[Hemoglobin changes (Hb) in miners exposed to high altitude and associated factors]. / Cambios en la hemoglobina (Hb) de trabajadores mineros expuestos a gran altura y factores asociados.

AIM: To determine the variation of hemoglobin (Hb) in two groups of miners working at different altitudes. METHODOLOGY: A longitudinal study conducted in a private company. Hb was obtained from entrance exams and annual checks of workers at two locations: at sea level and at Peruvian highlands (4,100 m), taken by trained staff and equipment calibrated to environmental conditions. We analyzed variations in the course of the years with the PA-GEE statistical test; p values were obtained. RESULTS: Of the 376 workers, 89% (322) were men, the median age was 32 years (range 20-57) and 84% (304) were at high altitude. In multivariate analysis, male sex (p < 0.001), body mass index (BMI; p = 0.021) and working at high altitude (p < 0.001) were associated with the greatest variation of Hb in time, adjusted for age, length, and type of work. DISCUSSION: These findings should be considered for health surveillance of workers exposed to similar conditions to prevent chronic mountain sickness. CONCLUSION: The change in Hb of miners was associated with male sex, BMI, and work at high altitude.

Physical activity and its association with chronic diseases in the elderly in 11 cities of Peru / Actividad física y su asociación con enfermedades crónicas en ancianos de 11 ciudades del Perú

Aim: To determine the frequency of physical activity and its association with chronic diseases in the elderly in eleven cities of Peru. Methods: A cross-sectional study of secondary data was conducted; the dependent variable was not the realization of physical activity, chronic disease and other physio-anthropometric variables were independent variables. For bivariate and multivariate analysis generalized linear models were used. A confidence level of 95% and p < 0.05 as statistically significant was considered. Results: Of the 1030 elderly 68% (698) did not perform physical activity. When performing the multivariate model was obtained for every year of age increased by 1.5% frequency do physical activity (RPA: 1.015, 95% CI 1.006-1.024, p = 0.001) for each additional centimeter waist decreased 0.6% performing physical activity (RPA: 0.994, 95% CI: 0.992-0.997, p < 0.001) and those suffering from other chronic heart disease (RPA: 1.15, 95% CI: 1.02-1.30. p = 0.019) had higher frequencies of no physical activity, adjusted for sex and city of residence. Conclusion: No physical activity was associated with suffering from some heart disease, older age and waist circumference. We need to consider these results from the study to promote physical activity in this population.

Objetivo: Determinar la frecuencia de actividad física y su asociación con enfermedades crónicas en ancianos de once ciudades del Perú. Métodos: Se realizó un estudio transversal analítico de datos secundarios. La variable dependiente fue la no realización de actividad física, y las independientes fueron las enfermedades crónicas y otras variables fisioantropométricas. Para el análisis bivariado y multivariado se usaron los modelos lineales generalizados. Se consideró un nivel de confianza del 95% y un valor de p < 0.05 como estadísticamente significativo. Resultados: De los 1030 ancianos, el 68% (698) no realizaba actividad física. Con el modelo multivariado se obtuvo que, por cada año de edad, aumentaba un 1.5% la frecuencia no hacer actividad física (razón de prevalencia ajustada [RPa]: 1.015; intervalo de confianza del 95% [IC 95%]: 1.006-1.024; p = 0.001); por cada centímetro de cintura adicional, disminuía un 0.6% la realización de actividad física (RPa: 0.994; IC 95%: 0.992-0.997; p < 0.001); y aquellos que padecían otra enfermedad cardiaca crónica (RPa: 1.15; IC 95%:1.02-1.30; p = 0.019) tenían mayores frecuencias de no realizar actividad física, ajustado por el sexo y por la ciudad de residencia. Conclusión: El no realizar actividad física se asoció con padecer alguna enfermedad cardiaca, mayor edad y el perímetro de cintura. Es necesario tener en cuenta estos resultados para promover la actividad física en esta población.

Exploring the chemical and pharmacological variability of Lepidium meyenii: a comprehensive review of the effects of maca.

Maca (Lepidium meyenii), a biennial herbaceous plant indigenous to the Andes Mountains, has a rich history of traditional use for its purported health benefits. Maca's chemical composition varies due to ecotypes, growth conditions, and post-harvest processing, contributing to its intricate phytochemical profile, including, macamides, macaenes, and glucosinolates, among other components. This review provides an in-depth revision and analysis of Maca's diverse bioactive metabolites, focusing on the pharmacological properties registered in pre-clinical and clinical studies. Maca is generally safe, with rare adverse effects, supported by preclinical studies revealing low toxicity and good human tolerance. Preclinical investigations highlight the benefits attributed to Maca compounds, including neuroprotection, anti-inflammatory properties, immunoregulation, and antioxidant effects. Maca has also shown potential for enhancing fertility, combating fatigue, and exhibiting potential antitumor properties. Maca's versatility extends to metabolic regulation, gastrointestinal health, cardio protection, antihypertensive activity, photoprotection, muscle growth, hepatoprotection, proangiogenic effects, antithrombotic properties, and antiallergic activity. Clinical studies, primarily focused on sexual health, indicate improved sexual desire, erectile function, and subjective wellbeing in men. Maca also shows promise in alleviating menopausal symptoms in women and enhancing physical performance. Further research is essential to uncover the mechanisms and clinical applications of Maca's unique bioactive metabolites, solidifying its place as a subject of growing scientific interest.

