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Motivation for the study. Therapeutic guidelines for COVID-19 in children changed constantly during the pandemic. In Peru, the variation of the treatment during the different waves of the pandemic has not been studied. Main findings. During the third wave, there was a greater number of patients with COVID-19; however, these patients had less severe symptoms. The use of ceftriaxone and azithromycin was less frequent during the third wave. The use of immunoglobulin was only found in patients with pediatric inflammatory multisystemic syndrome. Implications. Determining the patterns of medication use during the COVID-19 pandemic in the pediatric population will allow us to evaluate how the therapeutic decision-making process evolved in this population.
Motivación para realizar el estudio. Las guías terapéuticas acerca de COVID-19 en población pediátrica variaron constantemente durante la pandemia. En el Perú, la variación de estos tratamientos en las diferentes olas de la pandemia no ha sido estudiada. Principales hallazgos. Durante la tercera ola hubo un mayor número de pacientes con COVID-19; sin embargo, estos presentaron cuadros menos severos. El uso de ceftriaxona y azitromicina fue menos frecuente durante la tercera ola. El uso de inmunoglobulina solo se observó en pacientes con síndrome inflamatorio multisistémico pediátrico. Implicancias. Determinar los patrones de uso de medicamentos durante la pandemia por COVID-19 en población pediátrica nos permitirá evaluar cómo evolucionó el proceso de toma de decisiones terapéuticas en esta población.
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COVID-19 , Niño , Humanos , COVID-19/epidemiología , Perú/epidemiología , Pandemias , Azitromicina/uso terapéutico , HospitalesRESUMEN
El objetivo del estudio fue describir el uso de medicamentos en pacientes pediátricos con COVID-19 hospitalizados en el Instituto Nacional de Salud del Niño - San Borja (INSN-SB) de Lima, Perú, entre marzo del 2020 y marzo del 2022. Por ello, realizamos un estudio observacional descriptivo y evaluamos el uso de seis medicamentos: corticoides, ceftriaxona, azitromicina, inmunoglobulina, hidroxicloroquina e ivermectina. Finalmente, comparamos los resultados entre subpoblaciones definidas según la ola de la pandemia por COVID-19. Incluimos 421 pacientes pediátricos. Al 40,4% se le indicó corticoides, 35,6% ceftriaxona, 12,1% azitromicina, 3,6% inmunoglobulina, 2,4% hidroxicloroquina y 0,5% ivermectina. El uso de ceftriaxona y azitromicina fue menos frecuente durante la tercera ola. El uso de hidroxicloroquina fue casi exclusivo de la primera ola. El uso de inmunoglobulina solo se observó en pacientes con síndrome inflamatorio multisistémico pediátrico. La indicación de los medicamentos evaluados fue en general menor en la tercera ola.
This study aimed to describe the use of medication in pediatric patients with COVID-19 hospitalized at the National Children's Health Institute - San Borja (INSN-SB) in Lima, Peru, between March 2020 and March 2022. Therefore, we conducted a descriptive, observational study to evaluate the use of six medications: corticosteroids, ceftriaxone, azithromycin, immunoglobulin, hydroxychloroquine, and ivermectin. We compared the results among subpopulations defined according to the COVID-19 pandemic waves. We included 421 pediatric patients. Corticosteroids were prescribed to 40.4%, ceftriaxone to 35.6%, azithromycin to 12.1%, immunoglobulin to 3.6%, hydroxychloroquine to 2.4%, and ivermectin to 0.5% of the patients. The use of ceftriaxone and azithromycin was less frequent during the third wave. Hydroxychloroquine was used almost exclusively during the first wave. Only patients with pediatric multisystem inflammatory syndrome used immunoglobulin. Overall, the prescription of the evaluated medications decreased during the third wave.
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Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Toma de DecisionesRESUMEN
Introducción: Las políticas de salud pública para la disminución de la incidencia, transmisión y mortalidad de la COVID-19 se enfocan en medidas extradomiciliarias y descuidan el contagio dentro del hogar. El objetivo fue estimar la tasa de ataque secundario domiciliario de SARS-CoV-2. Material y Métodos: Se realizó una revisión sistemática de estudios observacionales que evaluaron la transmisión domiciliaria de SARS-CoV-2 publicados entre diciembre de 2019 y el 1 setiembre de 2021 en las bases de datos Medline, Scopus, LILACS y Google Scholar. La definición de contacto domiciliario se refirió a toda persona que habitaba la misma vivienda que el paciente índice. El riesgo de sesgo fue evaluado con una versión modificada de la escala Newcastle-Ottawa. Se realizó un metaanálisis con un modelo de efectos aleatorios para calcular la tasa de ataque domiciliaria, subanálisis con variables sociodemográficas, epidemiológicas y comorbilidades, así como metaregresión. Resultados: De 4491 estudios encontrados, 44 fueron incluidos en el análisis. La tasa de ataque secundario domiciliario general fue de 27.7% (IC95%: 23% 32.7%). Además, fue mayor cuando el caso índice era sintomático (28.3%, IC95%: 8.1% 54.7%) o el contacto era adulto mayor (42.3%, IC95%: 32% 52.9%). Asimismo, la tasa fue mayor cuando los contactos domiciliarios presentaban diabetes mellitus (57.4%, IC95%: 45.2% 69.3%) e hipertensión arterial (51.1%, IC95%: 38% 64.1%). Conclusiones: La tasa de ataque secundario domiciliario de SARS-CoV-2 fue de 27.7%, siendo mayor al tener un caso índice adulto, contacto adulto mayor y contacto con diabetes mellitus o hipertensión arterial.
