Pan-immune-inflammation value and survival in patients with breast cancer from a Peruvian reference hospital.

The pan-immune-inflammation value (PIV), calculated as (neutrophil × platelet × monocyte)/lymphocyte count, may be useful for estimating survival in breast cancer patients. To determine the prognostic value of PIV for overall survival in breast cancer patients in Lima, Peru. A retrospective cohort study was conducted. 97 breast cancer patients diagnosed between January 2010 and December 2016 had their medical records analyzed. The primary dependent variable was overall survival, and the key independent variable was the PIV, divided into high (≥ 310) and low (< 310) groups. Patient data included demographics, treatment protocols and other clinical variables. Statistical analysis involved Kaplan-Meier survival curves and Cox proportional hazards modeling. Patients with a PIV ≥ 310 had significantly lower 5-year survival functions (p = 0.004). Similar significant differences in survival were observed for clinical stage III-IV (p = 0.015), hemoglobin levels < 12 mg/Dl (p = 0.007), histological grade (p = 0.019), and nuclear grade (p < 0.001); however, molecular classification did not show a significant survival difference (p = 0.371). The adjusted Hazard Ratios showed that PIV ≥ 310 was significantly associated with poor outcome (5.08, IC95%: 1.52-16.92). While clinical stage and hemoglobin levels were associated with survival in the unadjusted model. These factors did not maintain significance after adjustment. PIV is an independent predictor of reduced survival in Peruvian breast cancer patients.

Quality Assessment of Systematic Reviews Performed As An Undergraduate thesis in A Peruvian University: A Systematic Review.

Objective: To determine the quality of systematic reviews submitted as a thesis in the Medical School of Ricardo Palma University. Methods: We conducted a systematic review. We included systematic reviews submitted as theses from Ricardo Palma University, and we excluded narrative reviews, editorials, clinical experiments, and those with incomplete data. We performed a structured search on EMBASE, PubMed, Scopus, and Institutional Repository from the Ricardo Palma University and RENATI. The risk of bias assessment was performed through the AMSTAR-2 and the modified AMSTAR-2 tools. The primary outcome was review quality. A qualitative synthesis of the information was performed. Results: One thousand four hundred eighty-seven theses were identified, and exclusion criteria were applied, whereby 11 theses were selected for review and thorough consultation. Of the 11 selected theses, and through the AMSTAR-2 and modified AMSTAR-2 tools, the findings reached were that 90.9% of the included theses presented critically low quality that was not modified even when the quality was reevaluated after its publication as a scientific article. Conclusion: The systematic reviews presented as undergraduate thesis in the Medical School of Ricardo Palma University showed low and critically low quality. Improvement in systematic review training is required for both students and institutional advisors.

Resting Energy Expenditure, comparison of predictive formulas with bioimpedance: Peruvian population / Gasto Energético en Reposo, comparación de fórmulas predictivas con la bioimpedancia: población peruana

Introduction: In areas with limited access to healthcare systems, Resting Energy Expenditure (REE) estimation is performed using predictive equations to calculate an individual's caloric requirement. One problem is that these equations were validated in populations with different characteristics from those in Latin America, such as race, height, or body mass, leading to potential errors in the prediction of this parameter. Objective: To determine the REE using predictive formulas compared with bioimpedance in Peruvians. Materials and methods: A comparative analytical cross-sectional study with secondary database analysis of the CRONICAS cohort. Results: we worked with a total of 666 subjects. The Mjeor equation was the one with the highest rating of 0.95, a lower mean absolute percentage error (MAPE) of 4.69%, and equivalence was found with the REE values. In the multiple regression, it was observed that the Mjeor equation was the one that least overestimated the REE, increasing 0.77 Kcal/day (95% CI: 0.769-0.814; p<0.001) for each point that increased the REE determined by bioimpedance. The strength of association between Mjeor and bioimpedance was 0.9037. Furthermore, in the regression of the data (weight, height, age) in the Mjeor equation it was observed that the coefficients obtained were the same as those used in the original equation. Conclusions: The Mjeor equation seems to be the most adequate to estimate the REE in the Peruvian population. Future prospective studies should confirm the usefulness of this formula with potential utility in primary health care(AU)

Introducción: En zonas con acceso limitado a sistemas de salud, la estimación del Gasto Energético en Reposo (GER) se realiza utilizando ecuaciones predictivas para calcular el requerimiento calórico de un individuo. Uno de los problemas es que estas ecuaciones fueron validadas en poblaciones con características diferentes a las latinoamericanas, como raza, talla o masa corporal, lo que conlleva a potenciales errores en la predicción de este parámetro. Objetivo: Determinar el GER mediante fórmulas predictivas comparadas con la bioimpedancia en peruanos. Materiales y métodos: Estudio transversal analítico comparativo con análisis secundario de base de datos de la cohorte CRONICAS. Resultados: Se trabajó con un total de 666 sujetos. La ecuación de Mjeor fue la que obtuvo la puntuación más alta de 0,95, un error medio porcentual absoluto (MAPE) inferior de 4,69%, y se encontró equivalencia con los valores del GER. En la regresión múltiple, se observó que la ecuación de Mjeor fue la que menos sobreestimó el GER, aumentando 0,77 Kcal/día (IC 95%: 0,769-0,814; p<0,001) por cada punto que aumentaba el GER determinado por bioimpedancia. La fuerza de asociación entre Mjeor y bioimpedancia fue de 0,9037. Además, en la regresión de los datos (peso, talla, edad) de la ecuación de Mjeor se observó que los coeficientes obtenidos eran los mismos que los utilizados en la ecuación original. Conclusiones: La ecuación de Mjeor parece ser la más adecuada para estimar el GER en la población peruana. Futuros estudios prospectivos deberán confirmar la utilidad de esta fórmula para su potencial utilidad en la atención primaria de salud(AU)

[Undiagnosed arterial hypertension in a Latin American country, 2019 to 2021]. / Hipertensión arterial no diagnosticada en un país de Latinoamérica, 2019 a 2021.

