Identifying Gaps in the Treatment Guidelines for Hepatitis C in Peru to Meet International Standards: A Narrative Review.

Hepatitis C virus still represents a major cause of morbidity and mortality worldwide. In Peru, two national practice guidelines for the management of this infection were published more than 5 years ago; however, the latest breakthroughs in the treatment make it necessary to update these guidelines. We reviewed the most recent recommendations of the international guidelines and compared them with the current Peruvian guidelines. We found major differences, such as the use of Glecaprevir/Pibrentasvir as a first-line therapy, which is contemplated in the World Health Organization guideline, and recommended by American and European guidelines, but is not considered in the Peruvian guidelines. Another crucial difference lies in the management of patients with chronic kidney disease, who are treated nowadays with a variety of direct-acting antivirals, with no restrictions on the use of Sofosbuvir-based regimens in first-world countries, an approach that has not been adopted in Peru. We believe that standardization of the recommendations of the Peruvian guidelines is imperative, including the new therapeutic strategies that have emerged in recent years. We also suggest conducting a cost effectiveness analysis in the Peruvian context to allow for the implementation of new antivirals, and to achieve a better control of hepatitis C in the country.

Case Report: Neurobrucellosis Presenting as Malignancy.

Neurobrucellosis, caused by Brucella species, is a zoonotic infection that may involve the central nervous system. Although uncommon, it can manifest as a solitary intracranial mass. We report a case of neurobrucellosis in a 25-year-old woman from Peru who presented with headache, weight loss, and right-side hemiparesis and paresthesia. A contrast-enhanced magnetic resonance imaging scan revealed an intracerebral mass in the left temporal lobe. Serum testing subsequently were positive. Brain biopsy demonstrated non-necrotizing granulomas without malignant cells. Neurobrucellosis should be considered in the differential diagnosis of brain space occupying lesions in endemic countries.

Lemierre-like syndrome after soft tissue infection due to methicillin-resistant Staphylococcus aureus: A case report and literature review.

RATIONALE: Lemierre-like syndrome (LLS) is characterized by bacteremia, septic thrombophlebitis of the internal jugular vein, and metastatic abscesses. In contrast to classic Lemierre syndrome, sources of infection are not related to oropharyngeal infections, as are frequent soft tissue infections. In recent years, Staphylococcus aureus has been identified as an emergent pathogen that causes this syndrome. The mortality rate of LLS caused by this pathogen is approximately 16%. Timely diagnosis, antibiotic treatment, and infection control are the cornerstones to treat LLS. Anticoagulant therapy as adjuvant treatment remains controversial. PATIENT CONCERNS: A 31-year-old woman from California, United States (US), was admitted to the emergency room with a history of 2 days of fever and severe throbbing pain in the left cervical region. Thorax and neck CT tomography revealed confluent cavities suggestive of septic embolism in the lungs and a filiform thrombus in the lumen of the left internal jugular vein, with moderate swelling of the soft and muscular tissues. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the blood culture. DIAGNOSIS: The thrombus in the internal jugular vein associated with cellulitis in the neck and multiple cavitary lesions in the lungs support the diagnosis of LLS caused by MRSA with septic embolization. INTERVENTIONS: During treatment, the patient received vancomycin IV for 25 days and returned to the US with linezolid orally. In addition, assisted video-thoracoscopy and bilateral mini-thoracotomy with pleural decortication were performed for infectious source control, where 1700cc of purulent pleural fluid was drained. OUTCOMES: The patient was discharged with optimal evolution. LESSONS: LLS should be suspected in patients with skin and soft tissue infections who develop thrombosis or metastatic infections. MRSA infections should be considered in patients from areas where this pathogen is prevalent.

Cerebrospinal fluid shunting for the management of cryptococcal meningitis: a scoping review.

