Evaluation of factors influencing handgrip strength asymmetry in elderly Peruvians.

Background: Sarcopenia is a musculoskeletal disease involving the reduction of muscle mass, strength, and performance. Handgrip strength (HGS) measurements included in frailty assessments are great biomarkers of aging and are related to functional deficits. We assessed the association between potential influencing factors and HGS asymmetry in older Peruvian adults. Methods: We used a database of the Peruvian Naval Medical Center "Cirujano Santiago Távara" located in Callao, Peru. All the patients included were ≥60 years old and had an HGS measurement in the dominant and non-dominant hand. Results: From a total of 1468 patients, 74.66% had HGS asymmetry. After adjustment, calf circumference weakness (aPR = 1.08, 95% CI = 1.01 - 1.15), falls risk (aPR = 1.08, 95% CI = 1.02 - 1.16), and an altered Lawton index (aPR = 0.92, 95% CI = 0.84 - 0.99) were associated with HGS asymmetry. Conclusion: Our findings suggest that HGS asymmetry should be measured along with other geriatric assessments used to evaluate health outcomes in the elderly to enhance health promotion and prevention aimed at preserving muscle strength to curb functional limitations in the elderly.

Prevalence of diabetic foot at risk of ulcer development and its components stratification according to the international working group on the diabetic foot (IWGDF): A systematic review with metanalysis.

AIMS: To determine the overall prevalence of diabetic foot at risk according to the International Working Group on the Diabetic Foot stratification. MATERIALS AND METHODS: We searched PubMed/Medline, Scopus, Web of Science, and Embase. We included cross-sectional studies or cohorts from 1999 to March 2022. We performed a meta-analysis of proportions using a random-effects model. We assessed heterogeneity through subgroup analysis by continent and other characteristics. RESULTS: We included 36 studies with a total population of 11,850 people from 23 countries. The estimated overall prevalence of diabetic foot at risk was 53.2% (95% CI: 45.1-61.3), I2 = 98.7%, p < 0.001. In the analysis by subgroups, South and Central America had the highest prevalence and Africa the lowest. The factors explaining the heterogeneity were the presence of chronic kidney disease, diagnostic method for peripheral arterial disease, and quality. The estimates presented very low certainty of evidence. CONCLUSIONS: The overall prevalence of diabetic foot at risk is high. The high heterogeneity between continents can be explained by methodological aspects and the type of population. However, using the same classification is necessary for standardization of the way of measuring the components, as well as better designed general population-based studies.

Presentación mixta de cetoacidosis diabética y estado hiperosmolar hiperglucémico en el embarazo: reporte de caso / Mixed presentation of diabetic ketoacidosis and hyperglycemic hyperosmolar state in pregnant woman: Case report

Resumen ANTECEDENTES: La cetoacidosis diabética y el estado hiperosmolar hiperglucémico son complicaciones agudas de la diabetes que se superponen en uno de cada cuatro casos, y cada una pone en peligro la vida de la madre y del feto. Existe poca información acerca del diagnóstico y tratamiento de las complicaciones agudas de la diabetes en el embarazo. OBJETIVO: Reportar el caso de una embarazada sin controles prenatales y sin antecedentes personales ni familiares de importancia que tuvo una crisis hiperglucémica mixta asociada con eclampsia y óbito. CASO CLÍNICO: Paciente primigesta, de 21 años, con 33 semanas de embarazo que ingresó al hospital debido a: náuseas, disnea y ausencia de movimientos fetales. Al ingreso se encontró somnolienta y con presión arterial elevada. Los exámenes de laboratorio se reportaron compatibles con cetoacidosis diabética y estado hiperosmolar hiperglucémico. A pesar del tratamiento, sobrevino la eclampsia. El embarazo finalizó mediante cesárea, con un recién nacido sin latidos cardiacos. La paciente evolucionó favorablemente con la atención multidisciplinaria. Fue dada de alta con valores de glucosa y presión arterial en límites normales. CONCLUSIÓN: Las crisis hiperglucémicas durante el embarazo se asocian con morbilidad y mortalidad materna y fetal, además de trastornos hipertensivos. El diagnóstico temprano de diabetes en los controles prenatales es fundamental para evitar este cuadro.

