, the median age was 51 and 49 years in each period and in both moments the male sex predominated with 72.9% and 63.2%. The fatality rate was 7.7% and 6% in each pandemic wave. Between both waves, a difference was found regarding sex and respiratory rate. The factors associated with fatality in both waves were age, SatO/FiO and lactate dehydrogenase (LDH). Conclusions: The fatality rate due to COVID-19 in adult patients hospitalized in a private clinic during the first two pandemic waves was low and the associated factors were age, SatO/FiO and LDH.

Análisis de Costos de cuidados en salud para pacientes con cáncer al final de la vida: Hospital versus domicilio con cuidados paliativos, en el tercer nivel de atención / Analysis of health care costs for patients with cancer at the end of life: Hospital versus home with palliative care, at the third level of care

Introducción: La etapa final de pacientes oncológicos genera elevados costos, sobretodo en hospitales. Objetivos: Determinar la diferencia de costos de atención al final de la vida de pacientes oncológicos en el hospital versus el domicilio. Material y métodos: Estudio retrospectivo de análisis de costos en pacientes fallecidos por cáncer en estadio clínico IV de un hospital terciario de la seguridad social, marzo 2018. Se comparó un grupo domiciliario (GD) de un programa paliativo con un grupo hospitalario (GH) admitido por emergencia. Se estimaron costos directos de servicios profesionales, hospitalización, procedimientos, exámenes auxiliares y medicamentos. Para el análisis estadístico se utilizó Chi cuadrado y T de Student, considerando un valor p<0,05 y utilizando SPSS 24.0. Resultados: Se incluyeron 81 pacientes en GD y 22 en GH, edad entre 36 y 96 años, con una mediana de 72 años en GD y 77 en GH (p=0,97), sexo femenino 59 y 73% respectivamente (p=0,25), predominando cáncer de origen digestivo y genitourinario. El costo promedio por paciente en GD fue 497 dólares americanos y en el GH 1908 (p<0,01), con un promedio diario por pacientes de 17 vs 447 respectivamente. En el GH predominaron los costos de hospitalización, exámenes auxiliares (tomografía, resonancia, análisis de gases arteriales, proteína C reactiva) y antibióticos (ertapenem y colistina), mientras que en GD el mayor costo fue en servicio médicos y medicamentos. Conclusión: Los costos médicos en la etapa final de vida de pacientes con cáncer avanzado son 3,8 veces mayor cuando fallece en el hospital que en el domicilio.

Background: The final stage of cancer patients generates high costs, especially in hospitals. To determine the difference in care costs Objectives:at the end of life for cancer patients in the hospital versus at home. Material and methods: Retrospective cost analysis study in patients who died of clinical stage IV cancer in a tertiary social security hospital, March 2018. Ahome group (Home) of a palliative program was compared with a hospital group (Hospital) admitted from the emergency department. Direct costs of professionalservices,hospitalization,procedures,auxiliaryexams,and medications were estimated. Chi square and Student's Twere used for statistical analysis, considering a value of p<0.05 and using SPSS 24.0. Results: 81 patients in Home and 22 in Hospital were included, aged between 36 and 96 years, with a median of 72 years in Home and 77 in Hospital (p=0.97), female sex 59 and 73% respectively (p= 0.25), predominantly cancer of digestive and genitourinary origin. The average cost per patient in Home was 497 US dollars and in Hospital 1908 (p<0.01), with a daily average per patient of 17 vs 447 respectively. In the Hospital, the costs of hospitalization, auxiliary tests (tomography, resonance, arterial gas analysis, C-reactive protein) and antibiotics (ertapenem and colistin) predominated, while in the Home the highest cost was in medical services and medications. Conclusion: The medical costs in the final stage of life of patients with advanced cancer are 3.8 times higher when they die in the hospital than at home.