Perception of risk to COVID-19 and mental health indicators in workers of a Peruvian hospital: An analytical cross-sectional study. / Percepción de riesgo a COVID-19 e indicadores de salud mental en trabajadores de un hospital peruano: estudio transversal analítico.

Introduction: COVID-19 has caused great fear on health professionals and could affect their mental health, therefore it is important to determine the association between the perception of risk to COVID-19 and mental health in workers of a Peruvian hospital. Methods: Analytical cross-sectional study, through virtual survey. The dependent variables were: depression, anxiety and stress; The independent variable was perception of risk to COVID-19 and the covariates: sociodemographic, family, work and clinical data. Crude and adjusted prevalence ratios were found with a 95% confidence interval and a significance level of 5%. Results: There was no association between risk perception and depression (adjusted prevalence ratio: 0.98 95% confidence interval: 0.89 to 1.08), anxiety (adjusted prevalence ratio: 0.94 95% confidence interval: 0.89 to 1.00), stress (adjusted prevalence ratio: 0.89 95% confidence interval 0.76 to 1.04). In the multivariate analysis, an association was found between depression with direct contact with the COVID-19 patient (adjusted prevalence ratio: 2.06, 95% confidence interval: 1.14 to 3.70) and with having a comorbidity (adjusted prevalence ratio: 2.56 95% confidence interval: 1.52 to 4.30); likewise, between anxiety with number of children (adjusted prevalence ratio: 1.09 95% confidence interval: 1.00 to 1.18), with direct contact with COVID-19 patient (adjusted prevalence ratio: 2.67 95% confidence interval 1.46 to 4.85) and having comorbidity (adjusted prevalence ratio: 2.00 95% confidence interval: 1.40 to 2.86); finally, between stress with direct contact with the COVID-19 patient (adjusted prevalence ratio: 2.86, 95% confidence interval: 1.20 to 6.83). Conclusions: No statistically significant association was found between risk perception and depression, anxiety, or stress. However, there was an association between depression, anxiety, and stress, each with direct contact with COVID-19 patients; between anxiety and depression, each with having comorbidities and, finally, anxiety with the number of children.

Objetivo: El COVID-19 atemoriza a profesionales sanitarios, pudiendo afectar su salud mental. El objetivo de este estudio fue determinar la asociación entre la percepción de riesgo a COVID-19 y la salud mental en trabajadores de un hospital peruano. Método: Estudio transversal analítico, mediante encuesta virtual. Las variables dependientes fueron depresión, ansiedad y estrés. La variable independiente fue percepción de riesgo a COVID-19 y las covariables fueron datos sociodemográficos, familiares, laborales y clínicos. Se hallaron razones de prevalencia crudas y ajustadas con un intervalo de confianza al 95% y un nivel de significancia del 5%. Resultados: No hubo asociación entre percepción de riesgo y depresión (razón de prevalencia ajustado: 0,98; intervalo de confianza 95%: 0,89 a 1,08), ansiedad (razón de prevalencia ajustado: 0,94; intervalo de confianza 95%: 0,89 a 1,00), estrés (razón de prevalencia ajustado: 0,89; intervalo de confianza 95%: 0,76 a 1,04). En el análisis multivariado se encontró asociación entre depresión con contacto directo con paciente COVID-19 (razón de prevalencia ajustados: 2,06; intervalo de confianza 95%: 1,14 a 3,70) y con tener una comorbilidad (razón de prevalencia ajustados: 2,56; intervalo de confianza 95%: 1,52 a 4,30); entre ansiedad con número de hijos (razón de prevalencia ajustados: 1,09; intervalo de confianza 95%: 1,00 a 1,18), con contacto directo con paciente COVID-19 (razón de prevalencia ajustados: 2,67; intervalo de confianza 95%: 1,46 a 4,85) y con tener comorbilidad (razón de prevalencia ajustados: 2,00; intervalo de confianza 95%: 1,40 a 2,86); entre estrés con contacto directo con paciente COVID-19 (razón de prevalencia ajustados: 2,86; intervalo de confianza 95%: 1,20 a 6,83). Conclusiones: No hubo asociación entre percepción de riesgo y depresión, ansiedad ni estrés. Hubo asociación entre depresión, ansiedad y estrés, cada uno con el contacto directo con pacientes COVID-19; entre ansiedad y depresión, cada uno con tener comorbilidades, y ansiedad con el número de hijos.

Correlation between stress and lifestyle in teachers at some schools in Lima, Peru, during telework in 2020.

BACKGROUND: Stress and unhealthy lifestyle are serious problems in public health and education, particularly due to their significant relevance in the context of the COVID-19 pandemic. OBJECTIVES: To determine the correlation between stress and lifestyle in teachers at some schools in Lima, Peru, during telework in 2020. METHODS: This observational, quantitative, analytical, cross-sectional study was conducted in 217 school teachers from Lima. Lifestyle was measured using the FANTASTIC questionnaire; stress was measured using the Teaching Stress Scale (ED-6), comprised of the anxiety, depression, maladaptive beliefs, work pressure and poor coping dimensions. The Spearman correlation between numerical variables, and the difference of the FANTASTIC score according to the categorical variables, were analyzed with the Mann-Whitney U test or Kruskal-Wallis test, as necessary. Multivariable analysis was done with a multiple linear regression model to find raw and adjusted ß (ßa). RESULTS: The median of the ED-6 scale was 81 (RI: 64-105). Sixty-four percent of the teachers had a good-excellent lifestyle; 27.2%, regular; and 8.49%, bad-dangerous. The FANTASTIC score had an inverse correlation with ED-6 (ßa: -0.16, 95%; CI: -0.20 to -0.12) adjusted for age and cohabitation with children. Likewise, teachers between 40 and 49 years old (ßa: 2.89, 95%; CI: 0.17 to 5.62) had a better lifestyle; and teachers who lived with children (ßa: -5.48, 95%; CI: -7.89 to -3.06), a worse lifestyle. CONCLUSIONS: As stress increased, the lifestyle quality worsened in teachers at some schools in Lima, Peru, during telework in 2020.