Abstract BACKGROUND: Diabetic ketoacidosis and hyperglycemic hyperosmolar state are acute complications of diabetes. These two overlap in one in four cases, and each endangers the life of the mother and the fetus. There is little information about the diagnosis and management of acute complications of diabetes in pregnancy. OBJECTIVE: To report the case of a pregnant woman without prenatal controls and without significant personal or family history who developed a mixed hyperglycemic crisis associated with eclampsia and death. CLINICAL CASE: 21-year-old primigravida admitted at 33 weeks' gestation due to nausea, dyspnea and absence of fetal movements. She was drowsy and had high blood pressure values. Laboratory tests were consistent with a mixed presentation of diabetic ketoacidosis and hyperosmolar hyperglycemic state. Despite treatment, the patient developed eclampsia. Cesarean delivery was performed, extracting a newborn without fetal heartbeat. The patient evolved favorably with multidisciplinary management. She was discharged with glucose and blood pressure values within normal limits. CONCLUSION: Hyperglycemic crises in pregnancy are associated with maternal-fetal morbidity and mortality and hypertensive disorders of pregnancy. Early diagnosis of diabetes in prenatal checkups is essential to avoid this condition.

Systematic review of warfarin-induced skin necrosis case reports and secondary analysis of factors associated with mortality.

OBJECTIVE: Warfarin-induced skin necrosis (WSN) is a rare (0.0.1%-0.1%) and severe adverse reaction. The clinical characteristics of this reaction and its mortality rate have not been explored in a large population. Therefore, we present the case of a Peruvian patient who developed WSN and perform a systematic review of case reports of WSN. METHODS: A systematic search was performed using the Pubmed/Medline, Scopus, Web of Science and Embase databases. Patient clinical data were collected and extracted from every case report. Furthermore, we analysed the factors associated with mortality because of WSN using the Poisson regression model with robust variations, obtaining risk ratios (RR) and their respective confidence intervals (95% CI). RESULTS: We identified 90 case reports that included a total of 111 patients with WSN (mean age 52.5 years), 20.72% of whom died of complications because of WSN. Being male (RR: 2.87; 95% CI 1.21-6.83) and having three or more affected regions (RR: 6.81; 95% CI 2.62-17.74) were associated with an increased risk of death caused by WSN. CONCLUSION: This systematic review identified 90 case reports of WSN with three or more affected body regions. Male sex was associated with an increased risk of death. Further studies are needed to analyse and confirm these results.

Análisis bibliométrico de la producción científica sobre cuidados paliativos en Scopus / Bibliometric analysis of the scientific production on palliative care in Scopus

Introducción y objetivo: Los cuidados paliativos son un enfoque que mejora la calidad de vida de los pacientes terminales. En los siguientes años habrá una gran necesidad de este servicio debido al aumento de la población de edad avanzada y de las enfermedades que afectan a este grupo. No todos los países de Latinoamérica y el Caribe tienen políticas nacionales de cuidados paliativos. El objetivo de este estudio es describir la producción científica sobre cuidados paliativos en Latinoamérica y el Caribe. Métodos: Se realizó un estudio bibliométrico sobre cuidados paliativos en la base de datos Scopus entre 1990 y 2019 cuyos autores tengan al menos una filiación de Latinoamérica y el Caribe. Resultados: Se obtuvo un total de 2030 documentos, observándose un crecimiento sostenido desde el año 2000. Los países con la mayor cantidad de artículos publicados fueron Brasil con 948 (45,65 %), México con 373 (18,36 %) y Argentina con 274 (13,48 %). El conglomerado por palabras clave nos mostró la formación de 3 grupos: terapia paliativa, terapia paliativa en cáncer y grupo etario. Discusión: Si bien en los últimos años ha habido un aumento en el número de artículos publicados, el aporte de cada país es desigual; los 3 primeros países aportan más del 75 % del total de las publicaciones. Se debe promover las políticas nacionales y la investigación en cuidados paliativos con el objetivo de encontrar otros enfoques y terapias para pacientes que requieran cuidados paliativos. (AU)

Introduction and objective: Palliative care is an approach that improves the quality of life in terminally ill patients. In the coming years, there will be a great need for this service due to an increase in the elderly population and in the diseases that affect this age group. Not all Latin American and Caribbean countries have national palliative care policies. The aim of this study was to describe the scientific production on palliative care in Latin America and the Caribbean. Methods: A bibliometric study on palliative care was conducted in the Scopus database between 1990 and 2019, focusing on papers whose authors had at least one affiliation from Latin America and the Caribbean. Results: A total of 2030 documents were obtained, showing a sustained growth since 2000. The countries with the highest number of published articles were Brazil with 948 (45.65 %), Mexico with 373 (18.36 %), and Argentina with 274 (13.48 %). Clustering by keywords showed the formation of 3 groups: palliative therapy, palliative therapy in cancer, and age group. Discussion: Although there has been an increase in the number of articles published in recent years, the contribution of each country is unequal, with the first 3 countries accounting for more than 75 % of the total number of publications. National policies and research in palliative care should be promoted with the aim of finding other approaches and therapies for patients requiring palliative care. (AU)