Alineamiento de la producción científica a las prioridades de investigación en el Seguro Social de Salud del Perú: Propuesta de fortalecimiento y descentralización de la investigación / Alignment of scientific production to research priorities in the Peruvian Health Social Health Insurance: Purpose to strengthening and decentralization of research

Introducción: Uno de los indicadores del impacto del establecimiento de prioridades en investigación en salud es la producción científica. EsSalud planteó nueve temas de investigación prioritarios (TIP) y 20 preguntas de investigación prioritarias (PIP) 2017-2019. Evaluamos el alineamiento a estas prioridades de investigación en los artículos científicos publicados con filiación de EsSalud durante 2017-2020, y caracterizamos aquellos financiados por esta institución. Material y Métodos: Análisis de los artículos científicos registrados en la base de datos de producción científica de EsSalud 2017-2020. Empleamos una metodología estandarizada y por duplicado para evaluar el alineamiento a los TIP y PIP 2017-2019 de EsSalud. La evaluación del alineamiento a las PIP sólo lo realizamos en artículos originales y resúmenes de congreso. Reportamos frecuencias de alineamiento a cada TIP y PIP, y frecuencia de alineamiento a por lo menos un TIP según características de los artículos. Además, se reportó las características de los artículos financiados por EsSalud. Resultados: Un total de 170 de 1283 artículos se alinearon a al menos un TIP. Ocho de las veinte PIP no fueron respondidas. Los artículos con autores que pertenecen o recibieron financiamiento del IETSI-EsSalud tuvieron la mayor tasa de alineación. Finalmente, los artículos financiados por EsSalud fueron principalmente estudios observacionales, guías de práctica clínica y revisiones sistemáticas. Conclusión: Los artículos científicos publicados con filiación de EsSalud durante el 2017 al 2020 tienen baja alineación con las prioridades de investigación de la institución. Por lo tanto, es necesario generar un proceso de gestión de implementación, seguimiento y evaluación de las prioridades de investigación en la institución.

Background: One of the impact indicators of priorities in health research-setting is the scientific production that refers to these priorities. EsSalud raised nine priority research topics (PRT) and 20 priority research questions (PRQ) for the 2017-2019 period. We assess the alignment to these research priorities in the scientific articles published during the 2017-2020 period by EsSalud, and we characterize those financed by this institution. Material and Methods: Analysis of the scientific articles registered in the EsSalud scientific production database for the period 2017-2020. We used a standardized methodology and in duplicate to evaluate the alignment of a scientific article to the PRTand PRQ 2017-2019 of EsSalud. The evaluation of the alignment to the PRQs is only carried out in original articles and congress summaries. We report alignment frequencies to each PRTand PRQ, and we report the frequency of alignment to at least one PRT according to the articles' characteristics. In addition, the characteristics of the articles financed by EsSalud were reported. Results: 170 out of 1283 articles were aligned to at least one PRT. Eight of the twenty PRQs went unanswered. Articles with authors who belong to or received funding from IETSI-EsSalud had the highest alignment rate. Finally, the highly cited articles financed by EsSalud were mainly observational studies, clinical practice guidelines and systematic reviews. Conclusion: The articles published by EsSalud during 2017 to 2020 have low alignment with institutional research priorities. Furthermore, it is necessary a process of implementation, monitoring, and evaluation of research priorities in the institution.

Relación entre los grupos sanguíneos A, B y O y mortalidad por infección con SARS-CoV-2 en pacientes hospitalizados

El objetivo del estudio fue investigar la relación entre los grupos sanguíneos A, B y O y la mortalidad en pacientes hospitalizados por una infección grave por SARS-CoV-2. La investigación fue observacional retrospectiva en un hospital de tercer nivel en Lima, Perú. Se incluyó a 203 pacientes, con una edad media de 62,58 ± 16,45 años, y el 71,92 % eran varones. La frecuencia de los grupos sanguíneos O, A y B fue del 75,37 %, 17,24 % y 7,39 %, respectivamente. Se encontró asociación con la mortalidad por infección grave por COVID-19 con los grupos sanguíneos que no son A (grupo O, grupo B), con un PR (razón de prevalencia) de 2,25 IC (intervalo de confianza) 95 % 1,07-4,71. Al ajustar por las principales variables, la asociación con RP persistió en 2,78 IC 95 % 1,06-7,24. En conclusión, en los pacientes hospitalizados por una infección grave por SARS-CoV-2, los grupos sanguíneos O y B estarían asociados con una mayor mortalidad que los pacientes del grupo sanguíneo A.