Objective: This scoping review aimed to describe studies that evaluate the management of cryptococcal meningitis (CM) using cerebrospinal fluid (CSF) shunts, types of shunts used, and clinically relevant patient outcomes. Methods: We searched in the following databases: PubMed, Web of Science/Core collection, Embase, the Cochrane Library, and clinicaltrials.gov on 1 April 2022. We included two-arm and one-arm cohort studies that evaluated clinically relevant patient outcomes. Case reports were used to describe the type of CSF shunts used and the rationale behind its selection. The selection and extraction processes were independently performed by two authors. Results: This study included 20 cohort studies and 26 case reports. Only seven cohort studies compared two groups. Ventriculoperitoneal shunt was the most commonly used type of shunt (82.1%). The main indications for placing a shunt were persistently high opening pressure (57.1%) and persisting neurological symptoms or deterioration (54.3%). Cohort studies suggest that patients with shunt showed improvement in some outcomes such as neurological symptoms and hospital stay length. The most common shunt complications were post-operative fever (1-35.6%) and shunt obstruction (7-16%). Conclusion: CSF shunts may improve some clinically relevant outcomes in patients with CM, but the evidence is very uncertain.

Effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis: a systematic review.

OBJECTIVES: To evaluate the efficacy of antituberculosis therapy on pregnancy outcomes in infertile women with genital tuberculosis. DESIGN: Systematic review. DATA SOURCES: We searched in PubMed/MEDLINE, CENTRAL and EMBASE up to 15 January 2023. Additionally, we manually search the reference lists of included studies. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCT), non-RCTs (non-RCT) and cohort studies that evaluated the effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis compared with not receiving antituberculosis treatment or receiving the treatment for a shorter period. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data. We used Cochrane Risk of Bias 1.0 and Risk Of Bias In Non-randomised Studies tools for risk of bias assessment and meta-analysis was not performed. We used Grading of Recommendations, Assessment, Development and Evaluations approach to assess the certainty of the evidence. RESULTS: Two RCTs and one non-RCT were included. The antituberculosis regimens were based on isoniazid, rifampicin, pyrazinamide and ethambutol for 6-12 months. In women without structural damage, very low certainty of evidence from one RCT showed that the antituberculosis treatment may have little to no effect on pregnancy, full-term pregnancy, abortion or intrauterine death and ectopic pregnancy, but the evidence is very uncertain. In women with structural damage, very low certainty of evidence from one non-RCT showed that the antituberculosis treatment may reduce the pregnancy rate (297 fewer per 1000, 95% CI -416 to -101), but the evidence is very uncertain. In addition, very low certainty of evidence from one RCT compared a 9-month vs 6-month antituberculosis treatment regimen showed similar effects between the schemes, but the evidence is very uncertain. Two RCTs reported that no adverse events of antituberculosis treatment were noted or were similar in both groups. CONCLUSION: The effect of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis is very uncertain. PROSPERO REGISTRATION NUMBER: CRD42022273145.

Association between concern about COVID-19, social support and knowledge about tuberculosis with adherence to antituberculosis treatment in Lima, Perú / Asociación entre preocupación frente a la COVID-19, el apoyo social y el conocimiento sobre tuberculosis con el cumplimiento del tratamiento antituberculoso en Lima, Perú

INTRODUCTION: In the context of the COVID-19 pandemic, information on factors associated with adherence to antituberculosis treatment in areas with high prevalence of tuberculosis is scarce. OBJETIVE: To evaluate whether there is an association between social support, concern about COVID-19 infection and knowledge about tuberculosis, and non-adherence to antituberculosis treatment. MATERIALS AND METHODOS: A cross-sectional study was carried out on patients under antituberculosis treatment, from January to March, 2022, in centers located in areas with a high prevalence of tuberculosis in Lima. We used the Morisky Green-Levine questionnaire to assess adherence to treatment as the dependent variable; the independent variables were evaluated using the Medical Outcomes Study Social Support Survey for perceived social support and concern about COVID-19 infection, and the Battle Test to assess patients' knowledge about their disease. We used Poisson regression with robust variance to evaluate the association between the independent variables and the dependent one. RESULTS: Out of 101 participants (73.3% male with an average age of 35.1 ± 16 years), 51.5% were non-adherent to antituberculosis treatment. Medium or high level of concern about getting COVID-19 was associated with a higher prevalence of non-adherence to treatment (odds ratio: 1.68; 95 % confidence interval: 1.09-2.57) (adjusted for considered confounding variables). CONCLUSIONS: Non-adherence is a frequent condition among patients living in an area with a high prevalence of tuberculosis in Lima, especially among those with a higher concern for COVID-19 infection.

