Factors associated with indication of prophylactic extraction of the lower third molar in orthodontic practice.

Background: To date, there is no consensus on the factors that influence on indication for prophylactic extraction of the third molar, however it is a common indication in orthodontics. Aim: To determine the factors associated with indication of prophylactic extraction of the lower third molar in orthodontic practice. Material and Methods: This cross-sectional analytical study used an online survey to obtain responses from 100 professionals with clinical practice in orthodontics. The Survey Monkey software was used to enter a valid and reliable questionnaire of 11 questions to obtain demographic and clinical information of the professional, as well as some patient conditions that could be considered in a possible indication for prophylactic extraction. The questionnaire was sent through social networks and instant messaging applications. Chi Square test was used to evaluate associated factors and binomial logistic regression to identify risk or protective factors. Results: Factors significantly associated with indication of prophylactic extraction of the lower third molar were experience in orthodontics (p-value = 0.060; OR=0.325), characteristics of impaction (p-value = 0.012; OR=3.689), prevention of pericoronitis (p-value = 0.014; OR=3.769) and help stability of treatment results (p-value = 0.002; OR=6.074). Conclusions: The risk factors to indication for prophylactic extraction of the lower third molar were impaction of the third molar, prevention of pericoronitis and helping the stability of the results after treatment. Furthermore, experience in orthodontics was identified as a protective factor for this indication. Key words:Orthodontics, risk factors, third molar, tooth extraction.

Crisis due to war: anxiety, depression and stress in the population of 13 Latin American countries.

Sustainability may be at risk in a population that has altered health, according to Sustainable Development Goal 3 (SDG 3): Health and well-being. The ongoing conflict between Russia and Ukraine could jeopardize SDG 3, specifically the mental health of the population. The present study sought to determine the association between severe anxiety, depression and stress in population of 13 Latin American countries according to fear about the war conflict. It was a cross-sectional, analytical and multicenter study. Anxiety, depression and stress were measured with the DASS-21 test (Cronbach's Alpha: 0.97) and fear due to an armed crisis with a questionnaire already validated in Latin America (Cronbach's Alpha: 0.92), which was also adjusted for sex, age, education level and country of residence. Descriptive and analytical statistics were obtained. Of the 2,626 respondents, the main fear was that weapons of mass destruction would be used. In the multivariate models, strong associations were found between fear of a possible world-scale armed conflict and having severe or very severe levels of anxiety (aPR: 1.97; 95% CI: 1.64-2.36; value of p <0.001), depression (aPR: 1.91; 95% CI: 1.54-2.36; value of p <0.001) or stress (aPR: 2.05; 95% CI: 1.63-2.57; value of p <0.001). Sustainability linked to SDG 3, specifically mental health, is affected by this type of significant events, given the possible global war crisis that could trigger major events, even more so if added to the deterioration already experienced by COVID-19 in the Latin American region, insecurity and constant political uncertainty.

Post-Traumatic Stress Associated with Telework-Related Job Limitation in Latin America.

During the pandemic, there has been evidence of work limitations during telework, which are believed to cause mental health problems. Our objective was to assess the association between perceived work limitations during telework and posttraumatic stress during the COVID-19 pandemic in Latin America. A cross-sectional study was conducted in Latin America in 2020. Exposure was measured by self-reporting using a self-perception questionnaire; the SPRINT-E questionnaire was used for outcome measurements. Generalized linear models were applied. Of 1329 participants, 15.2% (n = 202) had posttraumatic stress. In a multivariate analysis, the highest frequency of posttraumatic stress was found among those with moderate depression or more (PR = 1.29; 95% CI: 1.03-1.61), moderate or more anxiety (PR = 2.34; 95% CI: 1.61-3.41), and moderate or more stress (PR = 2.45; 95% CI: 1.46-4.12). In conclusion, there is an association between perceived work limitations during telework and posttraumatic stress in Latin American workers. For this reason, it is recommended that occupational physicians, companies, and institutions assess the frequency of posttraumatic stress and monitor the mental health of workers.

Latin American perceptions of fear and exaggeration transmitted by the media with regard to COVID-19: frequency and association with severe mental pathologies.

