Decline of cytology-based cervical cancer screening for COVID-19: a single-center Peruvian experience. / Declive del cribado de cáncer cervical basado en citología by COVID-19: una experiencia unicéntrica peruana.

Introduction: Cervical cancer is the second most frequent malignant disease in the Peruvian female population, and the Papanicolaou test is its main screening tool. However, the COVID-19 pandemic can hinder cervical cancer screening, reducing its scope. Objective: To analyze the decline of Papanicolaou-based cervical cancer screening due to COVID-19 in a specialized hospital in Lima. Methods: We designed a retrospective study (from 2015 to 2020) on 355 029 Papanicolaou smears at the Hospital Nacional Madre Niño San Bartolomé. T-test and one-way ANOVA were used to define differences in the study period and Ljung-Box test with ARIMA (1,0,0) model to describe and forecast monthly expected Papanicolaou smears for 2020. Results: Throughout the six years of the study, the average Papanicolaou smears was 59 171.5 ± 8898.7 per year. However, in 2020 only 16 273 (4.58%) Papanicolaou tests were performed with a monthly mean of 1356.1 ± 684.2 (95% confidence interval 149.7 to 2861.9) (p < 0.001). The forecast showed 66 960 Papanicolaou smears for 2020 and a monthly mean of 5580 ± 129.3. Actual screenings during that year were only 16 273 Papanicolaou smears, resulting in a 76.7% reduction in cervical cancer screening during the pandemic. Conclusions: Our results suggest a dramatic decrease in cervical cancer screening based on Papanicolaou smears during 2020 in Peru due to prevention and control measures against COVID-19.

Introducción: El cáncer de cuello uterino es la segunda neoplasia más frecuente en la población femenina peruana y la prueba de Papanicolau es la principal estrategia de cribado. Sin embargo, la pandemia de COVID-19 puede bloquear el tamizaje cervicovaginal pudiendo reducir su alcance. Objetivo: Analizar el declive del cribado de cáncer de cuello uterino basado en la prueba de Papanicolaou, debido a COVID-19 en un hospital especializado de Lima. Métodos: Diseñamos un estudio retrospectivo (de 2015 a 2020) en 355 029 pruebas de Papanicolau en el Hospital Nacional Madre Niño San Bartolomé. Se utilizó la prueba T y ANOVA para definir las diferencias en el periodo del estudio y la prueba de Ljung-Box con modelo ARIMA (1,0,0) para describir y pronosticar mensualmente las pruebas de Papanicolau esperadas para el año 2020. Resultados: Durante los seis años del estudio el promedio fue de 59 171,5 ± 8898,7 pruebas de Papanicolau por año. Sin embargo, en 2020 solo se realizaron 16 273 (4,58%) pruebas de Papanicolau con una media mensual de 1356,1 ± 684,2 (intervalo de confianza 95%: 149,7 a 2861,9) (p < 0,001). El pronóstico mostró 66 960 pruebas de Papanicolau para el año 2020 y una media mensual de 5580 ± 129,3. Los tamizajes reales durante ese año fueron solamente de 16 273 pruebas de Papanicolau , generando un 76,7% de reducción del tamizaje de cáncer de cuello uterino durante la pandemia. Conclusiones: Conclusiones.

The comorbidity of diabetes-depression and its association with disability amongst elderly prison inmates.

OBJECTIVES: The objective of the study was to verify the strength of association of depression as a comorbidity of diabetes with the presence of six types of disability in the elderly in prison. MATERIAL AND METHOD: Cross-sectional association study based on a secondary analysis of the 2016 Peru National Penitentiary Census. The population were older adults, who were held in prisons in Peru. Inmates 60 years of age or older, and both sexes were included. The response variables were the six types of permanent disability. The exposure variables were the self-report of diabetes, depression and the comorbidity of depression with diabetes diagnosed by a health professional. The sample was constituted by 2. 658 older adults. RESULTS: There was an increase in the probability of presenting the six disabilities analyzed due to the presence of comorbid diabetes with depression (p <0.05). The measure of greatest strength of association is for the disability to relate OR(a) 10.23, followed by the disability to move OR(a) 6.12 and the lowest strength of association found was for the hearing impairment OR(a) 2.80. DISCUSSION: A significant increase was found in the probability of presenting the six disabilities analyzed due to the presence of comorbid diabetes with depression compared to suffering from only one of these conditions or not suffering from them.

Emergence and Molecular Epidemiology of Campylobacter jejuni ST-2993 Associated with a Large Outbreak of Guillain-Barré Syndrome in Peru.