Introducción: En el contexto de la pandemia por la COVID-19 es escasa la información de factores asociados al cumplimiento del tratamiento antituberculoso en las zonas de alta prevalencia de tuberculosis. Objetivo: Evaluar si existe asociación entre el apoyo social, la preocupación por el contagio de COVID-19 y el conocimiento de la tuberculosis, frente al incumplimiento del tratamiento antituberculoso. Materiales y métodos: Se trata de un estudio transversal de pacientes en tratamiento antituberculoso durante los meses de enero a marzo del 2022 en centros ubicados en áreas de alta prevalencia de tuberculosis en Lima. Se utilizó el cuestionario de Morisky Green-Levine para evaluar el cumplimiento del tratamiento como variable dependiente; las variables independientes se evaluaron usando el Medical Outcomes Study Social Support Survey para determinar el apoyo social percibido y la preocupación por la infección de COVID-19, y el test de Batalla para evaluar el conocimiento del paciente sobre su enfermedad. Se utilizó la regresión de Poisson con varianza robusta para determinar la asociación entre las variables. Resultados: De un total de 101 participantes (73,3 % hombres y edad media 35,1 ± 16 años), el 51,5 % no observaron el tratamiento antituberculoso. El nivel de preocupación medio o alto de contagiarse y desarrollar COVID-19 se asoció con una mayor prevalencia de incumplimiento del tratamiento (razón de prevalencia: 1,68; intervalo de confianza del 95 %: 1,09-2,57) (ajustada por las variables de confusión consideradas). Conclusiones: El incumplimiento del tratamiento antituberculoso es una condición frecuente entre los pacientes de una zona de alta prevalencia de tuberculosis en Lima especialmente entre aquellos con mayor preocupación al contagio por el virus de SARSCoV-2, causante de la COVID-19.

Asociación entre preocupación frente a la COVID-19, el apoyo social y el conocimiento sobre tuberculosis con el cumplimiento del tratamiento antituberculoso en Lima, Perú / Association between concern about COVID-19, social support and knowledge about tuberculosis with adherence to antituberculosis treatment in Lima, Perú

Introducción. En el contexto de la pandemia por la COVID-19 es escasa la información de factores asociados al cumplimiento del tratamiento antituberculoso en las zonas de alta prevalencia de tuberculosis. Objetivo. Evaluar si existe asociación entre el apoyo social, la preocupación por el contagio de COVID-19 y el conocimiento de la tuberculosis, frente al incumplimiento del tratamiento antituberculoso. Materiales y métodos. Se trata de un estudio transversal de pacientes en tratamiento antituberculoso durante los meses de enero a marzo del 2022 en centros ubicados en áreas de alta prevalencia de tuberculosis en Lima. Se utilizó el cuestionario de Morisky Green-Levine para evaluar el cumplimiento del tratamiento como variable dependiente; las variables independientes se evaluaron usando el Medical Outcomes Study Social Support Survey para determinar el apoyo social percibido y la preocupación por la infección de COVID-19, y el test de Batalla para evaluar el conocimiento del paciente sobre su enfermedad. Se utilizó la regresión de Poisson con varianza robusta para determinar la asociación entre las variables. Resultados. De un total de 101 participantes (73,3 % hombres y edad media 35,1 ± 16 años), el 51,5 % no observaron el tratamiento antituberculoso. El nivel de preocupación medio o alto de contagiarse y desarrollar COVID-19 se asoció con una mayor prevalencia de incumplimiento del tratamiento (razón de prevalencia: 1,68; intervalo de confianza del 95 %: 1,09-2,57) (ajustada por las variables de confusión consideradas). Conclusiones. El incumplimiento del tratamiento antituberculoso es una condición frecuente entre los pacientes de una zona de alta prevalencia de tuberculosis en Lima especialmente entre aquellos con mayor preocupación al contagio por el virus de SARS- CoV-2, causante de la COVID-19.

