Effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis: a systematic review.

OBJECTIVES: To evaluate the efficacy of antituberculosis therapy on pregnancy outcomes in infertile women with genital tuberculosis. DESIGN: Systematic review. DATA SOURCES: We searched in PubMed/MEDLINE, CENTRAL and EMBASE up to 15 January 2023. Additionally, we manually search the reference lists of included studies. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCT), non-RCTs (non-RCT) and cohort studies that evaluated the effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis compared with not receiving antituberculosis treatment or receiving the treatment for a shorter period. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data. We used Cochrane Risk of Bias 1.0 and Risk Of Bias In Non-randomised Studies tools for risk of bias assessment and meta-analysis was not performed. We used Grading of Recommendations, Assessment, Development and Evaluations approach to assess the certainty of the evidence. RESULTS: Two RCTs and one non-RCT were included. The antituberculosis regimens were based on isoniazid, rifampicin, pyrazinamide and ethambutol for 6-12 months. In women without structural damage, very low certainty of evidence from one RCT showed that the antituberculosis treatment may have little to no effect on pregnancy, full-term pregnancy, abortion or intrauterine death and ectopic pregnancy, but the evidence is very uncertain. In women with structural damage, very low certainty of evidence from one non-RCT showed that the antituberculosis treatment may reduce the pregnancy rate (297 fewer per 1000, 95% CI -416 to -101), but the evidence is very uncertain. In addition, very low certainty of evidence from one RCT compared a 9-month vs 6-month antituberculosis treatment regimen showed similar effects between the schemes, but the evidence is very uncertain. Two RCTs reported that no adverse events of antituberculosis treatment were noted or were similar in both groups. CONCLUSION: The effect of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis is very uncertain. PROSPERO REGISTRATION NUMBER: CRD42022273145.

Características clínico-epidemiológicas de adolescentes multíparas atendidas en el Instituto Nacional Materno Perinatal de Lima, Perú / Clinical-epidemiological characteristics of adolescent multiparous patients attendedat the Instituto Nacional Materno Perinatal of Lima, Perú

Introducción. El embarazo adolescente es un problema de salud pública con consecuencias médicas y sociales. Objetivo. Determinar las características clínicas y epidemiológicas de las adolescentes multíparas atendidas en el Instituto Nacional Materno Perinatal entre 2014 y 2016. Material y métodos. Estudio descriptivo de serie de casos. La población estuvo constituida por todas las adolescentes puérperas multíparas atendidas en el Instituto Nacional Materno Perinatal entre 2014 y 2016 cuyos datos fueron incluidos en el Sistema Informático Perinatal. Resultados. Se incluyó un total de 567 adolescentes, el 96,3% de las pacientes pertenecían a la adolescencia tardía, eran convivientes (80,8%), con secundaria incompleta (51,3%), amas de casa (88,7%), con mediano riesgo social (54,7%) e IMC pre gestacional normal en el 57,7%. La mayoría (70.7%) fueron gestantes no controladas, con inicio tardío de controles prenatales (75{5%), predominancia de partos a término (86{2%) y eligieron a los inyectables (45{9%) como anticoncepción al egreso. La mayoría tuvo dos embarazos (85,7%), dos partos (95,9%), ningún aborto (89,2%) y hubo predominio de partos vaginales (67,5%). Conclusión. Las características clínicas y epidemiológicas de las multíparas adolescentes son similares a estudios previos realizados en Perú, con excepción del predominio de partos a término. Palabras Claves: embarazo; adolescencia; paridad; cesárea

Introduction. Adolescent pregnancy is a public health problem with medical andsocial consequences. Objective.Determine the clinical and epidemiological characteristics of multiparous puerperal adolescents attendedat the Instituto Nacional Materno Perinatal between 2014 and 2016. Material and methods.A descriptive case series study. The population was made up of all the multiparous adolescent postpartum women attended at the Instituto Nacional Materno Perinatal between 2014 and 2016 whose data were included in the Perinatal Computer System. Results.A total of 567 adolescents were included,96.3% of the patients belonged to late adolescence, were living in common law union (80.8%), with incomplete secondary education (51.3%), housewives (88.7%), with medium social risk (54.7%) and normal pregestational BMI in 57.7%; the majority (70.7%) were uncontrolled pregnant women, with late onset of prenatal controls (75.5%), predominance of term deliveries (86.2%) and they chose injectables (45.9%) as contraception at discharge. The majority had two pregnancies (85.7%), two deliveries (95.9%), no abortion (89.2%) and predominance of vaginal deliveries (67.5%). Conclusions.The clinical and epidemiological characteristics of adolescent multiparous are similar to previous studies carried out in Peru, with the exception of predominance of term deliveries. Key words:pregnancy; adolescence; parity; cesareansection