Background: Public health policies for decreasing the incidence, transmission, and mortality of COVID-19 focus on extradomiciliary measures and neglect transmission within the home. We aimed to estimate the rate of secondary home attack of SARS-CoV-2. Material and Methods: We conducted a systematic review of observational studies that evaluated home transmission of SARS-CoV-2 published between December 2019 and September 1, 2021 in Medline, Scopus, LILACS, and Google Scholar databases. The definition of household contact referred to any person living in the same house as the index patient. The risk of bias was assessed with a modified version of the Newcastle-Ottawa tool. A meta-analysis was performed with a random-effects model to calculate the household attack rate, subanalysis with sociodemographic, epidemiological variables, and comorbidities, as well as meta-regression. Results: Of 4491 studies found, 44 were included in the analysis. The overall household secondary attack rate was 27.7% (95%CI: 23% 32.7%). Furthermore, it was higher when the index case was symptomatic (28.3%, 95%CI: 8.1% 54.7%) or the contact was an older adult (42.3%, 95%CI: 32% 52.9%). Likewise, the rate was higher when the household contacts had diabetes mellitus (57.4%, 95%CI: 45.2% 69.3%) and arterial hypertension (51.1%, 95%CI: 38% 64.1%). Conclusions: The SARS-CoV-2 household secondary attack rate was 27.7%, being higher when there was an adult index case, older adult contact and contact with diabetes mellitus or hypertension.
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BACKGROUND: The accuracy of urine dipsticks to detect increased albuminuria is uncertain. We aimed to assess the diagnostic accuracy of urine dipsticks for detecting albuminuria. METHODS: A systematic review of studies that assessed the diagnostic accuracy of urine dipstick testing for detecting albuminuria has been conducted (using as reference standard the albuminuria in a 24-hour sample or the albumin-to-creatinine ratio) in Scopus, PubMed, and Google Scholar. The risk of bias of the included studies has been assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Whenever possible, we performed meta-analyses for sensitivity and specificity. The certainty of the evidence has also been assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. RESULTS: A total of 14 studies have been included in this review, having assessed all albumin-to-creatinine ratio (ACR) as assessed standard. Each study used different dipstick types. The resulting pooled sensitivity and specificity for each cutoff point were as follows: for ACR >30 mg/g (13 studies): 0.82 (95% confidence interval: 0.76-0.87) and 0.88 (0.83-0.91); for ACR 30-300 mg/g (7 studies): 0.72 (0.68-0.77) and 0.82 (0.76-0.89); and for ACR >300 mg/g (7 studies): 0.84 (0.71-0.90) and 0.97 (0.95-0.99), respectively. An overall high risk of bias, an important heterogeneity in all pooled analysis, and a very low certainty of the evidence have been found. CONCLUSIONS: Pooled sensitivity and specificity of urine dipsticks have been calculated for different ACR cutoff points. However, the dipstick types differed across studies, and the certainty of the evidence was very low. Thus, further well-designed studies are needed to reach more confident estimates and to assess accuracy differences across dipstick types. REGISTRATION: PROSPERO (CRD42019124637).
