Prevalence and incidence of neuropsychiatric disorders in post hospitalized COVID-19 patients in South America: a systematic review and meta-analysis.

Introduction: There are multiple reports of neuropsychiatric disorders (NDs) such as stress, depression, post-traumatic stress disorder (PTSD), or anxiety, in patients who have survived the acute phase of COVID-19, being even more frequent in people who were hospitalized with moderate or severe disease. South America (SA) was one of the most affected continents during this time due to its health, social, political and economic context. We aimed to determine the prevalence and incidence of NDs in patients following hospitalization for COVID-19 in SA. Materials and methods: We searched in PubMed, Embase, Scopus, Web of Science, LILACS, SciELO, and Google Scholar databases up to October 2022. We performed proportion meta-analysis with a random-effect model and Freeman-Tukey Double Arcsine transformation using the STATA 16.1 program. Finally, we evaluated heterogeneity by subgroup analysis and certainty of evidence with the GRADE approach. Results: We included eight studies from four countries. We only pooled six studies with prevalence measures. The estimated prevalence of all NDs was 31.48% (two-studies, 95%CI: 25.82-37.43). Depression, anxiety, insomnia, PTSD, and memory alterations had a pooled prevalence of 16.23% (three-studies, 95%CI: 7.18-27.93, I2: 94.22), 18.72% (three-studies, 95%CI: 11.65-26.97, I2: 87.56), 43.07% (three-studies, 95%CI: 32.77-53.37, I2: 92.61), 31.78% (three-studies, 95%CI: 14.33-52.40, I2: 97.96), and 38.24% (two-studies, 95%CI: 35.5-40.97), respectively. The evidence included was deemed as moderate to high certainty. Conclusion: We suggest that NDs should be prioritized in research and care in South America with public policies that can support their identification and prompt management to improve the quality of life of patients. More studies are needed to adequately study the prevalence of NDs in South America, their associated factors, and evaluate the causes of heterogeneity. Systematic review registration: https://doi.org/10.6084/m9.figshare.21901041.v1.

[Clinical practice guideline for the management of acute pancreatitis in the social security of Peru (Essalud)]. / Guía de práctica clínica para el manejo de la pancreatitis aguda en el seguro social del Perú (Essalud).

This article summarizes the clinical practice guideline (CPG) for the management of acute pancreatitis in the Social Security of Peru (EsSalud), to provide evidence-based clinical recommendations for the management of acute pancreatitis in EsSalud. A guideline development group (GEG) was formed that included medical specialists and methodologists. The GEG formulated 7 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when considered relevant- primary studies were carried out in PubMed during 2022. The evidence was selected to answer each of the clinical questions posed. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice, and the corresponding flow charts. Finally, the CPG was approved with Resolution No. 105-IETSI-ESSALUD-2022. This CPG addressed 7 clinical questions on fluid therapy, start of enteral nutrition, analgesia, type of nutrition, antibiotic, and surgical treatment. Based on these questions, 8 recommendations (1 strong and 7 conditional), 13 BPCs, and 1 flowchart were formulated. This article summarizes the methodology and evidence-based conclusions of the CPG for the management of acute pancreatitis in EsSalud.

Guía de práctica clínica para el manejo de la pancreatitis aguda en el seguro social del Perú (Essalud)

El presente artículo resume la guía de práctica clínica (GPC) para el manejo de la pancreatitis aguda en el Seguro Social del Perú (EsSalud). Su objetivo es proveer recomendaciones clínicas basadas en evidencia para el manejo de la pancreatitis aguda en EsSalud. Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 7 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios en PubMed durante el 2022. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y flujogramas correspondientes. Finalmente, la GPC fue aprobada con Resolución N° 105-IETSI-ESSALUD-2022. La presente GPC abordó 7 preguntas clínicas sobre fluidoterapia, momento de inicio de nutrición enteral, analgesia, tipo de nutrición, tratamiento antibiótico y quirúrgico. En base a dichas preguntas se formularon 8 recomendaciones (1 fuerte y 7 condicionales), 13 BPC, y 1 flujograma. El presente artículo resume la metodología y las conclusiones basadas en evidencia de la GPC para el manejo de la pancreatitis aguda en EsSalud.

