Systematic review on the implementation of metrological assurance systems for medical devices in Latin America.

Background: Metrology plays a crucial role in small healthcare service businesses to ensure the quality of products and services. While legal metrology in healthcare exists in some regions, it lacks harmonization. In other countries, there is limited presence of metrology in medical and biomedical engineering. We aimed to evaluate the implementation of metrological assurance systems for medical devices in Latin America. Methods: A systematic review was conducted following PRISMA 2020 guidelines and registered with PROSPERO (CRD42022359284). Searches were performed across 13 databases from October 30th to November 3rd, 2022. The search equation was "(((quality assurance) AND (metrology)) AND (medical devices))." A total of 7,789 documents were identified, of which only 16 met the inclusion criteria. Results: The majority of studies (75%) were conducted in Colombia, with a significant portion being undergraduate theses. The primary normative references used in the analyzed studies were ISO 10012 and ISO 17025, with the majority (68.75%) relying on national legislation for their approach. One study in Colombia referenced eight standards, and one in Brazil analyzed user involvement in medical device management. Among the included studies, 56.25% were conducted in healthcare institutions, mainly clinics. Most studies provided implementation guidelines, with ISO 10012 being prominent, alongside ISO 17025, which implicitly addresses ISO 9001 elements. Global bias was low across all studies. Conclusion: Our results underscore the importance of metrological assurance in managing medical devices in Latin America. The utilization of international standards and national legislation illustrates the diverse approaches adopted by different institutions. Future research should focus on optimizing metrological practices to enhance quality and safety in healthcare.

Geospatial analysis of cardiovascular mortality before and during the COVID-19 pandemic in Peru: analysis of the national death registry to support emergency management in Peru.

Background: COVID-19 has led to significant global mortality, with Peru being among the countries most affected. While pre-existing comorbidities have been linked to most cases, the exact distribution of fatalities within the country remains unclear. We aimed to assess deaths attributed to cardiovascular diseases (CVD) before and during the COVID-19 pandemic across various regions and provinces in Peru. Methods: An observational georeferencing study was designed. Peru faced four waves of COVID-19 over three years, with variable impacts across its three regions (Coast, Highlands, and Jungle). Deaths related to cardiovascular diseases, such as heart failure (HF), arrhythmia, acute myocardial infarction (AMI), strokes, and acute coronary syndrome, were examined as primary variables. The study period spanned pre-pandemic years (2017-2019) and pandemic years (2020-2021), utilizing death data from the National Death Information System (SINADEF). The georeferencing analysis was conducted using ArcGIS v10.3. Results: A total of 28,197 deaths were recorded during the study period, with significant increases during the pandemic (2020-2021). Cardiovascular deaths were disproportionately higher during the pandemic, totaling 19,376 compared to 8,821 in the pre-pandemic period (p < 0.001). AMI and HF were the leading causes of mortality, showing significant increases from the pre-pandemic (5,573 and 2,584 deaths) to the pandemic period (12,579 and 5,628 deaths), respectively. Deaths due to CVD predominantly affected individuals aged over 60, with significant increases between the two study periods (7,245 vs. 16,497 deaths, p = 0.002). Geospatial analysis revealed regional disparities in CVD mortality, highlighting provinces like Lima and Callao as COVID-19 critical areas. The substantial increase in cardiovascular deaths during the COVID-19 pandemic in Peru showed distinctive patterns across regions and provinces. Conclusions: Geospatial analysis identified higher-risk areas and can guide specific interventions to mitigate the impact of future health crises. Understanding the dynamic relationship between pandemics and cardiovascular health is crucial for effective public health strategies.

Healthy Habits, Physical Activity, Stress, and Food Consumption Trends in Chilean Adults with Irritable Bowel Syndrome during the COVID-19 Pandemic.

The COVID-19 pandemic has increased stress levels in the population due to radical lifestyle changes caused by containment measures. Studies suggest that high levels of stress may be related to the development of irritable bowel syndrome (IBS). This study aims to explain how quarantine habits and lifestyles acted as risk factors for the frequency of this syndrome during the COVID-19 pandemic. An observational study was conducted with 34 Chilean participants (average age 24.5 ± 3.85 years), of whom 21 (62%) were female. Surveys on consumption trends and lifestyles created by the authors were administered. Additionally, we used the global physical activity questionnaire (GPAQ) and the depression anxiety stress scales (DASS-21) to assess psychological stress and the Rome IV criteria to assess IBS. Significant differences were found between individuals with better healthy habits compared to those with poor healthy habits. The former showed lower sedentary activity (32%, p = 0.005), only 27% were fast eaters (vs. 44%, p = 0.001), had shorter nap intervals (14% vs. 28%, p = 0.03), and higher vegetable consumption (p = 0.02). There were 20 cases (59%) of IBS, with a strong association with the female sex (p = 0.004), where females were 15 times more likely to develop it compared to males (p = 0.008). Additionally, when alcohol consumption was added to females, there was a higher likelihood of developing this syndrome (p = 0.009), as individuals who consumed alcohol were 12 times more likely to develop it compared to those who did not (p = 0.02). Among other factors, it was observed that 57% of those with the syndrome consumed drinks more often (p = 0.02) but consumed fewer nuts (p = 0.009). In conclusion, IBS has a multifactorial etiology, and correcting individual habits such as alcohol consumption could potentially prevent or delay its development. Therefore, it is important to maintain healthy lifestyles, regardless of non-modifiable factors such as gender, in order to better cope with this syndrome.

