RESUMO
OBJECTIVE: To investigate the level of awareness of primary immunodeficiency diseases among physicians working at Instituto Nacional de Salud del Niño. METHODS: Cross-sectional study including pediatric residents and pediatricians working at the Instituto Nacional de Salud del Niño during the study period (2017-2019). Physicians working at the immunology unit and surgery departments were excluded. Three aspects of awareness of primary immunodeficiency diseases were investigated: education, general knowledge, and diagnostic suspicion and actions taken in the face of suspicion. RESULTS: This sample comprised 83 physicians with a median age of 33 years. Most physicians were women (71.1%) and half were pediatric residents. During their undergraduate studies, 43.1% had taken primary immunodeficiency disease courses, and 39.2% had attended conferences on this topic. During their residency training, 25.9% had taken primary immunodeficiency disease courses, and 60.3% had participated in conferences on this topic. Among pediatricians, 50% had taken primary immunodeficiency disease courses, and 53.1% had attended conferences on this topic. Only 39.8% of physicians reported being familiar with the list of 10 warning signs developed by the Jeffrey Modell Foundation. More than half of physicians considered the lack of access to laboratory tests the major challenge in making diagnosis of primary immunodeficiency diseases. CONCLUSION: This study revealed limited awareness of primary immunodeficiency diseases among physicians working at Instituto Nacional de Salud del Niño. Although most physicians suspected primary immunodeficiency diseases in patients with a history of recurrent infections and frequent use of antibiotics, not all of them were familiar with the list of 10 warning signs proposed by the Jeffrey Modell Foundation, nor were they able to describe ancillary tests requested in suspected cases.
Assuntos
Antibacterianos , Doenças da Imunodeficiência Primária , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Peru/epidemiologiaRESUMO
Objetivo General: Identificar el perfil clínico y de laboratorio al momento del diagnóstico del lupus eritematoso sistémico (LES) en pacientes del Hospital Nacional Arzobispo Loayza (HNAL) del 2009-2013. Metodología: Estudio descriptivo, observacional, transversal. La población estudiada fueron pacientes del HNAL con el diagnóstico de LES del 2009-2013. Se registró información de las historias clínicas mediante una ficha de recolección de datos validada mediante juicio de expertos. Los resultados fueron analizados utilizando el paquete estadístico SPSS 20, y presentados mediante medias, medianas y rango intercuartilar (RIC). Resultados: 67 pacientes con edad promedio de 34±13 años al momento del diagnóstico. Las medianas del tiempo de enfermedad previo al diagnóstico y de demora al diagnóstico fueron 3 (RIC 1-6) y 0 (RIC 0-1) meses, respectivamente. Todos los pacientes presentaron síndrome general. Las manifestaciones clínicas más frecuentes fueron artritis/sinovitis (65,7 por ciento), alopecia sin cicatrices (25,4 por ciento) y fotosensibilidad (22,4 por ciento). Las manifestaciones de laboratorio más frecuentes fueron anticuerpo antinuclear positivo (83,6 por ciento) linfopenia e hipocomplementemia (ambos con 62,7 por ciento). La distribución del cumplimiento de criterios del American College of Rheumatology (ACR) y Systemic Lupus International Collaborating Clinics (SLICC) fue del 67,2 por ciento y 80,6 por ciento, respectivamente. La mediana del número de criterios ACR y SLICC al diagnóstico fue 4 (RIC 3-5) y 5 (RIC 4-6), respectivamente; 31,3 por ciento presentaron exclusivamente criterio médico para el diagnóstico. Conclusiones: Las principales manifestaciones implican alteraciones sistémicas y órgano-específicas, como hematológicas, articulares e inmunológicas. Se resalta la importancia del criterio médico para el diagnóstico de LES en la práctica clínica.
General Objective: To identify clinical and laboratory characteristics at diagnosis of systemic lupus erythematosus (SLE) at National Hospital Arzobispo Loayza (HNAL) since 2009 to 2013. Methodology: Descriptive, observational and cross-type study. Population studied were patients with the diagnosis of SLE in the register of the Department of Statistics of the National Hospital Arzobispo Loayza among 2009 to 2013. Information from medical records was recorded by a data collection sheet validated by expert judgment, analyzing with SPSS 20.0 Results: 67 patients with an average age of 34±13 years were included. Median time to disease prior to diagnosis and delay to diagnosis were 3 (IQR 1-6) and o (IQR 0-1) months, respectively. All the patients had general syndrome. The most common clinical manifestations were arthritis/synovitis (65.7 per cent), photosensitivity (22.4 per cent) and alopecia unscarred (25.4 per cent). The most frequent manifestations of laboratory features were title positive for antinuclear antibody (83.6 per cent), lymphopenia and hypocomplementemia (bother with 62.7 per cent). The compliance of criteria of the American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) was 67.2 per cent and 80.6 per cent, respectively. The median of criteria at diagnosis for ACR and SLICC was 4 (IQR 3-5) and 5 (IQR 4-6), respectively. On the other hand, 31.3 per cent of the patients were diagnosis purely by medical criteria for the diagnosis of SLE. Conclusions: The main manifestations involve systemic and specific alterations, as hematological, joint and immune. Furthermore, it is relevant the importance of the medical criteria for diagnosis of SLE at the clinical practice.