Proportion of cancer cases and deaths attributable to potentially modifiable risk factors in Peru.

BACKGROUND: Limited evidence exists on the population attributable fraction (PAF) of cancer cases and deaths in Latin America. In Peru several studies have been published regarding the PAF of various risk factors and their associated diseases. The objective of this study was to estimate the fraction of cancer cases and deaths attributable to potentially modifiable risk factors in Peru in 2018, before the COVID-19 pandemic in the population of 15 years old and older. METHODS: An ecological study was conducted using the prevalence of exposure of the Peruvian population to modifiable risk factors for cancer, the relative risk associated with each factor, and the number of cancer cases and deaths in 2018 as inputs. We used the Parkin formula with a Montecarlo statistical simulation model to calculate the PAF and confidence intervals. The number of new cancer cases and deaths attributed to each risk factor was determined by multiplying the number of cases and deaths in each gender by the PAF of each risk factor. FINDINGS: In Peru, 38.5% of new cases (34.5% in men and 42% in women) and 43.4% of cancer-related deaths (43.4% in men and 43.4% in women) were attributable to modifiable risk factors. The number of cancers attributable was 25,308 (10,439 in men and 14,869 in women) and the number of deaths attributable to cancer was 14,839 (6,953 in men and 7,886 in women). The predominant modifiable risk factors contributing to the highest number of cases and deaths were HPV infection (4,563 cases, 2,409 deaths), current tobacco use (3,348 cases, 2,180 deaths), and helicobacter pylori infection (2,677 cases, 1,873 deaths). Among the risk factors, oncogenic infections constituted the group with the highest PAF (16.6% for cases, 19.2% for deaths) followed by other unhealthy lifestyle factors (14.2% for cases, 16.7% for deaths), tobacco (7.2% for cases, 7.2% for deaths) and ultraviolet radiation (0.5% for cases, 0.3% for deaths). CONCLUSIONS: Prior to the COVID-19 pandemic, 38.5% of cancer cases and 43.4% of cancer-related deaths in Peru were linked to modifiable risk factors in the population of 15 years old and older. Most preventable cancer cases and deaths were related to oncogenic infections, primarily caused by HPV and helicobacter pylori, followed by tobacco and obesity.

Ultrastructural skin alterations of healthy subjects with anti-desmoglein 1 antibodies in endemic areas to pemphigus foliaceus: A case series.

Background: Endemic pemphigus foliaceus and endemic pemphigus vulgaris are autoimmune dermatologic disorders endemic to the Peruvian Amazon. Objective: To determine the ultrastructural skin alterations of three healthy subjects with anti DSG-1 antibodies in areas endemic to pemphigus foliaceus and pemphigus vulgaris in the Peruvian Amazon. Patients and methods: Case series carried out from data of three clinically healthy subjects positive to anti DSG-1 antibodies, from Peru. This study consists of a sub-analysis of data gathered in a previous study. Results: Ultrastructural results are presented from the skin biopsies of three clinically healthy patients positive to anti-desmoglein 1 (DSG-1) antibodies. High Resolution Optical Microscopy (HROM) showed the absence of acantholysis. Transmission Electron Microscopy (TEM) showed the widening of intercellular space between keratinocytes, the presence of vacuoles in intercellular space with granular material and cytoplasmic vacuolization, loss of desmosome structure, loss of normal distribution among tonofilaments and lateral separation among cells in the stratum basale. Conclusion: According to our results, healthy subjects that present anti-desmoglein 1 antibodies can develop ultrastructural alterations that are visible through transmission electron microscopy but not through conventional optical microscopy.

The Fruit Intake-Adiposity Paradox: Findings from a Peruvian Cross-Sectional Study.

