HIV treatment cascade in regions of Peru with the highest HIV prevalence.

OBJECTIVES: To describe the HIV treatment cascade and care continuum in regions of highest HIV prevalence in Peru. METHODS: An observational longitudinal study was carried out in 14 tertiary hospitals in Peru. These are the main hospitals that administer antiretroviral treatment (ART) in the regions that represent approximately 95% of reports of HIV/AIDS cases in Peru in 2013. We included individuals older than 18 years newly diagnosed with HIV from 1 January 2011 to 31 December 2012. Medical records were reviewed until 2015. RESULTS: A total of 2119 people living with HIV (PLHIV) were identified in the selected health facilities (mean age = 35.26 years, 78% male). 97.25% [1845/1897; 95% confidence interval (CI): 96.4-97.9%] of the patients attended the consultation at least once during the follow-up, but only 64.84% (885/1365; 95% CI: 62.2-67.4%) attended within a month after the diagnosis. After starting ART, 74.63% (95% CI: 71.9-77.2%) of PLHIV remained in healthcare. Regardless of the time after diagnosis, 88.40% (1837/2078; 95% CI: 86.9-89.7%) of PLHIV started ART during the observation time. However, 78.68% (95% CI: 76.8-80.4%) did so during the first post-treatment year and only 28.88% (95% CI: 27.9-31.9%) after 1 month. After starting treatment, it was observed that 51.60% (95% CI: 49.2-54%) of PLHIV reached viral suppression during the follow-up period. CONCLUSIONS: Further analysis and improvements in the definition of indicators are required to achieve conclusive results; however, these data will give us a general understanding of the progress of Peruvian health policies in achieving the goal established by the WHO.

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.

Asociación entre depresión y deterioro cognitivo en adultos mayores de un centro de atencion integral de Lima

RESUMEN Fundamento: la salud psíquica y cognitiva de los adultos mayores puede presentar cambios relacionados con el envejecimiento. Con frecuencia la depresión conlleva deterioro cognitivo, condiciones que deben identificarse para la detección oportuna y prevención de daños. Objetivo: determinar la asociación entre el nivel de depresión y deterioro cognitivo en adultos mayores de un centro de atención integral de la ciudad de Lima, Perú. Métodos: se realizó un estudio transversal y analítico en adultos mayores de 60 años, asistentes a un centro de adultos mayores de Lima, entre enero y julio 2017. Se consideró como variable dependiente al deterioro cognitivo y las variables independientes fueron: la depresión y las características sociodemográficas. Se realizó estadística descriptiva basada en el cálculo de frecuencias, porcentajes, dispersión y medidas de tendencia central. Para encontrar la asociación entre las variables independientes y el deterioro cognitivo se utilizó la prueba de Chi cuadrado o la prueba exacta de Fisher. Los cálculos se realizaron con un nivel de confianza de 95 %. Resultados: el promedio de edad fue de 67,4± 7,4 años. El 20,7 % presentó depresión y el 31,0 % deterioro cognitivo. En el análisis bivariado se encontró que la edad de 70 años a más (p<0,001; OR=23,0 I.C. [6,68-79,15]), el nivel educativo no superior (p=0,015; OR=4,63 IC95 º% [1,25-17,16] y depresión (p=0,012; OR=3,82 I.C.95 % [1,3-11,24]) estuvieron asociados con el deterioro cogntivo. El análisis multivariado se encontró que solo la edad estuvo asociada a deterioro cognitivo (p<0,001; OR=24,93 IC95 % [6,04-97,74]). Conclusiones: una mayor edad, el bajo nivel educativo y la depresión estuvieron asociados al deterioro cognitivo, de estos factores, solo la edad de 70 años y más fue un factor independiente asociado al deterioro cognitivo.