Introduction. In the context of the COVID-19 pandemic, information on factors associated with adherence to antituberculosis treatment in areas with high prevalence of tuberculosis is scarce. Objective. To evaluate whether there is an association between social support, concern about COVID-19 infection and knowledge about tuberculosis, and non-adherence to antituberculosis treatment. Materials and methods. A cross-sectional study was carried out on patients under antituberculosis treatment, from January to March, 2022, in centers located in areas with a high prevalence of tuberculosis in Lima. We used the Morisky Green-Levine questionnaire to assess adherence to treatment as the dependent variable; the independent variables were evaluated using the Medical Outcomes Study Social Support Survey for perceived social support and concern about COVID-19 infection, and the Battle Test to assess patients' knowledge about their disease. We used Poisson regression with robust variance to evaluate the association between the independent variables and the dependent one. Results. Out of 101 participants (73.3% male with an average age of 35.1 ±16 years), 51.5% were non-adherent to antituberculosis treatment. Medium or high level of concern about getting COVID-19 was associated with a higher prevalence of non-adherence to treatment (odds ratio: 1.68; 95 % confidence interval: 1.09-2.57) (adjusted for considered confounding variables). Conclusions. Non-adherence is a frequent condition among patients living in an area with a high prevalence of tuberculosis in Lima, especially among those with a higher concern for COVID-19 infection.

Perceptions and Intention to Get Vaccinated against Mpox among the LGBTIQ+ Community during the 2022 Outbreak: A Cross-Sectional Study in Peru.

Vaccination against mpox can control the outbreak by targeting high-risk groups such as the LGBTIQ+ community. The aim of the study was to evaluate the perceptions and intentions to get vaccinated against mpox among the LGBTIQ+ community in Peru. We conducted a cross-sectional study from 1 November 2022 to 17 January 2023 in Peru. We included individuals over 18 years old, belonging to the LGBTIQ+ community, and residing in the departments of Lima and Callao. To evaluate the factors associated with the intention to be vaccinated, we used Poisson regression with robust variance to create a multivariate model. The study comprised 373 individuals who self-identified as members of the LGBTIQ+ community. The participants had a mean age of 31 years (SD ± 9), with 85.0% males and 75.3% reporting to be homosexual men. The majority (88.5%) expressed their intention to receive the vaccine against mpox. Believing that the vaccine is safe was associated with a higher intention to be vaccinated (aPR: 1.24; 95% CI: 1.02 to 1.50; p = 0.028). Our study population showed a high level of mpox vaccination intent. Educational campaigns reinforcing the concept of vaccine safety should be conducted to increase the intention and possibly the vaccination rate in the LGBTIQ+ community.

Level of Knowledge Regarding Mpox among Peruvian Physicians during the 2022 Outbreak: A Cross-Sectional Study.

Introduction: Due to the high incidence of mpox in Peru and the poor knowledge about this disease among healthcare workers in non-endemic countries, it is crucial to determine the knowledge status of Peruvian physicians. Methodology: We conducted an analytical cross-sectional study based on an online survey from August to September 2022. Physicians who had a medical license and lived and practiced medicine in Peru were included. To evaluate the factors associated with a higher level of knowledge, we used crude (cPR) and adjusted (aPR) prevalence ratios with 95% confidence intervals (95% CI) using Poisson regression. Results: We included 463 physicians. The mean age was 36.6 (SD: 10.3) years, and most were male (58.1%). Regarding knowledge, the median knowledge score was 14 [IQR: 13 to 15] out of 17 points. In terms of knowledge gaps, only 60.7% of the participants knew that there was an FDA-approved vaccine for mpox, 49.0% of participants knew about mpox proctitis and 33.3% acknowledged that it could be transmitted by the bite of an infected rodent. We found that taking care of patients with mpox (aPR: 1.39; 95% CI: 1.13 to 1.72) was associated with higher knowledge (>p50), while living in the eastern macro-region (aPR: 0.62; 95% CI: 0.42 to 0.93) was associated with lower knowledge (≤p50). Conclusions: Our study showed a high level of knowledge about mpox among Peruvian physicians. However, educational campaigns may be necessary, especially for physicians from the eastern region and those who do not have clinical experience with mpox.