Due to the increase in obesity worldwide, international organizations have promoted the adoption of a healthy lifestyle, as part of which fruit consumption stands out. However, there are controversies regarding the role of fruit consumption in mitigating this disease. The objective of the present study was to analyze the association between fruit intake and body mass index (BMI) and waist circumference (WC) in a representative sample of Peruvians. This is an analytical cross-sectional study. Secondary data analysis was conducted using information from the Demographic and Health Survey of Peru (2019-2021). The outcome variables were BMI and WC. The exploratory variable was fruit intake, which was expressed in three different presentations: portion, salad, and juice. A generalized linear model of the Gaussian family and identity link function were performed to obtain the crude and adjusted beta coefficients. A total of 98,741 subjects were included in the study. Females comprised 54.4% of the sample. In the multivariate analysis, for each serving of fruit intake, the BMI decreased by 0.15 kg/m2 (ß = -0.15; 95% CI -0.24 to -0.07), while the WC was reduced by 0.40 cm (ß = -0.40; 95% CI -0.52 to -0.27). A negative association between fruit salad intake and WC was found (ß = -0.28; 95% CI -0.56 to -0.01). No statistically significant association between fruit salad intake and BMI was found. In the case of fruit juice, for each glass of juice consumed, the BMI increased by 0.27 kg/m2 (ß = 0.27; 95% CI 0.14 to 0.40), while the WC increased by 0.40 cm (ß = 0.40; 95% CI 0.20 to 0.60). Fruit intake per serving is negatively related to general body adiposity and central fat distribution, while fruit salad intake is negatively related to central distribution adiposity. However, the consumption of fruit in the form of juices is positively associated with a significant increase in BMI and WC.

Factors Associated with Symptoms of Depression among People with Obesity: Analysis of a 3-Year-Peruvian National Survey.

INTRODUCTION: Obesity and depression contribute to the global burden of economic cost, morbidity, and mortality. Nevertheless, not all people with obesity develop depression. OBJECTIVE: To determine the factors associated with depressive symptoms among people aged 15 or older with obesity from the National Demographic and Family Health Survey (ENDES in Spanish 2019-2021). METHODS: Cross-sectional analytical study. The outcome of interest was the presence of depressive symptoms, assessed using the Patient Health Questionnaire-9 (PHQ-9). Crude (cPR) and adjusted (aPR) prevalence ratios were estimated using GLM Poisson distribution with robust variance estimates. RESULTS: The prevalence of depression symptoms was 6.97%. In the multivariate analysis, a statistically significant association was found between depressive symptoms and female sex (PRa: 2.59; 95% CI 1.95-3.43); mountain region (PRa: 1.51; 95% CI 1.18-1.92); wealth index poor (PRa: 1.37; 95% CI 1.05-1.79, medium (PRa: 1.49; 95% CI 1.11-2.02), and rich (PRa: 1.65; 95% CI 1.21-2.26); daily tobacco use (PRa: 2.05, 95% CI 1.09-3.87); physical disability (PRa: 1.96, 95% CI 1.07-3.57); and a history of arterial hypertension (PRa: 2.05; 95% CI 1.63-2.55). CONCLUSION: There are several sociodemographic factors (such as being female and living in the Andean region) and individual factors (daily use of tobacco and history of hypertension) associated with depressive symptoms in Peruvian inhabitants aged 15 or older with obesity. In this study, the COVID-19 pandemic was associated with an increase in depressive symptoms.

Hospitalization, death, and probable reinfection in Peruvian healthcare workers infected with SARS-CoV-2: a national retrospective cohort study.