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BACKGROUND: Adolescent pregnancy carries a high risk of severe health issues for both the mother and the newborn. Worldwide, 21 million adolescents give birth every year, with high percentages in Latin America. Most of the risk factors are met in indigenous communities, which is an underrepresented and poorly studied population. We aimed to assess the determinants of adolescent pregnancy in indigenous communities from the Peruvian central jungle. METHODS: Through a case-control study, female adolescents aged 13 to 19 years old from seven indigenous communities of the Peruvian central jungle were interviewed. Adolescents with (cases) and with no (controls) pregnancy history, such as current pregnancy, children and abortion, fulfilled our eligible criteria. Our instrument explored: sociodemographic, adolescent and family characteristics, as well as perceptions of adolescent pregnancy. We performed a penalized maximum likelihood logistic regression analysis to obtain Odds Ratios (OR) and their 95% confidence intervals (95% CI). RESULTS: We enrolled 34 cases and 107 controls. Overall, 53.9% were 15 to 19 years old. We found a significant association of being 15-19 years old (OR = 6.88, 95% CI 2.38-19.86, p < 0.0001) and an elementary school level of instruction (OR = 5.59, 95% CI 1.95-16.06, p = 0.001) with the risk of adolescent pregnancy. A marginal statistical significance between having five to six siblings and adolescent pregnancy was also reported (OR = 2.70, 95% CI 0.85-8.61, p = 0.094). Furthermore, adolescents with sexual and reproductive health communication with parents had a lower risk of adolescent pregnancy (OR = 0.17, 95% CI 0.06-0.47, p = 0.001). CONCLUSION: Our results suggest that public health and educational efforts should be age-specific focused within indigenous communities of the Peruvian central jungle, encouraging parents to talk about sexual and reproductive health topics with adolescents.
Worldwide, 21 million adolescents give birth every year, with high percentages in Latin America and rural areas. Indigenous communities are mainly located in rural areas and are exposed to multiple risk factors of adolescent pregnancy. We aimed to find the factors that have an influence on adolescent pregnancy in indigenous communities from the Peruvian central jungle. We conducted a casecontrol study identifying female indigenous adolescents from the Peruvian central jungle with or without pregnancy history. Our survey explored sociodemographic, adolescent and family characteristics, as well as perceptions of adolescent pregnancy. Being 15 to 19 years old, having an elementary educational level, and five to six siblings increased the risk of adolescent pregnancy. On the other hand, adolescents with sexual and reproductive health communication with parents had a lower risk of adolescent pregnancy. Furthermore, eight out of ten adolescents opposed to sexual intercourse at an early age. Public health and educational efforts should be age-specific focused within indigenous communities of the Peruvian central jungle, encouraging parents to talk about sexual and reproductive health with adolescents.
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Embarazo en Adolescencia , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Femenino , Humanos , Recién Nacido , Perú/epidemiología , Embarazo , Salud Reproductiva , Conducta Sexual , Adulto JovenRESUMEN
This review aimed to assess whether the FINDRISC, a risk score for type 2 diabetes mellitus (T2DM), has been externally validated in Latin America and the Caribbean (LAC). We conducted a systematic review following the CHARMS (CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies) framework. Reports were included if they validated or re-estimated the FINDRISC in population-based samples, health facilities or administrative data. Reports were excluded if they only studied patients or at-risk individuals. The search was conducted in Medline, Embase, Global Health, Scopus and LILACS. Risk of bias was assessed with the PROBAST (Prediction model Risk of Bias ASsessment Tool) tool. From 1582 titles and abstracts, 4 (n=7502) reports were included for qualitative summary. All reports were from South America; there were slightly more women, and the mean age ranged from 29.5 to 49.7 years. Undiagnosed T2DM prevalence ranged from 2.6% to 5.1%. None of the studies conducted an independent external validation of the FINDRISC; conversely, they used the same (or very similar) predictors to fit a new model. None of the studies reported calibration metrics. The area under the receiver operating curve was consistently above 65.0%. All studies had high risk of bias. There has not been any external validation of the FINDRISC model in LAC. Selected reports re-estimated the FINDRISC, although they have several methodological limitations. There is a need for big data to develop-or improve-T2DM diagnostic and prognostic models in LAC. This could benefit T2DM screening and early diagnosis.