This article summarizes the clinical practice guideline (CPG) for the management of acute pancreatitis in the Social Security of Peru (EsSalud), to provide evidence-based clinical recommendations for the management of acute pancreatitis in EsSalud. A guideline development group (GEG) was formed that included medical specialists and methodologists. The GEG formulated 7 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when considered relevant-primary studies were carried out in PubMed during 2022. The evidence was selected to answer each of the clinical questions posed. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice, and the corresponding ow charts. Finally, the CPG was approved with Resolution No. 105-IETSI-ESSALUD-2022. This CPG addressed 7 clinical questions on buid therapy, start of enteral nutrition, analgesia, type of nutrition, antibiotic, and surgical treatment. Based on these questions, 8 recommendations (1 strong and 7 conditional), 13 BPCs, and 1 flowchart were formulated. This article summarizes the methodology and evidence-based conclusions of the CPG for the management of acute pancreatitis in EsSalud.

Primary headache disorders in Latin America and the Caribbean: A meta-analysis of population-based studies.

BACKGROUND: In this manuscript, we aim to systematically estimate the pooled prevalence and incidence of primary headaches and its subtypes (migraine, tension-type headache, and chronic headaches) in Latin America and the Caribbean, describing its epidemiological profile and associated factors. METHODS: We systematically searched PubMed/MEDLINE, Scopus, and LILACS (From conception to March 2021), for populational studies reporting the epidemiology of primary headaches and their associated factors in Latin America and the Caribbean. The data extraction was conducted independently. We performed random-effect model meta-analysis of prevalence (overall primary headaches and by subtypes) and associated factors, assessed potential sources of heterogeneity, the risk of bias, publication bias, and the evidence certainty (GRADE methodology). RESULTS: We included 32 populational studies (38 subpopulations, n = 63,813). The prevalence of primary headaches was 41.4% (95% CI 31.1-52.2%; n = 54,357), 15% for migraine (95% CI 12.0-18.3; n = 53,658 individuals), 20.6% for tension-type headache (95% CI 12.4-30.2; n = 25,840), and 6% for chronic headaches (95% CI 3.3-9.6; n = 21,720), with high between-study heterogeneity. No incidence data was found. Female sex, white ethnicity, high BMI, comorbid mental health disorders, and low-back pain were associated with higher prevalence of primary headaches. The prevalence was less in rural areas. CONCLUSION: In Latin America and the Caribbean, primary headaches are highly prevalent affecting young females disproportionally. The prevalence of chronic headaches is higher than in other systematic global and regional estimations. The presence of comorbidities as modifiable risk factors should encourage their integration as targets for community-based preventive and therapeutic interventions. PROTOCOL REGISTRATION NUMBER: CRD42018105116.

Microsurgical and endovascular treatment of posterior inferior cerebellar artery aneurysms: a systematic review and meta-analysis.

INTRODUCTION: Posterior inferior cerebellar artery (PICA) aneurysms are uncommon vascular lesions of the posterior fossa. In addition to aneurysmal morphology, structural anatomic considerations may confer additional procedural risk, and as a result there is currently no consensus as to whether a surgical or endovascular approach offers greater safety and efficacy for patients. EVIDENCE ACQUISITION: We systematically examined peer-reviewed literature describing PICA aneurysm treatment planning from January 2000 to May 2021 using the PRISMA methodology. A meta-analysis of proportions was performed. Certainty of the evidence was assessed using the GRADE approach. EVIDENCE SYNTHESIS: Fifty-eight studies including 1673 PICA aneurysms were analyzed. Overall treatment occlusion rate was 97% (95% confidence interval [CI]: 93-100%) for surgery and 85% (95% CI: 78-92%) for endovascular therapy. The recurrence rate was 6% in the endovascular group and 1% for surgery. Overall morbidity and mortality were 16% and 7%, respectively. Intraoperative complications occurred in 9% of the surgical patients. CONCLUSIONS: Despite a large body of literature, analysis indicates that 62% of studies had moderate or serious risk of bias, suggesting very-low certainty results. Therefore, treatment via either approach should be determined on a case-by-case basis and according to institutional experience.