Immune responses in COVID-19 and tuberculosis coinfection: A scoping review.

Background and aim: Patients with COVID-19 and tuberculosis coinfection are at an increased risk of severe disease and death. We therefore sought to evaluate the current evidence which assessed the immune response in COVID-19 and tuberculosis coinfection. Methods: We searched Pubmed/MEDLINE, EMBASE, Scopus, and Web of Science to identify articles published between 2020 and 2021. We included observational studies evaluating the immune response in patients with tuberculosis and COVID-19 compared to patients with COVID-19 alone. Results: Four cross-sectional studies (372 participants) were identified. In patients with asymptomatic COVID-19 and latent tuberculosis (LTBI), increased cytokines, chemokines, growth factors and humoral responses were found. In addition, patients with symptomatic COVID-19 and LTBI had higher leukocytes counts and less inflammation. Regarding patients with COVID-19 and active tuberculosis (aTB), they exhibited decreased total lymphocyte counts, CD4 T cells specific against SARS-CoV-2 and responsiveness to SARS-CoV-2 antigens compared to patients with only COVID-19. Conclusion: Although the evidence is limited, an apparent positive immunomodulation is observed in patients with COVID-19 and LTBI. On the other hand, patients with COVID-19 and aTB present a dysregulated immune response. Longitudinal studies are needed to confirm these findings and expand knowledge.

Prevalence and Associations between Anxiety, Depression, and Stress among Peruvian University Students during the covid-19 Pandemic / Prevalencia y asociaciones de ansiedad, depresión y estrés en estudiantes universitarios peruanos durante la pandemia de covid-19 / Prevalência e associações de ansiedade, depressão e estresse em estudantes universitários peruanos durante a pandemia de covid-19

The pandemic has brought about social changes, which may have affected mental health.The purpose of this study was to determine the prevalence of and associations between anxiety, depression, and stress among Peruvian university students during the covid-19 pandemic. Materials and Methods: This was an analytical, multi-centered, cross-sectional study conducted with 2,572 university students from 16 Peruvian cities. Depression, anxiety, and stress diagnoses were obtained with the dass-21 scale (stress alpha: 0.85; anx-iety alpha: 0.84; and depression alpha: 0.87). The values were crossed with significant social and educational variables. Results: Anxiety was the most common condition (extremely severe in 4 %, severe in 3 %, and mod-erate in 10 %). Whereas stress and depression were not associated with the course of studies (p > 0.330 and p > 0.440, respectively), anxiety was lower among students pursuing health-related degrees (p = 0.011). Women showed higher levels of stress (p = 0.040) and anxiety (p = 0.017). Older participants had relatively lower stress (p = 0.002), depression (p = 0.006), and anxiety (p = 0.044) levels. Third-year students had higher depression levels than first-year students (p = 0.011). Conclusions: Significant prevalence levels and associations were identified for the three conditions, which should be monitored to determine their current status, given the possible future occurrence of panic attacks or post-traumatic stress, among other complications.