Objective: To determine the factors associated with undiagnosed hypertension. Method: A quantitative, observational, retrospective, cross-sectional and analytical study was carried out in people aged 15 years and over included in the Demographic and Family Health Survey from 2019 to 2021 in Peru. A statistical analysis was carried out using the corrected F test, and crude and adjusted prevalence ratio (aPR), with a 95% confidence interval (95%CI) for inferential analysis, through Poisson regression with robust variance. Likewise, the CSPLAN analysis was carried out for complex samples according to the sample design and taking into account the weighting factor. Results: In the multivariate analysis, a significant association was found between the factors male sex (aPR: 1.22; 95%CI: 1.19-1.26), age from 30 to 49 years (aPR: 0.94; 95%CI: 0.92-0.96), native ethnicity (aPR: 1.07; 95%CI: 1.04-1.10), having health insurance (aPR: 0.91; 95%CI: 0.89-0.93), suffering from some permanent limitation (aPR: 0.83; 95%CI: 0.76-0.91) and diabetes mellitus (aPR: 0.59; 95%CI: 0.55-0.64). No significant association was found with educational level, language, Afro-Peruvian ethnicity, or alcohol or tobacco consumption (p > 0.05). Conclusions: The prevalence of undiagnosed arterial hypertension is high, 69.5%. The associated factors are male sex, native ethnicity, age between 30 and 49 years, having health insurance, suffering from some permanent limitation and having diabetes mellitus.

Objetivo: Determinar los factores asociados a hipertensión arterial no diagnosticada. Método: Estudio de tipo cuantitativo, observacional, retrospectivo, transversal y analítico, en personas de 15 y más años de edad contenidas en la Encuesta Demográfica y Salud Familiar de 2019 a 2021 en Perú. Se realizó un análisis estadístico haciendo uso de la prueba F corregida y la razón de prevalencia cruda y ajustada (RPa), con un intervalo de confianza del 95% (IC95%) para el análisis inferencial, a través de regresión de Poisson con varianza robusta. Asimismo, se realizó el análisis CSPLAN para muestras complejas de acuerdo con el diseño de la muestra y teniendo en cuenta el factor de ponderación. Resultados: En el análisis multivariado se halló una asociación significativa de los factores sexo masculino (RPa: 1.22; IC95%: 1.19-1.26), edad de 30 a 49 años (RPa: 0.94; IC95%: 0.92-0.96), etnia nativa (RPa: 1.07; IC95%: 1.04-1.10), tenencia de un seguro de salud (RPa: 0.91; IC95%: 0.89-0.93), sufrir alguna limitación permanente (RPa: 0.83; IC95%: 0.76-0.91) y diabetes mellitus (RPa: 0.59; IC95%: 0.55-0.64). No se encontró asociación significativa con el nivel de instrucción, el idioma, la etnia afroperuana ni el consumo de alcohol o tabaco (p > 0.05). Conclusiones: La prevalencia de hipertensión arterial no diagnosticada es alta, del 69.5%. Los factores asociados son el sexo masculino, la etnia nativa, la edad entre 30 y 49 años, la tenencia de un seguro de salud, sufrir alguna limitación permanente y tener diabetes mellitus.

Proportion of cancer cases and deaths attributable to potentially modifiable risk factors in Peru.

BACKGROUND: Limited evidence exists on the population attributable fraction (PAF) of cancer cases and deaths in Latin America. In Peru several studies have been published regarding the PAF of various risk factors and their associated diseases. The objective of this study was to estimate the fraction of cancer cases and deaths attributable to potentially modifiable risk factors in Peru in 2018, before the COVID-19 pandemic in the population of 15 years old and older. METHODS: An ecological study was conducted using the prevalence of exposure of the Peruvian population to modifiable risk factors for cancer, the relative risk associated with each factor, and the number of cancer cases and deaths in 2018 as inputs. We used the Parkin formula with a Montecarlo statistical simulation model to calculate the PAF and confidence intervals. The number of new cancer cases and deaths attributed to each risk factor was determined by multiplying the number of cases and deaths in each gender by the PAF of each risk factor. FINDINGS: In Peru, 38.5% of new cases (34.5% in men and 42% in women) and 43.4% of cancer-related deaths (43.4% in men and 43.4% in women) were attributable to modifiable risk factors. The number of cancers attributable was 25,308 (10,439 in men and 14,869 in women) and the number of deaths attributable to cancer was 14,839 (6,953 in men and 7,886 in women). The predominant modifiable risk factors contributing to the highest number of cases and deaths were HPV infection (4,563 cases, 2,409 deaths), current tobacco use (3,348 cases, 2,180 deaths), and helicobacter pylori infection (2,677 cases, 1,873 deaths). Among the risk factors, oncogenic infections constituted the group with the highest PAF (16.6% for cases, 19.2% for deaths) followed by other unhealthy lifestyle factors (14.2% for cases, 16.7% for deaths), tobacco (7.2% for cases, 7.2% for deaths) and ultraviolet radiation (0.5% for cases, 0.3% for deaths). CONCLUSIONS: Prior to the COVID-19 pandemic, 38.5% of cancer cases and 43.4% of cancer-related deaths in Peru were linked to modifiable risk factors in the population of 15 years old and older. Most preventable cancer cases and deaths were related to oncogenic infections, primarily caused by HPV and helicobacter pylori, followed by tobacco and obesity.