ABSTRACT Background: the mental and cognitive health of older adults can present changes related to aging. Depression often leads to cognitive impairment, conditions that must be identified for timely detection and prevention of damage. Objective: to determine the association between the level of depression and cognitive impairment in older adults from a comprehensive care center in the city of Lima, Perú. Methods: a cross-sectional and analytical study was carried out in adults over 60 years of age, attending a center for the elderly in Lima, between January and July 2017. Cognitive deterioration was considered the dependent variable and the independent variables were depression and characteristics. sociodemographic. Descriptive statistics were performed based on the calculation of frequencies, percentages, dispersion and measures of central tendency. To find the association between the independent variables and cognitive impairment, the Chi-square test or Fisher's exact test was used. The calculations were made with a confidence level of 95 %. Results: the average age was 67.4±7.4 years. 20.7 % presented depression and 31.0 % cognitive impairment. In the bivariate analysis, it was found that the age of 70 years or more (p<0.001; OR=23.0 I.C. [6.68-79.15]), the educational level not superior (p=0.015; OR=4, 63 95% CI [1.25-17.16] and depression (p=0.012; OR=3.82 95% CI [1.3-11.24]) were associated with cognitive impairment. that only age was associated with cognitive impairment (p<0.001; OR=24.93 CI95 % [6.04-97.74]). Conclusions: older age, low educational level and depression were associated with cognitive impairment, of these factors, only age 70 years or older was an independent factor associated with cognitive impairment.

Prevalencia, manifestaciones clínicas y factores asociados al COVID-19 de larga duración / Prevalence, clinical manifestations, and associated factors of long COVID-19

El objetivo fue describir la prevalencia, las manifestaciones clínicas y los factores asociados de COVID-19 de larga duración. Se realizó una búsqueda bibliográfica de revisiones sistemáticas y metaanálisis sobre COVID-19 de larga duración en MEDLINE (vía PubMed) hasta el 7 de abril de 2022. Se encontraron 37 artículos y se incluyeron 3. La calidad de la evidencia fue evaluada a través de los criterios de AMSTAR 2. La prevalencia reportada de COVID-19 de larga duración fue 43% (IC95%: 39% ­ 46%). Las principales manifestaciones clínicas fueron debilidad (41% [IC95%: 25% ­ 59%]), malestar general (33% [IC95%: 15% ­ 57%]), fatiga (31% [IC95%: 24% ­ 39%]), alteración en la concentración (26% [IC95%: 21% ­ 32%]) y sensación de falta de aire (25% [IC95%: 18% ­ 34%]). Los factores asociados a COVID de larga duración incluyeron sexo femenino, severidad de cuadro inicial, edad y presencia de comorbilidades.

The aim was to describe the prevalence, clinical manifestations, and associated factors of long-COVID. Bibliographic research of systematic reviews and meta-analyses was carried out in MEDLINE (through PubMed) until April 7th, 2022. 37 articles were found and 3 were included. Evidence quality was assessed via AMSTAR 2 criteria. Long-COVID prevalence is 43% (IC95%: 39% ­ 46%). Main clinical manifestations were weakness (41% [IC95%: 25% ­ 59%]), malaise (33% [IC95%: 15% ­ 57%]), fatigue (31% [IC95%: 24% ­ 39%]), concentration impairment (26% [IC95%: 21% ­ 32%]), and breathlessness (25% [IC95%: 18% ­ 34%]). Factors associated with long COVID were female sex, initial disease severity, age, and presence of comorbidities.

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.

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)

Comparison of EQ-5D Values Sets Among South American Countries.

OBJECTIVE: Social health preference sets are necessary for conducting health economic evaluations. Values from other countries are often used when local sets are not available, which may alter the results. We aimed to evaluate the degree of variability of currently available country-specific value sets of the EuroQol EQ-5D instrument from South American countries (SAC). METHODS: We selected EQ-5D value sets from SAC and 2 reference countries. We obtained crosswalk value sets for the countries that use the EQ-5D-3L instrument. We compared the value sets with the Kruskal-Wallis test and then carried out pairwise comparisons with the Sign test. We also assessed correlations among the countries' value sets using the Spearman test. We calculated the absolute difference across countries for each health state, considering a difference of greater than 0.05 relevant. RESULTS: The range of value sets varied greatly. The Peruvian value set had the widest range (1 to -1.076) and the lowest values (median: 0.055; interquartile range: -0.171 to 0.275). The Ecuadorian set had the highest values (median: 0.587; interquartile range: 0.443-0.704). The Peruvian value set also had the greatest proportion of health states (43.6%) with a negative value, and the Uruguayan set had the smallest proportion (0.9%). Differences among countries were significant in all cases, with the greatest difference between Ecuador and Peru (median difference: 0.495; 95% confidence interval: 0.515-0.528). CONCLUSION: Social health preference sets varied greatly among SAC. Using non-local values could distort resource allocation decisions; hence, we recommend that countries obtain and use local value sets.

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.