la pandemia vivida obligó a cambios sociales que pudieron influir en la salud mental. El objetivo fue determinar la prevalencia y asociaciones de ansiedad, depresión y estrés en estudiantes universitarios peruanos durante la pandemia por covid-19. Materiales y métodos: estudio transversal analítico y multicéntrico, en 2572 estudiantes universitarios de 16 ciudades de Perú. Los diagnósticos de depresión, ansiedad y estrés se obtuvieron con la escala dass-21 (alfa estrés: 0.85; alfa ansiedad: 0.84 y alfa depresión: 0.87). A estos se los cruzó con importantes variables socioeducativas. Resultados: la ansiedad fue la patología más frecuente (4 % de forma extrema severa, 3 % de forma severa y 10 % de forma mode-rada); el estrés y la depresión no tienen asociación con la carrera profesional (p > 0.330 y p > 0.440, res-pectivamente); en cambio, la ansiedad fue menor en los estudiantes de carreras de salud (p = 0.011). Las mujeres tuvieron más estrés (p = 0.040) y ansiedad (p = 0.017). A mayor edad, hubo menos estrés (p = 0.002), depresión (p = 0.006) y ansiedad (p = 0.044). Los de tercer año tuvieron más depresión en comparación con los de primer año (p = 0.011). Conclusiones: existen importantes prevalencias y asociaciones de las tres patologías evaluadas, lo que debe ser monitorizado según como están actualmente. Esto por las posibles futuras manifestaciones de crisis de pánico, estrés postraumático, entre otras.

a pandemia que estamos vivenciando forçou mudanças sociais, que podem influenciar na saúde mental. O objetivo do estudo é determinar a prevalência e associações de ansiedade, depressão e estresse em estudantes universitários peruanos durante a pandemia de covid-19. Materiais e métodos:estudo transversal analítico e multicêntrico, com 2572 estudantes universitários provenientes de 16 cidades do Peru. Os diagnósticos de depressão, ansiedade e estresse foram obtidos com a escala dass-21 (Alpha para estresse: 0,85; Alpha para ansiedade: 0,84 e Alpha para depressão: 0,87), estes foram cruza-dos com importantes variáveis socioeducativas. Resultados: a ansiedade foi a patologia mais frequente (4 % em sua forma extremamente grave, 3 % forma grave e 10 % forma moderada); estresse e depressão não foram associados à carreira profissional (p > 0,330 e p > 0,440, respectivamente); por outro lado, a ansiedade foi menor nos estudantes da carreira da saúde (p = 0,011). As mulheres apresentaram mais estresse (p = 0,040) e ansiedade (p = 0,017); quanto maior a idade houve menos estresse (p = 0,002), depressão (p = 0,006) e ansiedade (p = 0,044). Estudantes do 3º ano apresentaram mais depressão em comparação aos do 1º ano (p = 0,011). Conclusões: existem prevalências e associações importantes entre as três patologias avaliadas, que devem ser monitoradas de acordo com a forma como se encontram atualmente. Isso se deve às possíveis manifestações futuras de ataques de pânico, estresse pós-traumá-tico, entre outras complicações.

Asociación entre dependencia funcional y calidad de vida en pacientes adultos mayores oncológicos / Association between functional dependence and quality of life in older adult oncology patients

RESUMEN Introducción: La presencia de comorbilidades modula el proceso de envejecimiento, el diagnóstico de cáncer puede comprometer de manera importante la salud del adulto mayor, lo cual repercute en su calidad de vida. Objetivo: Determinar la asociación entre la dependencia funcional y la calidad de vida en pacientes oncológicos adultos mayores tratados con radioterapia. Métodos: Estudio analítico retrospectivo, realizado en 181 pacientes ambulatorios del Centro Médico Naval del Callao, Perú, varones, mayores de 60 años. Se valoró la dependencia funcional mediante los índices de Barthel y el de Lawton; y la calidad de vida mediante la escala de calidad de vida en adultos mayores de la Organización Mundial de la Salud (WHOQoL-Old). Resultados: Se encontró asociación estadísticamente significativa entre dependencia funcional y calidad de vida, tanto para las actividades básicas de la vida diaria (PR= 1,04 [IC 95 %; 1,01-1,07]) como para las actividades instrumentales de la vida diaria (PR= 1,08 (IC 95 %: 1,01 - 1,13). Conclusiones: En los pacientes adultos mayores oncológicos tratados con radioterapia, se encuentra asociación significativa entre dependencia funcional y una pobre calidad de vida.

