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.

Clinical validation of RCSMS: A rapid and sensitive CRISPR-Cas12a test for the molecular detection of SARS-CoV-2 from saliva.

Peru's holds the highest COVID death rate per capita worldwide. Key to this outcome is the lack of robust, rapid, and accurate molecular tests to circumvent the elevated costs and logistics of SARS-CoV-2 detection via RT-qPCR. To facilitate massive and timely COVID-19 testing in rural and socioeconomically deprived contexts, we implemented and validated RCSMS, a rapid and sensitive CRISPR-Cas12a test for the molecular detection of SARS-CoV-2 from saliva. RCSMS uses the power of CRISPR-Cas technology and lateral flow strips to easily visualize the presence of SARS-CoV-2 even in laboratories with limited equipment. We show that a low-cost thermochemical treatment with TCEP/EDTA is sufficient to inactivate viral particles and cellular nucleases in saliva, eliminating the need to extract viral RNA with commercial kits, as well as the cumbersome nasopharyngeal swab procedure and the requirement of biosafety level 2 laboratories for molecular analyses. Notably, RCSMS performed outstandingly in a clinical validation done with 352 patients from two hospitals in Lima, detecting as low as 50 viral copies per 10 µl reaction in 40 min, with sensitivity and specificity of 96.5% and 99.0%, respectively, relative to RT-qPCR. The negative and positive predicted values obtained from this field validation indicate that RCSMS can be confidently deployed in both high and low prevalence settings. Like other CRISPR-Cas-based biosensors, RCSMS can be easily reprogrammed for the detection of new SARS-CoV-2 variants. We conclude that RCSMS is a fast, efficient and inexpensive alternative to RT-qPCR for expanding COVID-19 testing capacity in Peru and other low- and middle-income countries with precarious healthcare systems.

Correction: Arce-Huamani et al. Efficacy and Safety of Apixaban versus Dalteparin as a Treatment for Cancer-Associated Venous Thromboembolism: A Systematic Review and Meta-Analysis. Medicina 2023, 59, 1867.

There was an error in the original publication [...].

Efficacy and Safety of Apixaban versus Dalteparin as a Treatment for Cancer-Associated Venous Thromboembolism: A Systematic Review and Meta-Analysis.

Background and Objectives: Venous thromboembolism (VTE) is common in cancer patients. Anticoagulant therapy with low-molecular-weight heparins (LMWHs) and direct oral anticoagulants (DOACs), such as dalteparin and apixaban, have demonstrated efficacy and safety. However, more comparative research of these drugs is still needed. This study aimed to synthesize evidence on the efficacy of apixaban compared to dalteparin in reducing recurrent VTE, major bleeding, and clinically relevant non-major bleeding associated with cancer. Materials and Methods: We systematically searched the PubMed, Scopus, Web of Science, Embase, Cochrane Library, and ClinicalTrials databases up to 5 January 2023, for randomized controlled trials comparing apixaban versus dalteparin as treatment for cancer-associated VTE. Five studies were included. Effects according to meta-analyses were reported as relative risks (RRs) and their 95% confidence intervals (CIs). Results: It was found that 33 of 734 (4.5%) patients treated with apixaban and 56 of 767 (7.3%) with dalteparin had recurrent VTE as the efficacy outcome (RR 0.49, 95% CI 0.15-1.58, I2 38%). Major bleeding occurred in 25 of 734 patients treated with apixaban (3.4%) and 27 of 767 with dalteparin (3.5%) (RR 1.29, 95% CI 0.31-5.27, I2 59%). Likewise, clinically relevant non-major bleeding occurred in 64 of 734 patients treated with apixaban (8.7%) and 46 of 767 (5.9%) with dalteparin (RR 1.52, 95% CI 1.05-2.19, I2 0%). Conclusions: Apixaban showed a lower risk of recurrent VTE than dalteparin in patients with cancer-associated VTE, albeit with no statistical difference. Statistical significance was observed for no major clinically relevant bleeding but not for major bleeding.