Campylobacter jejuni infection is considered the most frequent factor associated with Guillain-Barré syndrome (GBS). In 2019, a large outbreak of GBS was detected in Peru, being associated with C. jejuni detected in stool samples from these patients. The aim of this study was to determine the molecular epidemiology of C. jejuni strains (ST-2993) associated with a large GBS outbreak in Peru. In this study, 26 C. jejuni strains belonging to the ST-2293, obtained from 2019 to 2020, were sequenced using Illumina technology. Five low-quality sequences were removed using bioinformatics, and 21 genomes (17 clinical strains and 4 chicken strains) were considered in the phylogenetic analysis and comparative genomics. Phylogenetic reconstruction, including genomes from international databases, showed a connection between Peruvian and Chinese GBS strains, both of them having lipooligosaccharides (LOS) locus genes related to molecular mimicry with gangliosides in peripheral nerves. Also, ST-2993 was detected in Amazon strains recovered many years before the 2019 outbreak, but with no epidemiological connection with GBS. Besides, a close relationship between human and chicken C. jejuni strains indicated chicken as one of the probable reservoirs. Finally, comparative genomics revealed differences between Chinese and Peruvian strains, including the presence of a prophage inserted into the genome. In conclusion, C. jejuni ST-2993 strains recovered from the GBS outbreak are closely related to Peruvian Amazon strains. Moreover, ST-2993 has been circulated in Peru since 2003 in the Peruvian Amazonia, showing the necessity to reinforce the epidemiological surveillance of C. jejuni to improve the prevention and control of future GBS outbreaks. IMPORTANCE This article describes the molecular epidemiology of C. jejuni strains (ST-2993) associated with a large Guillain-Barré Syndrome (GBS) outbreak in Peru, sequencing several strains recovered from GBS patients and chickens from 2019 to 2020. Phylogenetic analysis showed a connection between Peruvian and Chinese GBS strains, both of them having lipooligosaccharides (LOS) locus genes related to molecular mimicry with gangliosides in peripheral nerves. Also, ST-2993 strains were detected in isolates recovered many years before the 2019 outbreak, but with no epidemiological connection with GBS. Besides, a close relationship between human and chicken strains indicated those animals as a probable reservoir. This information will help to understand the real situation of GBS in Peru and its causal agent, C. jejuni ST-2993, showing the necessity to increase epidemiological tracking of these kinds of pathogens to detect them and avoid GBS outbreaks in the future.

Comorbilidad de depresión-diabetes asociada a la discapacidad en el adulto mayor en prisión / Depression-diabetes co-morbidity associated with disability in older adults in prison

Objetivos: El objetivo del estudio fue verificar la fuerza de asociación de la comorbilidad depresión-diabetes con la presenciade seis tipos de discapacidad en el adulto mayor en prisión.Material y método: Estudio transversal de asociación cruzada en base a un análisis del Censo Nacional Penitenciario Perú 2016.La población de estudio fueron adultos mayores recluidos en establecimientos penitenciarios del Perú. Se incluyó a reclusos de60 años de edad o más, de ambos sexos. Las variables de respuesta fueron seis tipos de discapacidad permanente. Las variables deexposición fueron: tener diabetes, tener depresión y tener la comorbilidad depresión-diabetes diagnosticadas por un profesionalde la salud. La muestra quedó constituida por 2.658 adultos mayores.Resultados: Se encontró que la presencia de comorbilidad depresión-diabetes aumenta la posibilidad de presentar las seis discapacidades respecto a no presentar estas condiciones (p <0,05). La mayor fuerza de asociación se presentó la variable de discapacidad para relacionarse, con una razón de posibilidades [odds ratio (OR)] (c, crudo) de 10,23, seguida de la discapacidad paramoverse, con OR(a, ajustado) de 6,12. La menor fuerza de asociación encontrada fue para la discapacidad auditiva, con OR(a)de 2,80.Discusión: Se encontró un incremento importante de la probabilidad de presentar las seis discapacidades analizadas, debido a lapresencia de la comorbilidad depresión-diabetes en comparación con padecer solo alguna de estas condiciones o no padecerlas. (AU)

Objectives: The objective of the study was to verify the strength of association of depression as a comorbidity of diabeteswith the presence of six types of disability in the elderly in prison.Material and method: Cross-sectional association study based on a secondary analysis of the 2016 Peru National PenitentiaryCensus. The population were older adults, who were held in prisons in Peru. Inmates 60 years of age or older, and both sexeswere included. The response variables were the six types of permanent disability. The exposure variables were the self-reportof diabetes, depression and the comorbidity of depression with diabetes diagnosed by a health professional. The sample wasconstituted by 2. 658 older adults.Results: There was an increase in the probability of presenting the six disabilities analyzed due to the presence of comorbiddiabetes with depression (p <0.05). The measure of greatest strength of association is for the disability to relate OR(a) 10.23,followed by the disability to move OR(a) 6.12 and the lowest strength of association found was for the hearing impairment OR(a) 2.80. Discussion: A significant increase was found in the probability of presenting the six disabilities analyzed due to the presence of comorbid diabetes with depression compared to suffering from only one of these conditions or not suffering from them... (AU)