Mortality and associated risk factors in patients hospitalized due to COVID-19 in a Peruvian reference hospital.

OBJECTIVES: To determine the risk factors for in-hospital mortality in patients with COVID-19 from a Peruvian national hospital. METHODS: Retrospective cohort study of medical records of patients with COVID-19 hospitalized at Hospital Nacional Hipólito Unanue (HNHU) during the months of April to August 2020. The dependent variable was in-hospital mortality. Independent variables included sociodemographic and clinical characteristics, physical examination findings, oxygen saturation (SaO2) at admission, treatment received during hospitalization and laboratory results at admission. A Cox regression model was used to evaluate the crude and adjusted hazard ratios for associated factors. RESULTS: We included 1418 patients. Median age was 58 years (IQR 47-68 years) and 944 (66.6%) were male. The median length of hospitalization was 7 (4-13) days, and the mortality rate was 46%. The most frequent comorbidities were type 2 diabetes mellitus, hypertension, and obesity. In the adjusted analysis, mortality was associated with age (HR 1.02; 95%CI 1.02-1.03), history of surgery (HR 1.89; 95%CI 1.31-2.74), lower oxygen saturation at admission (HR 4.08; CI95% 2.72-8.05 for SaO2<70% compared to SaO2>94%), the presence of poor general condition (HR 1.81; 95% CI 1.29-2.53), altered state of consciousness (HR 1.58; 95%CI 1.18-2.11) and leukocyte levels (HR 1.01; 95%CI 1.00-1. 02). Treatment with ivermectin (HR 1.44; 95%CI 1.18-1.76) and azithromycin (HR 1.25; 95%CI 1.03-1.52) were associated with higher mortality. Treatment with corticosteroids at low to moderate doses was associated with lower mortality (HR 0.56 95%CI 0. 37-0. 86) in comparison to no steroid use. CONCLUSION: A high mortality was found in our cohort. Low oxygen saturation at admission, age, and the presence of hematological and biochemical alterations were associated with higher mortality. The use of hydroxychloroquine, ivermectin or azithromycin was not useful and was probably associated with unfavorable outcomes. The use of corticosteroids at moderate doses was associated with lower mortality.

Factors associated with the non-use of health services in LGBTI people from Peru. / Factores asociados a la no utilización de servicios de salud en personas LGBTI de Perú.

OBJECTIVE: To determine the factors associated with the non-use of health services in a sample of the lesbian, gay, bisexual, transgender, and intersex population of Peru. MATERIALS AND METHODS: Analytical cross-sectional study, analysis of secondary data from the First LGBTI Survey of Peru. Those who suffered from a medical condition during the last twelve months and had to receive medical attention were considered a variable of interest. Crude prevalence ratios (PRc) and adjusted (PRa), with 95% confidence intervals (95% CI) were calculated using Poisson regressions with robust variance. Three models were developed, adjusted to variables grouped according to sexual orientation, gender identity, and intersexuality. RESULTS: 55.4% were male at birth, the median age was 25 years (IR: 21-30). 16% stated that they had not sought medical attention. The three models presented a negative association in having suffered a chronic disease, infectious, contagious diseases, and mental illness and those who expressed their orientation openly. Not being respected for the gender they identified with was related to not using the services in model 3. Models 1 and 3 included a positive association with not being respected with the gender identified. CONCLUSION: Suffering from a mental illness, an infectious contagious disease, a chronic disease, and not being treated with respect according to their gender identity are factors associated with the non-use of health services.

OBJETIVO: Determinar los factores asociados a la no utilización de servicios de salud en una muestra de la población de lesbianas, gais, bisexuales, transgénero e intersexuales (LGBTI) de Perú. MATERIALES Y MÉTODOS: Estudio transversal analítico, análisis de datos secundarios de la Primera Encuesta LGBTI de Perú. Se tomó como variable de interés a las personas que tuvieron alguna enfermedad durante los últimos doce meses y que tuvieron que recibir atención médica. Se calcularon razones de prevalencias crudas (RPc) y ajustadas (RPa), con intervalos de confianza al 95% (IC   95%), usando regresiones de Poisson con varianza robusta. Se desarrollaron tres modelos, ajustados a variables agrupadas en correspondencia con la orientación sexual, identidad de género e intersexualidad, respectivamente. RESULTADOS: El 55,4% fueron registrados como varones al nacer, la mediana de la edad fue 25 años (Rango intercuartil: 21-30). El 16% manifestó no haber buscado atención médica. Los tres modelos presentaron una asociación negativa respecto de padecer una enfermedad crónica, enfermedad infectocontagiosa, enfermedad mental y en quienes expresaban su orientación abiertamente. El no ser respetados por el género con el que se identificaban estuvo relacionado a no usar los servicios en el modelo 3. Los modelos 1 y 3, incluyeron una asociación positiva con no ser respetados con el género que se identifica. CONCLUSIÓN: Padecer de alguna enfermedad mental, una enfermedad infectocontagiosa y una enfermedad crónica además de no ser tratado con respeto según el género con el que se identifica son factores asociados a la no utilización de los servicios de salud.