ABSTRACT Introduction: The presence of comorbidities modulates the aging process, the diagnosis of cancer can significantly compromise the health of the elderly, which affects their quality of life. Objective: Determine the association between the functional dependence and the quality of life in elderly oncology patients treated with radiotherapy. Methods: Retrospective analytical study, carried out in 181 outpatients of Centro Médico Naval del Callao, Perú, male, older than 60 years. The functional dependence was assessed with Barthel index and Lawton scale; and the quality of life was assessed with World Health Organization Quality of Life-Older Adults Module (WHOQoL-Old). Results: A statistically significant association was found between functional dependence and quality of life, for both the basic activities of daily living (PR= 1.04 [IC 95 %: 1.01-1.07]), and the instrumental activities of daily living (PR= 1.08 [IC 95 %: 1.01 - 1.13]). Conclusion: There was significant association between the functional dependence and the poor quality of life in the elderly oncology patients treated with radiotherapy.

Fecal Microbiota Transplantation for People Living with Human Immunodeficiency Virus: A Scoping Review.

The aim of this scoping review was to determine the characteristics of studies evaluating fecal microbiota transplantation (FMT), as well as its effects and safety as a therapeutic intervention for people living with human immunodeficiency virus (HIV). We conducted a scoping review following the methodology of the Joanna Briggs Institute. We searched the following databases: PubMed, Web of Science, Scopus, Embase, Cochrane Library, and Medline until September 19, 2021. Studies that used FMT in people living with HIV and explored its effects on the health of these people were included. Two randomized and 2 uncontrolled clinical trials with a total of 55 participants were included. Participants were well-controlled HIV-infected people. Regarding microbiota changes, three studies found significant post-FMT increases in Fusobacterium, Prevotella, α-diversity, Chao index, and/or Shannon index, and/or decreases in Bacteroides. Regarding markers of intestinal damage, one study found a decrease in intestinal fatty acid binding protein post-FMT, and another study found an increase in zonulin. Other outcomes evaluated by the studies were as follows: markers of immune and inflammatory activation, markers of immunocompetence (CD4+, and CD8+ T lymphocytes), and HIV viral load; however, none showed significant changes. Clinical outcomes were not evaluated by these studies. Regarding the safety of FMT, only mild adverse events were appreciated. No serious adverse event was reported. The clinical evidence for FMT in people living with HIV is sparse. FMT appears to have good tolerability and, no serious adverse event has been reported so far. Further clinical trials and evaluation of clinically important biomedical outcomes for FMT in people living with HIV are needed.

Primary muscular hydatidosis in an endemic area of Peru: report of two cases.

Primary muscular hydatidosis is an infrequent parasitic infection, caused by Echinococcus granulosus. We report 2 cases of female patients with diagnosis of primary muscular hydatidosis of the thigh. Both hail from an endemic area for hydatidosis, and had no pulmonary, hepatic, or systemic involvement. Cyst extraction was performed after the patients were given hypertonic solution, and antiparasitic treatment.

Prevalencia de síndrome de burnout en postulantes al examen de residencia médica / Prevalence of Burnout syndrome among Medical Residency applicants

Introducción: Los médicos que se preparan para rendir el examen de residencia médica, están expuestos a estrés laboral, debido a que adicionalmente tienen que trabajar para poder solventar sus estudios. Objetivos: Determinar la prevalencia del síndrome de burnout en médicos generales que se preparan para el examen de residencia médica. Métodos: Se realizó un estudio descriptivo y transversal, se aplicó el cuestionario Maslach Burnout Inventory (MBI) a médicos generales que trabajaban y que se preparaban para rendir el examen de residencia médica, que voluntariamente aceptaron participar en el estudio. Se realizó estadística univariada y bivariada; los cálculos fueron realizados con un nivel de confianza del 95 por ciento. Resultados: Se incluyó a un total de 306 médicos. El 56,9 por ciento fueron de sexo femenino y el promedio de edad fue de 28,5 ± 4,3 años. El 2,3 por ciento (7) de los médicos presentaron síndrome de burnout; las subescalas de despersonalización (42,2 por ciento) y agotamiento emocional (32 por ciento) tuvieron mayores porcentajes de índices altos. Conclusiones: La prevalencia de síndrome de burnout fue baja en los médicos generales que se preparan para el examen de residencia médica. Las subescalas con mayores índices fueron despersonalización y agotamiento emocional(AU)