Prolonged grief in relatives of deceased patients due to COVID-19 is associated with anxiety and depressive symptoms: A survey-based study in Peru.

Objective: Funeral practices have undergone significant changes during the COVID-19 pandemic. Thus, the death of a family member from this disease has altered the typical course of the bereavement process. Therefore, this study seeks to determine the relationship between the levels of grief, anxiety, and depression in relatives of patients who died from COVID-19 in Peru. Methods: A total of 250 volunteers were obtained, but after applying the inclusion criteria and not being able to contact five of them, the sample consisted of 115 participants over 18 years of age who lost a family member to COVID-19 between 2020 and 2021. They developed the Prolonged Grief Questionnaire-13 and the Zung Anxiety and Depression Questionnaires, in virtual surveys using Google FormTM (Google, CA). Results: Our analysis revealed that all cases of anxiety (18.3%) were present in individuals experiencing prolonged grief (76.5%), while 49.5% (57/115) of participants exhibited symptoms of depression. Furthermore, we identified a significant association between prolonged grief and both anxiety (p = 0.005) and depression (p < 0.001). Prolonged grief predominantly affected females (45.2%) and individuals aged 31-40 years (28.7%) (p < 0.001). Regarding predictors of anxiety symptoms, we found that both age group (p = 0.035) and grief (p < 0.001) played significant roles. Gender (p = 0.019) and grief (p < 0.001) emerged as predictors of depression, while gender alone predicted grief in relatives of individuals who succumbed to COVID-19 (p = 0.019). Conclusion: Our results suggest a clear association between prolonged grief and mental health issues among relatives of COVID-19 patients who have passed away. Consequently, it is imperative to provide comprehensive psychological and spiritual support throughout the grieving process, aiming to mitigate the negative impact of traumatic events.

There is no association between anxiety and lifestyle in older adults during the COVID-19 pandemic: A cross-sectional study.

Introduction and objective: The COVID-19 pandemic has caused mental health problems worldwide. Older people have been particularly affected by the lockdown as their health conditions have changed, although they have been kept in isolation to avoid exposure to contagion. We sought to determine the association between lifestyles and anxiety in older adults during the COVID-19 pandemic. Materials and methods: This study was cross-sectional. We enrolled 150 older adults of both sexes and with a history of chronic diseases from the municipality of El Agustino (Lima, Peru). The 20-item Geriatric Anxiety Scale and the 25-item Lifestyle Questionnaire on eating, physical activity, rest, and sleep were administered in Spanish during July-August 2021. Results: The mean age was 70.8 ± 8.1 years, 54.7% were male, and 75.3% practiced exercise. During the COVID-19 pandemic, 99.3% of the elderly had healthy lifestyles and 40% presented anxiety (mild, moderate, and severe anxiety in 26.7%, 8.7%, and 4.7%, respectively). We found no association between anxiety and lifestyle (p = 0.189), physical exercise was a predictor of lifestyle (p < 0.001) and we did not find predictors of anxiety symptoms (p > 0.05). Conclusions: Our results suggest that there was no link between anxiety symptoms and lifestyle in older adults during the lockdown. It is important to conduct in-depth research on factors associated with anxiety symptoms among older residents in other regions, focusing on population groups with the highest rates of infection and death from COVID-19.

Assessing empathy in healthcare services: a systematic review of South American healthcare workers' and patients' perceptions.

