[Clinical practice guidelines for the diagnosis and management chronic infection of hepatitis viral C of the Peruvian Health Social Security (EsSalud)]. / Guía de práctica clínica para el diagnóstico y tratamiento de la infección crónica por el virus de hepatitis C en el Seguro Social de Salud del Perú (EsSalud).

INTRODUCTION: This article summarizes the clinical practice guidelines (CPG) for the diagnosis and treatment of chronic infection of hepatitis viral C of the Peruvian Health Social Security (EsSalud). OBJECTIVE: To provide clinical recommendations based on evidence for the diagnosis and treatment of chronic infection of hepatitis viral C in EsSalud. METHODS: A guideline development group (GDG) was established, including medical specialists and methodologists. The GDG formulated 4 clinical questions to be answered in this CPG. Systematic searches of systematic reviews and primary studies (when pertinent) were conducted in PubMed, and Central (Cochrane) during 2019. The evidence was selected to answer each of the clinical questions. The accuracy of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice and the treatment flowchart. Finally, the CPG was approved with Resolution No. 151-IETSIESSALUD-2019. RESULTS: The present CPG addressed 4 clinical questions of four topics: screening, diagnosis, staging and treatment. Based on these questions, 13 recommendations (8 strong recommendations and 5 weak recommendations), 27 points of good clinical practice, and 1 flowchart were formulated. CONCLUSION: This paper summarizes the methodology and evidencebased conclusions from the CPG for for the diagnosis and treatment of chronic infection of hepatitis viral C of the EsSalud.

[Impact of COVID-19 on liver disease and the public health in Peru]. / Impacto del COVID-19 en las enfermedades hepáticas y la salud pública en el Perú.

The pandemic of COVID-19 (an infectious disease caused by the SARS-CoV2 virus), declared as such by the WHO, is spreading since its appearance in Wuhan (China) in December 2019, rapidly and unexpectedly throughout the world, causing millions of cases and thousands of deaths and has affected more than 120 countries. It was officially acknowledged in Peru on March 6th, 2020, and has spread rapidly throughout the country, causing first the crisis and then the collapse of the healthcare system, especially emergency care, admissions, and overcrowded intensive care units, not having a specific treatment or the foreseeable possibility of a short-term vaccine. COVID-19 is currently known for being a systemic disease that can affect multiple organs and tissues and can be fatal. The goal of this review is to present what has been described in recent studies, published worldwide and including our country, that have reported clinical manifestations, outlining possible mechanisms of liver dysfunction related to COVID-19 and its repercussions, especially on the digestive system. These studies analyze and discuss the potential impact on liver diseases, offering recommendations of experts and scientific organizations regarding prevention, control and management measures, outlining also some public health strategies in our country for the proper care of COVID-19 patients in times of widespread crisis.

[Recommendations of the Society of Gastroenterology of Peru to avoid the spread of SARS-CoV-2 through digestive endoscopy procedures]. / Recomendaciones de la Sociedad de Gastroenterología del Perú para evitar la propagación del SARS-CoV-2 a través de procedimientos de endoscopía digestiva.

The SARS-CoV-2 coronavirus produces the disease called COVID-19, currently spreading in a rapidly evolving pandemic. It can be transmitted by contact, drops and aerosols, and has been isolated from gastrointestinal secretions and faeces. During digestive endoscopy, transmission by any of these mechanisms could occur. It is recommended to limit digestive endoscopy to cases of digestive bleeding, severe dysphagia, foreign body in the digestive tract, biliary obstruction with intractable pain or cholangitis, pseudocyst or complicated encapsulated pancreatic necrosis, gastrointestinal obstruction, and cases at risk of deterioration over time. It is recommended to screen patients based on temperature, symptoms, and epidemiological factors to classify them according to their risk of infection. For procedures in low risk patients, personnel must wear a disposable gown, gloves, eye or face shield, standard surgical mask, disposable hat, disposable shoe covers. In cases of intermediate or high risk, or confirmed COVID-19, protection should be increased using disposable waterproof gown, N95 respirator or similar, and double glove. In case of shortage it may be necessary to reuse N95 respirators for up to 5 uses, following CDC recommendations for donning, removing and storing to prevent secondary contact contamination. Likewise, all protective equipment should be put on and removed according to CDC recommendations. The presence of personnel in endoscopy should be limited to the bare minimum. Said personnel must have daily temperature control and if it is above 37.3ºC, the corresponding evaluation must be carried out. After each procedure, the stretcher and room surfaces should be properly disinfected. High-level disinfection of endoscopes eliminates SARS-CoV-2.

Impacto del COVID-19 en las enfermedades hepáticas y la salud pública en el Perú / Impact of COVID-19 on liver disease and the public health in Peru

RESUMEN La pandemia declarada por la OMS originada por el COVID-19 (enfermedad infecciosa originada por el virus SARS-CoV2), desde su aparición en Wuhan, China en diciembre 2019; esta diseminándose rápidamente y de manera inesperada por todo el mundo originando millones de casos y miles de muertes, afectando más de 120 países y desde el 06 marzo 2020 al Perú, distribuyéndose rápidamente por todo el país, originando crisis y colapso del sistema de servicios de salud, especialmente de las atenciones en emergencia, hospitalizaciones y unidades de cuidados intensivos abarrotadas; sin tener aún un tratamiento específico ni la posibilidad de una vacuna a corto plazo. Se sabe actualmente que COVID-19, es una enfermedad sistémica que puede afectar múltiples órganos y tejidos y que puede ser fatal. El objetivo de esta revisión es mostrar lo descrito en los recientes estudios publicados a nivel mundial incluido nuestro país, que han reportado sus manifestaciones clínicas, esbozando posibles mecanismos de disfunción hepática relacionados a COVID-19 y sus repercusiones, en especial sobre el aparato digestivo; analizando y discutiendo el potencial impacto sobre ellas y las enfermedades del hígado, enunciando las recomendaciones de expertos y organizaciones científicas respecto a medidas de prevención, control y manejo, además de esbozar algunas estrategias de salud pública en nuestro país para la adecuada atención de estos pacientes en tiempos de crisis generalizada.