Clinical practice guidelines for the diagnosis and management of Duchenne muscular dystrophy: a scoping review.

Introduction: Our objective was to identify recent CPGs for the diagnosis and management of DMD and summarize their characteristics and reliability. Methods: We conducted a scoping review of CPGs using MEDLINE, the Turning Research Into Practice (TRIP) database, Google Scholar, guidelines created by organizations, and other repositories to identify CPGs published in the last 5 years. Our protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses for scoping reviews. To assess the reliability of the CPGs, we used all the domains included in the Appraisal of Guidelines Research and Evaluation II. Results: We selected three CPGs published or updated between 2015 and 2020. All the guidelines showed good or adequate methodological rigor but presented pitfalls in stakeholder involvement and applicability domains. Recommendations were coherent across CPGs on steroid treatment, except for minor differences in dosing regimens. However, the recommendations were different for new drugs. Discussion: There is a need for current and reliable CPGs that develop broad topics on the management of DMD and consider the challenges of developing recommendations for RDs.

Diagnosis of Guillain-Barré syndrome and use of Brighton criteria in Peruvian hospitals.

BACKGROUND: Guillain-Barré syndrome (GBS) is an autoimmune disease of the peripheral nervous system that caused multiple epidemiological outbreaks in Peru during 2018 and 2019. It is usually diagnosed using the Brighton criteria (BC). OBJECTIVE: We aimed to determine the performance of Peruvian neurologists in diagnosing GBS based on the BC, along with its associated factors. METHODS: This was a retrospective multicenter cohort study. We included patients diagnosed with GBS between 2007 and 2018 in three public hospitals in Lima, Peru. We collected data regarding demographic, clinical and management characteristics. We evaluated the use of the BC for confirmatory diagnosis of GBS and developed a logistic regression model to identify factors associated with its use. RESULTS: Out of 328 cases, we reviewed 201 available charts. The median age was 48 years, with male predominance. Over half of the patients presented an inadequate motor examination according to their Medical Research Council (MRC) score. Additional testing included lumbar puncture and electrophysiological testing, in over 70% of the cases. The BC showed certainty level 1 in 13.4% and levels 2 and 3 in 18.3%. Neither the quality of the motor examination nor the type of institution showed any association with the BC. CONCLUSIONS: Level 1 diagnostic certainty of the BC was met in less than one quarter of the cases with a GBS diagnosis in three centers in Lima, Peru, between 2007 and 2018. This level was not significantly associated with being treated in a specialized institute, rather than in a general hospital.

Validation of the Peruvian Spanish Version of the Stress and Anxiety to Viral Epidemics-6 Scale to Measure Viral Anxiety of Medical Students During COVID-19.

Introduction: The COVID-19 pandemic has created academic problems for Peruvian medical students leading to anxiety and depression. Hence, validated scales, such as the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), are required to identify and propose interventions to improve mental health. We aimed to perform a psychometric validation of the Peruvian version of SAVE-6 on medical students during the COVID-19 pandemic in Lima, Peru, in 2022. Methods: A total of 260 medical students at National University of San Marcos (UNMSM) participated in an online survey in January 2022. We collected sociodemographic characteristics and classified psychiatric symptoms using SAVE-6, the Generalized Anxiety Disorder-7 items (GAD-7) scale, and the Patient Health Questionnaire-9 items (PHQ-9). We performed confirmatory and parallel factor analysis to examine the validity of the Peruvian Spanish version of SAVE-6. Results: We explored the reliability and validity of SAVE-6 and SAVE-6 after excluding item 5, since factor loading of item 5 is too low. Both scales showed good internal consistencies (Cronbach's α = 0.780 and.82 and McDonald's Ω = 0.792 and.829, respectively). Furthermore, SAVE-6 after excluding item 5 showed good convergent validity with GAD-7 (r = 0.224, p <.001) and PHQ-9 (r = 0.217, p <.001). Consequently, instead of the full SAVE-6, SAVE-6 excluding item 5 proved to be reliable and valid enough to assess the anxiety of Peruvian medical students during the pandemic. Conclusion: The Peruvian Spanish SAVE-6 scale excluding item 5, rather than the full SAVE-6, can be applied to measure viral anxiety of medical students in Peru with good validity and reliability.