[Parents' perceptions and intention to vaccinate their children under 12 years of age against COVID-19: a cross-sectional study in Peru]. / Percepciones e intención de los padres de vacunar a sus hijos bajo 12 años de edad contra la COVID-19: estudio transversal en Perú.

BACKGROUND: Despite the proven efficacy and safety of COVID-19 vaccines, pediatric vaccination coverage remains low in many countries. There are still doubts and fears in parents about vaccination in their children under 12 years of age. AIM: To evaluate the perceptions and intention of parents to vaccinate their children under 12 years of age. METHODS: Analytical cross-sectional study based on an online survey that evaluated the parents' perceptions regarding the risk of COVID-19 infection, the need for a vaccine, and the vaccine adverse events in their children under 12 years. We assessed the factors associated with the intention to vaccinate through crude (cPR) and adjusted prevalence rates (aPR), with confidence interval of 95% (CI 95%). RESULTS: 83.5% of respondents had the intention to vaccinate their children under 12 years of age. In the multivariate analysis, the factors associated with a decrease in the intention to vaccinate were to believe that the vaccine was not necessary (aPR 0.65; 95% CI 0.44 - 0.94), that it would not protect (aPR: 0.14; 95% CI 0.03 - 0.63), it would not be safe (aPR: 0.80; 95% CI 0.70 - 0.92) and it would cause long-term side effects (aPR: 0.92; 95% CI 0.85 - 1.00). On the other hand, living on the highlands or jungle was associated with an increase in the intention. CONCLUSION: In Peru, 16.5% of parents would not vaccinate their children under 12 years of age, because they perceived that the vaccine was not necessary and would not protect against COVID-19. In addition, they expressed concerns about the development of possible adverse events.

Percepciones e intención de los padres de vacunar a sus hijos bajo 12 años de edad contra la COVID-19: estudio transversal en Perú / Parents' perceptions and intention to vaccinate their children under 12 years of age against COVID-19: a cross-sectional study in Peru

INTRODUCCIÓN: A pesar de la probada eficacia y seguridad de las vacunas contra la COVID-19, la cobertura de vacunación pediátrica sigue siendo baja en muchos países. Aún existen dudas y temores en los padres sobre la vacunación en sus hijos bajo 12 años de edad. OBJETIVO: Evaluar las percepciones e intención de los padres de vacunar a sus hijos bajo 12 años en Perú. METODOLOGÍA: Estudio transversal analítico, a partir de una encuesta que recopiló la percepción de los padres sobre el riesgo de contagio por COVID-19, necesidad de vacunación y desarrollo de eventos adversos por la vacuna en niños bajo 12 años. Evaluamos los factores asociados a la intención de vacunación mediante razones de prevalencia crudas (RPc) y ajustadas (RPa) con intervalos de confianza al 95% (IC 95%). RESULTADOS: El 83,5% de los padres tenían la intención de vacunar a sus hijos bajo 12 años. En el análisis multivariado, los factores asociados a una disminución de la intención de vacunación fueron pensar que la vacuna no es necesaria (RPa: 0,65; IC 95% 0,44 - 0,94), que no protegería (RPa: 0,14; IC 95% 0,03 - 0,63), que no sería segura (RPa: 0,80; IC 95% 0,70 - 0,92) y que ocasionaría efectos negativos a largo plazo (RPa: 0,92; IC 95% 0,85 - 1,00). Por otro lado, residir en la Selva (RPa: 1,09; IC 95%: 1,03-1,15) o en la Sierra (RPa: 1,06; IC 95%: 1,00-1,11) se asoció a una mayor prevalencia de intención. CONCLUSIONES: En Perú, un 16,5% de padres no vacunaría a sus hijos bajo 12 años, ya que perciben que la vacuna no es necesaria y no protegería contra la COVID-19, además de tener la preocupación de posibles eventos adversos.