Infodemia y desinformación sobre COVID-19: Análisis bibliométrico / Infodemic and Misinformation about COVID-19: A Bibliometric analysis

La pandemia por el nuevo coronavirus ha traído consigo un fenómeno denominado infodemia, lo que ha generado desinformación y llega a afectar la salud de las personas. Por ello es nuestro objetivo describir a través de un análisis bibliométrico el avance de las publicaciones científicas sobre infodemia, además de identificar los tópicos y posibles soluciones que proponen. Se utilizó la base de datos de Scopus, mediante una fórmula de búsqueda a partir del uso de términos derivados de "infodemia", "desinformación" y COVID-19. Se encontró un total de 286 documentos, en su mayoría artículos originales, publicados en revistas de alto impacto. Al ser un área de reciente estudio no se encontraron patrones de colaboración, ni redes de coautoría(AU)

The novel coronavirus pandemic has brought about a phenomenon known as infodemic, generating misinformation and even affecting people's health. The purpose of the study was to conduct a bibliometric analysis to describe the progress of scientific publications about infodemic, and identify the topics and possible solutions they propose. A search was carried out in the database Scopus using search terms derived from "infodemic", "misinformation" and "COVID-19". A total 286 documents were found, most of which were original papers published in high impact journals. Being as it is a recent field of study, collaboration patterns and co-authorship networks were not found(AU)

Accidente ofídico fatal por Bothrops atrox en un niño de Ucayali, Perú / Ophidic accident by Bothrops atrox in a minor of Ucayali, Peru

Resumen El género Bothrops se encuentra ampliamente distribuido en la Amazonía peruana, siendo el responsable de más del 70 % de los casos de envenena miento por mordedura de serpiente. En el Perú se estima que ocurren 2 150 casos de mordedura de serpiente al año; no obstante, este número podría ser mucho mayor debido a una baja notificación. Se describe el caso de un menor de edad de la zona rural de Ucayali quien había sido mordido por un jergón "Bothrops atrox" y presentaba plaquetopenia, marcado edema cerca de la zona de la mordedura y dificultad para orinar, evolución tórpida a pesar de la terapia implementada y culminando en su deceso. El presente caso pone énfasis en el buen manejo terapéutico y la prontitud de su imple mentación para evitar complicaciones y desenlaces fatales.

Abstract The genus Bothorops is widely distributed in the Peruvian Amazon, being responsible for more than 70 % of cases of snake bite poisoning. In Perú it is estimated that 2150 cases of snakebite occur each year; however, this number could be much higher due to low notification. We describe the case of a minor, who reports having been bitten by a "Bothrops" in a rural area in the Ucayali region, with presence of thrombocytopenia, marked edema near the area of the bite and difficulty urinating with a torpid evolution despite the therapy implemented, culminating in the death of the patient. The present case emphasizes good therapeutic management and the promptness of its implementation to avoid complications and other fatal outcomes.

Trastornos de la marcha y el equilibrio en adultos mayores y su asociación con diabetes mellitus tipo 2 / Gait and balance disorder in elderly adults and its relation to diabetes mellitus type 2

Resumen: OBJETIVO: Identificar la relación entre diabetes mellitus tipo 2 y trastornos de la marcha y el equilibrio en una población geriátrica militar. MATERIAL Y MÉTODO: Estudio analítico de cohorte retrospectiva y análisis secundario de una base de datos. Se evaluó el trastorno de la marcha y el equilibrio en una población de militares retirados y sus familiares de enero de 2010 a diciembre de 2015. Se analizó la asociación entre diabetes mellitus tipo 2 y el trastorno de la marcha y el equilibrio con un modelo de regresión de Cox, ajustado por edad, sexo y grado militar y por los antecedentes de enfermedad renal crónica, hipertensión, índice de masa corporal, polifarmacia, actividad física, rendimiento físico y artrosis de cadera y de rodilla. RESULTADOS: Se incluyeron 1422 militares retirados y sus familiares. La media de edad fue de 77.97 ± 8.46 años. Los adultos mayores con y sin diabetes mellitus 2 fueron 240 (16.8%) y 1182 (83.1%), respectivamente. En total, 794 (55.8%) adultos mayores tenían trastorno de la marcha y el equilibrio, a diferencia de 628 (44.1%) que no lo padecían. El 50% de los adultos mayores diabéticos y 57% de los no diabéticos tenían trastorno de la marcha y el equilibrio. CONCLUSIÓN: La diabetes mellitus tipo 2 aumenta el trastorno de la marcha y el equilibrio 1.25 veces.