Introduction: The COVID-19 pandemic contributed to the spread of abundant misinformation by the media, which caused fear and concern. Objective: To determine the association between the pathologies of the mental sphere and the perceptions of fear and exaggeration transmitted by the media with respect to COVID-19 in Latin America. Methodology: The present study has an analytical cross-sectional design that is based on a validated survey to measure fear and exaggeration transmitted by the media and other sources (Cronbach's α: 0.90). We surveyed more than 6,000 people, originally from 12 Latin American countries, who associated this perceived exaggeration with stress, depression, and anxiety (measured through DASS-21, Cronbach's α: 0.96). Results: Social networks (40%) or television (34%) were perceived as the sources that exaggerate the magnitude of the events. In addition, television (35%) and social networks (28%) were perceived as the sources that generate much fear. On the contrary, physicians and health personnel are the sources that exaggerated less (10%) or provoked less fear (14%). Through a multivariate model, we found a higher level of global perception that was associated with whether the participant was older (p = 0.002), had severe or more serious anxiety (p = 0.033), or had stress (p = 0,037). However, in comparison with Peru (the most affected country), there was a lower level of perception in Chile (p < 0.001), Paraguay (p = 0.001), Mexico (p < 0.001), Ecuador (p = 0.001), and Costa Rica (p = 0.042). All of them were adjusted for gender and for those having severe or major depression. Conclusion: There exists an association between some mental pathologies and the perception that the media does not provide moderate information.

Manifestaciones laríngeas de COVID-19 / Laryngeal manifestations of COVID-19

Introducción: la infección por COVID-19 afecta el tracto aerodigestivo superior a través de la enzima convertidora de angiotensina 2 (ECA2) y/o la proteasa transmembrana serina 2 (TMPRSS2). Sus manifestaciones agudas y secuelas han sido muy variadas y no todas están relacionadas con la intubación orotraqueal. El objetivo es describir las características sociodemográficas, clínicas y los hallazgos endoscópicos de los pacientes con síntomas laringofaríngeos posteriores a una infección por SARS-CoV-2 evaluados en el Hospital Militar Central y Hospital Universitario Clínica San Rafael entre marzo de 2020 y marzo de 2022. Materiales y métodos: estudio observacional de corte transversal con datos sociodemográficos, comorbilidades, necesidad de intubación orotraqueal, variedad de síntomas y sus hallazgos endoscópicos. Resultados: se recolectaron datos de 118 pacientes; la edad media fue de 51 años ± 14,4. El síntoma más frecuente fue la disfonía (69,5 %), seguido de la disnea (39,8 %). El 58,9 % requirió intubación orotraqueal y, de estos, la manifestación más frecuente fue disfonía por tensión muscular (DTM) y estenosis subglótica-traqueal. En el 41,1 % restante su hallazgo más frecuente fue la laringitis irritativa. Conclusiones: la COVID-19 tiene múltiples manifestaciones laringofaríngeas en relación con su mecanismo de infección e invasión en los tejidos de esta zona, de tipo inflamatorio y estructural, y no todos están relacionados con la intubación.

Introduction: COVID 19 infection affects the upper aerodigestive tract through angiotensin-converting enzyme 2 (ACE2) and/or Transmembrane serine protease 2 (TMPRSS2). Its acute manifestations and sequelae have been very varied, and not all of them are related to orotracheal intubation. The objective is to describe the sociodemographic and clinical characteristics and the endoscopic findings of patients with laryngopharyngeal symptoms after SARS-CoV-2 infection evaluated at the Hospital Militar Central and Hospital Universitario Clínica San Rafael between March 2020 and March 2022. Methods: Cross-sectional observational study, obtaining sociodemographic data, comorbidities, need for orotracheal intubation, variety of symptoms and their endoscopic findings. Results: 118 patients were collected; the mean age was 51 years ± 14.4. The most frequent symptom was dysphonia (69.5%), followed by dyspnea (39.8%). 58.9% required orotracheal intubation and of these the most frequent manifestation was muscular tension dysphonia (MTD) and subglottictracheal stenosis. In the remaining 41.1%, the most frequent finding was irritative laryngitis. Conclusions: COVID-19 has multiple laryngopharyngeal manifestations in relation to its mechanism of infection and invasion in the tissues of this area, as an inflammatory and structural type, and not all of them are related to intubation.

Factores asociados a la percepción de repercusiones del internado hospitalario peruano durante la COVID-19

Introducción: La pandemia afectó el internado de estudiantes de salud en su asistencia hospitalaria, en la cual realizan las prácticas. Objetivo: Determinar los factores asociados a la percepción de repercusiones del internado hospitalario peruano durante la COVID-19. Métodos: Estudio transversal; se obtuvo estadística descriptiva, analítica bivariada y multivariada basado en una encuesta realizada de forma exploratoria, como parte de otra investigación mayor, a la cual se le asoció variables como edad, sexo, tipo de universidad, estrés, ansiedad, depresión y repercusiones del internado. Resultados: De los 121 encuestados, la mayoría pensó que su familia le hubiese apoyado si se enfermaba de gravedad, que pudo haber infectado a sus familiares o alguna amistad/conocido si acudían al hospital. Muchos estuvieron en desacuerdo con que el hospital o la universidad les darían los implementos de seguridad, por la falta de apoyo de estas entidades. Hubo asociación entre el pensar que se habría contagiado de la COVID-19 si iba al hospital versus el puntaje de ansiedad (p= 0,030), el sexo masculino, según la percepción de que la universidad les daría los materiales para cuidarse (p= 0,029) y el provenir de una universidad privada según el percibir que el hospital no le hubiese apoyado, si se enfermaba de gravedad (p= 0,049). Conclusión: Los factores asociados a la percepción de repercusiones del internado son el apoyo familiar, el poder contagiar a sus familiares, falta de materiales dados por las universidades y hospitales, la ansiedad, el sexo masculino y provenir de universidades privadas.