Greater occipital nerve block for chronic migraine patients: A meta-analysis.

INTRODUCTION: Greater occipital nerve block (GONB) is a minimally invasive procedure frequently used in patients with chronic migraine (CM); however, the quality of the evidence supporting its use is still unknown. Therefore, we aimed to conduct a systematic review, meta-analysis and quality assessment of GONB local anaesthetics combined or not with corticosteroids to prevent CM. METHODS: We searched Medline, Scopus and Web of Science up to October 2020. We included randomized control trials (RCT) and observational studies assessing GONB without language restrictions. Two researchers selected the studies, extracted the data and evaluated the risk of bias independently. The primary outcomes measured to assess efficacy were the change from baseline in the intensity and frequency of headache in the intervention group compared to placebo at a onetime point. We performed a meta-analysis with random effect models, and we evaluated random errors with trial sequential analysis (TSA). We assessed the risk of bias (ROB) with the ROB2 tool and the certainty of the evidence with GRADE. RESULTS: We identified 2864 studies in the databases and included three RCTs for quantitative synthesis. Most ROB assessments were 'high risk' or 'some concerns'. GONB reduced the intensity of headaches at the end of the first month (MD: -1.35, 95% CI: -2.12 to -0.59) and the second month (MD: -2.10, CI 95%: -2.94 to -1.26) as well as the frequency of headaches (first month: MD: -4.45 days, 95% CI: -6.56 to -2.34 days; second month: MD: -5.49, 95% CI -8.94 to -2.03 days). Corticosteroids did not show a significant decrease in the frequency of headaches during the first month of treatment (MD: -1.1 days, 95% CI: -4.1 to 1.8, p = .45). Included trials reported similar adverse events between groups. The exploratory TSA showed inconclusive results. Overall, the quality of the evidence was very low because of the substantial risk of bias and imprecision. CONCLUSION: The limited evidence available shows that GONB with local anaesthetics could reduce headache frequency and intensity compared to placebo, while adding corticosteroids did not show additional benefits. GONB was safe with a similar number of minor adverse events. However, our confidence in these estimates is very low since the evidence is based on a few trials, with a small sample size and a significant risk of bias. In addition, the exploratory TSA was inconclusive, so we need larger and specific trials.

Diagnosis of Guillain-Barré syndrome and use of Brighton criteria in Peruvian hospitals / Diagnóstico del Síndrome de Guillain-Barré y uso de los criterios de Brighton en hospitales Peruanos

ABSTRACT Background: Guillain-Barré syndrome (GBS) is an autoimmune disease of the peripheral nervous system that caused multiple epidemiological outbreaks in Peru during 2018 and 2019. It is usually diagnosed using the Brighton criteria (BC). Objective: We aimed to determine the performance of Peruvian neurologists in diagnosing GBS based on the BC, along with its associated factors. Methods: This was a retrospective multicenter cohort study. We included patients diagnosed with GBS between 2007 and 2018 in three public hospitals in Lima, Peru. We collected data regarding demographic, clinical and management characteristics. We evaluated the use of the BC for confirmatory diagnosis of GBS and developed a logistic regression model to identify factors associated with its use. Results: Out of 328 cases, we reviewed 201 available charts. The median age was 48 years, with male predominance. Over half of the patients presented an inadequate motor examination according to their Medical Research Council (MRC) score. Additional testing included lumbar puncture and electrophysiological testing, in over 70% of the cases. The BC showed certainty level 1 in 13.4% and levels 2 and 3 in 18.3%. Neither the quality of the motor examination nor the type of institution showed any association with the BC. Conclusions: Level 1 diagnostic certainty of the BC was met in less than one quarter of the cases with a GBS diagnosis in three centers in Lima, Peru, between 2007 and 2018. This level was not significantly associated with being treated in a specialized institute, rather than in a general hospital.