Introduction: Doctors who are preparing to take the medical residency exam are exposed to work stress, because they have to work to pay their studies. Objectives: To determine the prevalence of Burnout syndrome in general practitioners preparing for the residency exam. Methods: A descriptive and cross-sectional study was carried out, the Maslach Burnout Inventory (MBI) was applied in general practitioners who worked and were preparing to take the medical residency exam were included, who voluntarily agreed to participate in the study. Univariate and bivariate statistics were performed, the calculations were performed with a confidence level of 95 percent. Results: A total of 306 general practitioners were included. 56,9 percent were female and the average age was 28,5 ± 4,3 years. 2,3 percent (7) of the doctors had Burnout syndrome, the subscales of depersonalization (42,2 percent) and emotional exhaustion (32 percent) had higher percentages of high indexes. Conclusions: The prevalence of Burnout syndrome was low in general practitioners preparing for the medical residency examination. The subscales with the highest indices were depersonalization and emotional exhaustion(AU)

Características clínico - epidemiológicas de los accidentes ofídicos en un hospital de la Amazonía del Perú / Clinico-epidemiologic characteristics of ophidic accidents in a hospital of the amazonia of Peru

Introducción: En el Perú, los accidentes ofídicos son un importante problema de salud pública, debido a una amplia distribución territorial de diferentes tipos de serpientes. Objetivo: Describir las características clínico - epidemiológicas y el manejo de los accidentes ofídicos registrados en un hospital de Perú. Métodos: Estudio de serie de casos, realizado entre enero del 2011 a diciembre 2015 en el Hospital Santa Rosa de Puerto Maldonado. Se revisaron 256 historias clínicas de pacientes con diagnóstico definitivo de ofidismo. Se analizaron variables sociodemográficas, clínicas y evolución de los pacientes. Resultados: El 78,5 por ciento de pacientes fueron varones, el grupo de edad más afectado fueron los adultos. La mayoría de los accidentes ocurrieron en el mes de marzo (12,5 por ciento). Un 39 por ciento de los pacientes se dedicaba al trabajo agrícola. Entre las 16:00 y 19:59 horas se produjeron 35,2 por ciento de los accidentes, 71,1 por ciento reportó como causante del accidente a la serpiente Bothrops atrox. El 71,5 por ciento de las mordeduras se presentaron en miembros inferiores. La mayoría de pacientes recibió tratamiento específico con antibotrópico polivalente (90,6 por ciento). Conclusiones: En la población estudiada, el sexo más afectado es el masculino con una edad entre 27 a 59 años. La serpiente más frecuente causante de los accidentes fue la Bothrops atrox, más conocida entre los pobladores como "jergón". En la mayoría de los casos se administró como tratamiento específico el suero antiofídico(AU)

Introduction: In Peru, ophidian accidents are an important public health problem due to a wide territorial distribution of different types of snakes. Objective: To describe the clinical-epidemiological characteristics and the management of ophidian accidents registered in a hospital in Peru. Methods: Case series study carried out between January 2011 to December 2015 at the Santa Rosa Hospital in Puerto Maldonado, 256 medical records of patients with a definitive diagnosis of ophidism were reviewed. Sociodemographic and clinical variables and the evolution of the patients were analyzed. Results: A total of 78.5 percent of patients were men, the age group most affected were adults. Most of the accidents occurred in March (12.5 percent). 39 percent of the patients were engaged in agricultural work. Between 4:00 p.m. and 7:59 p.m., 35.2 percent of the accidents occurred. 71.1 percent reported the Bothrops atrox snake as the cause of the accident. 71.5 percent of the bites occurred on the lower limbs. Most patients received specific treatment with polyvalent anti-botropic (90.6 percent). Conclusions: In the studied population, the most affected sex is the male with an age between 27 and 59 years. The most frequent snake causing the accidents was the Bothrops atrox, better known among the inhabitants as "jergón". In most cases, antivenom was administered as a specific treatment(AU)

Pregnant woman from southern Peru with rabies infection who delivered a healthy baby.