Introduction: The pandemic affected the internship of health sciences students when they attended the hospital. Objective: To determine the factors associated with the perceived impact of the Peruvian hospital internship during COVID-19. Methods: Cross-sectional; descriptive, bivariate analytical and multivariate statistics were obtained based on an exploratory survey conducted as part of a larger investigation, to which variables such as age, sex, type of university, stress, anxiety, depression, and repercussions of the internship were associated. Results: Of 121 respondents, most of them thought that family would have supported if they have gotten a severe disease. Also, they thought that they could have infected their families or friends/acquaintances if they have gone to the hospital. Many of them disagreed on the statement about the hospital or university providing them safety implements. There was an association between thinking that they could have gotten COVID-19 if they have gone to the hospital versus anxiety score (p= 0,030), being a male according to the perception that the university provided materials to take care of themselves (p= 0,029), and having studied in a private university according to perceiving that the hospital would not have supported them if they have gotten seriously ill (p= 0,049). Conclusion: The factors associated with the perception of repercussions of the boarding school are family support, being able to infect their acquaintances, lack of materials provided by universities and hospitals, anxiety, being male, and coming from private universities.

Estenosis laringotraqueal posintubación por COVID-19 en dos hospitales / Post-intubation laryngotracheal stenosis due to COVID 19 in two hospitals

Introducción: la infección por COVID-19 ha dejado más 400 millones de personas infectadas hasta la fecha, y entre un 10 %-15 % requiere intubación orotraqueal. Esto ha desencadenado una ola de secuelas en la vía aérea a largo plazo, que han aumentado la morbimortalidad posinfecciosa. El objetivo de este trabajo fue describir las características demográficas, clínicas y los posibles factores de riesgo de los pacientes con estenosis laringotraqueal (ELT) posintubación por COVID-19 en el Hospital Universitario Clínica San Rafael y el Hospital Militar Central en Bogotá, Colombia. Materiales y métodos: estudio observacional descriptivo de serie de casos retrospectiva que recolectó datos sociodemográficos, comorbilidades, tiempos de intubación, características de estenosis, resultados de estudios endoscópicos, manejos ofrecidos y resultados. Resultados: se registraron 25 pacientes, 15 hombres (60 %) y 10 mujeres (40 %), con tiempos de intubación promedio de 15,7 días. Los subsitios más comprometidos fueron la tráquea (68,2 %) y la subglotis-tráquea (22,7%). La mayoría de pacientes requirió más de una intervención. La dilatación con balón y traqueostomía fueron los procedimientos más realizados. Conclusiones: la ELT es una complicación de la intubación orotraqueal que, asociada con la vasculitis, inflamación y necrosis coagulativa de la vía aérea, ha aumentado en los casos de infección grave por COVID-19

Introduction: COVID-19 infection has left more than 400 million people infected to date, and between 10%-15% require orotracheal intubation. This has triggered a wave of long-term airway sequelae, which have increased post-infectious morbidity and mortality. Objectives: To describe the demographic and clinical characteristics and possible risk factors of patients with laryngotracheal stenosis (LTE) post-intuba-tion by COVID19 at the Hospital Universitario Clínica San Rafael and the Hospital Militar Central in Bogotá, Colombia. Methods: Descriptive observational study of retrospective case series, collecting socio-demographic data, comorbidities, intu-bation times, stenosis characteristics, results of endoscopic studies, management offered and results. Results: 25 patients were collected, 15 men (60%) and 10 wo-men (40%), with average intubation times of 15.7 days. The most compromised subsites were the trachea (68.2%) and subglottis-trachea (22.7%). Most patients re-quired more than one intervention. Balloon dilation and tracheostomy were the most performed procedures. Conclusions: LTE is a complication of orotracheal intuba-tion, associated with vasculitis, inflammation and coagulative necrosis of the airway, has increased in cases in severe COVID-19 infection.

Prevalence of post-traumatic stress disorder risk post-COVID-19 in 12 countries in Latin America: a cross-sectional survey.

