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Insufficient data have been reported about the effect of the inactivated SARS-CoV-2 vaccine (BBIBP-CorV) on the humoral response through time in healthcare workers (HCW). This retrospective cohort studied the information of 252 HCW from a private laboratory, comparing the antibody-mediated response provoked by BBIBP-CorV between HCW previously infected with SARS-CoV-2 (PI) and not previously infected (NPI), employing the Elecsys® anti-SARS-CoV-2 S and the cPass™ SARS-CoV-2 Neutralization Antibody Detection kit at intervals of 21, 90, and 180 days after vaccination. The presence of neutralizing antibodies in HCW 21 days after full vaccination was 100% in PI and 91.60% in NPI. We observed a progressive decrease in antibody levels over time in both groups. Comparing HCW PI with NPI, PI had a 10.9, 14.3, and 8.6-fold higher antibody titer with the Elecsys® anti-SARS-CoV-2 S at 21 (p < 0.001), 90 (p< 0.001) and 180 days (p < 0.001) respectively, compared to NPI. Using the percent of signal inhibition (PSI) of the antibody neutralization cPass™, HCW PI showed a level of 1.3, 2.0, and 3.1 times more antibodies, at 21 (p < 0.001), 90 (p < 0.001), and 180 days (p < 0.001) respectively, compared to NPI. We determined a progressive decrease in humoral immunity over time, particularly higher in those NPI.
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Information on the effects of a heterologous booster in adult patients first vaccinated with the BBIBP-CorV vaccine is limited. This prospective cohort study evaluated the humoral response of 152 healthcare workers (HCWs) from a private laboratory in Lima (Peru) before and after receiving the BNT162b2 vaccine, with a seven-month interval since the BBIBP-CorV doses. We employed the Elecsys® anti-SARS-CoV-2 S and the cPass™ SARS-CoV-2 Neutralization Antibody (NAbs) assays to evaluate anti-S-RBD IgG and NAbs, respectively. Of the 152 HCWs, 79 (51.98%) were previously infected (PI) with SARS-CoV-2 and 73 (48.02%) were not previously infected (NPI). The proportion of HCWs with positive NAbs, seven months after the BBIBP-CorV immunization, was 49.31% in NPI and 92.40% in PI. After the booster, this ratio increased to 100% in both groups. The anti-S-RBD IgG and NAbs in the HCWs' NPI increased by 32.7 and 3.95 times more, respectively. In HCWs' PI, this increment was 5 and 1.42 times more, respectively. There was no statistical association between the history of previous SARS-CoV-2 infection and the titer of anti-S-RBD IgG and NAbs after the booster. The humoral immunity presented a robust increase after receiving the BNT162b2 booster and was more pronounced in NPI.
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Heart disease is the cause of sudden death in more than 80% of cases. Ischemic heart disease is the cause for 90% of all sudden cardiac deaths, while in the remaining 10% of cases, heart diseases have a hereditary origin and comprise a wide spectrum of disorders that include cardiomyopathies and channelopathies. The aim of this review is to highlight the importance of genetic counseling for patients with hereditary cardiovascular disease and its evaluation by a multidisciplinary team.
La cardiopatía es la causa de muerte súbita en más del 80% de casos. La cardiopatía isquémica es responsable en el 90% del total de las muertes súbitas cardiacas, mientras que en el 10% de casos restantes, las cardiopatías tienen un origen hereditario y comprenden un amplio espectro de trastornos que incluyen a las cardiomiopatías y las canalopatías. El objetivo de esta revisión es poner en evidencia la importancia del asesoramiento genético de los pacientes con enfermedad cardiovascular hereditaria y su evaluación a través de un equipo multidisciplinario.