Prevalence of SARS-CoV-2 Variants and Disease Outcome of COVID-19 Patients in the Amazonas Region of Peru.

Peru was severely affected by COVID-19 with a fatality rate that reached up to 6%. In this study, the relationship between SARS-CoV-2 variants and COVID-19 disease outcome in Amazonas, a region of northeastern Peru, was evaluated. The variants were determined by genomic sequencing, and clinical-epidemiological data were collected from 590 patients between April 2021 and February 2022. There was no association between mortality and hospitalization with any of the variants, but we did find that Omicron is more likely to infect vaccinated and nonvaccinated people. A significant association was also found between unvaccinated patients and hospitalization. Interestingly, in the indigenous population, there were fewer hospitalizations than in the general population. In conclusion, SARS-CoV-2 variants were not associated with the disease outcome in the Amazonas region, and indigenous population were found to be less vulnerable to severe COVID-19 illness.

Ultrastructural skin alterations of healthy subjects with anti-desmoglein 1 antibodies in endemic areas to pemphigus foliaceus: A case series.

Background: Endemic pemphigus foliaceus and endemic pemphigus vulgaris are autoimmune dermatologic disorders endemic to the Peruvian Amazon. Objective: To determine the ultrastructural skin alterations of three healthy subjects with anti DSG-1 antibodies in areas endemic to pemphigus foliaceus and pemphigus vulgaris in the Peruvian Amazon. Patients and methods: Case series carried out from data of three clinically healthy subjects positive to anti DSG-1 antibodies, from Peru. This study consists of a sub-analysis of data gathered in a previous study. Results: Ultrastructural results are presented from the skin biopsies of three clinically healthy patients positive to anti-desmoglein 1 (DSG-1) antibodies. High Resolution Optical Microscopy (HROM) showed the absence of acantholysis. Transmission Electron Microscopy (TEM) showed the widening of intercellular space between keratinocytes, the presence of vacuoles in intercellular space with granular material and cytoplasmic vacuolization, loss of desmosome structure, loss of normal distribution among tonofilaments and lateral separation among cells in the stratum basale. Conclusion: According to our results, healthy subjects that present anti-desmoglein 1 antibodies can develop ultrastructural alterations that are visible through transmission electron microscopy but not through conventional optical microscopy.

Factores que favorecen el tamizaje de cáncer de cuello uterino en mujeres de 12 a 49 años: Sub-análisis de la Encuesta Demográfica y de Salud Familiar 2019, Perú

Introducción: La prueba de Papanicolau ayuda a detectar de manera oportuna en la intervención de rutina el cáncer de cuello uterino. Objetivo: Analizar factores asociados al tamizaje para cáncer de cuello uterino en mujeres de 12 a 49 años en Perú durante el año 2019. Metodología: Se realizó un estudio observacional, analítico-transversal de un análisis secundario de datos de la Encuesta Demográfica y de Salud Familiar del 2019. Muestreo bietápico, probabilístico, equilibrado y estratificado. Se utilizó estadística descriptiva y analítica (nivel de inferencia p<0.05). Para el análisis bivariado y multivariado se utilizaron razones de prevalencia con intervalo de confianza de 95% y p<0.05. Resultados: La frecuencia de tamizaje de cáncer de cuello uterino en las regiones políticas con menores valores de prevalencia fueron Pasco (0,52%) y Tumbes (0,55%). Discusión: Los factores asociados al tamizaje de cáncer de cuello uterino son la edad, tener pareja, nivel educación superior, nivel socioeconómico pobre, residir en área rural, tener seguro de salud, edad de inicio de relaciones sexuales y haber escuchado del cáncer de cuello uterino.

Introduction: The Papanicolaou test smear helps detect cervical cancer in a timely manner in routine intervention. Objective: To analyze factors associated with screening for cervical cancer in women aged 12 to 49 years in Peru in 2019. Methods: An observational, analytical-cross-sectional study of a secondary analysis of data from 2019 Demographic and Family Health Survey was carried out. Two-stage, probabilistic, balanced, and stratified sampling. Descriptive and analytical statistics were used (level of inference p<0.05). For the bivariate and multivariate analysis, prevalence ratios were used with a 95% confidence interval and p<0.05. Results: The frequency of cervical cancer screening in the political regions with the lowest prevalence values were Pasco (0.52%) and Tumbes (0.55%). Discussion: The factors associated with cervical cancer screening are age, having a partner, higher education level, poor socioeconomic level, residing in a rural area, having health insurance, age at the start of sexual relations, and having heard of cervical cancer.