BACKGROUND: Peru has some of the worst outcomes worldwide as a result of the SARS-CoV-2 pandemic; it is presumed that this has also affected healthcare workers. This study aimed to establish whether occupation and other non-occupational variables were risk factors for possible reinfection, hospitalization, and mortality from COVID-19 in cohorts of Peruvian healthcare workers infected with SARS-CoV-2. METHODS: Retrospective cohort study. Healthcare workers who presented SARS-CoV-2 infection between March 1, 2020, and August 6, 2021, were included. Occupational cohorts were reconstructed from the following sources of information: National Epidemiological Surveillance System, molecular tests (NETLAB), results of serology and antigen tests (SICOVID-19), National Registry of Health Personnel (INFORHUS), and National Information System of Deaths (SINADEF). The incidence of probable reinfection, hospitalization, and death from COVID-19 was obtained in the cohorts of technicians and health assistants, nursing staff, midwives, dentists, doctors, and other healthcare workers. We evaluated whether the occupation and other non-occupational variables were risk factors for probable reinfection, hospitalization, and death from COVID-19 using log-binomial and probit binomial models, obtaining the adjusted relative risk (RRAJ). RESULTS: 90,398 healthcare workers were included in the study. Most cases were seen in technicians and health assistants (38.6%), and nursing staff (25.6%). 8.1% required hospitalization, 1.7% died from COVID-19, and 1.8% had probable reinfection. A similar incidence of probable reinfection was found in the six cohorts (1.7-1.9%). Doctors had a higher incidence of hospitalization (13.2%) and death (2.6%); however, they were also those who presented greater susceptibility linked to non-occupational variables (age and comorbidities). The multivariate analysis found that doctors (RRAJ = 1.720; CI 95: 1.569-1.886) had a higher risk of hospitalization and that the occupation of technician and health assistant was the only one that constituted a risk factor for mortality from COVID-19 (RRAJ = 1.256; 95% CI: 1.043-1.512). CONCLUSIONS: Peruvian technicians and health assistants would have a higher risk of death from COVID-19 than other healthcare workers, while doctors have a higher incidence of death probably linked to the high frequency of non-occupational risk factors. Doctors present a higher risk of hospitalization independent of comorbidities and age; likewise, all occupations show a similar risk of probable reinfection.

Epidemiological Characteristics of Deaths from COVID-19 in Peru during the Initial Pandemic Response.

BACKGROUND AND AIM: Peru is the country with the highest mortality rate from COVID-19 globally, so the analysis of the characteristics of deaths is of national and international interest. The aim was to determine the epidemiological characteristics of deaths from COVID-19 in Peru from 28 March to 21 May 2020. METHODS: Deaths from various sources were investigated, including the COVID-19 Epidemiological Surveillance and the National System of Deaths (SINADEF). In all, 3851 deaths that met the definition of a confirmed case and had a positive result of RT-PCR or rapid test IgM/IgG, were considered for the analysis. We obtained the epidemiological variables and carried out an analysis of time defined as the pre-hospital time from the onset of symptoms to hospitalization, and hospital time from the date of hospitalization to death. RESULTS: Deaths were more frequent in males (72.0%), seniors (68.8%) and residents of the region of Lima (42.7%). In 17.8% of cases, the death occurred out-of-hospital, and 31.4% had some comorbidity. The median of pre-hospital time was 7 days (IQR: 4.0-9.0) and for the hospital time was 5 days (IQR: 3.0-9.0). The multivariable analysis with Poisson regression with robust variance found that the age group, comorbidity diagnosis and the region of origin significantly influenced pre-hospital time; while sex, comorbidity diagnosis, healthcare provider and the region of origin significantly influenced hospital time. CONCLUSION: Deaths occurred mainly in males, seniors and on the coast, with considerable out-of-hospital deaths. Pre-hospital time was affected by age group, the diagnosis of comorbidities and the region of origin; while, hospital time was influenced by gender, the diagnosis of comorbidities, healthcare provider and the region of origin.

Arsenicism by Chronic Exposure to Mine Tailings in Peru: An Analysis of 17 Cases with Lesions on Skin and/or Annexes.