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RESUMEN Introducción: La oportuna prestación de servicios de salud es clave para reducir la morbimortalidad de pacientes crónicos, especialmente cuando se requiere una atención frente a un resultado crítico de exámenes auxiliares. En ese contexto, se evalúa un aplicativo web de resultados críticos en una Clínica privada acreditada por Joint Commission International (JCI). Objetivos: el presente estudio busca evaluar la efectividad de un aplicativo web en el reporte de resultados críticos de pacientes crónicos. Material y métodos: Se realizó un estudio de cohorte retrospectiva. Se compararon dos etapas: la etapa de línea de base (implementación del software) versus la etapa final (evaluación). Resultados: Se registraron 122 resultados críticos de pacientes crónicos en la etapa de implementación y 113 en la etapa de evaluación. Se encontró una disminución en la media del tiempo de respuesta del profesional en la etapa de evaluación con relación a la etapa de implementación. La transcripción en los registros incrementó del 75,4% al 93,8% p<0,001, la continuidad de la atención por el mismo médico incrementó del 41,0% al 54,9% p<0,03. Asimismo, se redujo en 68% la probabilidad de fallecimiento. Conclusiones: El aplicativo web de resultados críticos mejoró el registro de la atención y redujo la mortalidad de pacientes crónicos que tuvieron un resultado crítico.
ABSTRACT Introduction: Currently, the use of health technologies in the health system has become a subject of constant study and innovation. In this context, in an institution accredited by the Joint Commission International (JCI), a web application was implemented to manage critical results, which were defined as results that could put the patient's life at risk. Objectives: this study seeks to evaluate the effectiveness of an application in reporting critical results. Material and methodo: A retrospective cohort study was carried out. Two stages were compared: the baseline stage (software implementation) versus the final stage (evaluation). Results: 122 critical results were registered in the implementation stage and 113 in the evaluation stage. A decrease was found in the average response time of the professional in the evaluation stage in relation to the implementation stage. The transcription in the records increased from 75.4% to 93.8% p <0.00, the continuity of care by the same doctor increased from 41.0% to 54.9% p <0.03. Likewise, the probability of death was reduced by 68%. Conclusions: In the evaluation stage, mortality decreased and the transcription in the information registry of the critical results application improved towards the patient's clinical history. Likewise, it was possible to optimize the quality of care by ensuring that the follow-up of the patient throughout the entire care is carried out by the same doctor.
RESUMO
Introducción: La oportuna prestación de servicios de salud es clave para reducir la morbimortalidad de pacientes crónicos, especialmente cuando se requiere una atención frente a un resultado crítico de exámenes auxiliares. En ese contexto, se evalúa un aplicativo web de resultados críticos en una Clínica privada acreditada por Joint Commission International (JCI). Objetivos: el presente estudio busca evaluar la efectividad de un aplicativo web en el reporte de resultados críticos de pacientes crónicos. Material y métodos: Se realizó un estudio de cohorte retrospectiva. Se compararon dos etapas: la etapa de línea de base (implementación del software) versus la etapa final (evaluación). Resultados: Se registraron 122 resultados críticos de pacientes crónicos en la etapa de implementación y 113 en la etapa de evaluación. Se encontró una disminución en la media del tiempo de respuesta del profesional en la etapa de evaluación con relación a la etapa de implementación. La transcripción en los registros incrementó del 75,4% al 93,8% p<0,001, la continuidad de la atención por el mismo médico incrementó del 41,0% al 54,9% p<0,03. Asimismo, se redujo en 68% la probabilidad de fallecimiento. Conclusiones: El aplicativo web de resultados críticos mejoró el registro de la atención y redujo la mortalidad de pacientes crónicos que tuvieron un resultado crítico.
Introduction:Currently, the use of health technologies in the health system has become a subject of constant study and innovation. In this context, in an institution accredited by the Joint Commission International (JCI), a web application was implemented to manage critical results, which were defined as results that could put the patient's life at risk. Objectives: this study seeks to evaluate the effectiveness of an application in reporting critical results. Material and methods: Aretrospective cohort study was carried out. Two stages were compared: the baseline stage (software implementation) versus the final stage (evaluation). Results: 122 critical results were registered in the implementation stage and 113 in the evaluation stage. Adecrease was found in the average response time of the professional in the evaluation stage in relation to the implementation stage. The transcription in the records increased from 75.4% to 93.8% p <0.00, the continuity of care by the same doctor increased from 41.0% to 54.9% p <0.03. Likewise, the probability of death was reduced by 68%. Conclusions: Intheevaluationstage,mortalitydecreasedandthe transcription in the information registry of the critical results application improved towards the patient's clinical history. Likewise, it was possible to optimize the quality of care by ensuring that the follow-up of the patient throughout the entire care is carried out by the same doctor.