This study aimed to determine the relationship between ABO blood groups and mortality in patients hospitalized for severe SARS-CoV-2 infection. An observational and retrospective research was conducted in a tertiary care hospital in Lima, Peru. A total of 203 patients with a mean age of 62.58 ± 16.45 years were included in the research, out of whom 71.92 % were males. The frequency of O, A and B blood groups were 75.37 %, 17.24 % and 7.39 %, respectively. An association with mortality from severe COVID-19 infection was found with non-A blood groups (O group or B group), with a PR (prevalence ratio) of 2.25 and 95% CI (confidence interval) of 1.07 - 4.71. When adjusting the main variables, the association with PR remained in 2.78 and 95% CI in 1.06 - 7.24. In conclusion, patients hospitalized for severe SARS-CoV-2 infection with O and B blood groups seem to be associated with higher mortality rates than those with A blood group.

Investigación clínica: Situación actual y problemática en la divulgación / Clinical research: Current and problematic situation in the dissemination

La investigación clínica es la herramienta más importante para la identificación de estrategiasdiagnósticasyterapéuticasquederivenenunamayoreficaciay seguridad y que estas finalmente impacten en la recuperación de la salud. Además, la investigación clínica mejora el conocimiento científico, la transferencia tecnológica y la práctica asistencial entre otras ventajas.

Efectividad del aplicativo de resultados críticos para el apoyo al diagnóstico y terapéutico de pacientes crónicos atendidos en una Clínica privada entre el 2017 y 2018 / Effectiveness of the critical results application to support the diagnosis and therapy of chronic patients treated in a private clinic between 2017 and 2018

RESUMEN Introducción: La oportuna prestación de servicios de salud es clave para reducir la morbimortalidad de pacientes crónicos, especialmente cuando se requiere una atención frente a un resultado crítico de exámenes auxiliares. En ese contexto, se evalúa un aplicativo web de resultados críticos en una Clínica privada acreditada por Joint Commission International (JCI). Objetivos: el presente estudio busca evaluar la efectividad de un aplicativo web en el reporte de resultados críticos de pacientes crónicos. Material y métodos: Se realizó un estudio de cohorte retrospectiva. Se compararon dos etapas: la etapa de línea de base (implementación del software) versus la etapa final (evaluación). Resultados: Se registraron 122 resultados críticos de pacientes crónicos en la etapa de implementación y 113 en la etapa de evaluación. Se encontró una disminución en la media del tiempo de respuesta del profesional en la etapa de evaluación con relación a la etapa de implementación. La transcripción en los registros incrementó del 75,4% al 93,8% p<0,001, la continuidad de la atención por el mismo médico incrementó del 41,0% al 54,9% p<0,03. Asimismo, se redujo en 68% la probabilidad de fallecimiento. Conclusiones: El aplicativo web de resultados críticos mejoró el registro de la atención y redujo la mortalidad de pacientes crónicos que tuvieron un resultado crítico.

ABSTRACT Introduction: Currently, the use of health technologies in the health system has become a subject of constant study and innovation. In this context, in an institution accredited by the Joint Commission International (JCI), a web application was implemented to manage critical results, which were defined as results that could put the patient's life at risk. Objectives: this study seeks to evaluate the effectiveness of an application in reporting critical results. Material and methodo: A retrospective cohort study was carried out. Two stages were compared: the baseline stage (software implementation) versus the final stage (evaluation). Results: 122 critical results were registered in the implementation stage and 113 in the evaluation stage. A decrease was found in the average response time of the professional in the evaluation stage in relation to the implementation stage. The transcription in the records increased from 75.4% to 93.8% p <0.00, the continuity of care by the same doctor increased from 41.0% to 54.9% p <0.03. Likewise, the probability of death was reduced by 68%. Conclusions: In the evaluation stage, mortality decreased and the transcription in the information registry of the critical results application improved towards the patient's clinical history. Likewise, it was possible to optimize the quality of care by ensuring that the follow-up of the patient throughout the entire care is carried out by the same doctor.