The short-form of the Cyberchondria Severity Scale (CSS-12): Adaptation and validation of the Spanish version in young Peruvian students.

BACKGROUND: Cyberchondria is defined as the increase in health-related anxiety or anguish associated with excessive or repeated online searches for health-related information. Our objective was to cross-culturally adapt and validate the CSS-12 scale for Peruvian Spanish speakers, to determine whether the Bifactor model works as well in our population as in previous studies' and to explore whether the Bifactor-ESEM is a more suitable model. METHODS: We performed a cultural adaptation using the Delphi method and a validation study on medical students between 2018 and 2019. Reliability was evaluated by using Cronbach's alpha (α) and McDonald's omega (Ω) for internal consistency, and Pearson's r and intraclass correlation coefficient (ICC), for test-retest reliability. We evaluated construct validity by contrasting four measurement models for the CSS-12 and the convergent validity against health anxiety. RESULTS: The Spanish CSS-12 showed excellent reliability (α = .93; Ω = .93; ICC = .93; r = .96). The Bifactor ESEM model showed the best fit, supporting a unidimensional measure of the general cyberchondria. This measure was positively associated with health anxiety (r = .51). CONCLUSIONS: The Spanish CSS-12 provides a valid and reliable unidimensional measure of cyberchondria, which is distinguishable from the more general health anxiety. This can be applied to similar populations and future research. The Bifactor-ESEM model appears to offer a more accurate and realistic representation of the multifaceted nature of cyberchondria. We provide a free-to-use form of the Spanish CSS-12 as supplemental material.

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.

Compliance with Antibiotic Prophylaxis in Obstetric and Gynecological Surgeries in Two Peruvian Hospitals.

INTRODUCTION: Surgical site infections (SSI) can be as high in gynecology and obstetrics surgeries compared to other areas. Antimicrobial prophylaxis is an effective tool in the prevention of SSIs; however, it is often not adequately administered, so this study aimed to understand the compliance and factors associated with the use of the clinical practice guidelines for antibiotic prophylaxis in gynecological surgeries in two hospitals in the city of Huanuco, Peru. METHODS: An analytical cross-sectional study of all gynecologic surgeries performed during 2019 was performed. Compliance was determined based on the antibiotic chosen, dose, administration time, redosing, and prophylaxis duration. Age, hospital of origin, presence of comorbidities, surgery performed, as well as its duration, types of surgery, and anesthesia were considered as related factors. RESULTS: We collected 529 medical records of patients undergoing gynecological surgery with a median age of 33 years. The prophylactic antibiotic was correctly indicated in 55.5% of cases, and the dose was correct in 31.2%. Total compliance with the five variables evaluated was only 3.9%. Cefazolin was the most commonly used antibiotic. CONCLUSION: Low compliance with the institutional clinical practice guidelines for antibiotic prophylaxis was identified, showing that antimicrobial prophylaxis in the hospitals studied was inadequate.

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.

Contamination by Antibiotic-Resistant Bacteria on Cell Phones of Vendors in a Peruvian Market.

Background and Objectives. Multiple studies have evaluated the presence of bacterial contamination on cell phones in clinical settings; however, the presence and transmission of antibiotic-resistant bacteria on cell phones in the community have not been adequately elucidated. Material and Methods. A cross-sectional study was carried out to determine the presence of bacteria resistant to antibiotics on the cell phones of vendors in a Peruvian market and the associated factors. A sample of 127 vendors was obtained through stratified probabilistic sampling using a data collection form validated by experts. Cell phone samples were cultured using a standard technique, and antibiotic sensitivity was determined using the Kirby-Bauer technique. Chi-squared and Mann-Whitney U tests were used to determine factors associated with resistance in cell phone cultures. Results. Among the cell phones, 92.1% showed bacterial growth, predominantly Gram-positive bacteria (coagulase-negative staphylococci and Staphylococcus aureus), and 17% of the cultures showed resistance to at least three antibiotics evaluated. Two strains fell into the category of methicillin-resistant S. aureus, and three strains of E. coli had resistance to carbapenems. Conclusions. A short distance between customers and vendors, lack of a cell phone case, and having a cell phone with touchscreen are factors associated with antibiotic-resistant bacteria on cell phones.