BACKGROUND: Despite the proven efficacy and safety of COVID-19 vaccines, pediatric vaccination coverage remains low in many countries. There are still doubts and fears in parents about vaccination in their children under 12 years of age. AIM: To evaluate the perceptions and intention of parents to vaccinate their children under 12 years of age. METHODS: Analytical cross-sectional study based on an online survey that evaluated the parents' perceptions regarding the risk of COVID-19 infection, the need for a vaccine, and the vaccine adverse events in their children under 12 years. We assessed the factors associated with the intention to vaccinate through crude (cPR) and adjusted prevalence rates (aPR), with confidence interval of 95% (CI 95%). RESULTS: 83.5% of respondents had the intention to vaccinate their children under 12 years of age. In the multivariate analysis, the factors associated with a decrease in the intention to vaccinate were to believe that the vaccine was not necessary (aPR 0.65; 95% CI 0.44 - 0.94), that it would not protect (aPR: 0.14; 95% CI 0.03 - 0.63), it would not be safe (aPR: 0.80; 95% CI 0.70 - 0.92) and it would cause long-term side effects (aPR: 0.92; 95% CI 0.85 - 1.00). On the other hand, living on the highlands or jungle was associated with an increase in the intention. CONCLUSION: In Peru, 16.5% of parents would not vaccinate their children under 12 years of age, because they perceived that the vaccine was not necessary and would not protect against COVID-19. In addition, they expressed concerns about the development of possible adverse events.

Factors associated with the intention to participate in COVID-19 vaccine clinical trials: A cross-sectional study in Peru.

OBJECTIVE: To evaluate the factors associated with the intention to participate in COVID-19 vaccine clinical trials in the Peruvian population. METHODS: Cross-sectional study and secondary analysis of a database that involved Peruvian population during September 2020. The Poisson regression model was used to estimate the associated factors. RESULTS: Data from 3231 individuals were analyzed, 44.1% of whom intended to participate in COVID-19 vaccine clinical trials. Factors associated with the outcome were being male (RPa: 1.25; 95% CI: 1.15-1.35), being from the highlands region (RPa: 1.18; 95% CI: 1.09-1.28) or jungle (RPa: 1.30; 95% CI: 1.15-1.47), having a relative that is a healthcare professional (PRa: 1.16; 95% CI: 1.06-1.28), using a medical source of information (PRa: 1.28; 95% CI: 1.17-1.41), and trusting in the possible effectiveness of vaccines (PRa: 1.40; 95% CI: 1.29-1.51). The main reason for not participating in the trial was the possibility of developing side effects (69.80%). CONCLUSION: There is an urgent need to generate a perception of safety in COVID-19 vaccine clinical trials, to increase the population's intention to participate in these studies, and to provide evidence-based information about the vaccine.

Oxygen saturation as a predictor of mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru.