Objective: To characterize the epidemiology and clinical manifestations of arsenicism from chronic exposure to mine tailings in people with lesions on their skin and/or annexes in two mining districts in the highlands of Peru. Materials and Methods: In this case series study, we included 17 people that presented arsenical lesions in skin and annexes which were identified in two prior studies. We evaluated age, occupation, place of exposure, time of exposure, time of disease, manifestations on skin and annexes, location of lesions, severity, and 24-hour urine clearance of arsenic. Results: The average time of exposure was 16.5 ± 14.7 years, and the average length of disease was 9.8 ± 8.1 years. In this study, 70.6% were men, 41.2% were farmers and 17.6% were underage. The most frequent main manifestations in skin and annexes were plantar keratosis (23.5%), palmar (11.8%), palmoplantar (11.8%) and thoracic keratosis (5.9%). Other manifestations were palmoplantar keratosis with thoracic hyperpigmentation (17.6%), Mees' lines (17.6%) and hyper/hypopigmentation in thorax and back (11.8%). With relation to the severity of lesions, 35.3% were grade 1 (mild), 29.4 % were grade 0 (asymptomatic), 29.4 % were grade 2 (moderate), and 5.9% were grade 3 (severe). The median of 24-hour urine clearance of arsenic was 55 µg/L/24 hours. No cases of skin cancer were presented. Conclusion: The studied cases of arsenicism with lesions on skin and/or annexes by exposure to mine tailings present with differential characteristics in comparison to other forms of arsenicism such as less severity, lower urine clearance of arsenic, and absence of skin cancer cases.

Exposure to Atmospheric Ozone Disruption and Altitude Over 3500 m.a.s.l. are Associated with a Higher Prevalence of Photodermatoses in Pediatric Population of High-Altitude in Peru.

Objective: To determine if exposure to atmospheric ozone disruption and other factors are associated with photodermatoses in the high-altitude pediatric population in Peru. Materials and Methods: A cross-sectional study based on data obtained from studies of dermatological diseases among the population exposed to mine tailings in Peru which included children under the age of 18 in 6 population centers located over 2500 meters above sea level (m.a.s.l). We evaluated the presence of photodermatoses and possible associated factors obtaining the adjusted odds ratio (aOR) and confidence intervals (CI). Results: 594 children below the age of 18 participated in this study, 53.0% girls, the average age was 10.4 ± 4.1 years. 51.3% were exposed to a mini hole in the ozone layer, 60.1% resided at an altitude over 3500 m.a.s.l and 51.9% presented cutaneous manifestations of atopy upon physical examination. The prevalence of photodermatoses was 64.8%, of which the most frequent were actinic prurigo (49.3%), pityriasis alba (18.5%) and actinic cheilitis (4.4%). The multivariate analysis found that residing in a region exposed to the mini hole in the ozone layer (aOR = 4.23; CI 95%: 2.32-7.72) and residing at an altitude over 3500 m.a.s.l (aOR = 2.76; CI 95%: 1.57-4.86) were both independent associated factors to photodermatoses. Conclusion: A high prevalence of photodermatoses exists among the pediatric population living at high-altitude in Peru. Residing in a region exposed to a mini hole in the ozone layer and residing over 3500 m.a.s.l constituted associated factors.

Factors associated with excessive daytime sleepiness in informal drivers of buses on a high-altitude road.

Objective: To determine the factors associated with excessive daytime sleepiness (EDS) in informal interprovincial transport drivers of the Lima-Huancayo central highway (Peru) from January to March 2018. Methods: Cross-sectional study. The drivers were weighed and measured, then individual, sociodemographic, and occupational data were obtained which were recorded in a data collection form, then the Epworth Sleepiness Scale (ESS) was applied to the drivers. The prevalence and EDS-associated factors in drivers were obtained from this data. The multivariate analysis of the possible associated factors for EDS was performed with binary logistic regression, obtaining the adjusted odds ratio (AOR). Results: 162 drivers participated in the study. The average age was 42.0 ± 10.2 years (Range of 21-62 years), all the participants were male. 55. 6% had a technical degree, 42.0% were married and 55.6% had two to three children. The mean time of experience as a driver was 17.0 ± 6.8 years, 54.9% were overweight, and 32.1% were obese. 27.8% of drivers had EDS, the multivariate analysis found that the EDS-associated factors of the drivers were obesity (AOR=3.8, 95% CI: 1.422- 10.233), having 10 or more years of experience as a driver (AOR=3.1, 95% CI: 1.342-7.189) and overweight (AOR=2.9 CI 95%: 1.216-7.096). Conclusion: There is a high prevalence of EDS in informal drivers of interprovincial transport of the central high-altitude highway studied. Obesity was the main factor associated with EDS, along with being overweight and having 10 or more years of experience as a driver.