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.

Associated factors to depression diagnosed during incarceration in Peruvian male prisoners: a sub-analysis of the national census of prison population.

PURPOSE: Depression has become a major health concern, particularly in developing countries. This disorder is highly prevalent among certain vulnerable populations, such as prisoners. In Peru, prisons are overcrowded, and the health of prisoners is neglected. Thus, this study aims to estimate the prevalence of depression diagnosed during incarceration in male inmates from all Peruvian prisons and assess its associated factors. DESIGN/METHODOLOGY/APPROACH: A cross-sectional study was conducted based on the secondary data analysis of the National Census of Prison Population 2016 in Peru. This study included records of prisoners who reported whether they were diagnosed with depression by a health-care professional after admission into the prisons. Descriptive, bivariate and multivariable analyses were performed. FINDINGS: Of the 63,312 prisoners included in this study, 1,007 reported an in-prison diagnosis of depression by a health-care professional, which represents a prevalence of 1.59%. Substance use disorder (adjusted prevalence ratio [aPR] 3.10; 95% confidence interval [CI]: 1.91-5.03), hypertension (aPR 7.20; 95% CI: 6.28-8.24) and previous discrimination (aPR 1.97; 95% CI: 1.62-2.40) were strongly associated with depression, even when adjusting for multiple confounders. Other directly associated variables were, for example, violence during childhood, infrequent visits in prison and diabetes. ORIGINALITY/VALUE: The right of prisoners to adequate health care is being neglected in Peru. Mental health is a cornerstone of health quality. Acknowledging which factors are associated with depression in prison is important to implement strategies to improve the mental health of prisoners.

Asociation between nutritional status and depressive symptoms in a Peruvian adult population: A population-based study in Peru / Asociación entre el estado nutricional y la presencia de síntomas depresivos en una población adulta Peruana: Un estudio de base poblacional

Abstract Introduction Among the Peruvian population, the prevalence of overweight and obesity has increased, making it one of the main public health problems. There is also conflicting evidence on the association between increased BMI and depressive symptoms in the adult population. Objective To determine the association between nutritional status (NS) and depressive symptoms (DS) in the Peruvian population. Method We conducted a secondary data analysis of the Peruvian Demographic and Family Health Survey (ENDES). We assessed the NS according to body mass index (BMI), grouped into normal weight (BMI = 18.50 - 24.99), overweight (BMI = 25.00 - 29.99), 1A obesity (BMI = 30.00 - 32.49), and 1B obesity (BMI ≥ 32.50). DS were assessed using the Patient Health Questionnaire (PHQ-9) instrument. A generalized linear model stratified by sex was constructed to calculate crude (cPRc) and adjusted (aPR) prevalence ratios. Results A total of 26,463 records of people aged 18-60 years were assessed, yielding a 6.3% prevalence of DS (≥ 10 points). Females had a higher frequency of DS than males, which increased depending on their NS: normal weight 7.8%, overweight 8.2%, 1A obesity 9.0%, and 1B obesity 12.0%. Likewise, in the multivariate analysis, women with 1B obesity reported a higher frequency of DS (aPR = 1.30; 95% CI = [1.03, 1.63]). Discussion and conclusion There is a strong association between nutritional status and depressive symptoms in Peruvian women, with obese women being more likely to have depressive symptoms.