Background: Empathy in healthcare service refers to the ability of healthcare workers (HCWs) to put themselves in patients' shoes, which is necessary to ensure a good physician-patient relationship and provide quality care. Various studies have shown that empathy varies depending on the country, the instrument used, the evaluator, and the HCW's specialty. This systematic review aims to estimate the levels of empathy among HCWs in South American countries between 2000 and 2019. Methods: We conducted searches in 15 databases (PubMed, Scopus, Web of Science, EMBASE, Scielo, PsycoInfo, ScientDirect, Latindex, and LILIACS), four preprint servers (medRxiv, bioRxiv, SportRxiv, and Preprints), and other search engines such as Dimensions (20), Google Scholar, Yahoo!, and Alicia CONCyTec (c). We followed the PRISMA guidelines, and this study was registered in PROSPERO (CRD42023454007). Results: Out of 18,532 documents identified from November 10 to 28, 2021, 10 articles were included (n = 2,487 participants, of which 1989 were patients). Among the studies focusing on self-evaluated empathy, four relied on the Jefferson Scale of Empathy for medical professionals (JSE-HP). However, assessments from patients employing Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE) and Consultation and Relational Empathy (CARE) scale suggested high levels of empathy We found that both professionals and patients perceived that empathic care was provided, often at a medium or regular level. Surgery residents presented lower levels of empathy compared to obstetrics-gynecology and pediatrics physicians. Conclusion: Empathy is crucial in determining the quality of care and patient satisfaction during healthcare services provided by HCWs. Therefore, it is important to support professionals so that the various stressful situations they encounter in their work and daily life do not negatively influence the approach they provide to patients.

Use of mouthguards in Latin American field hockey athletes during the ODESUR 2022 Games.

BACKGROUND/AIMS: Athletes are susceptible to oral injuries. To reduce the incidence and severity of oral trauma, a custom-made mouthguard, a device positioned in the mouth to prevent damage to teeth and surrounding structures, is recommended. In field hockey, according to the international rules of this sport, using mouthguards is not mandatory, but it is recommended to wear them at all times while practicing this discipline. We aimed to determine characteristics and differences regarding mouthguard usage among field hockey players from different countries participating in the XII ODESUR Games. METHODS: We conducted a cross-sectional study that included 78 voluntary hockey athletes that met the inclusion criteria. The questionnaire used was validated by Panam Sports, collecting information on the type of mouthguard (custom-made or prefabricated), and the time of use of the mouthguard (range of 5 years). RESULTS: Of the total number of athletes, 96% used mouthguards, of which 64% were custom-made type, and 32% were prefabricated (p < .001). Custom-made mouthguards were used by 100%, 89%, and 64% of athletes in Argentina, Chile, and Peru, respectively, while only 40% of athletes in Paraguay and Uruguay used them. It has also been observed that more than 50% of the individuals have not controlled and replaced their intraoral devices for more than 10 years. CONCLUSIONS: Our results reveal a problem with a public health dimension and thus invite the standardization of guidelines with an educational approach to promoting and adopting good sports practices. This report is the first on using mouthguards in high-performance athletes during an international multisport event.

Increase in antibiotic resistance in diabetic foot infections among peruvian patients: a single-center cross-sectional study.

Background: Diabetic foot is one of the most significant complications in individuals with diabetes and is closely associated with lower limb amputation. The antibiotic susceptibility patterns of these bacterial isolates play a critical role in guiding effective treatment strategies We aimed to determine the most common bacterial agents causing diabetic foot infections in a tertiary-care hospital in Peru. Methods: Clinical and microbiological data were collected from 181 patients diagnosed with diabetic foot infections and positive microbiological culture results. All the samples were analyzed with the Vitek 2 compact system and the cut-off points were defined with the CLSI M100 guide. The data were segregated based on mono-microbial or poly-microbial cultures, bacterial types, and antibiotic susceptibility profiles. Results: A total of 32 bacterial species were identified, predominantly Gram-negative (63%). The most frequent bacterial agents isolated were Staphylococcus aureus (19.9%), Escherichia coli (12.2%), Pseudomonas aeruginosa (8.3%), and Proteus vulgaris (6.6%). These bacteria commonly exhibited resistance to Ampicillin, Ciprofloxacin, Levofloxacin, Trimethoprim-sulfamethoxazole, and Cefuroxime. E. coli showed the highest antibiotic resistance (19 antibiotics), while Gentamicin, Tobramycin, and Levofloxacin demonstrated the highest sensitivity against the most prevalent bacteria. Gram-negative bacteria also exhibited notable antibiotic-susceptibility to Meropenem, Piperacillin/tazobactam, and Amikacin. Regarding the presence of Extended-Spectrum Beta-Lactamase, 54 isolates tested positive, with 35 (64.8%) and 14 (42.4%) of these being S. aureus and E. coli. Conclusions: Bacterial agents causing diabetic foot infections pose a constant concern, particularly due to the increasing antibiotic resistance observed. This difficulty in treating the condition contributes to a higher risk of amputation and mortality. Further research on bacterial susceptibility is necessary to determine appropriate dosages for pharmacological treatment and to prevent the overuse of antibiotics.

The End of Life Accompanied by COVID-19: A Qualitative Study on Changes in Behavior and Stigmatization of the Grieving Families in Peru (Part II).