Teaching-learning process and the attitude toward scientific research among midwifery students.

BACKGROUND: Research in universities requires systematic and participatory processes that integrate teachers, contents, strategies and tools, and students and their own interests. Therefore, the main objective of this study was to establish the relationship between the perception of the teaching-learning process (TLP) and the attitude toward scientific research among midwifery students. MATERIALS AND METHODS: Descriptive cross-sectional study, conducted on 250 students from second to fourth year of study selected by convenience sampling. The data were collected with two self-administered Likert-type scales that were validated in content and construct, both with high reliability. Descriptive statistics were carried out; the Spearman correlation test was used prior to the application of the Kolmogorov-Smirnov test and Kendall's tau-b test. RESULTS: The favorable perception of the TLP was greater among second-year students (42.6%), in addition, 15.2% agreed that the advice of teachers contributes to the elaboration of the research protocol. The attitude of indifference toward research was more frequent in third-year students (58.2%) and 28.4% were deemed in disagreement to be able to identify and operationalize the variables. In the analysis of dimensions, the role of the student had a moderate relationship with the research design (rho = 0.536; P < 0.001), while a weak relationship was demonstrated between media and techniques with ethical and scientific value (rho = 0.104; P < 0.001). CONCLUSION: The TLP perceived by midwifery students and their attitudes toward scientific research had a direct and significant correlation. The proportion of students with favorable perception was greater among those with a favorable attitude.

Equipos de respuesta rápida de vigilancia epidemiológica: Mitigación de la pandemia de coronavirus en Perú, 2020 / Rapid Response Teams For Epidemiological Surveillance: Mitigation Of The Coronavirus Pandemic In Peru, 2020

El 30 de enero de 2020, con más de 9,700 casos confirmados en China, la Organización Mundial de la Salud declaró que el brote de coronavirus era una emergencia de salud pública de importancia internacional. A fines de enero el Centro Nacional de Epidemiologia, Prevención y Control de Enfermedades (CDC-Perú)del Ministerio de Salud elaboró el "Plan Nacional de Preparación y Respuesta frente a la Introducción del coronavirus 2019-nCoV", donde uno de los componentes estratégicos fue fortalecer la respuesta epidemiológica a través de acciones de mitigación que permitan la identificación temprana de casos, diagnóstico, seguimiento de contactos e identificación de personas con condiciones de riesgo.

On January 30, 2020, with more than 9,700 confirmed cases in China, the World Health Organization declared the coronavirus outbreak to be a public health emergency of international concern. At the end of January, the National Center for Epidemiology, Prevention and Control of Diseases (CDC-Peru) of the Ministry of Health prepared the "National Plan of Preparation and Response to the Introduction of the coronavirus 2019-nCoV", where one of the strategic components was strengthen the epidemiological response through mitigation actions that allow early identification of cases, diagnosis, follow-up of contacts and identification of people with risk conditions.

Estudio de Factibilidad para Evaluar la Proporción de Cáncer Atribuible a Factores de Riesgo Modificables en el Perú y Latinoamérica / Feasibility Study To Evaluate The Proportion Of Cancer Attributable To Modifiable Factors Of Risk In Peru And Latin America