Efectividad del aplicativo de resultados críticos para el apoyo al diagnóstico y terapéutico de pacientes crónicos atendidos en una Clínica privada entre el 2017 y 2018 / Effectiveness of the critical results application to support the diagnosis and therapy of chronic patients treated in a private clinic between 2017 and 2018

Introducción: La oportuna prestación de servicios de salud es clave para reducir la morbimortalidad de pacientes crónicos, especialmente cuando se requiere una atención frente a un resultado crítico de exámenes auxiliares. En ese contexto, se evalúa un aplicativo web de resultados críticos en una Clínica privada acreditada por Joint Commission International (JCI). Objetivos: el presente estudio busca evaluar la efectividad de un aplicativo web en el reporte de resultados críticos de pacientes crónicos. Material y métodos: Se realizó un estudio de cohorte retrospectiva. Se compararon dos etapas: la etapa de línea de base (implementación del software) versus la etapa final (evaluación). Resultados: Se registraron 122 resultados críticos de pacientes crónicos en la etapa de implementación y 113 en la etapa de evaluación. Se encontró una disminución en la media del tiempo de respuesta del profesional en la etapa de evaluación con relación a la etapa de implementación. La transcripción en los registros incrementó del 75,4% al 93,8% p<0,001, la continuidad de la atención por el mismo médico incrementó del 41,0% al 54,9% p<0,03. Asimismo, se redujo en 68% la probabilidad de fallecimiento. Conclusiones: El aplicativo web de resultados críticos mejoró el registro de la atención y redujo la mortalidad de pacientes crónicos que tuvieron un resultado crítico.

Introduction:Currently, the use of health technologies in the health system has become a subject of constant study and innovation. In this context, in an institution accredited by the Joint Commission International (JCI), a web application was implemented to manage critical results, which were defined as results that could put the patient's life at risk. Objectives: this study seeks to evaluate the effectiveness of an application in reporting critical results. Material and methods: Aretrospective cohort study was carried out. Two stages were compared: the baseline stage (software implementation) versus the final stage (evaluation). Results: 122 critical results were registered in the implementation stage and 113 in the evaluation stage. Adecrease was found in the average response time of the professional in the evaluation stage in relation to the implementation stage. The transcription in the records increased from 75.4% to 93.8% p <0.00, the continuity of care by the same doctor increased from 41.0% to 54.9% p <0.03. Likewise, the probability of death was reduced by 68%. Conclusions: Intheevaluationstage,mortalitydecreasedandthe transcription in the information registry of the critical results application improved towards the patient's clinical history. Likewise, it was possible to optimize the quality of care by ensuring that the follow-up of the patient throughout the entire care is carried out by the same doctor.

Índice desarrollo humano y la tasa de letalidad por Covid-19: Estudio ecológico en América / Human development and Covid-19 lethality rate: Ecological study in America

Introducción: El Índice de Desarrollo Humano (IDH), usa tres dimensiones de desarrollo como esperanza de vida, acceso a educación y el nivel de ingresos. Se ha visto a nivel mundial que los grupos socioeconómicamente vulnerables son los menos protegidos y enfrentan el mayor riesgo de COVID-19. Este estudio tiene como objetivo evaluar la correlación entre IDH, índice de inequidad GINI con la tasa de letalidad por COVID-19 en países de América. El estudio: Se desarrolló un estudio observacional ecológico, utilizando las métricas de COVID 19 de países de latino américa. La variable desenlace fue tasa de letalidad por COVID-19, y las variables exposición fueron IDH, GINI, esperanza de vida, años de escolaridad, proporción de mayores de 60 años y PBI per cápita. Recopilado los datos se hicieron análisis. Usamos el método de correlación de spearman, con un nivel de significancia de 95%. Hallazgos: Se evaluaron a 24 países de América Latina, encontrándose una tasa de letalidad por COVID 19 con una mediana de 2.41 y con 1.55 y 3.04 como percentil 25 y 75 respectivamente, obteniéndose además con valores extremos a Ecuador, México y Perú con 6.41, 7.57 y 9.12 respectivamente. Al evaluar la correlación de la tasa de letalidad por COVID 19 se encontró correlación lineal negativa débil entre el IDH, índice de escolaridad y esperanza de vida con rho= -0.253, -0.342 y -0.342 respectivamente, sin embargo no se encontró significancia estadística (Valor p >0.05). Conclusiones: Se encontró entre los países de latino américa que existe correlación lineal negativa débil entre la tasa de letalidad por COVID 19 y IDH, índice de escolaridad y esperanza de vida.