The rapid spread of SARS-CoV-2 has led to changes in every aspect of life and death. In Peru, where the longest quarantine has occurred with suboptimal results, the rituals have been turned around, impacting the relatives in multiple aspects. Here, we used a qualitative approach to analyze unresolved grief, hygiene changes, and stigma through semi-structured, online (Google Meet) interviews with 15 participants aged 20-72, who had lost family members to COVID-19. The recorded and transcribed interviews were analyzed using reflexive thematic analysis. Most participants had unresolved grief due to the blocking of funeral rituals, which could predispose them to prolonged mourning. After the loss of relatives, hygiene measures will be improved to avoid infections and new deaths in every family, while most participants felt no stigma in their milieu, since their relatives accompanied them during the funeral, supporting them from afar. It is important that interventions are implemented to prevent the progression of grief by providing mental health opportunities for the bereaved.

Favorable Attitudes Toward Research in Nursing Students During Internship: A Cross-Sectional Study in Peru.

Introduction and objective: Research attitudes among nursing students are essential to improve the quality of care and promote evidence-based practice. The objective of this study was to determine the attitude towards research of nursing students during their undergraduate internship and explore the demographic and study-related factors that may affect these attitudes. Materials and Methods: In this cross-sectional retrospective study, 100 nursing interns who are >18 years old, currently studying and working, and have a prior academic background were included. To assess the attitudes toward research, the 43-item Likert-like Scale of Attitudes Towards Research questionnaire was used, which has been previously validated in the Peruvian population and includes three distinct dimensions: affective, cognitive, and behavioral. Results: The mean age was 28.7 ± 5.2 years and 88% were women. Fifty percent had favorable attitudes toward research. The favorable attitude according to the affective, cognitive, and behavioral dimensions was 28%, 11%, and 45%, respectively. Although the youngest age group (20 to 30 years old) had the highest frequency of favorable attitudes (36%), no significant differences were found when compared to other age groups (p = .082). Conclusions: Nursing students presented favorable attitudes toward research during their undergraduate internship, especially among young students. However, more research is needed to understand how these attitudes are shaped and consolidated during the research process and how they can be further improved to promote evidence-based practice in nursing.

Use of grape-based stain (Vinatela) on cervical cytology: A Peruvian validation study.

Objectives: The Papanicolaou's (Pap's) stain is used for cervical cancer screening. It employs toxic-carcinogenic expensive reagents, which may not be easily accessible to many communities worldwide. The objective of this study was to validate the grape-based alcohol-extracted dye (Vinatela) on normal cervical samples for the Pap test. Material and Methods: Samples of the two grape species were collected from two vineyards through the Agroindustrial Research Institute of Universidad Privada San Juan Bautista. The dye extraction from the grape species and the dye performance to stain cells were conducted in three phases: (a) direct staining with pre-fermentation wine products, (b) direct fragmentation of grapes and direct staining with shells of the grapes, and (c) alcoholic extraction of the dye. Vinatela obtained from two species (Vitis vinifera "Tempranillo" and "Malbec") and posterior staining of cervical samples. We conducted a double-blind validation on 30 cervical samples. Results: The basophilic components of the cervical cells were stained. Alcoholic extraction staining protocol had a low yield. The nuclear and cytoplasmic borders, the nuclear details, and the polymorphonuclear nuclei were stained with Vinatela and could be differentiated during nuclear coloration. The initial staining protocol was 10- 20 min × (mean ~12 min) staining time. We noted a slightly better staining with V. v. Tempranillo as compared to V. v. Malbec (P = 0.045). Conclusion: Cervical cells stained with Vinatela stain from two grape species cultivated in the Southern of Peru, showed basophilic nuclear details.

Quality of life in families under quarantine: a cross-sectional study in seven countries during the first outbreak of COVID-19.

Background: The COVID-19 pandemic has disrupted human well-being worldwide in unforeseen ways. In early 2020, the spread of the virus left its mark on every affected country, impacting mental health by limiting daily activities and causing fatalities amidst public health strategies to mitigate its impact. The influence of COVID-19 on the quality of life (QoL) may vary between countries, underscoring the need to examine its effects on individuals and families during the mandatory home quarantine. We aimed to assess the QoL of individuals and families during home isolation by COVID-19 lockdown. Methods: A cross-sectional study was conducted from February to May 2020. We included adult partners (≥18 years) of families from Brazil, Colombia, Spain, Japan, Peru, Russia, and Venezuela. Using the 26-item World Health Organization Quality of Life Brief (WHOQOL-BREF) questionnaire we assess the impact of COVID-19 on their partner/family member's QoL. Results: The survey was completed by 466 participants (mean age = 38.59 ± 13.75 years; females = 298) and 76% worked mostly as health professionals from South America (69.2%), Europe (18.4%), and Asia (12.4%). The WHOQOL-BREF mean score from 38.38 ± 11.55 (range = 22.8-43.4). The average quality of life in South America (41.9 ± 1.2) was significantly higher than that of European countries (30.9 ± 11.5) (p = 0.002). The social relations dimension was the only one with values close to 100 (mean = 83.3) in 6/7 evaluated countries, where only Spain had a low score (41 ± 33.12). Women had a slightly lower quality of life than men, but it was not significant (40.2 ± 8.8 vs. 41.5 ± 9.9, p = 0.354), while we found differences in the overall QoL between young and older, and by employment type (p < 0.05). According to family structure, we found differences on QoL between nuclear and siblings' families (p = 0.024). Conclusion: Families from seven countries of three continents reported poor QoL during the first outbreak of COVID-19. The pandemic scenario has dramatically weakened the QoL in 3/4 dimensions, where social relationships have remained high. It is important to fully address the impact of this reduced QoL on families after several waves of infection and to provide comprehensive support in the post-COVID future.