Objetivo: Evaluar la factibilidad y validar de la propuesta metodológica para estimar la incidencia y mortalidad por cáncer atribuible a factores de riesgo modificables para el Perú y Latinoamérica. Métodos: Estudio piloto, ecológico a partir de fuentes secundarias. Se buscó y seleccionó los factores de riesgo modificables, prevalencia de exposicion, los riesgos relativos de dichos factores (RR) o una aproximación mediante la razón de posibilidades (OR). La información fue consignada en una ficha de recolección de datos la cual fue validada mediante juicio de expertos. Para el cálculo de la Fracción Atribuible Poblacional (FAP) se ensayó la fórmula planteada por Parkin y se desarrolló un modelo de simulación estadística con el software R. Studio V. 3.6.1. Resultados: En el Perú se cuenta con estudios de prevalencia para la mayoría de factores de riesgo modificables; asimismo, se dispone en Latinoamérica de estudios con estimaciones de OR para varios de los factores; sin embargo hubo que utilizar estudios de los Estados Unidos para los factores restantes. No hallamos estudios nacionales de radiaciones ionizantes ni ultravioleta. Se ensayó la sintaxis del modelo de simulación estadística la cual mostró ser válida y consistente con los resultados de estudios internacionales de FAP encontrándose dentro de los rangos de los estudios publicados. Conclusión: Es factible y viable realizar estudios de FAP de factores de riesgo modificables para cáncer en países de Latinoamérica, particularmente en el Perú, donde se cuenta con la información requerida para su estimación.

Objective: To evaluate the feasibility of the methodological proposal to estimate the incidence and mortality due to cancer attributable to modifiable risk factors for Peru and Latin America. Methods: Pilot study, ecological from secondary sources. Modifiable risk factors, exposure prevalence, relative risks of these factors (RR) or an approximation by means of possibilities ratio (OR) were searched and selected. The information was recorded in a data collection form which was validated by expert judgment. For the calculation of the Population Attributable Fraction (FAP), the formula proposed by Parkin was tested and a statistical simulation model was developed with R. Studio V. 3.6.1 software. Results: In Peru there are prevalence studies for the majority of modifiable risk factors; Likewise, studies with OR estimates for several of the factors are available in Latin America; however, studies from the United States had to be used for the remaining factors. No national studies of ionizing or ultraviolet radiation were found. The syntax of the statistical simulation model was tested, which proved to be valid and consistent with the results of international FAP studies within the ranges of published studies. Conclusion: It is feasible and viable to carry out PAF studies of modifiable risk factors for cancer in Latin American countries, particularly in Peru, where the information required for its estimation is available.

Presentación del documento técnico "Análisis de la situación del cáncer en el Perú, 2018" / Presentation Of The Technical Document: Analysis Of The Situation Of Cancer In Peru 2018

El diseño y planificación de las intervenciones de prevención y control así como la evaluación de las intervenciones ya implementadas requieren un análisis situacional a partir de diversos sistemas y fuentes de información que permitan dirigir y priorizar los recursos hacia las poblaciones más vulnerables y/o desfavorecidas. Los análisis de situación de salud constituyen una herramienta poderosa para la identificación de necesidades y prioridades siendo esenciales para la construcción de políticas en salud. El 27 de diciembre de 2019, el Centro Nacional de Epidemiología, Prevención y Control de Enfermedades presentó en el Paraninfo del Ministerio de Salud el "Análisis de la situación del cáncer en el Perú, 2018". Dicho documento técnico busca contribuir en base al análisis de datos de diversas fuentes de información al diseño de las intervenciones de prevención y control del cáncer en el país, particularmente en la formulación del Plan Nacional de Cuidados Integrales del Cáncer 2020-2024 que representa la continuación del Plan Esperanza.

The design and planning of prevention and control interventions as well as the evaluation of interventions already implemented require a situational analysis based on various systems and sources of information that allow directing and prioritizing resources to the most vulnerable and / or disadvantaged populations. Health situation analyzes constitute a powerful tool for the identification of needs and priorities, being essential for the construction of health policies. On December 27, 2019, the National Center for Epidemiology, Disease Prevention and Control presented in the Paraninfo of the Ministry of Health the "Analysis of the situation of cancer in Peru, 2018". This technical document seeks to contribute based on the analysis of data from various sources of information to the design of cancer prevention and control interventions in the country, particularly in the formulation of the National Plan for Comprehensive Cancer Care 2020-2024 which represents the continuation of the Hope Plan.