Características clínicas y epidemiológicas en adultos mayores con diagnóstico de fractura de cadera en un hospital de Lima, Perú / Clinical and epidemiological characteristics in older adults with a diagnosis of hip fracture in a hospital in Lima, Peru

RESUMEN: OBJETIVOS : Determinar las características clínicas y epidemiológicas en adultos mayores con fractura de cadera en un hospital de Lima, Perú. MÉTODO : Estudio tipo serie de casos realizado en el servicio de traumatología del Hospital Central PNP "Luis N. Sáenz" durante el periodo 2015-2018. Se revisaron historias clínicas de pacientes con diagnóstico de fractura de cadera. RESULTADOS : Se incluyeron un total de 140 historias. Se encontró predominio en el sexo femenino (54.3%) y en pacientes mayores de 80 años (45%). Gran parte de estos eventos ocurrieron en el domicilio (81.4%). Las fracturas intertrocantéricas fueron las más frecuentes (60%), sobre todo del lado derecho (51.4%), la osteosíntesis fue la opción terapéutica más usada (62.1%). El dolor (92%) y la impotencia funcional (91.4%) fueron la presentación clínica característica de las fracturas de cadera y la hipertensión arterial la patología más frecuentemente asociada (52.2%). CONCLUSIONES : La fractura de cadera afecta primordialmente a personas mayores de 80 años, en especial al sexo femenino con elevada comorbilidad. El mayor porcentaje se da como resultado de caídas producidas en el domicilio, siendo el dolor del lado afectado la principal manifestación. El tipo de fractura más frecuente es la intertrocantérica y el tratamiento más usado, la osteosíntesis.

ABSTRACT: OBJECTIVES : To determine the clinical and epidemiological characteristics in older adults with hip fracture in a hospital in Lima, Peru. METHODS : Case series type study carried out in the trauma department of the PNP Central Hospital "Luis N. Saenz" during the period 2015-2018. Medical records of patients diagnosed with hip fracture were reviewed. RESULTS : A total of 140 medical records were included. A predominance was found in the female sex (54.3%) and in patients over 80 years old (45%). Most of these events occurred at home (81.4%). Intertrochanteric fractures were the most frequent (60%), especially on the right side (51.4%), osteosynthesis was the most used therapeutic option (62.1%). Pain (92%) and functional impotence (91.4%) were the characteristic clinical presentation of hip fractures, and arterial hypertension was the most common associated pathology (52.2%). CONCLUSIONS : Hip fracture primarily affects people over 80 years of age, especially women with high comorbidity. The highest percentage occurs as a result of falls produced at home, with pain on the affected side being the main manifestation. The most common type of fracture is intertrochanteric, and the most used treatment is osteosynthesis.

Cabina de desinfección de personas para reducir la transmisión de COVID-19 en la comunidad / Disinfection booth for people to reduce the transmission of COVID-19 in the community

RESUMEN La pandemia de COVID-19 ha puesto a los gobiernos del mundo ante una situación sin precedentes en la cual es necesario tomar decisiones rápidas con respecto a las mejores estrategias para disminuir la transmisión. Como parte de estas estrategias, en muchos lugares del mundo se están implementando cabinas de desinfección de personas en la comunidad. El presente documento busca evaluar la efectividad y seguridad de la cabina de desinfección de personas para uso en la comunidad a través de una búsqueda exhaustiva en las principales bases de datos bibliográficas así como en las prinicipales instituciones relevantes a nivel mundial. Después de realizar la búsqueda, encontramos tres documentos técnicos en los que no se recomienda el uso de estas tecnologías debido a que no hay evidencia suficiente y por ser de potencial riesgo para las personas por afección en mucosas. Otro documento de recomendación de la OMS, si bien no menciona a la tecnología específicamente, menciona que se debería evitar el rociamiento de sustancias desinfectantes en las personas por riesgos en la salud. En conclusión, no encontramos evidencia científica que respalde el uso de esta tecnología.

ABSTRACT The COVID-19 pandemic has put the world's governments in an unprecedented situation in which it is necessary to make quick decisions regarding the best strategies to reduce transmission. As part of these strategies, disinfection booths in the community are being implemented in many parts of the world. This document seeks to evaluate the effectiveness and safety of the disinfection booth for people to use in the community through an exhaustive search in the main bibliographic databases as well as in the main relevant institutions worldwide. After conducting the search, we found three technical documents in which the use of these technologies is not recommended because there is insufficient evidence and because they are of potential risk for people due to mucosal conditions. Another WHO recommendation document, although it does not specifically mention technology, mentions that the spraying of disinfecting substances should be avoided in people due to health risks. In conclusion, we found no scientific evidence to support the use of this technology.