Resumen Antecedentes: El Síndrome de Guillain-Barré (SGB) es una enfermedad autoinmune del sistema nervioso periférico, causante de brotes epidemiológicos en Perú entre el 2018 y el 2019. El diagnóstico se realiza a través de los Criterios de Brighton (CB). Objetivo: Determinar el desempeño de neurólogos peruanos en diagnosticar SGB basándose en los CB, así como factores asociados. Métodos: Cohorte retrospectiva multicéntrica. Incluimos pacientes diagnosticados con SGB del 2007-2018 en 3 hospitales públicos en Lima, Perú. Recolectamos sus características demográficas, clínicas y de manejo. Evaluamos el uso de los CB para el diagnostico de SGB y empleamos un modelo de regresión logística para identificar los factores asociados con su uso. Resultados: De 328 casos, revisamos 201 historias disponibles. La edad mediana fue 48 años, con predominancia masculina. Mas del 50% de pacientes presento un examen motor inadecuado acorde con el puntaje MRC. Se realizaron exámenes auxiliares como punción lumbar y estudios electrofisiológicos en mas del 70% de pacientes. Se obtuvo un nivel de certeza 1 para los CB en un 13.4% de casos , y un nivel 2 o 3 en un 18.3%. El nivel no estuvo asociado con la calidad del examen motor ni el tipo de institución de atención. Conclusiones: Un diagnostico nivel 1 de certeza acorde con los BC se obtuvó en menos de un cuarto de casos diagnosticados como SGB. Este nivel no estuvo asociado con la atención en una institución especializada, comparado con un hospital general.

Toma de decisiones en la práctica clínica: Propuesta de un enfoque basado en evidencia "4E" / Decision-making in clinical practice: "4E" evidence-based framework proposal

Introducción: Las decisiones humanas son parcialmente racionales. En medicina, los escenarios críticos dificultan la toma de decisiones (TD). En esta revisión, proponemos el enfoque "4E" para mejorar la TD de intervenciones. Las "4E" incluyen decisiones: "eficaces" cuando las intervenciones han sido probadas en entornos controlados, "efectivas" cuando las intervenciones han sido probadas en entornos clínicos no controlados o pragmáticos, "eficientes" cuando los beneficios de una nueva intervención se evalúan con relación a sus costos, y decisiones que promuevan "equidad" cuando estas intervenciones se recomiendan de acuerdo con las necesidades del paciente, evitando barreras. El uso de este enfoque podría mejorar la TD en la práctica clínica, pero no es suficiente para garantizar su incorporación y uso. También es importante promover una dinámica organizativa, institucional y política de los sistemas de salud que promuevan el uso crítico de la evidencia para tomar decisiones.

Background:Human decisions are partially rational. In medicine, critical scenarios make decide-making (DM) difficult. In this review, we propose the "4E" approach to improve the DM of interventions. The "4E" approach includes decisions: "effectual" when interventions have been tested in controlled settings, "effective" when interventions have been tested in uncontrolled or pragmatic clinical settings, "efficient" when the benefits of a new intervention are evaluated by its costs, and decisionsthatpromote"equity"whentheseinterventionsare recommended according to the needs of the patient, avoiding barriers. Using this approach could improve DM in clinical practice, but it is not enough to guarantee its incorporation and use. It is also essential to promote the organizational, institutional, and political dynamics of health systems that promote evidence's critical use to make decisions

Is Surfer's myelopathy an acute hyperextension-induced myelopathy? A systematic synthesis of case studies and proposed diagnostic criteria.