Introduction: Latin America was the region most affected by COVID-19 in the second quarter of 2020, and consequently, the impact on mental health requires evaluation. The aim of this study was to assess the risk of post-traumatic stress disorder (PTSD) caused by bereavement due to COVID-19 in 12 countries in Latin America. Methods: The current study was an analytical cross-sectional study. Validated tests were applied for PTSD, depression, anxiety, and stress (DASS-21), questions about the respondent's condition or their environment, and demographic questions, as well as the length of the mourning period of suffering. Results: The outcomes demonstrated that the PTSD risk increased for women (p < 0.001), when a friend or acquaintance had COVID-19 (p = 0.002), when a close relative died from COVID-19 (p = 0.010), having severe depression (p <0.001), severe anxiety (p <0.001), severe stress (p <0.001), residing in Chile (p <0.001), Paraguay (p <0.001), Bolivia (p <0.001), Costa Rica (p <0.001) or El Salvador (p = 0.005). On the other hand, there was less risk of PTSD at an older age (p <0.001) or if respondents had a sentimental partner (p = 0.025). In the case of severe PTSD, there was a greater gender risk for women (p <0.001), a close relative dying from COVID-19 (p = 0.017), having severe depression (p <0.001), severe anxiety (p <0.001), severe stress (p <0.001), residing in Chile (p <0.001), Paraguay (p <0.001), Bolivia (p <0.001) and Costa Rica (p = 0.002). It was also observed that there was less risk of severe PTSD at an older age demographic (p <0.001). Discussion: It can be concluded that the percentages of PTSD are high in its clinical presentation as severe, especially among Latin American women.

Effect of Over-the-counter Whitening Toothpaste and Mouthwash in Orthodontics: A Literature Review.

Aim: To summarize and analyze all the available literature on the use of over-the-counter toothpaste and mouthwashes with whitening agents and their possible effects on orthodontic treatment. Background: Tooth color change frequently occurs during orthodontic treatment and represents a self-perceived need. According to the patient's perspective, there is a preference for the use of toothpaste and mouthwashes with some whitening effect. Materials and methods: An electronic bibliographic search in English was carried out until June 2022, in PubMed, Scopus, and Web of Science databases. Randomized or nonrandomized clinical trials and experimental laboratory studies were included. Review results: A total of 57 papers were obtained from an electronic search and 11 studies were included in the review. Outcomes such as strength force elastomeric, color stability, frictional resistance, ion release, shear bond strength (SBS), and adhesive remnant index (ARI) were evaluated. Conclusion: Toothpaste and mouthwashes with whitening action did not have a favorable effect on most of the outcomes evaluated. In some cases regular toothpaste showed a better effect and in other cases, there were no differences with the control group. Only in the outcome release of ions from wires to whitening effect in teeth with or without attached brackets, they have a better performance. Clinical significance: Due to the unfavorable effects of over-the-counter whitening toothpaste and mouthwashes on orthodontic materials and appliances, their use should be justified during treatment. How to cite this article: Chinchay-Ruesta S, Ortiz-Pizarro M, Rodríguez-Díaz DR, et al. Effect of Over-the-counter Whitening Toothpaste and Mouthwash in Orthodontics: A Literature Review. Int J Clin Pediatr Dent 2023;16(S-3):S311-S316.

Basic COVID-19 knowledge according to education level and country of residence: Analysis of twelve countries in Latin America.

Introduction: Knowing a disease is crucial for being able to fight it, especially in a region in which COVID-19 caused so many deaths, such as Latin America. Objective: To determine the association between basic knowledge of COVID-19 and education level according to country of residence in Latin America. Methodology: This is an analytical cross-sectional study. Basic level of knowledge was measured through nine close-ended questions (scale validated in Peru). The score obtained was analyzed through performing a crosstab vs. gender, age, education level, and country of residence. Results: Of a total of 9,222 respondents, almost all of them knew the common symptoms (99%), modes of transmission (93%), and knew how to recognize which was not a specific symptom (93%). Through the multivariate model, we found that there was no association with gender (p = 0.716) or age (p = 0.059), in comparison with those who had primary or a lower education level. All the other higher education levels had statistically significant scores (all p-values p < 0.001). When comparing knowledge according to countries, and using Peru as reference for comparison, Chile, Paraguay, Mexico, Bolivia, Panama, Ecuador, Costa Rica, and Colombia had a better level of knowledge (all p-values < 0.001); however, only El Salvador had a lower level (p < 0.001). Discussion: There was lack of knowledge of some topics, difference according to academic degree and country. As Peru was one of countries that obtained the lowest level of knowledge, it could have influenced the fact that it was the most affected country in the world.

Validity of a scale of Latin American perception of fear and concern transmitted by the media during the pandemic (MED-LAT-COVID-19).