A systematic review of mental health in rural Andean populations in Latin America during the COVID-19 pandemic.

Background: COVID-19 has been causing mental health problems around the world, with rural and indigenous peoples likely to be the most affected. This systematic review synthesizes and critically analyzes the existing literature on mental disorders in the rural Andean population in Latin America. Methods: A systematic review with narrative synthesis was carried out following the PRISMA guidelines. We searched nine databases (PubMed/MEDLINE, Scopus, EMBASE, ScienceDirect, Web of Science, Cochrane, Scielo, LILACS, and Latindex), five public prepublication servers (SocArXiv, medRxiv, bioRxiv, SportRXiv, and Preprints), ALICIA, and Google Scholar for articles that included the analysis of mental health problems using data collected from the rural Andean population in Latin America. These were eligible for inclusion. Articles that included Non-Latin American populations (including European or African migrants) and studies conducted prior to the COVID-19 pandemic (since the declaration of national lockdown) were excluded. Results: A total of 23,761 articles were retrieved, 14 of which met the inclusion requirements. Most were cross-sectional (n = 12) and related to anxiety (n = 9), depression (n = 8), and stress (n = 5). The mental health analysis of 5,976 rural dwellers from four countries in Latin America also included gray literature studies (n = 7) that allowed the quantification of mental health problems in adults (n = 7) and adolescents/children (n = 4). Only one study was multinational, and the quality of publications varied. Despite the high frequency of anxiety, depression, and stress symptoms among rural Latin American populations during COVID-19, published research is very limited. This review found preliminary evidence that the frequency of anxiety (45%), depression (27.6%), and stress (33.1%) in the rural population was associated with pandemic restrictions across countries. Measures of other psychiatric problems, such as distress or suicidal ideation, cannot be estimated. Conclusion: Regional-wide studies investigating changes in the frequency of symptoms of mental health problems in the context of the COVID-19 pandemic are warranted to inform culturally adapted prevention strategies. This study is limited to a narrative synthesis and may be subject to publication bias. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=320489.

Quality and Performance of Papanicolaou Test using the Clinical and Laboratory Standards Institute (CLSI) EP12-A2 Guidelines: A Single-Center Study in Peru.

Context: Quality assurance in cervical cytology is based on the cyto-histological correlation that is performed in several countries even without standardized protocols. Aims: To evaluate the quality of the Pap smear with the Clinical and Laboratory Standards Institute (CLSI) EP12-A2 guideline in a Peruvian hospital. Settings and Design: This prospective study was carried out at tertiary care national hospital. Methods and Material: The 156 cyto-histological results were collected and coded according to the Bethesda 2014 and FIGO system. The evaluation with the CLSI EP12-A2 guide allowed estimating the performance and quality of the test. Statistical Analysis Used: We performed a descriptive analysis of the cytological and histological data and correlation with the weight Kappa test. From the calculation of the likelihood ratios, the post-test probability was estimated using Bayes' theorem. Results: In cytology, 57 (36.5%) were undetermined abnormalities, 34 (21.8%) low-grade squamous intraepithelial lesion (SIL), and 42 (26.9%) high-grade SIL. Of the total biopsies, 56 (36.9%) were cervical intraepithelial neoplasia (CIN) grade 1, 23 (14.7%) were both CIN grade 2 and 3. We determined sensitivity, specificity, a positive and negative predictive value of 94%, 74.6%, 58%, and 97.1%, respectively. We determined a moderate cyto-histological agreement (κ = 0.57). Atypical squamous cells of undetermined significance (40%), and cannot exclude high-grade squamous intraepithelial lesions (42.1%) that showed higher overdiagnosis results. Conclusions: The quality and performance of the Papanicolaou test show high sensitivity and moderate specificity. The concordance found was moderate and the proportion of underdiagnosis was higher in abnormalities of undetermined significance.