Utilidad de la proteína C-reactiva para determinar la gravedad de infección por SARS-CoV-2 en Perú / Usefulness of C-reactive protein to determine the severity of SARS-CoV-2 infection in Peru

INTRODUCCIÓN: En los últimos años se han estudiado diversos biomarcadores para determinar los casos graves de COVID-19. La proteína C-reactiva (PCR) ha mostrado alta sensibilidad en la identificación de pacientes con enfermedad grave y utilidad comparable a la tomografía. OBJETIVO: Determinar la utilidad de la PCR para predecir gravedad de la infección por SARS-CoV-2 en pacientes hospitalizados en el Centro Médico Naval del Perú durante el periodo enero-septiembre del año 2021. MÉTODOS: Se empleó un diseño de tipo cuantitativo, observacional, analítico, retrospectivo, y de tipo prueba diagnóstica. Se calculó un tamaño muestral de 503 pacientes, quienes fueron divididos en dos grupos de acuerdo a su gravedad. RESULTADOS: Se determinó un punto de corte óptimo de 10,92 mg/L de los valores de PCR para el diagnóstico de enfermedad grave por COVID-19. Se calculó un área bajo la curva (AUC) de 0,762 y se obtuvieron valores de sensibilidad, especificidad, valores predictores positivo, negativo y precisión diagnóstica de 78,88%, 66,4%; 41,42%; 87,01%; y 67,27%, respectivamente. El normograma de Fagan mostró una probabilidad posprueba de 41%. En el modelo ajustado fueron significativas la PCR (ORa = 4,853; IC95% 2,987-7,886; p = 0,001), además de la ferritina (ORa = 1,001; IC 95%: 1,001-1,002; p = 0,001) e hipotiroidismo (OR ajustado = 4,899; IC 95%: 1,272-18,872; p = 0,021). CONCLUSIONES: El presente estudio mostró la asociación entre la PCR y la gravedad de infección por SARS-CoV-2 en un modelo ajustado, mostrando su potencial utilidad y contribuyendo a determinar el punto de corte de la PCR en población peruana y su comparación a nivel internacional.

BACKGROUND: Recently, many biomarkers have been studied to determine severe cases of COVID-19. C-reactive protein (CRP) has shown high sensitivity in identifying patients with severe disease and utility comparable to computed tomography. AIM: To determine the usefulness of CRP to predict the severity of SARS-CoV-2 infection in patients hospitalized at the Naval Medical Center of Peru during the period January-September in the year 2021. METHODS: A quantitative, observational, analytical, retrospective, and diagnostic test type design was used. A sample size of 503 patients was calculated, which were divided into two groups according to their severity. RESULTS: An optimal cut-off point of 10.92 mg/L for CRP levels was determined for the diagnosis of severe COVID-19. An area under the curve (AUC) of 0.762 was calculated and sensitivity, specificity, positive and negative predictive values and diagnostic accuracy values of 78.88%, 66.4%; 41.42%; 87.01%; and 67.27%; respectively. Fagan's normogram showed a post-test probability of 41%. In the adjusted model, CRP (aOR = 4.853; 95% CI 2.987-7.886; p = 0.001), ferritin (aOR = 1.001; 95% CI: 1.001-1.002; p = 0.001) and hypothyroidism (adjusted OR = 4899; 95% CI: 1272-18872; p = 0.021) showed significance. CONCLUSIONS: The present study showed an association between CRP and the severity of SARS-CoV-2 infection in an adjusted model, showing its potential utility and contributing to determine the cut-off point of CRP in the Peruvian population and its international comparison.

The Fruit Intake-Adiposity Paradox: Findings from a Peruvian Cross-Sectional Study.

Due to the increase in obesity worldwide, international organizations have promoted the adoption of a healthy lifestyle, as part of which fruit consumption stands out. However, there are controversies regarding the role of fruit consumption in mitigating this disease. The objective of the present study was to analyze the association between fruit intake and body mass index (BMI) and waist circumference (WC) in a representative sample of Peruvians. This is an analytical cross-sectional study. Secondary data analysis was conducted using information from the Demographic and Health Survey of Peru (2019-2021). The outcome variables were BMI and WC. The exploratory variable was fruit intake, which was expressed in three different presentations: portion, salad, and juice. A generalized linear model of the Gaussian family and identity link function were performed to obtain the crude and adjusted beta coefficients. A total of 98,741 subjects were included in the study. Females comprised 54.4% of the sample. In the multivariate analysis, for each serving of fruit intake, the BMI decreased by 0.15 kg/m2 (ß = -0.15; 95% CI -0.24 to -0.07), while the WC was reduced by 0.40 cm (ß = -0.40; 95% CI -0.52 to -0.27). A negative association between fruit salad intake and WC was found (ß = -0.28; 95% CI -0.56 to -0.01). No statistically significant association between fruit salad intake and BMI was found. In the case of fruit juice, for each glass of juice consumed, the BMI increased by 0.27 kg/m2 (ß = 0.27; 95% CI 0.14 to 0.40), while the WC increased by 0.40 cm (ß = 0.40; 95% CI 0.20 to 0.60). Fruit intake per serving is negatively related to general body adiposity and central fat distribution, while fruit salad intake is negatively related to central distribution adiposity. However, the consumption of fruit in the form of juices is positively associated with a significant increase in BMI and WC.

Factors Associated with Symptoms of Depression among People with Obesity: Analysis of a 3-Year-Peruvian National Survey.