BACKGROUND: Surfer's myelopathy is a rare complication of spinal hyperextension originally described in novice surfers. However, reports from patients practicing different activities had risen. AIM: To systematically synthesize the epidemiological and clinical evidence on acute hyperextension-induced myelopathy ("Surfer's myelopathy") and propose new diagnostic criteria. METHODS: We systematically searched four databases for all observational and case studies on the topic. We performed a narrative synthesis to propose diagnostic criteria and tested the criteria retrospectively on the included cases. A case report is also presented. RESULTS: Forty-two articles reporting 104 cases (median age 19 years, slightly male predominance) were included. All cases reported a nontraumatic hyperextension event (58% after surfing). All of the cases presented pain of hyperacute onset. The most frequent clinical feature was bladder or bowel dysfunction (84%). The thoracic region was the most frequently affected (87%) with longitudinal involvement until the conus (67%). At discharge or follow-up, 52% partially recovered. We propose five diagnostic criteria with three levels of certainty (definite, probable, and possible): (1) nontraumatic spine hyperextension activity (in individuals with no pre-existent spinal disease); (2) hyperacute onset (with acute pain onset); (3) spinal cord injury clinic (motor, sensory, or autonomic deficit); (4) MRI findings with central spinal cord abnormalities (multiple segments); and (5) no other alternative diagnosis. We identified 88% definite and 12% probable/possible cases. CONCLUSION: The acute hyperextension-induced myelopathy could occur not only during surfing but also during other activities. Therefore, increased awareness and education among sports communities and general physicians are needed.

Clinical Pathway for the Diagnosis and Management of Patients With Relapsing-Remitting Multiple Sclerosis: A First Proposal for the Peruvian Population.

Background: Relapsing-remitting multiple sclerosis (RRMS) is a subtype of degenerative inflammatory demyelinating disease of multifactorial origin that affects the central nervous system and leads to multifocal neurological impairment. Objectives: To develop a clinical pathway (CP) for the management of Peruvian patients with RRMS. Methods: First, we performed a literature review using Medline, Embase, Cochrane, ProQuest, and Science direct. Then, we structured the information as an ordered and logical series of five topics in a defined timeline: (1) How should MS be diagnosed? (2) How should a relapse be treated? (3) How should a DMT be initiated? (4) How should each DMT be used? and (5) How should the patients be followed? Results: The personnel involved in the care of patients with RRMS can use a series of flowcharts and diagrams that summarize the topics in paper or electronic format. Conclusions: We propose the first CP for RRMS in Peru that shows the essential steps for diagnosing, treating, and monitoring RRMS patients based on an evidence-based medicine method and local expert opinions. This CP will allow directing relevant clinical actions to strengthen the multidisciplinary management of RRMS in Peru.

Systematic review of warfarin-induced skin necrosis case reports and secondary analysis of factors associated with mortality.

OBJECTIVE: Warfarin-induced skin necrosis (WSN) is a rare (0.0.1%-0.1%) and severe adverse reaction. The clinical characteristics of this reaction and its mortality rate have not been explored in a large population. Therefore, we present the case of a Peruvian patient who developed WSN and perform a systematic review of case reports of WSN. METHODS: A systematic search was performed using the Pubmed/Medline, Scopus, Web of Science and Embase databases. Patient clinical data were collected and extracted from every case report. Furthermore, we analysed the factors associated with mortality because of WSN using the Poisson regression model with robust variations, obtaining risk ratios (RR) and their respective confidence intervals (95% CI). RESULTS: We identified 90 case reports that included a total of 111 patients with WSN (mean age 52.5 years), 20.72% of whom died of complications because of WSN. Being male (RR: 2.87; 95% CI 1.21-6.83) and having three or more affected regions (RR: 6.81; 95% CI 2.62-17.74) were associated with an increased risk of death caused by WSN. CONCLUSION: This systematic review identified 90 case reports of WSN with three or more affected body regions. Male sex was associated with an increased risk of death. Further studies are needed to analyse and confirm these results.