Actitudes del autocuidado de pacientes con tuberculosis en enfermeros peruanos luego de un brote hospitalario

Introducción: La tuberculosis es una de las principales causas de morbimortalidad en todo el mundo. Las medidas de prevención son clave para evitar su propagación y el contagio entre profesionales de salud. Objetivo: Determinar las actitudes del autocuidado sobre la tuberculosis en el personal de enfermería luego de un brote infeccioso hospitalario. Métodos: Estudio transversal, en personal de enfermería (n= 94; personal técnico n= 44; 46,8 %). Se incluyó al personal de enfermería voluntario > 18 años, de ambos sexos, que trabaje en el Departamento de Emergencia. Se usó el cuestionario de 15 ítems de Valle (2017), para estimar los conocimientos y actitudes sobre el autocuidado, 3 dimensiones: prevención, diagnóstico y tratamiento de la tuberculosis. Resultados: El promedio de edad de los participantes fue de 44,7 ± 8,8 años, el 88,3 % mujeres y el tiempo promedio de trabajo fue 11,2 ± 7,8 años. Se hallaron diferencias entre los años de servicio, entre los técnicos (8,55 ± 7,94 años) y profesionales (13,48 ± 6,98 años) (p< 0,001). El 100 % presentaron actitudes de aceptación del autocuidado en todas las dimensiones. El 4,5 % y el 27,3 % de técnicos presentaron actitudes de indiferencia en la dimensión diagnóstico y tratamiento de tuberculosis (p= 0,001). Conclusiones: Existen actitudes favorables en el personal de enfermería sobre autocuidado de la tuberculosis luego de un brote en un hospital de Lima, aunque en técnicos de enfermería se reportan actitudes de indiferencia en el diagnóstico y tratamiento de tuberculosis.

Introduction: Tuberculosis continues to be one of the main causes of morbidity and mortality worldwide. Prevention measures are key to prevent its spread and contagion among health professionals. The objective of the present study was to determine the self-care attitudes about tuberculosis in the nursing staff after a hospital infectious outbreak in Perú. Method: A cross-sectional study was conducted in nursing staff (n= 94; technical staff n= 44, 46.8%). Volunteer nursing staff > 18 years old, of both sexes, and who work in the Emergency Department were included. The 15-item questionnaire from Valle (2017) was used to estimate knowledge and attitudes about self-care in nursing staff in 3 dimensions: prevention, diagnosis and treatment of tuberculosis. Results: The average age of the participants was 44.7±8.8 years, 88.3 % were women, and the average working time was 11.2 ± 7.8 years. Difference was found between the years of service, among technicians (8.55 ± 7.94 years) and nursing professionals (13.48 ± 6.98 years) (p< 0.001). A hundred percent of nurses presented attitudes of acceptance of self-care in all dimensions; 4.5 % and 27.3% of nursing technicians presented attitudes of indifference in the tuberculosis diagnosis and treatment dimension (p= 0.001). Conclusions: There are favorable attitudes in the nursing staff about self-care of tuberculosis after an outbreak in a hospital in Lima, although in nursing technicians we report attitudes of indifference in the diagnosis and treatment of tuberculosis.

The Age of Young Nurses Is a Predictor of Burnout Syndrome during the Care of Patients with COVID-19.

BACKGROUND: Burnout Syndrome (BS) is a work fatigue phenomenon that leads to physical exhaustion during care work, and there could be an increase in the proportion of nurses affected during the COVID-19 pandemic, especially in those caring for infected patients. We aimed to determine BS in nurses during the COVID-19 pandemic. METHODS: An observational study was conducted on 100 nurses over the age of 18 and working in COVID-19 medical units in 2021. The 22-item Maslach Burnout Inventory questionnaire was used to estimate BS, and differences between age groups, gender, work time, and previous infection were estimated. RESULTS: The majority of nurses (mean 30 ± 5.5 years) were women (78%), and the most frequent working time was from 1 to 10 years (58%). A total of 88% of the nurses had moderate BS, affecting more males, aged between 20 and 30 years, and without previous infection. The youngest age group, 20-30 years, presented the highest mean BS with 53.8 (SD 4.18) points (95% CI: 52.79 to 54.8), showing differences with older nurses (p < 0.05). Prediction analysis showed that only age was a significant predictor for the development of SB (p < 0.001). CONCLUSIONS: BS negatively impacts young nurses during the care of COVID-19 patients, so strategies should be promoted to ensure a better working environment. Improving the workspace can include self-care strategies, changes in the system and work organization, an improvement of interpersonal relationships, and risk prevention.

COVID-19 may lower quality of life when infections and deaths increase: A longitudinal study in the Peruvian jungle.