Pediatric inflammatory multisystem syndrome associated with COVID-19: A report of 10 cases in a Peruvian hospital. / Síndrome inflamatorio multisistémico por COVID-19 en niños: reporte de diez casos en un hospital peruano.

Pediatric inflammatory multisystem syndrome temporally associated with COVID-19 is a potentially severe and rare condition that still needs a better understanding to guide its management. Reports worldwide, and especially in Latin America, are still scarce. This report presents ten cases of pediatric inflammatory multisystem syndrome temporally associated with COVID-19 in children between 2 and 12 years old treated in a Peruvian hospital, diagnosed using the Centers for Disease Control and Prevention criteria. Severe acute respiratory syndrome coronavirus 2 was detected through serological tests (immunoglobulin M or G). Most had gastrointestinal symptoms. Therapeutics consisted mainly of intravenous immunoglobulin, corticosteroids, ivermectin, hydroxychloroquine, digoxin, and antibiotic therapy. Three patients underwent mechanical ventilation; no mortality occurred in this case series. In conclusion, the manifestations presented here are similar to those reported in the literature. A timely diagnosis is necessary for proper management.

El síndrome inflamatorio multisistémico en niños asociado a COVID-19 es un cuadro potencialmente grave y poco frecuente, que necesita un mejor entendimiento para guiar su manejo. Los reportes a nivel mundial, y especialmente en Latinoamérica, son aún escasos. Se presentan diez casos de síndrome inflamatorio multisistémico por COVID-19 en niños entre 2 y 12 años de edad, atendidos en un hospital peruano, diagnosticados mediante los criterios de los Centros para el Control y Prevención de Enfermedades de Estados Unidos (CDC). La presencia de coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2) fue detectada a través de pruebas serológicas (inmunoglobulinas M y G). La mayoría presentó síntomas gastrointestinales. La terapéutica fue con inmunoglobulina endovenosa, corticosteroide, ivermectina, hidroxicloroquina, digoxina y antibióticos. Tres pacientes recibieron ventilación mecánica, ninguno falleció. En conclusión, las características presentadas en esta serie de casos son similares a los de la literatura existente; lo que implica que un diagnóstico oportuno es fundamental para su adecuado manejo.

Detection of Viral and Bacterial Respiratory Pathogens Identified by Molecular Methods in COVID-19 Hospitalized Patients and Its Impact on Mortality and Unfavorable Outcomes.

PURPOSE: The purpose of this study is to evaluate the frequency of viral and bacterial respiratory pathogens detected by molecular methods in sputum samples of patients hospitalized for COVID-19 and to evaluate its impact on mortality and unfavorable outcomes (in-hospital death or mechanical ventilation). PATIENTS AND METHODS: The prospective cohort included patients with diagnosis of COVID-19 hospitalized at Hospital Nacional Hipólito Unanue. Sociodemographic and clinical data were collected from clinical records. Sputum samples were analyzed with the Biofire Filmarray Pneumonia plus® respiratory panel. Crude and adjusted associations with unfavorable outcomes were evaluated using logistic regression models. RESULTS: Ninety-three patients who were able to collect sputum samples were recruited between September 8 and December 28, 2020. The median age was 61.7 years (IQR 52.3-69-8) and 66 (71%) were male. The most frequent symptoms were dyspnea, cough, fever, and general malaise found in 80 (86%), 76 (82%), 45 (48%), and 34 (37%) patients, respectively. Fifty-three percent of patients had comorbidities. Seventy-six (82%) patients received antibiotics prior to admission and 29 (31%) developed unfavorable outcome. Coinfection was evidenced in 38 (40.86%) cases. The most frequently found bacteria were Staphylococcus aureus, Streptococcus agalactiae, Haemophilus influenzae and Klebsiella pneumoniae in 11 (11.83%), 10 (10.75%), 10 (10.75%), and 8 (8.6%) cases, respectively. Streptococcus pneumoniae was found in one case (1.08%). We neither identify atypical bacteria nor influenza virus. No association was found between the presence of viral or bacterial microorganisms and development of unfavorable outcomes (OR 1.63; 95% CI 0.45-5.82). CONCLUSION: A high frequency of respiratory pathogens was detected by molecular methods in patients with COVID-19 pneumonia but were not associated with unfavorable outcomes. No atypical agents or influenza virus were found. The high use antibiotics before admission is a concern. Our data suggest that the use of drug therapy against atypical bacteria and viruses would not be justified in patients hospitalized for COVID-19.

[Enteroparasitosis in Peru and its relation to the Human Development Index]. / Enteroparasitosis en Perú y su relación con el Índice de desarrollo humano.

BACKGROUND: Diseases related to enteroparasites are a serious public health problem. OBJECTIVE: To assess the prevalence of enteroparasites in Peru and its relationship with the Human Development Index (HDI). MATERIAL AND METHODS: A coproparasitological study using the direct method from children and adults from the communities of Pamplona Alta in Lima, the province of San Sebastián de Quera, Castillo Grande, Pillco Marca and Puelles in Huánuco, Llupa-Huaraz in Ancash, and Machaguay in Arequipa, Peru, was carried out from 2012 to 2016. RESULTS: 864 samples were analyzed, and a total prevalence of 23.03% (199 cases) was found. The non-pathogenic protozoan Entamoeba coli, with 10.42% (90 cases), and the nematode Ascaris lumbricoides, with 6.37% (55 cases), were the most prevalent. PERMANOVA analysis based on the prevalences of enteroparasites in urban and rural areas of Peru showed differences among communities. The overall prevalence of urban communities was similar to that of the rural ones. CONCLUSIONS: Enteroparasitosis in Peru are not related to HDI. However, the levels of infestation by enteroparasites varied between the different communities, and they were related to the bioecological characteristics of parasites.