Background: The Human Development Index (HDI), uses three dimensions of development such as life expectancy, access to education and income level. It has been seen worldwide that socioeconomically vulnerable groups are the least protected and face the highest risk of COVID-19. This study aims to evaluate the correlation between HDI, GINI inequality index and COVID-19 case fatality rate in American countries. Study: An ecological observational study was developed, using COVID-19 metrics from Latin American countries. The outcome variable was COVID-19 case fatality rate, and the exposure variables were HDI, GINI, life expectancy, years of schooling, proportion of people over 60 years of age and GDPper capita. Once the data were collected, analyses were performed. We used the spearman correlation method, with a significance level of 95%. Findings: Twenty-four Latin American countries were evaluated, finding a COVID 19 case fatality rate with a median of 2.41 and with 1.55 and 3.04 as 25th and 75th percentile respectively, obtaining also with extreme values Ecuador, Mexico and Peru with 6.41, 7.57 and 9.12 respectively. When evaluating the correlation of the COVID 19 case fatality rate, a weak negative linear correlation was found between HDI, schooling index and life expectancy with rho= -0.253, -0.342 and -0.342 respectively, however, statistical significance was not found (p-value >0.05). Conclusions: It was found among Latin American countries that there is a weak negative linear correlation between COVID 19 case fatality rate and HDI, schooling index and life expectancy.

Resistencia antimicrobiana de uropatógenos en adultos mayores / Antimicrobial resistance of uropathogens in older adults

Introducción: En la actualidad, la resistencia antimicrobiana ha sido declarada por la Organización Mundial de la Salud como un problema de salud pública. Objetivo: Determinar el perfil de resistencia antimicrobiana de uropatógenos en adultos mayores. Métodos: Estudio descriptivo transversal de 567 urocultivos positivos de adultos mayores atendidos durante el año 2017 en una clínica privada en Lima, Perú. El análisis univariado se realizó por distribución de frecuencias, promedio y desviación estándar. Se estimó la asociación entre la producción de BLEE con respecto a las características epidemiológicas y el tipo de atención mediante Chi cuadrado con un nivel de significación de 0,05. Resultados: La edad promedio de la población fue de 74,1 años (DE:10,7). El 71,8 por ciento de los urocultivos positivos pertenecieron al sexo femenino. Los principales uropatógenos aislados en todos los niveles de atención fueron: E. coli, E. coli BLEE y K. pneumoniae BLEE. La E. coli presentó 69,3 por ciento de resistencia a ampicilina; y la E. coli BLEE tuvo el 100 por ciento de resistencia a ampicilina, ceftriaxona y ceftazidima. El 62 por ciento de microorganismos BLEE se encontraron en la atención ambulatoria. Se evidenció asociación estadísticamente significativa entre los agentes productores de BLEE y el sexo (p=0,004), mas no respecto al tipo de atención (p=0,144) ni subgrupos de edad (p=0,669). Conclusiones: La resistencia antimicrobiana es altamente prevalente en los adultos mayores. El sexo femenino fue el más afectado y el uropatógeno más frecuente la E. coli, este presenta una alta resistencia a ampicilina y mayor sensibilidad a nitrofurantoína. Se determinó un alto porcentaje de agentes productores de BLEE en la atención ambulatoria(AU)

Introduction: At present, the World Health Organization as a public health problem has declared antimicrobial resistance. Objective: To determine the antimicrobial resistance profile of uropathogens in older adults. Methods: Cross-sectional descriptive study of 567 positive urine cultures from older adults treated during 2017 in a private clinic in Lima, Peru. Univariate analysis was performed by frequency distribution, mean and standard deviation. The association between ESBL production with respect to epidemiological characteristics and type of care is estimated using Chi square with a significance level of 0.05. Results: The average age of the population was 74.1 years (SD: 10.7). 71.8percent of the positive urine cultures were from female sex. The main uropathogens isolated at all levels of care were E. coli, E. coli ESBL and K. pneumoniae ESBL. E. coli showed 69.3percent resistance to ampicillin; and E. coli ESBL had 100percent resistance to ampicillin, ceftriaxone, and ceftazidime. 62percent of ESBL microorganisms were found in outpatient care. There was a statistically significant association between ESBL-producing agents and gender (p = 0.004), but not with regard to type of care (p = 0.144) or age subgroups (p = 0.669). Conclusions: Antimicrobial resistance is highly prevalent in older adults. The female sex was the most affected and the most frequent uropathogen was E. coli, highly resistant to ampicillin and greater sensitivity to nitrofurantoin. High percentage of ESBL-producing agents was determined in outpatient care(AU)