INTRODUCTION: Obesity and depression contribute to the global burden of economic cost, morbidity, and mortality. Nevertheless, not all people with obesity develop depression. OBJECTIVE: To determine the factors associated with depressive symptoms among people aged 15 or older with obesity from the National Demographic and Family Health Survey (ENDES in Spanish 2019-2021). METHODS: Cross-sectional analytical study. The outcome of interest was the presence of depressive symptoms, assessed using the Patient Health Questionnaire-9 (PHQ-9). Crude (cPR) and adjusted (aPR) prevalence ratios were estimated using GLM Poisson distribution with robust variance estimates. RESULTS: The prevalence of depression symptoms was 6.97%. In the multivariate analysis, a statistically significant association was found between depressive symptoms and female sex (PRa: 2.59; 95% CI 1.95-3.43); mountain region (PRa: 1.51; 95% CI 1.18-1.92); wealth index poor (PRa: 1.37; 95% CI 1.05-1.79, medium (PRa: 1.49; 95% CI 1.11-2.02), and rich (PRa: 1.65; 95% CI 1.21-2.26); daily tobacco use (PRa: 2.05, 95% CI 1.09-3.87); physical disability (PRa: 1.96, 95% CI 1.07-3.57); and a history of arterial hypertension (PRa: 2.05; 95% CI 1.63-2.55). CONCLUSION: There are several sociodemographic factors (such as being female and living in the Andean region) and individual factors (daily use of tobacco and history of hypertension) associated with depressive symptoms in Peruvian inhabitants aged 15 or older with obesity. In this study, the COVID-19 pandemic was associated with an increase in depressive symptoms.

Management indicators in research 2022 INICIB-URP / Indicadores de gestión en investigación 2022 INICIB-URP

Given the importance of the research component to respond to phenomena and problems demanded by society , At Universidad Ricardo Palma, research has been fostered and promoted as an institutional policy. The Instituto de Investigación en Ciencias Biomédicas, which reports to the Rectorate and is integrated into the Facultad de Medicina Humana, has been working to contribute substantially to this growth in research. The research is directly related to the quality processes of higher education, innovation, extension, linking, licensing, accreditation, and finally, the ranking of universities. As is evident, the research is linked to the present and the future of universities. Therefore, measuring the impact of research is essential because educational institutions are and must be permanent generators of intellectual property, knowledge and human resources, which impact the educational, scientific, economic and social sectors.

Dada la importancia del componente investigación para dar respuesta afenómenos y problemas que demanda la sociedad , en la Universidad Ricardo Palma se viene impulsando y promoviendo la investigación como una politica institucional. El Instituto de Investigaciones en Ciencias Biomédicas, que depende de Rectorado y está integrado a la Facultad de Medicina Humana, viene trabajando para contribuir de manera sustancial a este crecimiento de lainvestigación. La investigación esta directamente relacionada con los procesos de calidad de la educación superior, innovación, extensión, vinculación, licenciamiento, acreditación y finalmente con el ranking de las universidades. Como resulta evidente la investigación esta ligada con el presente y el futuro de las universidades. Por ello, es fundamental medir el impacto de la investigación porque las instituciones educativas son y deben ser generadoras permanentes de propiedad intelectual, conocimiento y recursos humanos, que impacten en los sectores educativo, científico, económico y social.

Important advances in regenerative medicine. A vision to the future of ophthalmology / Avances importantes en medicina regenerativa. Una visión al futuro de la oftalmología

The treatment of corneal lesions continues to be a topic of great interest. However, despite the development of new technologies and due to the slow evolution and uncertain healing of corneal lesions, they still represent a public health problem since patients can be affected for life, affecting the family and the health system due to the costly and uncertain response to treatment. For this reason, the need arises to seek therapeutic alternatives to treat these patients.

El tratamiento de lesiones corneales sigue siendo un tema de gran interés. Pese al desarrollo de nuevas tecnologías y debido a la evolución lenta, e incierta cicatrización que tienen las lesiones corneales, estas todavía representan un problema de salud pública, ya que los pacientes pueden verse afectados de por vida afectando a la familia y al sistema de salud por lo costoso e incierta respuesta al tratamiento. Por esta razón, surge la necesidad de buscar alternativas terapéuticas para tratar a estos pacientes.

Epidemiological Characteristics of Deaths from COVID-19 in Peru during the Initial Pandemic Response.

BACKGROUND AND AIM: Peru is the country with the highest mortality rate from COVID-19 globally, so the analysis of the characteristics of deaths is of national and international interest. The aim was to determine the epidemiological characteristics of deaths from COVID-19 in Peru from 28 March to 21 May 2020. METHODS: Deaths from various sources were investigated, including the COVID-19 Epidemiological Surveillance and the National System of Deaths (SINADEF). In all, 3851 deaths that met the definition of a confirmed case and had a positive result of RT-PCR or rapid test IgM/IgG, were considered for the analysis. We obtained the epidemiological variables and carried out an analysis of time defined as the pre-hospital time from the onset of symptoms to hospitalization, and hospital time from the date of hospitalization to death. RESULTS: Deaths were more frequent in males (72.0%), seniors (68.8%) and residents of the region of Lima (42.7%). In 17.8% of cases, the death occurred out-of-hospital, and 31.4% had some comorbidity. The median of pre-hospital time was 7 days (IQR: 4.0-9.0) and for the hospital time was 5 days (IQR: 3.0-9.0). The multivariable analysis with Poisson regression with robust variance found that the age group, comorbidity diagnosis and the region of origin significantly influenced pre-hospital time; while sex, comorbidity diagnosis, healthcare provider and the region of origin significantly influenced hospital time. CONCLUSION: Deaths occurred mainly in males, seniors and on the coast, with considerable out-of-hospital deaths. Pre-hospital time was affected by age group, the diagnosis of comorbidities and the region of origin; while, hospital time was influenced by gender, the diagnosis of comorbidities, healthcare provider and the region of origin.