Introduction: The pandemic has caused fear, especially due to the daily disseminated news; however, there is not an instrument to measure this fear in multiple realities. Objective: To validate a scale for Latin American perception of fear and concern transmitted by the media during the pandemic. Methodology: This is an instrumental study. The survey was based on an instrument which was pre-validated in Peru and submitted to 15 experts in almost 10 countries. Subsequently, thousands of people were surveyed in 13 Latin American countries, whose answers were used for descriptive statistics for validation. Results: Confirmatory Factor Analysis (CFA) generated two re-specifications, where four items were eliminated from the original scale. With these changes, the global goodness of fit (absolute and incremental) were satisfactory (CFI = 0.978; TLI = 0.964; GFI = 0.976; AGFI = 0.949; RMSEA = 0.075 and RMR = 0.029). The first factor measures the media exaggeration (three questions); the second, the fear transmitted by the media (three questions); and the third, the fear transmitted by others different from the media (two questions). The Cronbach's alpha coefficient was higher than 0.70 for the scale and its factors. Conclusion: The MED-LAT-COVID-19 scale reported a good adjustment. It has eight items in three factors, which could be measured in an isolated way, or along with other tests that assess mental health in the current pandemic context.

Revalidation of an ultra-short scale for the measurement of perceived job security in Latin America. / Revalidación de escala ultracorta para la medición de la seguridad percibida para conservar el trabajo en Latinoamérica.

Introduction: Due to the measures imposed by governments to reduce the spread of this new virus, the economic sector was one of the most affected during the COVID-19 pandemic. Several labor sectors had to undergo a virtual adaptation process resulting in job instability and job loss. The objective of this study was to revalidate an ultra-short scale for measuring perceived job security in Latin America. Methods: A revalidation study was done on a short scale that measures worker's perceived security about losing or keeping their job in the near future. Results: The four items remained on the revalidated scale, where all four explained a single factor. The goodness-of-fit measures confirmed the single-factor model (χ: 7.06; df: 2; p = 0.29; mean square error: 0.015; goodness-of-fit index: 0.998; adjusted goodness-of-fit index: 0.991; comparative fit index: 0.999; Tucker-Lewis index: 0.997; normalized fit index: 0.998; incremental fit index: 0.999; and root mean square error of approximation: 0.036). The scale's reliability was calculated using McDonald's omega coefficient, obtaining an overall result of ω = 0.72. Conclusions: The scale was correctly revalidated in Latin America, and the four items were kept in a single reliable factor.

Introducción: El sector económico fue uno de los más afectados durante la pandemia de COVID-19, debido a las medidas impuestas por los gobiernos para reducir la propagación de este nuevo virus. En consecuencia, varios sectores laborales tuvieron que pasar por un proceso de adaptación virtual, resultando en la inestabilidad o pérdida de empleos. El objetivo fue revalidar una escala ultra corta para la medición de la seguridad percibida para conservar el trabajo en Latinoamérica. Métodos: Se realizó un estudio de validación de una escala corta que mide la seguridad percibida por el trabajador acerca de poder perder o mantener su trabajo en un corto tiempo. Resultados: Los cuatro ítems se mantuvieron en la escala revalidada, también estuvieron en un único factor. Los índices de bondad de ajuste confirmaron dicho factor único: χ2: 7,06; df: 2; p = 0,29; junto a los índices de error de cuadrático medio: 0,015; de bondad de ajuste: 0,998; ajustado de bondad de ajuste: 0,991; de ajuste comparativo: 0,999; de Tucker-Lewis: 0,997; de ajuste normalizado: 0,998; de ajuste incremental: 0,999 y el error cuadrático medio de aproximación: 0,036. En todo momento se mostró un ajuste adecuado. Posterior a eso se midió la confiabilidad, la cual se calculó con el coeficiente de Ω de McDonald, obteniendo un resultado de 0,72.

Revalidación de escala ultracorta para la medición de la seguridad percibida para conservar el trabajo en Latinoamérica / Revalidation of an ultra-short scale for the measurement of perceived job security in Latin America

Introducción El sector económico fue uno de los más afectados durante la pandemia de COVID-19, debido a las medidas impuestas por los gobiernos para reducir la propagación de este nuevo virus. En consecuencia, varios sectores laborales tuvieron que pasar por un proceso de adaptación virtual, resultando en la inestabilidad o pérdida de empleos. El objetivo fue revalidar una escala ultra corta para la medición de la seguridad percibida para conservar el trabajo en Latinoamérica. Métodos Se realizó un estudio de validación de una escala corta que mide la seguridad percibida por el trabajador acerca de poder perder o mantener su trabajo en un corto tiempo. Resultados Los cuatro ítems se mantuvieron en la escala revalidada, también estuvieron en un único factor. Los índices de bondad de ajuste confirmaron dicho factor único: χ2: 7,06; df: 2; p = 0,29; junto a los índices de error de cuadrático medio: 0,015; de bondad de ajuste: 0,998; ajustado de bondad de ajuste: 0,991; de ajuste comparativo: 0,999; de Tucker-Lewis: 0,997; de ajuste normalizado: 0,998; de ajuste incremental: 0,999 y el error cuadrático medio de aproximación: 0,036. En todo momento se mostró un ajuste adecuado. Posterior a eso se midió la confiabilidad, la cual se calculó con el coeficiente de Ω de McDonald, obteniendo un resultado de 0,72. Conclusiones La escala se revalidó de forma correcta en Latinoamérica y se mantuvieron los cuatro ítems en un único factor, siendo fiable.