INTRODUCTION: Peru is among the top ten countries with the highest number of coronavirus disease 2019 (COVID-19) cases worldwide. The aim of the study was to describe the clinical features of hospitalized adult patients with COVID-19 and to determine the prognostic factors associated with in-hospital mortality. METHODS: We conducted a retrospective cohort study among adult patients with COVID-19 admitted to Hospital Cayetano Heredia; a tertiary care hospital in Lima, Peru. The primary outcome was in-hospital mortality. Multivariate Cox proportional hazards regression was used to identify factors independently associated with in-hospital mortality. RESULTS: A total of 369 patients (median age 59 years [IQR:49-68]; 241 (65.31%) male) were included. Most patients (68.56%) reported at least one comorbidity; more frequently: obesity (42.55%), diabetes mellitus (21.95%), and hypertension (21.68%). The median duration of symptoms prior to hospital admission was 7 days (IQR: 5-10). Reported in-hospital mortality was 49.59%. By multiple Cox regression, oxygen saturation (SaO2) values of less than 90% on admission correlated with mortality, presenting 1.86 (95%CI: 1.02-3.39), 4.44 (95%CI: 2.46-8.02) and 7.74 (95%CI: 4.54-13.19) times greater risk of death for SaO2 of 89-85%, 84-80% and <80%, respectively, when compared to patients with SaO2 >90%. Additionally, age >60 years was associated with 1.88 times greater mortality. CONCLUSIONS: Oxygen saturation below 90% on admission is a strong predictor of in-hospital mortality in patients with COVID-19. In settings with limited resources, efforts to reduce mortality in COVID-19 should focus on early identification of hypoxemia and timely access to hospital care.

Clinical features and prognostic factors related to mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru / Características clínicas y factores asociados a mortalidad en pacientes adultos hospitalizados por COVID-19 en un hospital público de Lima, Perú. / Características clínicas e fatores associados à mortalidade em pacientes adultos internados pelo COVID-19 em um hospital público de Lima, Peru.

The COVID-19 pandemic has deeply affected the national health system in Peru, and despite the many strategies implemented to control the epidemic, the collapse of the sanitary system was imminent. We performed a retrospective cohort from the clinical records of adult patients with COVID-19 admitted in Hospital Cayetano Heredia (Lima, Peru), between March and June 2020. A total of 369 patient charts were included for analysis; 241 (65.31%) were male and the median age was 59 years (IQR: 49-68). Most patients (68.56%) reported at least one comorbidity; more frequently: obesity (42.55%), diabetes mellitus (21.95%), and hypertension (21.68%). The median duration of symptoms prior to hospital admission was 7 days (IQR: 5-10). Reported in-hospital mortality was 49.59%. By multiple Cox regression, oxygen saturation (SaO2) level at admission was the main predictor of patient mortality, with SaO2 levels of 84-80% and <80% had 4.44 (95%CI 2.46-8.02) and 7.74 (95%CI 4.54-13.19) times greater risk of death, respectively, when compared to patients with SaO2 >90%. Additionally, older age (>60 years old) was associated with 1.9 times greater mortality. Our study finds SaO2 at admission and older age to be independent predictors of in-hospital mortality. These findings suggest a delay in early detection of hypoxemia in the community, therefore, we propose the implementation of monitoring for hypoxemia among outpatients with COVID-19 as well as appropriate and timely oxygen therapy in admission.  

La pandemia por COVID-19 ha representado un duro golpe al sistema sanitario peruano, y las estrategias implementadas para el control de la epidemia han sido insuficientes en el contexto de colapso del sistema de salud. Se realizó una cohorte retrospectiva a partir de la revisión de las historias clínicas de pacientes adultos hospitalizados por COVID-19, entre marzo y junio de 2020, en el Hospital Cayetano Heredia, Lima- Perú. Se analizó 369 historias clínicas, 241 (65.31%) pacientes eran del sexo masculino y la mediana de edad era de 59 años (RIC: 49-68). El 68.56% presentaba al menos una comorbilidad, siendo las más frecuentes obesidad (42.55%), diabetes mellitus (21.95%) e hipertensión arterial (21.68%). La mediana de duración de síntomas previo al ingreso hospitalario fue de 7 días (RIC: 5-10). La mortalidad intrahospitalaria encontrada fue del 49.59%. En el análisis multivariado, la saturación de oxígeno al ingreso al hospital fue el principal factor predictor de mortalidad. Se observó un marcado incremento de mortalidad; encontrándose que la SatO2 de 84-80% y <80% tuvieron 4.44 (IC95% 2.46-8.02) y 7.74 (IC95% 4.54- 13.19) veces mayor riesgo de muerte, respectivamente, en comparación con pacientes con SatO2 basal >90%. Adicionalmente, la edad mayor a 60 años se asocia a 1.90 veces mayor mortalidad. Nuestro estudio muestra que la edad mayor a 60 años y el nivel de hipoxemia presente al momento de la admisión al hospital son factores asociados de forma independiente a la mortalidad intrahospitalaria. Los hallazgos sugieren una demora en detección de hipoxemia en la comunidad, por lo que se propone reforzar el sistema de monitoreo e identificación temprana de hipoxemia en pacientes con COVID-19, asociada a un soporte oxigenatorio en el momento oportuno.