ABSTRACT The pandemic of COVID-19 (an infectious disease caused by the SARS-CoV2 virus), declared as such by the WHO, is spreading since its appearance in Wuhan (China) in December 2019, rapidly and unexpectedly throughout the world, causing millions of cases and thousands of deaths and has affected more than 120 countries. It was officially acknowledged in Peru on March 6th, 2020, and has spread rapidly throughout the country, causing first the crisis and then the collapse of the healthcare system, especially emergency care, admissions, and overcrowded intensive care units, not having a specific treatment or the foreseeable possibility of a short-term vaccine. COVID-19 is currently known for being a systemic disease that can affect multiple organs and tissues and can be fatal. The goal of this review is to present what has been described in recent studies, published worldwide and including our country, that have reported clinical manifestations, outlining possible mechanisms of liver dysfunction related to COVID-19 and its repercussions, especially on the digestive system. These studies analyze and discuss the potential impact on liver diseases, offering recommendations of experts and scientific organizations regarding prevention, control and management measures, outlining also some public health strategies in our country for the proper care of COVID-19 patients in times of widespread crisis.

Recomendaciones de la Sociedad de Gastroenterología del Perú para evitar la propagación del SARS-CoV-2 a través de procedimientos de endoscopía digestiva / Recommendations of the Society of Gastroenterology of Peru to avoid the spread of SARS-CoV-2 through digestive endoscopy procedures

RESUMEN El coronavirus SARS-CoV-2 produce la enfermedad llamada COVID-19, actualmente propagándose en una pandemia de rápida evolución. Puede transmitirse por contacto, gotas y aerosoles, y ha sido aislado en secreciones gastrointestinales y heces. Durante la endoscopía digestiva podría ocurrir la transmisión por cualquiera de estos mecanismos. Se recomienda limitar la endoscopía digestiva a casos de hemorragia digestiva, disfagia severa, cuerpo extraño en tracto digestivo, obstrucción biliar con dolor intratable o colangitis, pseudoquiste o necrosis pancreática encapsulada complicada, obstrucción gastrointestinal, y casos con riesgo de deterioro en el tiempo. Se recomienda tamizar a los pacientes en base a la temperatura, síntomas, y factores epidemiológicos para clasificarlos según su riesgo de infección. Para procedimientos en pacientes de riesgo bajo el personal debe usar bata descartable, guantes, protector ocular o facial, mascarilla quirúrgica estándar, gorro descartable, cubiertas descartables para zapatos. En casos de riesgo intermedio o alto, o COVID-19 confirmado, se debe incrementar la protección usando bata descartable impermeable, respirador N95 o similar, y doble guante. En caso de escasez puede ser necesario reutilizar los respiradores N95 hasta un máximo de 5 usos, siguiendo las recomendaciones de CDC sobre la colocación, retiro y almacenamiento para prevenir la contaminación secundaria por contacto. Asimismo todo el equipo de protección debe colocarse y retirarse siguiendo las recomendaciones del CDC. La presencia de personal en la endoscopía debe limitarse al mínimo indispensable. Dicho personal debe tener control diario de temperatura y si ésta es mayor a 37,3 ºC se debe proceder a la evaluación correspondiente. Después de cada procedimiento se debe desinfectar apropiadamente la camilla y superficies de la sala. La desinfección de alto nivel de los endoscopios elimina el SARS-CoV-2.

ABSTRACT The SARS-CoV-2 coronavirus produces the disease called COVID-19, currently spreading in a rapidly evolving pandemic. It can be transmitted by contact, drops and aerosols, and has been isolated from gastrointestinal secretions and faeces. During digestive endoscopy, transmission by any of these mechanisms could occur. It is recommended to limit digestive endoscopy to cases of digestive bleeding, severe dysphagia, foreign body in the digestive tract, biliary obstruction with intractable pain or cholangitis, pseudocyst or complicated encapsulated pancreatic necrosis, gastrointestinal obstruction, and cases at risk of deterioration over time. It is recommended to screen patients based on temperature, symptoms, and epidemiological factors to classify them according to their risk of infection. For procedures in low risk patients, personnel must wear a disposable gown, gloves, eye or face shield, standard surgical mask, disposable hat, disposable shoe covers. In cases of intermediate or high risk, or confirmed COVID-19, protection should be increased using disposable waterproof gown, N95 respirator or similar, and double glove. In case of shortage it may be necessary to reuse N95 respirators for up to 5 uses, following CDC recommendations for donning, removing and storing to prevent secondary contact contamination. Likewise, all protective equipment should be put on and removed according to CDC recommendations. The presence of personnel in endoscopy should be limited to the bare minimum. Said personnel must have daily temperature control and if it is above 37.3ºC, the corresponding evaluation must be carried out. After each procedure, the stretcher and room surfaces should be properly disinfected. High-level disinfection of endoscopes eliminates SARS-CoV-2.