Cutaneous Manifestations of Zika in Peru.

This article aims to describe the cutaneous manifestations observed in the Zika epidemic in Peru during 2016 and 2017, as well as discuss the potential differential diagnoses. During the outbreak, the main reason for seeking medical advice was the development of a pruriginous maculopapular rash with a marked papular component, which started on the chest and later generalized to the rest of the body. Similar manifestations were noted in adults, children, and pregnant women. Other manifestations such as conjunctivitis, edema, or petechiae on the palate were rare. We suggest that in areas that are endemic for arboviral infections, in the differential diagnosis of a rash one must consider infections such as dengue, Zika, or chikungunya viruses. In nonendemic areas, the diagnosis is more difficult, as the rash may result from other viral infections not transmitted by arthropods and/or reactive or inflammatory diseases (urticaria, atopic dermatitis, systemic lupus erythematosus). We recommend that primary care health personnel are trained in the recognition of the mucocutaneous lesions caused by Zika virus infection, which could contribute to the identification of suspicious cases, particularly pregnant women.

Índice linfocito/monocito como factor pronóstico en linfoma células grandes B difuso en un hospital nacional de Lima-Perú, período 2010-2017 / Index lymphocyte/monocite as a pronosis factor in lymphoma large cells diffuse, Edgardo Rebagliati Martins Hospital 2010-2017

Objetivo: Evaluar el valor pronostico del índice linfocito monocito (ILM) en la sobrevida global de los pacientes con Linfoma de células grandes B difuso (LCGBD) del Hospital Edgardo Rebagliati Martins. Métodos: Estudio longitudinal retrospectivo. Se incluyó a los casos de LCGBD diagnosticados en el Hospital Nacional Edgardo Rebagliati Martins durante el período 2010-2017. No se realizó muestreo, se trabajó con la totalidad de la población que cumplió con los criterios de selección por ser esta pequeña y accesible. Se revisó las historias clínicas de los pacientes obteniéndose información del tiempo en meses de supervivencia, del ILM así como de variables sociodemográficas, clínicas y de laboratorio. Resultados: Se incluyó en el análisis a 121 pacientes con LCGBD; de ellos, el 57% eran de sexo femenino y 66.1% eran mayores de 60 años. De acuerdo al Status Zubrod, el 66,5% correspondieron al grado de mejor pronóstico y el 59.5% presento sintomas B asociados. Cerca del 60% fueron diagnosticados en estadios I y II y el 57% presento compromiso extraganglionar. El análisis bivariado con el modelo de riesgos proporcionales de Cox mostró que el ILM<2 constituyó un predictor de la supervivencia global del LCGBD (p=0,011) estimándose un HR=2.2 (IC 95%: 1.2-4.1); asimismo, un ILM< 1,7 también constituyó predictor (p=0,009) estimándose un HR=2.2 (IC 95%: 1.2-4.1). El ILM<2,7 no constituyó predictor de la supervivencia global. Conclusión: El ILM podría utilizarse como un índice pronóstico debido a que constituye un predictor de la supervivencia global de los pacientes con LCGBD del Hospital Nacional Edgardo Rebagliati Martins.

Objetive: To evaluate the prognostic value of the monocyte lymphocyte index (ILM) in the overall survival of patients with diffuse large B-cell lymphoma (LCGBD) of the Edgardo Rebagliati Martins Hospital. Methods: Retrospective longitudinal study. We included cases of LCGBD diagnosed in the National Hospital Edgardo Rebagliati Martins during the period 2010-2017. No sampling was done, we worked with the entire population that met the selection criteria because it is small and accessible. The patients' clinical histories were reviewed, obtaining information about the time in months of survival, ILM, as well as sociodemographic, clinical and laboratory variables. Results: 121 patients with LCGBD were included in the analysis; of them, 57% were female and 66.1% were older than 60 years. According to the Zubrod Status, 66.5% corresponded to the degree of better prognosis and 59.5% presented associated B symptoms. About 60% were diagnosed in stages I and II and 57% presented extranodal involvement. The bivariate analysis with the Cox proportional hazards model showed that the ILM <2 constituted a predictor of the overall survival of the LCGBD (p = 0.011), estimating HR = 2.2 (95% CI: 1.2-4.1); likewise, an ILM <1.7 was also a predictor (p = 0.009) with an estimated HR = 2.2 (95% CI: 1.2-4.1). ILM <2.7 was not a predictor of overall survival.. Conclusion: The ILM could be used as a prognostic index because it is a predictor of the overall survival of patients with LCGBD of the Edgardo Rebagliati Martins National Hospital.