Hospitalization, death, and probable reinfection in Peruvian healthcare workers infected with SARS-CoV-2: a national retrospective cohort study.

BACKGROUND: Peru has some of the worst outcomes worldwide as a result of the SARS-CoV-2 pandemic; it is presumed that this has also affected healthcare workers. This study aimed to establish whether occupation and other non-occupational variables were risk factors for possible reinfection, hospitalization, and mortality from COVID-19 in cohorts of Peruvian healthcare workers infected with SARS-CoV-2. METHODS: Retrospective cohort study. Healthcare workers who presented SARS-CoV-2 infection between March 1, 2020, and August 6, 2021, were included. Occupational cohorts were reconstructed from the following sources of information: National Epidemiological Surveillance System, molecular tests (NETLAB), results of serology and antigen tests (SICOVID-19), National Registry of Health Personnel (INFORHUS), and National Information System of Deaths (SINADEF). The incidence of probable reinfection, hospitalization, and death from COVID-19 was obtained in the cohorts of technicians and health assistants, nursing staff, midwives, dentists, doctors, and other healthcare workers. We evaluated whether the occupation and other non-occupational variables were risk factors for probable reinfection, hospitalization, and death from COVID-19 using log-binomial and probit binomial models, obtaining the adjusted relative risk (RRAJ). RESULTS: 90,398 healthcare workers were included in the study. Most cases were seen in technicians and health assistants (38.6%), and nursing staff (25.6%). 8.1% required hospitalization, 1.7% died from COVID-19, and 1.8% had probable reinfection. A similar incidence of probable reinfection was found in the six cohorts (1.7-1.9%). Doctors had a higher incidence of hospitalization (13.2%) and death (2.6%); however, they were also those who presented greater susceptibility linked to non-occupational variables (age and comorbidities). The multivariate analysis found that doctors (RRAJ = 1.720; CI 95: 1.569-1.886) had a higher risk of hospitalization and that the occupation of technician and health assistant was the only one that constituted a risk factor for mortality from COVID-19 (RRAJ = 1.256; 95% CI: 1.043-1.512). CONCLUSIONS: Peruvian technicians and health assistants would have a higher risk of death from COVID-19 than other healthcare workers, while doctors have a higher incidence of death probably linked to the high frequency of non-occupational risk factors. Doctors present a higher risk of hospitalization independent of comorbidities and age; likewise, all occupations show a similar risk of probable reinfection.

Factores asociados al cribado de Diabetes Mellitus en población Peruana ¿problema para la salud pública? / Factors Associated with Diabetes Mellitus Screening in Peruvian Population: A public health problem? / Fatores associados à triagem da Diabetes Mellitus na população Peruana: um problema de saúde pública?

Introducción: La Diabetes Mellitus tipo 2 es una enfermedad que representa un reto para la salud pública por su tendencia al crecimiento e impacto sobre todo en países en desarrollo. Objetivo: determinar los factores asociados a la no realización del cribado de diabetes mellitus tipo 2 según la encuesta demográfica y de salud familiar del año 2020 (ENDES-2020). Materiales y métodos: Estudio analítico transversal secundario de la ENDES-2020. Resultados: Las variables que mostraron asociación estadísticamente significativa para cribado de DM2 fueron: sexo masculino (PR=1,06, IC95% 1,02­1,10; p<0,001), edad entre 30 a 59 años (0,92; IC95% 0,89­0,95; p<0,001) y 60 años a más (PR=0,72; IC95% 0,65­0,79; p<0,001), educación primaria (PR=0,94, IC 95% 0,92 - 0,99; p<0,020), secundaria (PR=0,93; IC 95% 0,88­0,97; p=0,008) y superior (PR=0,86, IC 95% 0,85­0,94; p<0,001), ser pobre (PR=0,96, IC95% 0,92­0,99; p=0,016), medio (PR=0,93; IC95% 0,88 ­ 0,96; p=0,001), rico (PR=0,89; IC95% 0,84 ­ 0,94; p<0,001), muy rico (PR=0,81; IC95% 0,75­0,86; p<0,001), e hipertensión (PR=0,91; IC 95% 0,867­0,969; p=0,002). Discusión: El sexo masculino fue el único factor asociado a la no realización del cribado de diabetes mellitus tipo 2, mientras que, pertenecer a un grupo de edad mayor, tener hipertensión arterial, mayor nivel educativo y socioeconómico aumentó la posibilidad de realizarlo. Conclusión: Es imprescindible reforzar las estrategias de cribado en el primer nivel de atención, mediante la implementación de medidas de prevención.