A pandemia do COVID-19 representou um duro golpe no sistema de saúde peruano, e as estratégias implementadas para controlar a epidemia foram insuficientes no contexto do colapso do sistema de saúde. Foi realizada uma coorte retrospectiva com base na revisão dos prontuários de pacientes adultos internados pelo COVID-19, entre março e junho de 2020, no Hospital Cayetano Heredia, Lima-Peru. Foram analisados ​​369 prontuários, 241 (65,31%) pacientes eram do sexo masculino e a idade média foi de 59 anos (RIC: 49-68). 68,56% apresentavam pelo menos uma comorbidade, sendo as mais frequentes obesidade (42,55%), diabetes mellitus (21,95%) e hipertensão (21,68%). A duração mediana dos sintomas antes da internação foi de 7 dias (RIC: 5-10). A mortalidade hospitalar encontrada foi de 49,59%. Na análise multivariada, a saturação de oxigênio na admissão hospitalar foi o principal preditor de mortalidade. Um aumento acentuado na mortalidade foi observado; constatando que SatO2 de 84-80% e <80% tinha 4,44 (IC95% 2,46-8,02) e 7,74 (IC95% 4,54-13,19) vezes maior risco de morte, respectivamente, em comparação com pacientes com SatO2 basal> 90%. Além disso, a idade acima de 60 anos está associada a uma mortalidade 1,90 vezes maior. Nosso estudo mostra que a idade superior a 60 anos e o nível de hipoxemia presente no momento da admissão no hospital são fatores independentemente associados à mortalidade hospitalar. Os resultados sugerem um atraso na detecção de hipoxemia na comunidade, motivo pelo qual se propõe fortalecer o sistema de monitoramento e identificação precoce de hipoxemia em pacientes com COVID-19, associados ao suporte à oxigenação no momento apropriado.

Videoconferences of Infectious Diseases: An educational tool that transcends borders. A useful tool also for the current COVID-19 pandemic.

Not available.

[Epidemiological clinical and laboratory characterization of sporotrichosis in patients of a tertiary care hospital in Lima, Peru, from 1991 to 2014]. / Caracterización epidemiológica, clínica y de laboratorio de esporotricosis en pacientes de un hospital de tercer nivel en Lima-Perú, entre los años 1991 y 2014.

BACKGROUND: Sporothricosis is endemic in numerous Latin American countries and the rest of the world. In Peru is concentrated in regions with warm and humid climate being little known in the rest of the country. AIM: To describe the epidemiological, clinical and laboratory characteristics of patients diagnosed of sporotrichosis in a tertiary-care level hospital in Lima, Peru from 1991 to 2014. METHODS: This was a retrospective, case series. RESULTS: Ninety four patients were involved; most of them were male adults. This condition was acquired more frequently in Cajamarca, Apurímac, and Amazonas. Fixed and lymphocutaneous form were the most frequent forms of presentation in adults and were mostly distributed in upper limbs. Lesions located in head and neck were most frequent in children. Comorbidities were present in 15% of patients and were more frequent in those who presented disseminated cutaneous form. Seventy eight percent of cultures from skin lesions were positive within 7 days. The time to positivity of cultures was longer if the sample came from skin biopsies than skin scraping or skin aspiration. CONCLUSIONS: Most cases of sporotrichosis were acquired in areas of extreme poverty in Peru. The clinical, epidemiological and laboratory findings were similar to those reported elsewhere. The time to positivity of cultures varies based on the type of skin sample. This finding needs to be further evaluated in studies with an increased number of cases.