INTRODUCCIÓN: las enfermedades relacionadas con enteroparásitos son un grave problema de salud pública. OBJETIVO: evaluar la prevalencia de enteroparásitos en el Perú y su relación con el Índice de desarrollo humano (IDH). MATERIAL Y MÉTODOS: se realizó un estudio coproparasitológico por el método directo en niños y adultos de las comunidades de Pamplona Alta en Lima, de la provincia de San Sebastián de Quera, Castillo Grande, Pillco Marca y Puelles en Huánuco, Llupa-Huaraz en Ancash y Machaguay en Arequipa, Perú, de 2012 a 2016. RESULTADOS: se analizaron 864 muestras y se encontró una prevalencia total del 23.03% (199 casos). El protozoario no patógeno Entamoeba coli con 10.42% (90 casos) y el nematodo Ascaris lumbricoides con 6.37% (55 casos) fueron los más prevalentes. La prevalencia de protozoos fue mayor que la de los helmintos. No se observó asociación entre el IDH frente a la prevalencia total ni frente a las cuatro especies de enteroparásitos más frecuentes. El análisis PERMANOVA a partir de las prevalencias de enteroparásitos en áreas urbanas y rurales de Perú mostró diferencias entre las comunidades. La prevalencia total de las comunidades urbanas fue similar a la de las rurales. CONCLUSIONES: la enteroparasitosis en el Perú no se relaciona con el IDH. Sin embargo, los niveles de infestación por enteroparásitos variaron entre las diferentes comunidades y se relacionaron con las características bioecológicas de los parásitos.

Respuestas rápidas a la pandemia de COVID-19 a través de la ciencia y la colaboración global: el ensayo clínico Solidaridad.

COVID-19 represents a global crisis. Rapidly conducting a clinical trial with the rigor necessary to obtain reliable results requires the collaboration of various participants involved in the development, evaluation and authorization of clinical trials (CT) such as the trial sponsor, researchers, regulatory authority and the ethics committee (EC). Carrying out these studies is not only scientifically appropriate, but an ethical and moral obligation to guarantee our patients effective treatment. SOLIDARITY is a mega clinical trial that recruited thousands of subjects with moderate to severe disease, who were randomly assigned to one of the treatment groups under evaluation, including hydroxychloroquine, lopinavir/ritonavir associated or not with interferon; or remdesivir compared to standard therapy. Peru has joined the list of countries where the trial will be reproduced, through which it will be possible to quickly identify if any of these drugs offers a real benefit to patients.

La COVID-19 representa una crisis global. La realización rápida de un ensayo clínico con la rigurosidad necesaria para obtener resultados confiables requiere la colaboración de diversos actores que participan en el desarrollo, evaluación y autorización de los ensayos clínicos (EC), como el patrocinador del ensayo, los investigadores, la autoridad regulatoria y el comité de ética (CE). Llevar a cabo estos estudios no solo es científicamente apropiado, sino una obligación ética y moral para ofrecer a las personas infectadas con COVID-19 un tratamiento efectivo. Solidaridad es un megaensayo clínico que reclutará miles de sujetos de investigación con enfermedad moderada a grave, a quienes se les asignará aleatoriamente a uno de los grupos de tratamiento en evaluación incluyendo hidroxicloroquina, lopinavir/ritonavir asociado o no a interferón; o remdesivir en comparación con el manejo estándar. El Perú se ha sumado a la lista de países donde se reproducirá el ensayo, mediante el cual se podrá identificar rápidamente si alguno de estos fármacos ofrece un beneficio real a los pacientes.

Association between the altitude of residential areas and clinical diagnosis of chronic gastritis in ambulatory patients of Peru: A cross-sectional analytic study. / Asociación entre zonas altitudinales de residencia y diagnóstico clínico de gastritis crónica en pacientes ambulatorios de Perú: estudio transversal analítico.

INTRODUCTION: Chronic gastritis is one of the most common diseases in the population. Several factors influence its appearance; however, the effect of high altitude has not been studied thoroughly. OBJECTIVE: To determine the association between the altitude of the residential area and chronic gastritis in outpatients of Peru. METHODS: Observational, analytical, and cross-sectional study. Secondary data analysis was conducted. The dependent variable was chronic gastritis, obtained from patient references, and verified in the medical history according to the pathological history mentioned during medical consultation. The independent variable was the altitude of the residential areas (categorized into low altitude, intermediate altitude, high and very high), and the secondary co-variables were age, sex, and time living at altitude. Generalized linear models were used to estimate prevalence ratios using Poisson family and city as a cluster. RESULTS: Of the 4263 patients studied, 63% were female; the median age was 42 years. The overall prevalence of chronic gastritis was 12,9%. There was an association with chronic gastritis and altitude of residence at the intermediate and high levels, but not at the very high; with an adjusted prevalence ratio of 1.52 (95% confidence interval, 1.03 to 2.23); 2.01 (1.55 to 2.60) and 1.12 (0.84 to 1.48), respectively. CONCLUSIONS: We found a significant association between chronic gastritis and intermediate and high altitude but not at very high, which could be explained by hypobaric hypoxia in altitude that could lead to gastric wall lesions and other socio-demographic variables.