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RESUMEN El desarrollo de la atención primaria de salud en el Perú ha logrado importantes hitos en su historia. Los fundamentos sociales que dieron forma a los servicios de salud en el siglo anterior pueden explicarse por eventos durante la época colonial. Además, después de la Declaración de Alma-Ata en 1978, Perú enfrentó varios obstáculos que polarizaron aún más a la población de diferentes estratos económicos. Sin embargo, el Ministerio de Salud, junto con la cooperación internacional, comenzó a desarrollar programas de salud con el objetivo de brindar atención primaria a la población, con resultados fundamentales que ayudaron a unificar a la población y a estar un paso más cerca de lograr una cobertura de atención médica universal. Por lo tanto, en este documento, describimos los eventos que conducen al sistema de salud actual del Perú, los logros de los servicios de Atención Primaria de Salud y el uso de dispositivos tecnológicos para mejorar la salud pública
SUMMARY The development of primary health care in Peru has achieved important milestones in its history. The social foundations that were formed in the health services in the previous century can be explained by events during the colonial era. Furthermore, after the Declaration of Alma-Ata in 1978, Peru faced several obstacles that further polarized the population from different economic strata. However, the Ministry of Health, together with international cooperation, began to develop health programs with the objective of providing primary care to the population, with the fundamental results that will help to unify the population and be one-step closer to achieving universal health care coverage. Therefore, in this document, we describe the events leading to Peru's current health system, the achievements of Primary Health Care services, and the use of technological devices to improve public health.
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El osteosarcoma es una neoplasia maligna común del tejido óseo. No obstante, la variante denominada multicéntrica o multifocal, es una entidad rara. Además, si al momento del diagnóstico se identifica más de una lesión se le añade el término sincrónico. Se presenta el primer caso en el Perú de una paciente pediátrica de 9 años referida a nuestro instituto con imágenes radiológicas sugestivas de neoplasia ósea en fémur distal derecho. Posteriormente, se diagnosticó osteosarcoma multicéntrico sincrónico mediante biopsia y exámenes imagenológicos. Recibió tratamiento quimioterapéutico triple con ifosfamida, doxorrubicina y cisplatino, sin mejora en la condición clínica. Posteriormente, desarrolló metástasis pulmonar y recibió tratamiento paliativo con ciclosofamida. En conclusión, el osteosarcoma multicéntrico sincrónico es un tipo de neoplasia ósea maligna, altamente agresiva y de mal pronóstico. Nuestra experiencia con esta triple terapia de quimioterapia no tuvo una buena respuesta clínica. Sugerimos una evaluación individual para el tratamiento de esta variante
Osteosarcoma is a common malignancy affecting bones. However, the multicenter or multifocal variety is a rare condition. Also, if at the time of diagnosis more than one lesion is identified, then the 'synchronous' term is added to the case definition. We present the first case described in Peru of a 9-year old patient who was referred to our institution with radiological images suggesting a bone malignancy in her distal right femur. Afterwards, a synchronous multicenter sarcoma was diagnosed with biopsy and image studies. She received triple chemotherapy with ifosfamide, doxorubicin, and cisplatin, but there was no improvement in her clinical status. Later she developed lung metastases and she received palliative therapy with cyclophosphamide. In conclusion, synchronous multicenter osteosarcoma is a highly aggressive bone malignancy with a poor prognosis. Our experience with triple therapy did not lead to a good clinical response. We suggest individual assessment for treating this variant