Abstract: OBJECTIVE: To identify the association between diabetes mellitus type 2 and gait/ balance disorder in a retired military geriatric population. MATERIAL AND METHOD: A retrospective cohort study, database secondary analysis was done. Gait and balance disorder was evaluated in a population of retired military personnel from January 2010 to December 2015. An analysis was performed to assess the association of type 2 diabetes mellitus and gait and balance disorder with a Cox regression model, adjusted for age, sex, military rank, chronic kidney disease, hypertension, body mass index, polypharmacy, physical activity, physical performance and osteoarthritis. RESULTS: There were included 1422 retired military patients. The mean age was 77.9 ± 8.5 years. Older adults who had and had not diabetes mellitus 2 were 240 (16.8%) and 1182 (83.1%), respectively. A total of 794 (55.8%) patients had gait and balance disorder. Also, 50% of diabetic patients and 57% of non-diabetics had gait and balance disorder. CONCLUSION: Diabetes mellitus 2 increases gait and balance disorder risk by 1.25 times.

Envenenamiento por el mercurio inorgánico en menores en una zona urbana de minería ilegal / Poisoning by inorganic mercury in minors in an urban area of illegal mining

El artículo contiene introducción, material y métodos, resultados culminando con la discusión.

Diabetes mellitus tipo 2 y toxicidad por quimioterapia en adultos mayores con cáncer prostático / Type 2 Diabetes mellitus and chemotherapy toxicity in older adults with prostate cancer

Introducción: Siendo el cáncer prostático una neoplasia prevalente, el envejecimiento es un factor para la toxicidad quimioterapéutica, adicionalmente puede incrementarse por enfermedades crónicas, destacando la diabetes. A pesar de estos conocimientos, no hay estudios que evalúen la asociación entre la diabetes y el riesgo de toxicidad quimioterapéutica en estos pacientes. Objetivo: Determinar la asociación entre Diabetes Mellitus tipo 2 y riesgo de toxicidad por quimioterapia en adultos mayores con cáncer prostático del Servicio de Geriatría del Centro Médico Naval del Perú. Material y métodos: Estudio analítico de cohorte retrospectiva, análisis secundario de una base de datos. Se evaluaron los efectos adversos de quimioterapia y factores asociados de 161 marinos retirados con cáncer prostático entre 2013 y 2015. Se construyó un modelo de regresión de Cox sobre la toxicidad ajustado por el antecedente de diabetes, edad, antecedentes patológicos, antecedentes de consumo de tabaco, circunferencia de pantorrilla, actividad física, dependencia para ABVD, caídas, polifarmacia, fragilidad y vulnerabilidad. Resultados: El 23.6 por ciento presentó diabetes. La prevalencia de fragilidad fue del 39.7 por ciento y de vulnerabilidad, de 24.2 por ciento(G8) y 26.71 por ciento (VES-13). Los efectos adversos frecuentes fueron gastrointestinales (13.04 por ciento) y hematológicos (8.07 por ciento). Mediante el modelo de regresión ajustado, el antecedente de Diabetes Mellitus tipo 2, 3 o más antecedentes patológicos, antecedente de consumo de tabaco, circunferencia de pantorrilla, actividad física, dependencia de ABVD, caídas, polifarmacia, vulnerabilidad y fragilidad presentaron asociación significativa. Conclusiones: El antecedente de Diabetes Mellitus tipo 2 es un factor predictivo para el riesgo de toxicidad por quimioterapia en adultos mayores con cáncer prostático(AU)

Introduction: Prostate cancer is considered a predominant type of neoplasia and aging is a factor for chemotherapeutic toxicity, which can increase due to chronic diseases, particularly diabetes. Despite all this knowledge, there are no studies to evaluate the association between diabetes and the risk of chemotherapeutic toxicity in these patients. Objective: To determine the association between Type 2 Diabetes Mellitus and the risk of chemotherapy toxicity in in older adults with prostate cancer in the Geriatric Service of the Peruvian Naval Medical Center. Material and methods: Analytical retrospective cohort study and secondary database analysis. The adverse effects of chemotherapy and the associated factors of 161 retired sailors with prostate cancer were evaluated between 2013 and 2015. Cox Regression Model for Adjusted Toxicity was constructed for antecedents of diabetes, age, pathological antecedents, smoking antecedents, calf circumference, physical activity, dependence on ABVD, falls, polypharmacy, fragility, and vulnerability. Results: The 23.6 percent of patients had diabetes. The prevalence of fragility was 39.7 percent and the one of vulnerability was 24.2 percent (G8) and 26.71 percent (VES-13). The frequent adverse effects were: gastrointestinal (13.04 percent) and hematological (8.07 percent). The most significant associations by adjusted regression model were the antecedent of Type 2 Diabetes Mellitus, 3 or more pathological antecedents, smoking antecedents, calf circumference, physical activity, dependence on ABVD, falls, polypharmacy, fragility, and vulnerability. Conclusions: The antecedent of Type 2 Diabetes Mellitus is a predictive factor for the risk of chemotherapy toxicity in older adults with prostate cancer(AU)