Introduction Due to the measures imposed by governments to reduce the spread of this new virus, the economic sector was one of the most affected during the COVID-19 pandemic. Several labor sectors had to undergo a virtual adaptation process resulting in job instability and job loss. The objective of this study was to revalidate an ultra-short scale for measuring perceived job security in Latin America. Methods A revalidation study was done on a short scale that measures worker's perceived security about losing or keeping their job in the near future. Results The four items remained on the revalidated scale, where all four explained a single factor. The goodness-of-fit measures confirmed the single-factor model (χ: 7.06; df: 2; p = 0.29; mean square error: 0.015; goodness-of-fit index: 0.998; adjusted goodness-of-fit index: 0.991; comparative fit index: 0.999; Tucker-Lewis index: 0.997; normalized fit index: 0.998; incremental fit index: 0.999; and root mean square error of approximation: 0.036). The scale's reliability was calculated using McDonald's omega coefficient, obtaining an overall result of ω = 0.72. Conclusions The scale was correctly revalidated in Latin America, and the four items were kept in a single reliable factor.

Description of a One-Year Succession of Variants of Interest and Concern of SARS-CoV-2 in Venezuela.

Some of the lineages of SARS-CoV-2, the new coronavirus responsible for COVID-19, exhibit higher transmissibility or partial resistance to antibody-mediated neutralization and were designated by WHO as Variants of Interests (VOIs) or Concern (VOCs). The aim of this study was to monitor the dissemination of VOIs and VOCs in Venezuela from March 2021 to February 2022. A 614 nt genomic fragment was sequenced for the detection of some relevant mutations of these variants. Their presence was confirmed by complete genome sequencing, with a correlation higher than 99% between both methodologies. After the introduction of the Gamma VOC since the beginning of the year 2021, the variants Alpha VOC and Lambda VOI were detected as early as March 2021, at a very low frequency. In contrast, the Mu VOI, detected in May 2021, was able to circulate throughout the country. After the detection of the Delta VOC in June 2021, it became the predominant circulating variant. With the arrival of the Omicron VOC in December, this variant was able to displace the Delta one in less than one month.

Factores asociados a fragilidad en adultos mayores hospitalizados en servicios quirúrgicos

Objetivo: Identificar los factores asociados a fragilidad en adultos mayores hospitalizados en servicios quirúrgicos de un hospital de Lambayeque, Marzo-Junio 2019. Materiales y Métodos: Estudio cuantitativo observacional transversal analítico. Se evaluaron los pacientes adultos mayores de los servicios quirúrgicos del Hospital Nacional Almanzor Aguinaga Asenjo durante el 2019. Se utilizó una ficha de recolección y escalas validadas para valorar integralmente al adulto mayor; La muestra fue de 358 pacientes; el muestreo fue de tipo censal. Resultados: La media de la edad fue de 75 años (±9 años). El género más frecuente fueron varones 184 personas (51,4%).el riesgo cardiológico III estuvo asociado a fragilidad en el análisis bivariado, de los 46 casos complicaciones, 30 fueron de pacientes frágiles (2 de cada 3). Se hallaron 105 pacientes frágiles (29%) y 137 pacientes pre-frágiles (38%). Conclusión: Los factores asociados a fragilidad fueron: género femenino, iletrados o nivel primaria, comorbilidad baja y alta, pacientes con probable demencia, con riesgo social, con desnutrición y con hemoglobina anormal; la media de edad fue de 75 años (±9 años), con ingesta media de 3 fármacos por día (±2 fármacos) y la comorbilidad más frecuente fue Hipertensión arterial, seguida de Diabetes Mellitus tipo 2 sin lesión de órgano diana, y las menos frecuentes fueron enfermedad arterial periférica seguido de hepatopatía leve.