Resumen Introducción Actualmente se ha incrementado la prevalencia de sobrepeso y obesidad en la población peruana, lo que la ha convertido en uno de los principales problemas de salud pública. Asimismo, existe evidencia contradictoria sobre la asociación entre el aumento del IMC y los síntomas depresivos en la población adulta. Objetivo Determinar la asociación entre el estado nutricional (EN) y los síntomas depresivos (SD) en la población peruana. Método Realizamos un análisis secundario de datos de la Encuesta Demográfica de Salud Familiar del Perú (ENDES). Se evaluó el EN según el índice de masa corporal (IMC), agrupándose en normopeso (IMC = 18.50 - 24.99), sobrepeso (IMC = 25.00 - 29.99), obesidad 1A (IMC = 30.0 - 32.49) y obesidad 1B (IMC ≥ 32.50). Los SD se evaluaron mediante el instrumento Patient Health Questionnaire (PHQ-9). Se construyó un modelo lineal generalizado estratificado por sexo para el cálculo de razones de prevalencias crudas (RPc) y ajustadas (RPa). Resultados Se evaluó un total de 26,463 registros de personas de entre 18 y 60 años. La prevalencia de SD (≥ 10 puntos) fue 6.3%. Las mujeres presentaron una mayor frecuencia de SD que los varones, la cual se incrementó con el EN, siendo: normopeso 7.8%, sobrepeso 8.2%, obesidad 1A 9.0% y obesidad 1B 12.0%. Asimismo, en el análisis multivariado, las mujeres con obesidad 1B reportaron una mayor frecuencia de SD (RPa = 1.30; IC 95% = [1.03, 1.63]). Discusión y conclusión Existe una gran asociación entre el estado nutricional y los síntomas depresivos en mujeres peruanas. Así, se llega a la conclusión de que las mujeres obesas tienen mayor probabilidad de presentar síntomas depresivos.

Spatial distribution, determinants and trends of full vaccination coverage in children aged 12-59 months in Peru: A subanalysis of the Peruvian Demographic and Health Survey.

OBJECTIVE: To assess the spatial distribution, trends and determinants of crude full vaccination coverage (FVC) in children aged 12-59 months between 2010 and 2019 in Peru. DESIGN, SETTING AND ANALYSIS: A cross-sectional study based on the secondary data analysis of the 2010 and 2019 Peruvian Demographic and Health Surveys (DHSs) was conducted. Logit based multivariate decomposition analysis was employed to identify factors contributing to differences in FVC between 2010 and 2019. The spatial distribution of FVC in 2019 was evaluated through spatial autocorrelation (Global Moran's I), ordinary kriging interpolation (Gaussian process regression) and Bernoulli-based purely spatial scan statistic. OUTCOME MEASURE: FVC, as crude coverage, was defined as having completely received BCG; three doses of diphtheria, pertussis, and tetanus, and polio vaccines; and measles vaccine by 12 months of age. PARTICIPANTS: A total of 5 751 and 14 144 children aged 12-59 months from 2010 and 2019 DHSs, respectively, were included. RESULTS: FVC increased from 53.62% (95% CI 51.75% to 55.49%) in 2010 to 75.86% (95% CI 74.84% to 76.85%) in 2019. Most of the increase (70.39%) was attributable to differences in coefficients effects. Family size, visit of health workers in the last 12 months, age of the mother at first delivery, place of delivery and antenatal care follow-up were all significantly associated with the increase. The trend of FVC was non-linear and increased by 2.22% annually between 2010 and 2019. FVC distribution was heterogeneous at intradepartmental and interdepartmental level. Seven high-risk clusters of incomplete coverage were identified. CONCLUSIONS: Although FVC has increased in Peru, it still remains below the recommended threshold. The increase of FVC was mainly attributed to the change in the effects of the characteristics of the population. There was high heterogeneity across Peruvian regions with the presence of high-risk clusters. Interventions must be redirected to reduce these geographical disparities.

Narrativas del donante de plasma convaleciente en EsSalud: motivaciones, miedos, expectativas y experiencias