Parasitosis intestinal y estado inmunológico en pacientes adultos con infección por VIH del Centro Médico Naval "Cirujano Mayor Santiago Távara" / Parasitic intestinal diseases and immune status in adult patients with HIV infection at the Peruvian Naval Medical Center "Cirujano Mayor Santiago Távara"

Objetivo: Describir los tipos parasitosis intestinales y el estado inmunológico en pacientes portadores del virus de la inmunodeficiencia humana (VIH +). Materiales y métodos: Se realizó un estudio descriptivo, comparativo y retrospectivo, a través de la selección de 81 historias clínicas pertenecientes al Servicio de Infectología del Centro Médico Naval "Cirujano Mayor Santiago Távara", con el permiso de las autoridades del centro. Las historias contaban con el único criterio de inclusión considerado en la investigación que fue diagnóstico de infección por VIH. Los datos que se obtuvieron fueron los resultados de examen coproparasitológico y citometría de flujo para linfocitos T CD4, la presencia o ausencia de sintomatología intestinal, y pertenencia al programa de tratamiento antirretroviral de alta actividad (TARGA) o al tratamiento antirretroviral convencional. Resultados: El 37 % presentaron parasitosis intestinal. Se observó con mayor frecuencia a Entamoeba coli (20 %), que es no patógeno para el ser humano. Entre los patógenos hallados se encuentran Isospora belli (15,6 %), Giardia lamblia (15,6 %), Blastocystis hominis (11,2 %) y Cryptosporidium sp. (11,2 %). El 32,1 % de los casos presentaron diarrea, mientras que el 67,9 % fueron asintomáticos. En el grupo de asintomáticos, el promedio de CD4 es de 280 células/μL, mientras en los que tuvieron diarrea fue de 195 células/μL. Conclusiones: Los enteroparásitos Isospora belli, Cyclospora cayetanensis, Blastocystis hominis son hallados con mayor frecuencia en recuentos de CD4 <199 células/uL. Los parásitos no patógenos Entamoeba coli, Endolimax nana, Trichomonas hominis, Chilomastix mesnili se encuentran con mayor frecuencia en pacientes con recuentos de CD4 >200 células/uL

Objective: To describe the types of parasitic intestinal diseases and the immune status in human immunodeficiency virus-positive (HIV+) patients. Materials and methods: A descriptive, comparative and retrospective study was carried out through the selection of 81 medical records from the Infectious Disease Service of the Naval Medical Center "Cirujano Mayor Santiago Távara", with the authorization of the pertinent authorities. Said medical records included the only inclusion criterion considered in the research: the diagnosis of HIV infection. The following data was obtained: results from a copro-parasitological examination and a flow cytometry for CD4 T lymphocyte count, presence or absence of gastrointestinal symptoms, and participation in the Highly Active Antiretroviral Therapy (HAART) program or the conventional antiretroviral treatment program. Results: Thirty-seven percent (37 %) of the patients presented parasitic intestinal diseases, with Entamoeba coli being the most frequently observed parasite (20 %), which is not pathogenic for humans. Among the pathogens, Isospora belli (15.6 %), Giardia lamblia (15.6 %), Blastocystis hominis (11.2 %) and Cryptosporidium sp. (11.2 %) were found. Thirty-two point one percent (32.1 %) of the subjects had diarrhea, while 67.9 % were asymptomatic. In the asymptomatic group, the average CD4 cell count was 280 cells/μL, while in those with diarrhea it was 195 cells/μL. Conclusions: Enteroparasites Isospora belli, Cyclospora cayetanensis and Blastocystis hominis are most frequently found at CD4 cell counts <199 cells/uL. Non-pathogenic parasites Entamoeba coli, Endolimax nana, Trichomonas hominis and Chilomastix mesnili are most frequently found in patients with CD4 cell counts >200 cells/μL