Intervenciones farmacológicas para el tratamiento de la Enfermedad por Coronavirus (COVID-19) / Pharmacological interventions for the treatment of Coronavirus Disease (COVID-19)

RESUMEN Varios fármacos han sido propuestos como alternativas terapéuticas para COVID-19. Se efectuó una búsqueda sistematica en MEDLINE (vía PubMed) hasta el 20 de marzo de 2020, con el fin de identificar la evidencia disponible sobre intervenciones farmacológicas para tratamiento específico de COVID-19. 947 publicaciones fueron identificadas y 15 estudios seleccionados: 3 ensayos clínicos, 5 series de casos y 7 reportes de casos. La calidad de la evidencia procedente de ensayos clínicos fue evaluada según la metodología GRADE. La evidencia existente para hidroxicloroquina, favipiravir y lopinavir/ritonavir procede de ensayos clínicos que reportan resultados favorables para los dos primeros fármacos en tanto que no se observó ningún beneficio al adicionar lopinavir/ritonavir al tratamiento estándar. Sin embargo, debido a las limitaciones metodológicas, la evidencia es de muy baja certeza para hidroxicloroquina y de baja certeza para favipiravir y lopinavir/ritonavir. Respecto al uso de arbidol interferón, o el uso combinado de estos con lopinavir/ritonavir, la evidencia es limitada ya que deriva de serie de casos o reporte de casos con resultados no determinantes. No se identificaron estudios que permitan determinar la eficacia y seguridad de intervenciones farmacológicas frente a COVID-19.

ABSTRACT Several drugs have been proposed as therapeutic alternatives for COVID-19. An electronic systematic search of MEDLINE (via PubMed) was carried out until March 20th 2020, in order to identify the available evidence on pharmacological interventions for specific treatment of COVID-19. The quality of the evidence from clinical trials was evaluated according to the GRADE methodology. 947 publications were identified and 15 studies were selected: 3 clinical trials, 5 case series and 7 case reports. The existing evidence for hydroxychloroquine, favipiravir and lopinavir/ritonavir comes from clinical trials reporting favorable results for the first two drugs, while no benefit was observed when lopinavir/ritonavir was added to standard treatment. However, due to methodological issues, the evidence for hydroxychloroquine is very low. For favipiravir and lopinavir/ritonavir the evidence is low. Regarding the use of arbidol interferon, or the combined use of these with lopinavir/ritonavir, the evidence is limited since it derives from case series or case report with non-determining results. No studies were identified that reliably demonstrate the efficacy and safety of any pharmacological intervention against COVID-19.

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.

Conocimientos y actitudes sobre el zika en gestantes del sur de Lima, Perú / Knowledge and attitudes about Zika in pregnant women from the south of Lima, Peru

RESUMEN OBJETIVOS: determinar el conocimiento y las actitudes sobre el Zika en gestantes del sur de Lima MÉTODO: Estudio transversal analítico. Se incluyeron gestantes que acudieron al establecimiento de Salud Materno Infantil de Villa María del Triunfo durante octubre del 2017. RESULTADOS: Participaron 97 gestantes, la edad promedio fue de 28,23±7,9. El mayor grupo de edad fue de 16-28 años (54,6%). Al realizar la categorización del nivel de conocimientos, apreciamos que la mayoría tuvo conocimientos buenos sobre la enfermedad (78,4%) y todas tuvieron actitudes positivas. Las gestantes con mayor nivel educativo tuvieron un mejor conocimiento de la enfermedad (p<0,001) CONCLUSIONES: El conocimiento y las actitudes de las gestantes sobre el zika, fueron por lo general buenos.

ABSTRACT OBJECTIVES: To determine knowledge and attitudes about Zika in pregnant women from southern Lima. METHOD: Cross-sectional analytical study. Pregnant women were included who attended the Maternal and Child Health center in Villa María del Triunfo during October 2017. RESULTS: 97 pregnant women participated, the average age was 28.23 ± 7.9. The largest age group was 16-28 years (54.6%). When categorizing the level of knowledge, we appreciate that most had good knowledge about the disease (78.4%) and all had positive attitudes. Pregnant women with a higher educational level had a better knowledge of the disease (p <0.001). CONCLUSIONS: The knowledge and attitudes of the pregnant women about Zika were generally good.