Objetivos: Explorar, desde las narrativas de la población de donantes de plasma convaleciente en un ensayo clínico, las experiencias en el proceso de donación de sangre. Métodos: Se realizó un estudio cualitativo con diseño fenomenológico. La investigación se llevó a cabo en un hospital de la seguridad social del Perú aplicándose entrevistas semiestructuradas a profundidad. Resultados: Se entrevistó a once donantes de plasma convaleciente. Se identificó que las principales motivaciones de los donantes fueron tanto el poder contribuir a la investigación nacional como, apoyar a pacientes afectados por la COVID-19. Los principales miedos se centran en el posible riesgo de contagio dentro del hospital. Por otro lado, los donantes resaltaron la atención y acompañamiento del personal de salud en el proceso. Las principales expectativas y sugerencias apuntan hacia una mayor difusión de las campañas de donación de sangre en general, con especial énfasis en el tema de seguridad, la mejora en el tiempo del procedimiento de donación (en el caso de la donación de plasma convaleciente, desde el enrolamiento hasta la extracción de plasma convaleciente) y, la implementación de espacios amigables para incentivar las futuras campañas de donación de sangre en general. Conclusiones: Las experiencias de los donantes de plasma convaleciente fueron positivas. Sin embargo, aún hay mejoras que realizar a nivel de procesos e infraestructuras para asegurar campañas exitosas de donación de sangre futuras.

Objectives: To know and explore from convalescent plasma donators' voices the experience in the blood donation process at a social security hospital. Methods: Qualitative study with a phenomenological design. The investigation was carried out in 01 hospitals of the social security of Peru. Semi-structured interviews were carried out. Results: Eleven donors of convalescent plasma were interviewed. The main motivations for donating were being able to contribute to national research and supporting patients affected by COVID-19. Fears focus on the possible risk of contagion within the hospital. Donors emphasised the attention and support of health personnel alongside the donation procedure. The main expectations and suggestions point towards greater dissemination of donation campaigns with special emphasis on safety. Likewise, an improvement in the time of the donation procedure (from enrolment to the extraction of convalescent plasma), and the implementation of friendly spaces to encourage future blood donation campaigns were highlighted. Conclusions: The experience of the convalescent plasma donors was positive. However, improvements must be made in terms of processes and infrastructure to ensure future successful blood donation campaigns.

The first successful cochlear implant in Latin America after severe aminoglycoside-induced ototoxicity in a Peruvian patient cured of extensively drug-resistant tuberculosis

Introduction: Multidrug-resistant tuberculosis is a significant public health problem for which drugs are used with many adverse effects. Among the devastating consequences of these diseases, there is a wide variation in the incidence of ototoxicity and hearing loss in patients with multidrug-resistant and extremely resistant tuberculosis. Cochlear implants may be indicated in patients with unilateral/severe bilateral hearing loss with no benefit from conventional hearing aids, but their use in patients with tuberculosis is rare. Case report: We present the first case of a right unilateral cochlear implant performed on a 34-year-old Peruvian patient who presented profound sensorineural hearing loss of cochlear origin. Conclusion: Cochlear implant surgery is an essential milestone in the treatment of patients with auditory sequelae of tuberculosis treatment. Close monitoring of possible complications of tuberculosis treatment should be strengthened in countries with a high incidence of multidrug-resistant and extremely resistant tuberculosis.

Introducción: La tuberculosis multidrogorresistente es un importante problema de salud pública para el que se utilizan fármacos con múltiples efectos adversos. Entre las devastadoras consecuencias de estas enfermedades, existe una amplia variación en la incidencia de ototoxicidad y pérdida auditiva en pacientes con tuberculosis multirresistente y extremadamente resistente. Los implantes cocleares pueden estar indicados en pacientes con pérdida auditiva unilateral/bilateral severa sin beneficio de los audífonos convencionales, pero su uso en pacientes con tuberculosis es raro. Reporte de un caso: Presentamos el primer caso de implante coclear unilateral derecho realizado a un paciente peruano de 34 años que presentaba hipoacusia neurosensorial profunda de origen coclear. Conclusión: La cirugía de implante coclear es un hito fundamental en el tratamiento de los pacientes con secuelas auditivas del tratamiento de la tuberculosis. Se debe fortalecer la vigilancia estrecha de las posibles complicaciones del tratamiento de la tuberculosis en los países con una alta incidencia de tuberculosis multirresistente y extremadamente resistente.

The Neutrophil-to-Lymphocyte Ratio and the Platelet-to-Lymphocyte Ratio as Predictors of Mortality in Older Adults Hospitalized with COVID-19 in Peru.