Rabies in pregnancy is rare with a high mortality. We report a pregnant woman who developed urban rabies from the bite of an infected dog. An emergency Cesarean section was performed at 31 weeks of gestation, and a premature baby was delivered who survived and did not develop rabies. The mother, however, suffered a rapid clinical deterioration and was admitted to intensive care where a Milwaukee protocol was followed. The patient survived 19 months but developed severe neurological sequelae secondary to rabies encephalitis and finally died of respiratory failure.

Síndrome de Noonan e insuficiencia aórtica severa en un paciente adulto / Noonan Syndrome and Severe Aortic Regurgitation in an Adult Patient

Introducción: El síndrome de Noonan es una enfermedad congénita con una incidencia de 1:1000-2500 recién nacidos vivos. Se encuentra subdiagnosticada en nuestro medio debido a la variabilidad clínica, lo cual no permite un adecuado control y seguimiento para detectar complicaciones consecuentes a los defectos cardiovasculares congénitos. En Perú no existen reportes de casos sobre el síndrome de Noonan y sus complicaciones. Objetivo: Discutir la importancia del examen clínico para su adecuado diagnóstico a partir de las características del síndrome de Noonan en un adulto. Caso clínico: Presentamos el caso de un varón de 33 años con síndrome de Noonan, endocarditis infecciosa e insuficiencia aórtica severa. Conclusiones: Se resalta la importancia del examen físico y el uso de criterios diagnósticos para realizar el diagnóstico del síndrome de Noonan(AU)

Introduction: Noonan syndrome is a congenital disease with an incidence of 1: 1000-2500 live newborns. Due to its clinical variability, it is underdiagnosed in our setting, which does not allow adequate control and follow-up to detect complications resulting from congenital cardiovascular defects. In Peru, there are no case reports on Noonan syndrome and its complications. Objective: To discuss the importance of clinical examination for adequate diagnosis of Noonan syndrome, based on the characteristics of the disease in an adult. Clinical case: We present the case of a 33-year-old male patient with Noonan syndrome, infective endocarditis, and severe aortic regurgitation. Conclusions: The importance of physical examination and the use of diagnostic criteria to diagnose Noonan syndrome are highlighted(AU)

Prácticas de salud sexual en adolescentes de dos colegios del sur de la región Lima, Perú / Sexual health practices in adolescents from two schools in the south of the Lima region, Peru

OBJETIVO: Determinar las prácticas de salud sexual en adolescentes de dos colegios de la provincia de Cañete, Región Lima. MÉTODO: Estudio descriptivo transversal realizado en adolescentes entre 15 y 17 años de edad. RESULTADOS: Se incluyó un total de 127 estudiantes. 50,4% (64) fueron mujeres. La edad promedio fue de 15.67 ±0,65. El 24% (30) de los alumnos habían iniciado relaciones sexuales. Los varones tuvieron más probabilidad de inicio de relaciones sexuales que las mujeres (OR= 4,67 IC95% [1,83-11,95]; p = 0,001) y de acceso a los servicios de salud (OR= 2,51 IC95% [1,065 - 5,92]; p=0,032). Las mujeres tuvieron mayor probabilidad de recibir educación sexual de sus padres (OR = 2,2 IC95% [1,05-4,65]; p= 0,035). CONCLUSIONES: El inicio de relaciones sexuales en los alumnos estuvo dentro de lo reportado en la literatura nacional, los varones tuvieron más probabilidad de inicio de relaciones sexuales y las mujeres mayor probabilidad de recibir educación sexual de sus padres.

OBJECTIVE: To determine the sexual health practices in adolescents from two schools in the province of Cañete, Lima Region. METHOD: Cross-sectional descriptive study carried out in adolescents between 15 and 17 years of age. RESULTS: A total of 127 students were included. 50.4% (64) were women. The average age was 15.67 ± 0.65. The 24% (30) of the students had started sexual relations. Males were more likely to initiate sexual intercourse than females (OR = 4.67 95% CI [1.83-11.95]; p = 0.001) and access to health services (OR = 2.51 CI95 % [1,065-5,92]; p = 0.032). Women were more likely to receive sexual education from their parents (OR = 2.2 95% CI [1.05-4.65]; p = 0.035). CONCLUSIONS: The beginning of sexual relations in the students was within that reported in the national literature, the men were more likely to initiate sexual relations and the women were more likely to receive sexual education from their parents.