Background: Quality of life (QoL) is a multifactorial concept on the perception of the individual's wellbeing underpinned by environmental, psychological, and physical factors. Several studies have shown changes in QoL in the COVID-19 pandemic and may be due to increases in mortality rates, however, no study has investigated this among Peruvian jungle dwellers. Here, we have sought to estimate the QoL of individuals before and after the increase in cases and deaths from COVID-19. Methods: A questionnaire-based longitudinal study was conducted in 102 inhabitants (mean 40.75 ± 7.49 years). The Spanish version of the WHOQOL-BREF was used in two stages: April and June. The first stage was accomplished before the first confirmed case of COVID-19, and the second stage was when the daily mortality rate was 3.5% with an incidence of 87%. Results: Sixty (54.8%) participants were women, 67 (61.9%) were >31 years, and 38 (34.5%) and 32 (29.1%) participants had primary and secondary education, respectively. In the first and second stage we obtained an overall mean QoL of 46.65 ± 23.2 and 35 ± 27.7 points, respectively. Individuals had significantly lower QoL in the face of increased deaths in physical (p = 0.001), mental (p = 0.028) and environmental (p = 0.001) health domains, with the latter having the greatest impact (51.84 ± 5.81 vs. 16.66 ± 5.55 points). Conclusion: Quality of life of Peruvian jungle dwellers is reduced during periods of increased mortality and incidence by COVID-19. Preventive strategies aimed at reducing the impact of COVID-19 on the mental health and global wellbeing of individuals living in the Amazon are recommended to Peruvian authorities.

Clinical, Phenotypic, and Demographic Characteristics of Peruvian Children and Neonates with Autosomal and Sex Chromosome Aneuploidies.

OBJECTIVE: Autosomal and sex chromosome aneuploidies are associated with multiple risk factors that determine their frequency and their social and health impact. We aimed to determine the clinical, phenotypic, and demographic characteristics of Peruvian children and neonates with autosomal and sex chromosome aneuploidies. MATERIALS AND METHODS: This was a retrospective study conducted on 510 pediatric patients. We conducted a cytogenetic analysis with G-bands by trypsin using Giemsa (GTG) banding, and the results were reported using the International System for Cytogenetics Nomenclature 2013 system. RESULTS: Of 399 children (mean age 2.1 ± 4 years), 84 (16.47%) had aneuploidies, with 86.90% being autosomal (73.81% trisomies). In autosomal aneuploidies, 67.85% (n = 57) of the children had Down syndrome where the most common cause was free trisomy 21 (52 cases, 61.91%), followed by Robertsonian translocation (4 cases, 4.76%). Edwards and Patau syndrome affected 4 (4.76%) and 1 (1.19%) neonate. The most frequent phenotypic characteristics in children with Down syndrome were Down syndrome-like facies (45.61%) and macroglossia (19.29%). Of sex chromosome aneuploidies, 6/7 were abnormalities of the X chromosome (mainly 45,X). Neonate's age (19 ± 44.9 months), paternal age (49 ± 9 years), height (93.4 ± 176 cm), and gestational age (30 ± 15.4 weeks) were significantly correlated with the presence of sex chromosome and autosomal aneuploidies (P < .001; P = .025; and P = .001). CONCLUSIONS: Down syndrome and Turner's syndrome were the most frequent aneuploidy and sex chromosome aneuploidy, respectively. In addition, some of the clinical, phenotypic, and demographic characteristics, such as newborn's age, paternal age, gestational age, and height, were significantly correlated with the occurrence of aneuploidy. In this sense, these characteristics could be considered risk factors among this population.

Aproximaciones sobre el acto de mirar: la peste de Azoth

Las neurociencias contemporáneas continúan separando el acto de ver en los procesos de la visión y los procesos de la motricidad ocular, sin plantear aun una explicación unificadora de ambos en una misma realidad: como el acto de mirar. El objetivo del presente artículo es explicar este acto a través de la serie de eventos neurológicos que suceden y entender que se mira con la conciencia. Se explican los procesos visuales en base al enfoque neurocientífico contemporáneo y la Teoría Sociobiológica Informacional en "La Peste de Azoth" de Nicolas Poussin. Mientras que la explicación tradicional de la neurociencia refiere que todo estímulo activa un receptor, siguiendo una vía nerviosa hasta el cerebro, desde la Teoría Sociobiológica Informacional, el acto de mirar es una actividad epiconsciente, una construcción que resulta de la suma emergente de los cinco niveles de complejidad. Estos integran este proceso en los movimientos que describen los ojos y la acción de lo que se mira simultáneamente. "La Peste de Azoth" muestra una ciudad azotada por la peste bubónica, con dos rasgos: maldición divina y presencia de miasmas respirables. Poussin no solo pintó los motivos de una explicación mágica (tradicional) y científica, sino también de una explicación tecnológica (bacteriológica) que emergería dos siglos después de su muerte. En conclusión, el acto de mirar desde la Teoría Sociobiológica Informacional, es un proceso que principian en el neocortex y que integra la información en cinco niveles. Esta explicación permite entender La Peste de Azoth" como un enfoque tecnológico adelantado.