Costs Related to Frontotemporal Dementia in Latin America: A Scoping Review of Economic Health Studies.

Introduction: Frontotemporal dementia (FTD) is a complex syndrome characterized by changes in behavior, language, executive control, and motor symptoms. Its annual economic burden per patient in developed countries has been classified as considerable, amounting to US$119,654 per patient, almost double the patient costs reported for Alzheimer's disease. However, there is little information regarding cost-of-illness (COI) for FTD in Latin-America (LA). Aim: To describe the costs related to FTD in LA. Methods: We included COI studies on FTD conducted in LA published in English, Spanish, or Portuguese from inception to September 2020. We carried out a systematic search in Pubmed/Medline, Scopus, Web of Science, Scielo, Cochrane, and gray literature. For quality assessment, we used a COI assessment tool available in the literature. All costs were reported in USD for 1 year and adjusted for inflation. Results: We included three studies from Argentina, Brazil, and Peru. Direct costs (DCs) included medication (from US$959.20 to US$ 4,279.20), health care costs (from US$ 2,275.80 to US$7,856.16), and caregiver costs (from US$9,634.00 to US$28,730.28). Indirect costs (ICs) amounted to US$43,076.88. Conclusions: In LA countries, the reporting of costs related to FTD continues to be oriented toward DCs. They remain lower than in developed countries, possibly due to the limited health budget allocated. Only one Brazilian report analyzed ICs, representing the highest percentage of the total costs. Therefore, studies on the COI of this disease in LA are essential, focusing on both out-of-pocket spending and the potential economic loss to patients' homes and families.

Clinical-epidemiological characteristics associated with discharge outcomes and seasonality among surviving patients with Guillain-Barré syndrome in a national third-level hospital, Lima, Peru.

BACKGROUND: Guillain-Barré syndrome (GBS) is an autoimmune disease that affects the peripheral nervous system. Severe motor deficit (SMD), respiratory impairment, cranial nerve involvement and autonomic dysfunction are associated with a poor prognosis. OBJECTIVE: To investigate the association between the clinical-epidemiological characteristics and the discharge results among Peruvian patients with GBS. METHODS: We carried out a retrospective observational study on patients with GBS who survived until discharge. We used the Brighton Collaboration's criteria and considered Hughes Severity Scale (HSS) scores greater than two to be SMD. We defined the discharge results as an improvement if the HSS score decreased by at least one point from admission to hospital discharge and defined hospital stay as prolonged if > 14 days. RESULTS: We analyzed 92 patients, among whom 70.7% were male. Quadriparesis (81.1%) and hyporeflexia (86.8%) were the most characteristic manifestations. We observed that more than half of the cases were in summer and winter. Gastrointestinal infections were associated with a higher proportion of prolonged stays. The proportion of improvement was lower among patients who had an SMD at hospital admission. We confirmed these results through fitting in multivariate models. CONCLUSIONS: The prolonged stay was related to previous gastrointestinal infection, while a less improvement in SMD individuals at admission. Prospective multicenter surveillance systems are needed for monitoring GBS cases in low-income settings like Peru.

Clinical-epidemiological characteristics associated with discharge outcomes and seasonality among surviving patients with Guillain-Barré syndrome in a national third-level hospital, Lima, Peru / Características clínico-epidemiológicas asociadas con los resultados al alta y la estacionalidad entre los pacientes sobrevivientes con síndrome de Guillain-Barré en un hospital nacional de tercer nivel, Lima, Peru