Introduction: Type 2 Diabetes Mellitus (T2DM) is a disease that poses a challenge to public health due to its growth trend and impact, especially in developing countries. This study aimed to determine the factors associated with not being screened for T2DM according to the 2020 Demographic and Family Health Survey (ENDES-2020). Materials and Methods: Secondary, cross-sectional, analytical study using the ENDES-2020 data. Results: The variables that showed a statistically significant association for T2DM screening were the following: male sex (PR=1.06, 95% CI: 1.02­1.10; p<0.001), ages between 30 and 59 years (0.92, 95% CI: 0.89­0.95; p<0.001) and 60 years and older (PR=0.72, 95% CI: 0.65­0.79; p<0.001), primary education (PR=0.94, 95% CI: 0.92­0.99; p<0.020), secondary education (PR=0.93, 95% CI: 0.88­0.97; p=0.008) higher education (PR=0.86, 95% CI: 0.85­0.94; p<0.001), poor (PR=0.96, 95% CI: 0.92­0.99; p=0.016), middle income (PR=0.93, 95% CI: 0.88­0.96; p=0.001), rich (PR=0.89, 95% CI: 0.84­0.94; p<0.001), very rich (PR=0.81, 95% CI: 0.75­0.86; p<0.001), and hypertension (PR=0.91, 95% CI: 0.867­0.969; p=0.002). Discussion: Being male was the only factor associated with not being screened for T2DM, whereas belonging to an older age group, having arterial hypertension, and having higher education and socioeconomic levels increased the possibility of being screened. Conclusion: It is essential to strengthening screening strategies at the primary level of care by implementing preventive measures.

Introdução: A diabetes melito tipo 2 é uma doença que representa um desafio à saúde pública devido a sua crescente tendência e impacto, especialmente em países em desenvolvimento. O objetivo deste estudo foi determinar os fatores associados à não realização de triagem para diabetes mellitus tipo 2 de acordo com a Pesquisa Demográfica e de Saúde da Família 2020 (DHS-2020). Materiais e métodos: Estudo analítico transversal secundário do ENDES-2020. Resultados: As variáveis que mostraram associação estatisticamente significativa para a triagem DM2 foram: sexo masculino (PR=1,06, 95%CI 1,02-1,10, p<0,001), idade 30-59 anos (0,92, 95%CI 0,89-0,95, p<0,001) e 60 anos ou mais (PR=0,72, 95%CI 0,65-0,79, p<0,001), educação primária (PR=0,94, 95%CI 0,92-0,99, p<0,020), educação secundária (PR=0,93, 95%CI 0,88-0,97, p=0,008), e educação secundária superior (PR=0,93, 95%CI 0,88-0,97, p=0,008); p=0,008) e superior (PR=0,86, 95% CI 0,85-0,94; p<0,001), pobre (PR=0,96, 95% CI 0,92-0,99; p=0,016), médio (PR=0,93, 95% CI 0,88 - 0,96; p=0,001), rica (PR=0,89; 95%CI 0,84 - 0,94; p<0,001), muito rica (PR=0,81; 95%CI 0,75-0,86; p<0,001), e hipertensão (PR=0,91; 95%CI 0,867-0,969; p=0,002). Discussão: O sexo masculino foi o único fator associado com a não realização de triagem para diabetes mellitus tipo 2, enquanto pertencia a uma faixa etária mais velha, ter hipertensão, educação superior e status socioeconômico aumentou a probabilidade de triagem. Conclusão: É essencial reforçar as estratégias de triagem no nível da atenção primária através da implementação de medidas preventivas.

Conocimientos, actitudes y prácticas sobre el consumo de sal en la población peruana: Estudio transversal / Knowledge, attitudes and practices about salt consumption in the Peruvian population: A crosssectional study

Introducción: La reducción del consumo de sal se ha identificado como una de las intervenciones prioritarias para prevenir las enfermedades no transmisibles a nivel mundial. Por ello, se recomienda que uno de los tres pilares para reducir su ingesta es reconocer el nivel de conocimientos, actitudes y prácticas relacionadas con el consumo de sal (CAP-sal). Objetivo: Determinar el nivel de CAP-sal y los factores asociados a estos en la población peruana. Materiales y métodos: Estudio transversal analítico realizado mediante encuesta virtual en población adulta peruana. Resultados: Se trabajó con una muestra de 918 sujetos. La proporción de participantes con conocimiento, actitudes y prácticas suficientes, fue del 54,58 %; 50,22 % y 40,31 %, respectivamente. Las variables que aumentan la probabilidad de tener un nivel suficiente de CAP-sal fueron el sexo femenino, la presencia de obesidad e HTA. Mientras que los antecedentes familiares y área de residencia lo fueron únicamente para conocimientos, el grado de instrucción para conocimientos y prácticas, y la actividad física tanto para actitudes como prácticas. Conclusiones: Tanto el nivel de conocimiento y actitudes fueron suficientes en la mitad de la muestra, pero las prácticas se encuentran por debajo de esta. Existen brechas que varían según las características sociodemográficas, como la edad, sexo, antecedentes de HTA, obesidad y realización de actividad física. Resultados que podrían apoyar la inclusión de la promoción de una nutrición saludable en la población peruana(AU)