INTRODUCCIÓN: La gastritis crónica es unas de las enfermedades más comunes en la población y varía por regiones. Existen diversos factores que influyen en su aparición. Sin embargo, no se ha estudiado a profundidad el efecto de la altura. OBJETIVOS: Determinar la asociación entre la zona altitudinal de residencia y gastritis crónica en pacientes ambulatorios de Perú. MÉTODOS: Estudio transversal analítico. Se realizó a través del análisis secundario de datos. La variable dependiente fue gastritis crónica, tomada del reporte del paciente y verificado en la historia clínica, según antecedentes patológicos mencionados durante consulta médica. La variable independiente fue la zona altitudinal de residencia (divida en baja altitud, altitud intermedia, elevada y muy elevada). Las covariables secundarias fueron edad, sexo y tiempo viviendo en altura. Se realizaron modelos lineales generalizados para estimar razones de prevalencias, usando familia Poisson y ciudad como clúster. RESULTADOS: De los 4263 pacientes estudiados, 63% fue del sexo femenino; la mediana de la edad fue de 42 años. La prevalencia global de gastritis crónica fue 12,9%. Hubo asociación con gastritis crónica y altura de residencia a nivel intermedio, elevado, pero no con muy elevado, con una razón de prevalencia ajustada de 1,52 (intervalo de confianza 95%: 1,03 a 2,23); 2,01 (1,55 a 2,60) y 1,12 (0,84 a 1,48), respectivamente. CONCLUSIONES: Se encontró una asociación significativa entre gastritis crónica y altitud intermedia y elevada, pero no en muy elevada. Esto se explicaría por la hipoxia hipobárica en alturas, que podría conllevar lesiones en la pared gástrica, la adaptación de los peruanos a las alturas y por otras variables sociodemográficas.

Male Chauvinism Among Peruvian Medical Students: Related Socio-Educational Factors in 12 Peruvian Universities. / Machismo entre los estudiantes de medicina peruanos: Factores socio-educativos relacionados en 12 universidades peruanas.

INTRODUCTION: Male chauvinism is rooted in certain populations, but it has not been measured among those who will be responsible for healthcare. OBJECTIVE: To determine the factors associated with male chauvinism among the medical students of 12 Peruvian universities. METHODS: Cross-sectional multicentre analytical study, with previously collected data, which used validated tests to measure male chauvinism and strong religious beliefs. In addition, other social and educational factors were analysed and the data was crossed. Descriptive and analytical statistics were obtained. RESULTS: In the multivariate analysis, we found an association between male chauvinism and religious non-believers (RP=1.88; 95% CI, 1.47-2.40), as well as being female (RP=0.35; 95% CI, 0.27-0.46). Of the 12 universities evaluated, the least chauvinistic university was in Lima. Using this university as a comparison category, the statistically more chauvinistic universities were a private university in Chiclayo (α=3.63; p<0.001), followed by a university in Huancayo (α=3.20; p=0.001), Huancayo national university (α=2.79; p<0.001) and the public university of Ica (α=2.32; p=0.006); the crossed data were adjusted for age. CONCLUSIONS: It was found that male chauvinism is greater among non-religious believers, men and in some universities, with a predominance of universities in the central highlands of Peru or that had migrants from the mountains. This is important, since it gives us an overview about this trait in those who will be responsible for the future healthcare of Peruvians.

Factors associated with homophobia in medical students from eleven Peruvian universities. / Factores asociados a la homofobia en estudiantes de Medicina de once universidades peruanas.

BACKGROUND: The consequences of homophobia can affect the integrity, mental and physical health of homosexual individuals in society. There are few studies in Peru that have evaluated homophobia in the medical student population. OBJECTIVE: To establish the social, educational and cultural factors associated with homophobia among Peruvian medical students. METHODS: A cross-sectional analytical study was conducted in 12 medicine schools in Peru. Homophobia was defined according to a validated test, which was associated with other variables. Statistical associations were identified. RESULTS: The lowest percentages of homophobic students (15-20%) were found in the four universities in Lima, while universities in the interior of the country had the highest percentages (22-62%). Performing a multivariate analysis, we found that the frequency of homophobia was lower for the following variables: the female gender (PRa=0.74; 95% CI, 0.61-0.92; p=0.005), studying at a university in Lima (PRa=0.57; 95% CI, 0.43-0.75; p<0.001), professing the Catholic religion (PRa=0.53; 95% CI, 0.37-0.76; p<0.001), knowing a homosexual (PRa=0.73; 95% CI, 0.60-0.90; p=0.003) and having treated a homosexual patient (PRa=0.76; 95% CI, 0.59-0.98; p=0.036). In contrast, the frequency of homophobia increased in male chauvinists (PRa=1.37; 95% CI, 1.09-1.72; p=0.007), adjusted by four variables. CONCLUSIONS: Homophobia was less common in women, in those who study in the capital, those who profess Catholicism and those who know/have treated a homosexual. In contrast, male chauvinists were more homophobic.