Background: The prognostic value of the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in patients with COVID-19 is rarely described in older adults. We aimed to estimate the prognostic value of NLR and PLR, determining the mortality of adults over 60 years of age hospitalized for COVID-19 in three hospitals in Peru from March to May 2020. Methods: We performed a secondary analysis of data from a retrospective cohort carried out in Lambayeque, Peru, from March 18 to May 13, 2020. Older adults hospitalized for COVID-19 were included. The outcome variable was in-hospital mortality by all causes, while the exposure variable was the NLR and PLR (categorized in tertiles and numerically, performing a logarithmic transformation). We included sociodemographic variables, comorbidities, vital functions, laboratory markers, and treatment received during hospital stay. We evaluated the association between NLR and PLR using the hazard ratio (HR) in a Cox regression model. We estimated HR with their respective 95% confidence intervals (95% CI). We estimated cumulative/dynamic time-dependent ROC curves and reported area under the curve ROC (AUC-ROC) for 15-, 30-, and 60-day mortality with their respective simultaneous confidence intervals (confidence bands (CB)). Also, we estimated an optimal cut-off point based on the maximally selected rank statistics. Results: A total of 262 hospitalized older adults were analyzed, 71.8% (n = 188) of whom were male with a median age of 70 years (interquartile range: 65-78). The mean NLR and PLR were 16.8 (95% CI: 14.9-18.7; SD: 15.5) and 50.3 (95% CI: 44.6-55.9; SD: 46.3), respectively. The mortality rate was 68.7% (95% CI: 62.7-74.3). The adjusted Cox regression analysis showed that the high NLR (adjusted HR (aHR) = 2.12; 95% CI: 1.43-3.14) and PLR (aHR = 1.90; 95% CI: 1.30-2.79) tertiles were associated with a higher risk of mortality. The maximum AUC-ROC values at 60 days of follow-up for NLR and PLR were 0.713 (95%CB: 0.627-0.800) and 0.697 (95%CB: 0.583-0.754), respectively. Conclusions: The NLR and PLR are predictors of higher risk of mortality, and these results suggest that both could be reliable and practical markers for the identification of older adults at high risk of mortality by COVID-19. NLR and PLR have prognostic value, with an AUC greater than 0.5; however, by themselves, they are weak prognostic markers. It is important to carry out future studies incorporating these two markers into preexisting models or designing new ones considering them.

Haemosporidians from a Neglected Group of Terrestrial Wild Birds in the Peruvian Amazonia.

Haemosporidians are a widespread group of blood parasites transmitted by vectors. Despite their relevance for bird conservation, few studies have been conducted in the Amazonia and even less in terrestrial wild birds. We analysed blood samples from 168 game birds, collected from 2008 to 2015 by subsistence hunters of an indigenous rural community in the Peruvian Amazonia. DNA was tested for Haemoproteus spp., Plasmodium spp. and Leucocytozoon spp. and positive amplicons were sequenced and curated for phylogenetic analysis. Haemosporidian prevalence was 72% overall, 66.7% for Haemoproteus spp. and 5.4% for Plasmodium spp. and respectively by bird species: Spix's Guan (Penelope jacquacu, n = 72) 87.5% and 0%, Razor-billed Curassow (Mitu tuberosum, n = 45) 77.8% and 6.7%, White-winged Trumpeter (Psophia leucoptera, n = 20) 6.3% and 12.5%, Blue-throated Piping-guan (Pipile cumanensis, n = 16) 73.3% and 6.7%, and Great Tinamou (Tinamus major, n = 15) 10% and 15%. Leucocytozoon spp. was not found. P. leucoptera and T. major were less likely to be infected with Haemoproteus spp. Fruit abundance had a negative association with Haemoproteus spp. prevalence and precipitation was negatively associated with Plasmodium spp. prevalence. The 106 sequences examined represented 29 lineages, 82.8% of them were new lineages (Plasmodium n = 3, Haemoproteus n = 21). Novel host-parasite associations and lineages were unveiled, including probably new species of Plasmodium spp. Our results highlight the scientific value of alternative sampling methods and the collaboration with local communities.

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.

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.