Introduction: Reducing salt intake has been identified as one of the priority interventions to prevent non-communicable diseases worldwide. For this reason, it is recommended that one of the three pillars to reduce its intake is to recognize the level of Knowledge, Attitudes and Practices related to salt consumption (CAP-salt, in Spanish). Objective: To determine the level of CAP-salt and the factors associated with these in the Peruvian population. Materials and Methods: Cross-sectional analytical study carried out through a virtual survey of the Peruvian population. Results: We studied 918 subjects. The proportion of patients with sufficient knowledge, attitudes and practices was 54.58 %; 50.22 % and 40.31 %, respectively. The factors that increase the probability of having sufficient CAPsalt were female sex, the presence of obesity and hypertension. While family history and area of residence were only for knowledge, the degree of education for knowledge and practices, and physical activity for both attitudes and practices. Conclusions: The level of knowledge and sufficient attitudes are present in half of the population, but the practices are below this. In turn, several gaps vary according to sociodemographic characteristics, such as age, sex, history of hypertension, obesity, and physical activity, which could be the target of the new population awareness goals(AU)

Impacto de la retinopatía hipertensiva asociada a cardiopatías coronarias / Impact of hypertensive retinopathy associated with coronary heart disease

Introducción: La asociación entre la retinopatía hipertensiva y cardiopatías coronarias es un tema de una larga controversia. La retinopatía hipertensiva ha sido definida como un predictor de mortalidad y morbilidad en pacientes hipertensos desde hace mucho tiempo. Además, estudios recientes han demostrado que la microvasculatura retiniana refleja la patología en los pequeños vasos sistémicos, incluida la microcirculación coronaria. Objetivos: El objetivo fue realizar una revisión sistemática y un análisis cualitativo y cuantitativo mediante un metanálisis para determinar la asociación entre la retinopatía hipertensiva y cardiopatías coronarias. Métodos: Se realizó la búsqueda sistemática de estudios relacionados con el tema. La fuente de búsqueda fue PubMed y Google Scholar. La revisión sistemática y meta-análisis se desarrollaron con las pautas Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Resultados: Se demostró que existe una asociación entre la retinopatía hipertensiva y la enfermedad de la arteria coronaria. (P=0,01; RR 1,29; IC 95 por ciento: 1,06 a 1,56), se evaluó la hipertrofia ventricular izquierda como desenlace, se encontró un efecto estadísticamente significativo que asocia a la retinopatía hipertensiva con la hipertrofia ventricular izquierda (p=0,03; RR: 1,71; IC 95 por ciento: 1,31 a 2,24). Conclusiones: Se encontró asociación entre retinopatía hipertensiva y las cardiopatías coronarias más frecuentes (Enfermedad coronaria e HVI)(AU)

Introduction: The association between hypertensive retinopathy and coronary heart disease is a subject of long-standing controversy. Hypertensive retinopathy has long been defined as a predictor of mortality and morbidity in hypertensive patients. In addition, recent studies have shown that the retinal microvasculature reflects pathology in small systemic vessels, including the coronary microcirculation. Objectives: The aim was to perform a systematic review and a qualitative and quantitative analysis by meta-analysis to determine the association between hypertensive retinopathy and coronary heart disease. Methods: A systematic search for studies related to the topic was performed. The search source was PubMed and Google Scholar. The systematic review and meta-analysis were developed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Results: An association between hypertensive retinopathy and coronary artery disease was demonstrated (P=0.01; RR 1.29; 95 percent CI: 1.06 to 1.56), left ventricular hypertrophy was evaluated as an outcome, a statistically significant effect was found associating hypertensive retinopathy with left ventricular hypertrophy (P=0.03; RR: 1.71; 95 percent CI: 1.31 to 2.24). Conclusions: An association was found between hypertensive retinopathy and the most frequent coronary heart diseases (coronary artery disease and LVH)(AU)

Arsenicism by Chronic Exposure to Mine Tailings in Peru: An Analysis of 17 Cases with Lesions on Skin and/or Annexes.

Objective: To characterize the epidemiology and clinical manifestations of arsenicism from chronic exposure to mine tailings in people with lesions on their skin and/or annexes in two mining districts in the highlands of Peru. Materials and Methods: In this case series study, we included 17 people that presented arsenical lesions in skin and annexes which were identified in two prior studies. We evaluated age, occupation, place of exposure, time of exposure, time of disease, manifestations on skin and annexes, location of lesions, severity, and 24-hour urine clearance of arsenic. Results: The average time of exposure was 16.5 ± 14.7 years, and the average length of disease was 9.8 ± 8.1 years. In this study, 70.6% were men, 41.2% were farmers and 17.6% were underage. The most frequent main manifestations in skin and annexes were plantar keratosis (23.5%), palmar (11.8%), palmoplantar (11.8%) and thoracic keratosis (5.9%). Other manifestations were palmoplantar keratosis with thoracic hyperpigmentation (17.6%), Mees' lines (17.6%) and hyper/hypopigmentation in thorax and back (11.8%). With relation to the severity of lesions, 35.3% were grade 1 (mild), 29.4 % were grade 0 (asymptomatic), 29.4 % were grade 2 (moderate), and 5.9% were grade 3 (severe). The median of 24-hour urine clearance of arsenic was 55 µg/L/24 hours. No cases of skin cancer were presented. Conclusion: The studied cases of arsenicism with lesions on skin and/or annexes by exposure to mine tailings present with differential characteristics in comparison to other forms of arsenicism such as less severity, lower urine clearance of arsenic, and absence of skin cancer cases.