Objective: To identify the factors associated with frailty in older adults hospitalized in surgical services of a Lambayeque hospital, March-June 2019. Materials and Methods: Analytical cross-sectional observational quantitative study. The elderly patients of the surgical services of the Almanzor Aguinaga Asenjo National Hospital were evaluated during 2019. A collection sheet and validated scales were used to comprehensively assess the elderly; The sample consisted of 358 patients; the sampling was census type. Results: The mean age was 75 years (± 9 years). The most frequent gender was male 184 people (51.4%). Cardiological risk III was associated with frailty in the bivariate analysis, of the 46 complication cases, 30 were frail patients (2 out of 3). 105 frail patients (29%) and 137 pre-frail patients (38%) were found. Conclusion: The factors associated with frailty were: female gender, illiterate or primary level, low and high comorbidity, patients with probable dementia, with social risk, with malnutrition and with abnormal hemoglobin; the mean age was 75 years (± 9 years), with a mean intake of 3 drugs per day (± 2 drugs) and the most frequent comorbidity was arterial hypertension, followed by type 2 Diabetes Mellitus without target organ injury, and less frequent were peripheral arterial disease followed by mild liver disease.

First Case of Monkeypox in Venezuela: Partial Complete Genome Sequence Allowed Its Grouping into the West African Clade II.

The ongoing epidemic of monkeypox virus (MPXV) infection has already reached more than 50,000 persons worldwide until the end of August 2022. We report the first case detected in Venezuela. The patient reported traveling from Spain and contact with friends tested positive for MPXV after his return. Partial complete genome phylogenetic analysis allowed to group the isolate within the clade II of MPXV, the major one circulating worldwide. No other case of MPXV has been detected until the end of August 2022 in the country, although the presence of undiagnosed cases due to the fear of stigmatization cannot be ruled out.

Introduction and rapid dissemination of SARS-CoV-2 Gamma Variant of Concern in Venezuela.

In less than two years since SARS-CoV-2 emerged, the new coronavirus responsible for COVID-19, has accumulated a great number of mutations. Many of these mutations are located in the Spike protein and some of them confer to the virus higher transmissibility or partial resistance to antibody mediated neutralization. Viral variants with such confirmed abilities are designated by WHO as Variants of Concern (VOCs). The aim of this study was to monitor the introduction of variants and VOCs in Venezuela. A small fragment of the viral genome was sequenced for the detection of the most relevant mutations found in VOCs. This approach allowed the detection of Gamma VOC. Its presence was confirmed by complete genome sequencing. The Gamma VOC was detected in Venezuela since January 2021, and in March 2021 was predominant in the East and Central side of the country, representing more than 95% of cases sequenced in all the country in April-May 2021. In addition to the Gamma VOC, other isolates carrying the mutation E484K were also detected. The frequency of this mutation has been increasing worldwide, as shown in a survey of sequences carrying E484K mutation in GISAID, and was detected in Venezuela in many probable cases of reinfection. Complete genome sequencing of these cases allowed us to identify E484K mutation in association with Gamma VOC and other lineages. In conclusion, the strategy adopted in this study is suitable for genomic surveillance of variants for countries lacking robust genome sequencing capacities. In the period studied, Gamma VOC seems to have rapidly become the dominant variant throughout the country.

Síntomas gastrointestinales como manifestaciones extrapulmonares en pacientes con COVID-19. Una revisión narrativa / Gastrointestinal symptoms as extrapulmonary manifestations in patients with COVID-19. A narrative review

RESUMEN La infección por SARS-CoV-2 afecta principalmente el sistema respiratorio; pero, también se han observado múltiples manifestaciones extrapulmonares en diversos sistemas y órganos. Las células epiteliales del tubo digestivo y árbol hepatobiliar expresan ECA2 y TMPRSS2 necesarios para el ingreso viral, por otro lado, el ARN viral ha sido detectado en muestras de heces, incluso después de haberse negativizado en muestras respiratorias. La presencia de manifestaciones clínicas digestivas se asocia a mayor carga viral y en ocasiones pueden ser las únicas manifestaciones de COVID-19, incluso en ausencia de síntomas respiratorios. Los síntomas más comunes son anorexia y diarrea, náuseas, vómitos y dolor abdominal, siendo este último característico de pacientes gravemente enfermos. Es muy poco frecuente la presencia de hemorragia gastrointestinal, colitis hemorrágica o hepatitis aguda. Ante un paciente con manifestaciones gastrointestinales debe considerarse a COVID-19 dentro del diagnóstico diferencial.

ABSTRACT SARS-CoV-2 infection mainly affects the respiratory system; but, multiple extrapulmonary manifestations have also been observed in various systems and organs. The epithelial cells of the digestive tract and hepatobiliary tree express ECA2 and TMPRSS2 necessary for viral entry, on the other hand, viral RNA has been detected in stool samples, even after having become negative in respiratory samples. The presence of clinical digestive manifestations is associated with a higher viral load and can sometimes be the only manifestations of COVID-19, even in the absence of respiratory symptoms. The most common symptoms are anorexia and diarrhea, nausea, vomiting, and abdominal pain, the latter being characteristic of seriously ill patients. Gastrointestinal bleeding, hemorrhagic colitis, or acute hepatitis are very rare. In a patient with gastrointestinal manifestations, COVID-19 should be considered within the differential diagnosis.