Percepción de riesgo a COVID-19 e indicadores de salud mental en trabajadores de un hospital peruano: estudio transversal analítico / Perception of risk to COVID-19 and mental health indicators in workers of a Peruvian hospital: an analytical cross-sectional study

Objetivo El COVID-19 atemoriza a profesionales sanitarios, pudiendo afectar su salud mental. El objetivo de este estudio fue determinar la asociación entre la percepción de riesgo a COVID-19 y la salud mental en trabajadores de un hospital peruano. Método Estudio transversal analítico, mediante encuesta virtual. Las variables dependientes fueron depresión, ansiedad y estrés. La variable independiente fue percepción de riesgo a COVID-19 y las covariables fueron datos sociodemográficos, familiares, laborales y clínicos. Se hallaron razones de prevalencia crudas y ajustadas con un intervalo de confianza al 95% y un nivel de significancia del 5%. Resultados No hubo asociación entre percepción de riesgo y depresión (razón de prevalencia ajustado: 0,98; intervalo de confianza 95%: 0,89 a 1,08), ansiedad (razón de prevalencia ajustado: 0,94; intervalo de confianza 95%: 0,89 a 1,00), estrés (razón de prevalencia ajustado: 0,89; intervalo de confianza 95%: 0,76 a 1,04). En el análisis multivariado se encontró asociación entre depresión con contacto directo con paciente COVID-19 (razón de prevalencia ajustados: 2,06; intervalo de confianza 95%: 1,14 a 3,70) y con tener una comorbilidad (razón de prevalencia ajustados: 2,56; intervalo de confianza 95%: 1,52 a 4,30); entre ansiedad con número de hijos (razón de prevalencia ajustados: 1,09; intervalo de confianza 95%: 1,00 a 1,18), con contacto directo con paciente COVID-19 (razón de prevalencia ajustados: 2,67; intervalo de confianza 95%: 1,46 a 4,85) y con tener comorbilidad (razón de prevalencia ajustados: 2,00; intervalo de confianza 95%: 1,40 a 2,86); entre estrés con contacto directo con paciente COVID-19 (razón de prevalencia ajustados: 2,86; intervalo de confianza 95%: 1,20 a 6,83). Conclusiones No hubo asociación entre percepción de riesgo y depresión, ansiedad ni estrés. Hubo asociación entre depresión, ansiedad y estrés, cada uno con el contacto directo con pacientes COVID-19; entre ansiedad y depresión, cada uno con tener comorbilidades, y ansiedad con el número de hijos.

Introduction COVID-19 has caused great fear on health professionals and could affect their mental health, therefore it is important to determine the association between the perception of risk to COVID-19 and mental health in workers of a Peruvian hospital. Methods Analytical cross-sectional study, through virtual survey. The dependent variables were: depression, anxiety and stress; The independent variable was perception of risk to COVID-19 and the covariates: sociodemographic, family, work and clinical data. Crude and adjusted prevalence ratios were found with a 95% confidence interval and a significance level of 5%. Results There was no association between risk perception and depression (adjusted prevalence ratio: 0.98 95% confidence interval: 0.89 to 1.08), anxiety (adjusted prevalence ratio: 0.94 95% confidence interval: 0.89 to 1.00), stress (adjusted prevalence ratio: 0.89 95% confidence interval 0.76 to 1.04). In the multivariate analysis, an association was found between depression with direct contact with the COVID-19 patient (adjusted prevalence ratio: 2.06, 95% confidence interval: 1.14 to 3.70) and with having a comorbidity (adjusted prevalence ratio: 2.56 95% confidence interval: 1.52 to 4.30); likewise, between anxiety with number of children (adjusted prevalence ratio: 1.09 95% confidence interval: 1.00 to 1.18), with direct contact with COVID-19 patient (adjusted prevalence ratio: 2.67 95% confidence interval 1.46 to 4.85) and having comorbidity (adjusted prevalence ratio: 2.00 95% confidence interval: 1.40 to 2.86); finally, between stress with direct contact with the COVID-19 patient (adjusted prevalence ratio: 2.86, 95% confidence interval: 1.20 to 6.83). Conclusions No statistically significant association was found between risk perception and depression, anxiety, or stress. However, there was an association between depression, anxiety, and stress, each with direct contact with COVID-19 patients; between anxiety and depression, each with having comorbidities and, finally, anxiety with the number of children.

Asociación entre enfermedades cardiometabólicas y depresión en un hospital de referencia peruano / Association between cardiometabolic diseases and depression in a Peruvian reference hospital

INTRODUCCIÓN: Se ha postulado la relación entre la presencia de enfermedades cardiometabólicas con problemas de salud mental, en particular la depresión. OBJETIVOS: Determinar la asociación entre la presencia de enfermedades cardiometabólicas y la presencia de sintomatología depresiva evaluada mediante el cuestionario PHQ-9 en pacientes atendidos en consultorios externos de medicina interna del Hospital Nacional Hipólito Unanue. METODOLOGÍA: Estudio observacional, analítico, transversal. Se definió enfermedad cardiometabólica como la presencia de diabetes mellitus, hipertensión arterial, dislipidemia, y/u obesidad. Se utilizó el cuestionario PHQ-9 para evaluar la presencia de síntomas sugerentes de depresión. Se evaluó la asociación cruda y ajustada a posibles confusores. Para el análisis multivariado se utilizó un modelo de regresión de Poisson para hallar razones de prevalencia con sus respectivos intervalos de confianza al 95%. Se consideró un p<0,05 como estadísticamente significativo. Resultados: Se incluyeron 252 pacientes, de los que 205 (81,4%) presentaron enfermedades cardiometabólicas y 181 (71,9%) presentaron síntomas consistentes con algún grado de depresión. La presencia de enfermedades cardiometabólicas se asoció a síntomas depresivos tanto en el análisis crudo (RPc 1,43; IC 95% 1,08-1,89; p=0,012) como en el ajustado (RPa 1,31; IC 95% 1,00-1,71; p=0,048). Adicionalmente se encontró asociación entre el sexo femenino y sintomatología depresiva (RPa 1,35; IC 95% 1,11-1,63; p=0,002). CONCLUSIONES: La presencia de enfermedades cardiometabólicas se asoció con la presencia de síntomas depresivos en pacientes atendidos en la consulta externa de medicina interna. El abordaje de la salud mental debe ser parte integral del manejo multidisciplinario del paciente con enfermedad cardiometabólica.