ABSTRACT Background: Guillain-Barré syndrome (GBS) is an autoimmune disease that affects the peripheral nervous system. Severe motor deficit (SMD), respiratory impairment, cranial nerve involvement and autonomic dysfunction are associated with a poor prognosis. Objective: To investigate the association between the clinical-epidemiological characteristics and the discharge results among Peruvian patients with GBS. Methods: We carried out a retrospective observational study on patients with GBS who survived until discharge. We used the Brighton Collaboration's criteria and considered Hughes Severity Scale (HSS) scores greater than two to be SMD. We defined the discharge results as an improvement if the HSS score decreased by at least one point from admission to hospital discharge and defined hospital stay as prolonged if > 14 days. Results: We analyzed 92 patients, among whom 70.7% were male. Quadriparesis (81.1%) and hyporeflexia (86.8%) were the most characteristic manifestations. We observed that more than half of the cases were in summer and winter. Gastrointestinal infections were associated with a higher proportion of prolonged stays. The proportion of improvement was lower among patients who had an SMD at hospital admission. We confirmed these results through fitting in multivariate models. Conclusions: The prolonged stay was related to previous gastrointestinal infection, while a less improvement in SMD individuals at admission. Prospective multicenter surveillance systems are needed for monitoring GBS cases in low-income settings like Peru.

RESUMEN Antecedentes: El síndrome de Guillain-Barré (SGB) es una enfermedad autoinmune que afecta al sistema nervioso periférico. Déficit motor severo (DMS), compromiso respiratorio, afectación de pares craneales y disfunción autonómica se asocian con un mal pronóstico. Objetivo: Investigar la asociación entre las características clínico-epidemiológicas y los resultados del alta en pacientes peruanos con SGB. Métodos: Realizamos un estudio observacional retrospectivo de pacientes con SGB supervivientes hasta el alta. Consideramos los criterios de colaboración de Brighton y una escala de severidad de Hughes (ESH) superior a dos como un DMS. Definimos los resultados del alta como una mejoría si el ESH disminuyó en al menos un punto desde el ingreso hasta el alta hospitalaria y una estadía prolongada si el tiempo de hospitalización fue > 14 días. Resultados: Analizamos 92 pacientes, de los cuales el 70,7% eran varones. La cuadriparesia (81,1%) y la hiporreflexia (86,8%) fueron las manifestaciones más características. Observamos más de la mitad de los casos en verano e invierno. Las infecciones gastrointestinales se asociaron con una mayor proporción de estadías prolongadas. La proporción de mejoría fue menor en los pacientes que tenían un DMS al ingreso hospitalario. Confirmamos estos resultados con modelos multivariados ajustados. Conclusiones: La estadía prolongada se relacionó con infección gastrointestinal previa, mientras que una mejoría menor en individuos con DMS al ingreso. Necesitamos sistemas de vigilancia multicéntricos prospectivos para monitorear los casos de SGB en un entorno de bajos ingresos como Perú.

Prevalence and incidence of diabetic peripheral neuropathy in Latin America and the Caribbean: A systematic review and meta-analysis.

AIMS: The objective of this systematic review and meta-analysis is to estimate the prevalence and incidence of diabetic peripheral neuropathy (DPN) in Latin America and the Caribbean (LAC). MATERIALS AND METHODS: We searched MEDLINE, SCOPUS, Web of Science, EMBASE and LILACS databases of published observational studies in LAC up to December 2020. Meta-analyses of proportions were performed using random-effects models using Stata Program 15.1. Heterogeneity was evaluated through sensitivity, subgroup, and meta-regression analyses. Evidence certainty was performed with the GRADE approach. RESULTS: Twenty-nine studies from eight countries were included. The estimated prevalence of DPN was 46.5% (95%CI: 38.0-55.0) with a significant heterogeneity (I2 = 98.2%; p<0.01). Only two studies reported incidence, and the pooled effect size was 13.7% (95%CI: 10.6-17.2). We found an increasing trend of cumulative DPN prevalence over time. The main sources of heterogeneity associated with higher prevalence were diagnosis criteria, higher A1c (%), and inadequate sample size. We judge the included evidence as very low certainty. CONCLUSION: The overall prevalence of DPN is high in LAC with significant heterogeneity between and within countries that could be explained by population type and methodological aspects. Significant gaps (e.g., under-representation of most countries, lack of incidence studies, and heterogenous case definition) were identified. Standardized and population-based studies of DPN in LAC are needed.