La realidad del paciente en hemodiálisis antes de la pandemia COVID-19 / The reality of patients in hemodialysis before COVID-19 pandemic

En una prueba piloto realizada en el departamento de Lambayeque (Perú) sobre el perfil del paciente que ingresa por primera vez a hemodiálisis con enfermedad renal crónica grado cinco (ERC 5) se ha encontrado evidencias diferentes a otros países de América Latina. La modalidad de tratamiento para los pacientes con ERC 5 aumentó a través de la hemodiálisis según El Registro Latinoamericano de Diálisis y Trasplante Renal del 2000 al 2008. En el Perú, se registra un 84,75% de pacientes con esta forma de tratamiento, sigue vigente en nuestro país y en los demás.

In a pilot test carried out in the department of Lambayeque (Peru) about the profile of patients who entered hemodialysis for the first time with grade five chronic kidney disease (CKD 5), evidence was found different from other Latin American. The treatment modality for CKD 5 patients increased through hemodialysis according to the Latin American Registry of Dialysis and Kidney Transplantation from 2000 to 2008. In Peru, 84.75% of patients are registered with this form of treatment still in force in our country and others.

Terapias target más quimioterapia comparado con quimioterapia en cáncer de mama triple negativo EC IV o recurrente. Revisión sistemática y metaanálisis / Target therapies plus chemotherapy compared to chemotherapy in Stage IV or recurrent triple negative breast cancer. A Systematic Review and Meta-analysis

Objetivo: Realizar una revisión sistemática y metaanálisis para comparar terapias target más quimioterapia con quimioterapia en el tratamiento de pacientes con cáncer de mama triple negativo EC IV o recurrente. Material y Métodos: Una búsqueda sistemática de estudios clínicos aleatorizados para el tratamiento de cáncer de mama triple negativo en EC IV o recurrente. Los desenlaces de interés fueron Sobrevida Global (SG) y sobrevida libre de progresión (SLP). Se registró datos de cada estudio clínico para los desenlaces y se estimó RR. Resultados: 10 estudios fueron incluidos y los participantes oscilaron entre 53 a 902 por estudio. La sobrevida global observamos que la terapia target más quimioterapia en las pacientes con cáncer de mama triple negativo EC IV o recurrente estuvo asociado a una disminución del 15% del riesgo de mortalidad con un RR (IC 95%): 0,85 (0,70 a 1,03). En relación al nivel de riesgo libre de progresión observamos que en la intervención se presentó una disminución del 16% en el riesgo de progresión con un RR (IC 95%): 0,84 (0,74 a 0,95). La sobrevida libre de progresión en las pacientes con la intervención oscilo entre 2,8 a 9,7 meses, mientras que en la terapia convencional osciló entre 1,5 a 6,2 meses. Conclusión: Las pacientes con cáncer de mama EC IV o recurrente triple negativo que recibieron terapia target más quimioterapia presentaron tendencia a la disminución en el riesgo de progresión de enfermedad (SLP) y mortalidad (OS), sin embargo, ­­­­se requieren más estudios clínicos para validar su significancia.

Background:Breast cancer is the most common malignancy in women worldwide. Patients with triple negative breast cancer represent a subgroup with unfavorable prognosis especially in advanced stages of the disease. Several first-line therapeutic agents have been described. Objective: To perform a systematic review and meta-analysis to compare target therapies plus chemotherapy with chemotherapy in the treatment of patients with triple negative breast cancer Stage IV or recurrent. Asystematic search identified randomized Material and Methods: clinical studies for the treatment of triple negative breast cancer in Stage IV or recurrent. The outcomes of interest were overall survival (OS) and progression-free survival (PFS). Data from each clinical study were recorded for the outcomes and the relative risk was estimated. Results:10 studies were included and participants ranged from 53 to 902 per study. Regarding overall survival, we observed that target therapy plus chemotherapy in patients with triple-negative Stage IV or recurrent breast cancer was associated with a 15% decrease in the risk of mortality with a RR (95% CI): 0.85 (0.70 to 1.03). In relation to the level of progression-free risk, we observed that the intervention showed a 16% decrease in the risk of progression with a RR (95% CI): 0.84 (0.74 to 0.95). Progression-free survival in patients with the intervention ranged from 2.8 to 9.7 months, while in conventional therapy it ranged from 1.5 to 6.2 months. Conclusion:Patients with Stage IV or recurrent triple negative breast cancer who received target therapy plus chemotherapy showed a trend towards decreased risk of disease progression (PFS) and mortality (OS), however, more clinical studies are required to validate its significance.