Psychometric validation of the Peruvian version of a short scale to assess psychological violence in health professionals: A cross-sectional study. / Validación psicométrica de la versión peruana de la escala breve para evaluar violencia psicológica en profesionales sanitarios: estudio transversal.

OBJECTIVE: This study aimed to adapt a Peruvian version of the brief scale to assess psychological violence in health professionals (EVP-salud), exploring its validity and reliability properties. METHODS: We made a cross-sectional study of psychometric evaluation conducted between January 2019 and February 2020. It involved the voluntary and anonymous participation of 316 health professionals and administrative workers from 17 health centers in Peru, who were administered the 22-item psychological violence scale. In addition, three other instruments were used to assess convergent and discriminative validity. RESULTS: In contrast to other findings using similar instruments, the item composition of the abbreviated psychological violence scale converges on three components that assess isolation, intimidation, and belittling violence. This validation provides evidence of good fit in criterion and construct, explaining 66.7% of the accumulated variance and up to 54.3% when the final version is reduced to 13 items and three factors. The data reflect a high inverse association between psychological violence and intrinsic job satisfaction. CONCLUSIONS: The empirical results indicate psychometric properties of the instrument, with strong support in the validity and appropriate reliability according to the internal consistency indexes.

OBJETIVO: El objetivo de este estudio fue adaptar una versión peruana de la escala breve para evaluar la violencia psicológica en profesionales sanitarios (EVP-salud), explorando sus propiedades de validez y de fiabilidad. MÉTODOS: Estudio transversal de evaluación psicométrica. El estudio se llevó a cabo entre enero de 2019 y febrero de 2020. En él participaron en forma voluntaria y anónima 316 profesionales de la salud y trabajadores administrativos de 17 centros sanitarios del país, a quienes se aplicó la escala de violencia psicológica de 22 reactivos. Además, se administraron otros tres instrumentos para evaluar la validez convergente y discriminativa. RESULTADOS: En contraste con los hallazgos reportados para instrumentos similares, la composición de ítems de la escala abreviada de violencia psicológica converge en tres componentes que evalúan la violencia de aislamiento, de intimidación y de desprestigio. La validación abordada proporciona evidencias con buen ajuste, tanto de criterio como de constructo, que explican el 66,7% de la varianza acumulada y hasta 54,3%, aproximadamente, al reducirse la versión final a 13 reactivos y tres factores. Los datos reflejan una alta asociación inversa entre la violencia psicológica y la satisfacción laboral intrínseca. CONCLUSIONES: Los resultados empíricos indican propiedades psicométricas del instrumento, con fuerte apoyo en la validez y apropiada fiabilidad, según los índices de consistencia interna.

Cost and pollution by the use of xylene in cervical cytology in four Peruvian hospitals.

Background: Cytological samples are cleared with xylene in two or three baths during a Pap test, however, this solvent has a high degree of toxicity, and being a controlled reagent infers high costs for its purchase and implications for environmental pollution. We estimated the impact of xylene during the Pap test in terms of the number of liters and cost of two baths of xylene, and also estimated the impact with three baths  Methods: This cross-sectional study was carried out in four hospitals of EsSalud in Peru in two stages. First, the analysis of the impact due to the use of two baths of xylene was conducted during the period 2015-2019, and second, the estimates were calculated based on the assumption of three baths of xylene for the years 2020-2025. The assumption was based on the recommendations of the 2018 EsSalud cytology guideline. The monthly amount of xylene was ~10 liters per bath/month and the cost per liter was estimated at 8.13 USD (27 soles).  Results: For the staining of 594,898 cytology tests, 7,848 liters of xylene were necessary, resulting in a cost of 60,861 USD (202,068 soles) during the period 2015-2019. The estimates showed a maximum assumption of 9,483 liters and 77,110 USD (256,040 soles) for the use of three baths of xylene in the four EsSalud hospitals (p = 0.0025) during the period 2020-2025.   Conclusions: We determined that there was a high economic impact of using xylene with two baths from 2015 to 2019 and a dramatic increase in costs with the possible use of three baths of xylene in the Pap test for the following five years.