Contemporary neurosciences continue to separate the act of seeing in the processes of vision and the processes of ocular motor skills, without even proposing a unifying explanation of both aspects of the same reality: as the act of looking. The aim of this article is to explain the act of looking through the series of neurological events that occur and to understand that one looks with consciousness. Visual processes are explained based on the contemporary neuroscientific approach and Informational Sociobiological Theory in Nicolas Poussin's "The Plague of Azoth". While the traditional explanation traditional explanation of neuroscience refers that every stimulus activates a receptor, following a nervous path to the brain, from the Informational Sociobiological Theory, the act of looking is an epiconscious activity, a construction that results from the sum emerging from the five levels of complexity. These integrate this process in the movements that describe the eyes and the action of what is seen simultaneously. "The Plague of Azoth" shows a city plagued by the bubonic plague, with two traits: a divine curse and the presence of breathable miasmas. Poussin not only painted the grounds for a magical (traditional) and scientific explanation, but also for a technological (bacteriological) explanation that would emerge two centuries after his death. In conclusion, the act of looking from the Informational Sociobiological Theory is a process that begins in the neocortex and that integrates information at five levels. This explanation allows us to understand "The Plague of Azoth" as an advanced technological approach.

Detection of pathogenic Aeromonas hydrophila from two rainbow trout (Oncorhynchus mykiss) farms in Peru.

Fish farms are one of the principal food industries located in peri-urban and rural communities that use available resources to ensure the quality of their products. However, trout can suffer from bacterial infections affecting the sector and being a key component of human health risk. We aimed to identify and characterize Enterobacteriaceae in 46 trout (Oncorhynchus mykiss) in two fish farms in Lima, Peru. Adult trouts older than seven weeks (> 200 grams weight) were included. Cultures were performed in duplicate (n=192 trials) with swabs from the squamous surface and visceral cavity. The isolates were identified with the Vitek® 2 Compact system, and the minimum inhibitory concentrations (MIC) were interpreted with the CLSI VET 03-A guide. At El Molino and El Angelito fish farms, 66 (68.8%) and 57 (59.4%) isolates were obtained. The most frequently isolated species were Escherichia coli (56.8%), Proteus sp. (4.2%) and Klebsiella pneumoniae (2.6%). E. coli was present in all sampling areas, and Aeromonas hydrophila was only present in one open viscera sample at El Angelito fish farm. A. hydrophila showed antibiotic resistance to Ampicillin/Sulbactam (≥32 MIC), Oxytetracycline (>8 MIC), Imipenem (8 MIC), Levofloxacin (>8 MIC), and Ceftazidime (≥64 MIC). Our results suggest the presence of multi-resistant A. hydrophila in O. mykiss. Further studies are needed to understand the developmental context of A. hydrophila, which is crucial to the food industry, aquaculture and public health.

As pisciculturas são uma das principais indústrias alimentícias localizadas em comunidades peri-urbanas e rurais que utilizam os recursos disponíveis para garantir a qualidade de seus produtos. No entanto, a truta pode sofrer de infecções bacterianas que afetam o setor e são um componente chave do risco para a saúde humana. Nosso objetivo foi identificar e caracterizar Enterobacteriaceae em 46 trutas (Oncorhynchus mykiss) em duas pisciculturas em Lima, Peru. Foram incluídas trutas adultas com mais de sete semanas (> 200 gramas de peso). As culturas foram realizadas em duplicata (n=192 tentativas) com swabs da superfície escamosa e da cavidade visceral. Os isolados foram identificados com o sistema Vitek® 2 Compact, e as concentrações inibitórias mínimas (CIM) foram interpretadas com o guia CLSI VET 03-A. Nas pisciculturas El Molino e El Angelito foram obtidos 66 (68,8%) e 57 (59,4%) isolados. As espécies mais frequentemente isoladas foram Escherichia coli (56,8%), Proteus sp. (4,2%) e Klebsiella pneumoniae (2,6%). E. coli estava presente em todas as áreas de amostragem, e Aeromonas hydrophila estava presente apenas em uma amostra de vísceras abertas na piscicultura El Angelito. A. hydrophila mostrou resistência a antibióticos para Ampicilina/Sulbactam (≥32 MIC), Oxitetraciclina (>8 MIC), Imipenem (8 MIC), Levofloxacina (>8 MIC) e Ceftazidima (≥64 MIC). Nossos resultados sugerem a presença de A. hydrophila multirresistente em O. mykiss. Mais estudos são necessários para entender o contexto de desenvolvimento de A. hydrophila, que é crucial para a indústria de alimentos, aquicultura e saúde pública.