Oxidative stress in patients with endemic pemphigus foliaceus and healthy subjects with anti-desmoglein 1 antibodies.

BACKGROUND: Previous studies have shown oxidative stress in pemphigus vulgaris and pemphigus foliaceus, nevertheless, it remains unknown whether a similar response is characteristic of endemic pemphigus foliaceus in Peru. OBJECTIVES: To determine the oxidative stress response in endemic pemphigus foliaceus patients and subjects with positive for anti-desmoglein1 antibodies (anti-dsg1) from endemic areas of Peru. SUBJECTS AND METHODS: This is a cross-sectional study. The study population included 21 patients with Endemic Pemphigus foliaceus and 12 healthy subjects with anti-dsg1 antibodies from the Peruvian Amazon (Ucayali), as well as 30 healthy control subjects. Malondialdehyde, an indicator of lipid peroxidation by free radicals, was measured in serum. RESULTS: We collected 21 cases of endemic pemphigus foliaceus, 15 of them with active chronic disease and 6 in clinical remission. Serum malondialdehyde values in patients with chronic active evolution and healthy subjects with anti-dsg1 antibodies were statistically higher than those of healthy controls (p<0.001). There was no significant difference between serum values of localized and generalized clinical forms. STUDY LIMITATIONS: The main limitation of this present study is the small number of patients with endemic pemphigus and healthy subjects positive for desmoglein 1 antibodies. CONCLUSIONS: The increased serum levels of malondialdehyde in patients with chronic active endemic pemphigus foliaceus and healthy subjects from endemic areas with anti-dsg1 antibodies may suggest a contribution of systemic lipid peroxidation in the pathogenesis of endemic pemphigus foliaceus.

Oxidative stress in patients with endemic pemphigus foliaceus and healthy subjects with anti-desmoglein 1 antibodies

Abstract: Background: Previous studies have shown oxidative stress in pemphigus vulgaris and pemphigus foliaceus, nevertheless, it remains unknown whether a similar response is characteristic of endemic pemphigus foliaceus in Peru. Objectives: To determine the oxidative stress response in endemic pemphigus foliaceus patients and subjects with positive for anti-desmoglein1 antibodies (anti-dsg1) from endemic areas of Peru. Subjects and Methods: This is a cross-sectional study. The study population included 21 patients with Endemic Pemphigus foliaceus and 12 healthy subjects with anti-dsg1 antibodies from the Peruvian Amazon (Ucayali), as well as 30 healthy control subjects. Malondialdehyde, an indicator of lipid peroxidation by free radicals, was measured in serum. Results: We collected 21 cases of endemic pemphigus foliaceus, 15 of them with active chronic disease and 6 in clinical remission. Serum malondialdehyde values in patients with chronic active evolution and healthy subjects with anti-dsg1 antibodies were statistically higher than those of healthy controls (p<0.001). There was no significant difference between serum values of localized and generalized clinical forms. Study limitations: The main limitation of this present study is the small number of patients with endemic pemphigus and healthy subjects positive for desmoglein 1 antibodies. Conclusions: The increased serum levels of malondialdehyde in patients with chronic active endemic pemphigus foliaceus and healthy subjects from endemic areas with anti-dsg1 antibodies may suggest a contribution of systemic lipid peroxidation in the pathogenesis of endemic pemphigus foliaceus.