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Diabetes Mellitus Tipo 2 , Adulto , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , América Latina/epidemiología , Persona de Mediana Edad , Pronóstico , Factores de RiesgoRESUMEN
Introducción: la tuberculosis es la enfermedad infecciosa más importante del ser humano por su alta incidencia mundial, constituyendo un problema de salud pública. Los conocimientos, actitudes y prácticas sobre ella han sido evaluados en estudiantes universitarios y profesionales de ciencias de la salud, pero otros han sido desatendidos. Objetivos: evaluar conocimientos, actitudes y prácticas sobre tuberculosis en estudiantes que no pertenecen a ciencias de la salud de una universidad peruana. Métodos: estudio transversal analítico, se encuestó estudiantes de la Universidad Nacional del Centro del Perú usando un cuestionario estructurado. Luego se caracterizó cada una de las secciones y buscó diferencias según las características de los alumnos mediante los modelos lineales generalizados. Resultados: de 631 estudiantes, 54,7 por ciento fueron mujeres, 66,6 por ciento obtuvo puntaje bajo en la prueba de conocimientos; 47,7 por ciento señaló que el agente etiológico es un virus, 74,9 por ciento desconoce el término tuberculosis latente y solo 29,6 por ciento conoce que la medida correcta para tratarla es no dejar de tomar las pastillas. Los medios de comunicación fueron la principal fuente de información (55,0 por ciento). Predominó un puntaje alto en la evaluación de actitudes (66,7 por ciento) y prácticas (55,8 por ciento). No hubo diferencias de los conocimientos y prácticas según las características de los alumnos (p>0,05). Conclusiones: los programas de educación sanitaria deberían ser reforzados para mejorar los conocimientos de los estudiantes universitarios y de otros centros similares(AU)
Introduction: Tuberculosis is the most important infectious disease in the human being due to its high global incidence, constituting a public health concern. The knowledge, attitudes and practices about it have been evaluated in university students and health sciences professionals, but others have been neglected. Objectives: To evaluate the knowledge, attitudes and practices about tuberculosis in students who do not belong to health sciences of a Peruvian university. Methods: Analytical cross-sectional study that included students from the National University of Central Peru who were surveyed using a structured questionnaire. Then each section was characterized and the differences were found according to the characteristics of the students and through the generalized linear models. Results: Out of 631 students, 54.7 percent were women, 66.6 percent scored low on the knowledge test; 47.7 percent reported that the etiologic agent is a virus, 74.9 percent are unaware of the term latent tuberculosis. while only 29.6 percent know that the correct measure to treat it is not to stop taking the pills. The media was the main source of information (55.0 percent). A high score was predominant in the assessment of attitudes (66.7 percent) and practices (55.8 percent). There were no differences in knowledge and practices, according to the characteristics of the students (p>0.05). Conclusions: Health education programs should be strengthened to improve the knowledge of university students and other similar centers(AU)
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Humanos , Conocimientos, Actitudes y Práctica en Salud , Tuberculosis , Perú/epidemiología , Estudios TransversalesRESUMEN
Introducción: la tuberculosis es la enfermedad infecciosa más importante del ser humano por su alta incidencia mundial, constituyendo un problema de salud pública. Los conocimientos, actitudes y prácticas sobre ella han sido evaluados en estudiantes universitarios y profesionales de ciencias de la salud, pero otros han sido desatendidos. Objetivos: evaluar conocimientos, actitudes y prácticas sobre tuberculosis en estudiantes que no pertenecen a ciencias de la salud de una universidad peruana. Métodos: estudio transversal analítico, se encuestó estudiantes de la Universidad Nacional del Centro del Perú usando un cuestionario estructurado. Luego se caracterizó cada una de las secciones y buscó diferencias según las características de los alumnos mediante los modelos lineales generalizados. Resultados: de 631 estudiantes, 54,7 por ciento fueron mujeres, 66,6 por ciento obtuvo puntaje bajo en la prueba de conocimientos; 47,7 por ciento señaló que el agente etiológico es un virus, 74,9 por ciento desconoce el término tuberculosis latente y solo 29,6 por ciento conoce que la medida correcta para tratarla es no dejar de tomar las pastillas. Los medios de comunicación fueron la principal fuente de información (55,0 por ciento). Predominó un puntaje alto en la evaluación de actitudes (66,7 por ciento) y prácticas (55,8 por ciento). No hubo diferencias de los conocimientos y prácticas según las características de los alumnos (p>0,05). Conclusiones: los programas de educación sanitaria deberían ser reforzados para mejorar los conocimientos de los estudiantes universitarios y de otros centros similares(AU)
Introduction: Tuberculosis is the most important infectious disease in the human being due to its high global incidence, constituting a public health concern. The knowledge, attitudes and practices about it have been evaluated in university students and health sciences professionals, but others have been neglected. Objectives: To evaluate the knowledge, attitudes and practices about tuberculosis in students who do not belong to health sciences of a Peruvian university. Methods: Analytical cross-sectional study that included students from the National University of Central Peru who were surveyed using a structured questionnaire. Then each section was characterized and the differences were found according to the characteristics of the students and through the generalized linear models. Results: Out of 631 students, 54.7 percent were women, 66.6 percent scored low on the knowledge test; 47.7 percent reported that the etiologic agent is a virus, 74.9 percent are unaware of the term latent tuberculosis. while only 29.6 percent know that the correct measure to treat it is not to stop taking the pills. The media was the main source of information (55.0 percent). A high score was predominant in the assessment of attitudes (66.7 percent) and practices (55.8 percent). There were no differences in knowledge and practices, according to the characteristics of the students (p>0.05). Conclusions: Health education programs should be strengthened to improve the knowledge of university students and other similar centers(AU)