INTRODUCTION: It has been postulated the relationship between presence of cardiometabolic diseases with mental health problems, particularly depression. Objectives: To determine the association between cardiometabolic diseases and presence of depressive symptoms, evaluated by PHQ-9 questionnaire, in patients attended at the outpatient clinic of internal medicine service at Hospital Nacional Hipolito Unanue. METHODS: Observational analytical cross-sectional study. Cardiometabolic disease was defined as the presence of diabetes mellitus, high blood pressure, dyslipidemia, and/or obesity. The PHQ-9 questionnaire was used to evaluate the presence of symptoms suggestive of depression. The association was evaluated crude and adjusted for possible confounders. For the multivariate analysis, a Poisson regression model was used to find prevalence ratios with their respective 95% confidence intervals. A p<0.05 was considered statistically significant. RESULTS: 252 patients were included, of which 205 (81,4%) presented cardiometabolic diseases and 181 (71,9%) presented symptoms consistent with some grade of depression. The presence of cardiometabolic diseases was associated with depressive symptoms both in the crude analysis (PRc 1.43; CI 95% 1.08-1.89; p=0.012) and in the adjusted one (PRa 1.31; CI 95% 1.00-1.71; p=0.048). Additionally, an association was found between female sex and depressive symptoms (PRa 1,35; CI 95% 1,11-1,63; p=0,002). CONCLUSIONS: The presence of cardiometabolic diseases was associated with the presence of depressive symptoms in patients seen at the outpatient clinic of internal medicine. The mental health approach should be an integral part of the multidisciplinary management for the patient with cardiometabolic disease.

Factores asociados a enterobiosis en niños de dos comunidades nativas Ese'Eja del departamento Madre de Dios, Perú / Factors associated with enterobiosis in children of the Ese'Eja native communities in department of Madre de Dios, Peru

Introducción: La enterobiosis es una de las principales infecciones intestinales del mundo. Objetivo: Determinar los factores asociados a la infección por Enterobius vermicularis en niños de dos comunidades nativas Ese'Eja en Madre de Dios, Perú. Métodos: Estudio transversal analítico. Se trabajó con niños (77) de 1 a 11 años durante los meses de febrero a marzo de 2014. Para diagnosticar la enterobiosis se usó el test de Graham. Las manifestaciones clínicas fueron evaluadas por un médico y los factores asociados mediante una encuesta aplicada a los padres de los niños evaluados. Se usó estadística descriptiva y analítica, se utilizaron razones de prevalencia crudas y ajustadas con un IC 95 por ciento se consideró p< 0,05 como significativo. Resultados: La prevalencia de enterobiosis fue de 32,47 por ciento (25). Los factores asociados (RP e IC 95 por ciento) en el análisis bivariado fueron onicofagia 2,1 (1,1-3,9), chuparse los dedos 5,4 (2,1-2,7), uñas largas 7 (2,6-18,6), intercambio de ropa 2,3 (1,1-3,7), cambio de ropa interior 3,3 (1,8-5,9), uso de calzado 7 (2,6-18,4), juego con tierra 6,9 (1,7-27,3), juego con mascotas 6,4 (2,1-19,7), lavado de manos antes de comer 7,9 (3,6-17,1), lavado de manos después de comer 1,9 (1,7-3,66), 6 o más personas en la casa 3,9 (1,9-7,9), disposición de excretas a campo abierto 3,3 (1,7-6,2) y el menor nivel socioeconómico 2,6 (1,3-5,4). No hubo asociaciones en el análisis multivariado. Conclusiones: Existe una alta prevalencia de enterobiosis en la población estudiada y los factores de riesgo son similares a los antecedentes locales. Urge hacer programas de prevención y promoción de salud respecto al tema para reducir este problema(AU)

Introduction: Enterobiasis is one of the main intestinal infections worldwide. Objective: Determine the factors associated to Enterobius vermicularis infection in children from two native Ese'Eja communities in Madre de Dios, Peru. Methods: An analytical cross-sectional study was conducted in February-March 2014 of 77 children aged 1-11 years. Enterobiasis diagnosis was based on Graham's test. Clinical manifestations were evaluated by a physician, whereas associated factors were determined through a survey applied to the parents of the children studied. Use was made of descriptive and analytical statistical analysis, and crude and adjusted prevalence ratios with a CI of 95 percent. A p value of 0.05 was considered significant. Results: Enterobiasis prevalence was 32.47 percent (25). The associated factors (PR and CI 95 percent) in the bivariate analysis were onychophagia 2.1 (1.1-3.9), finger sucking 5.4 (2.1-2.7), long nails 7 (2.6-18.6), exchanging clothes 2.3 (1.1-3.7), changing underwear 3.3 (1.8-5.9), wearing shoes 7 (2.6-18.4), playing with earth 6.9 (1.7-27.3), playing with pets 6.4 (2.1-19.7), handwashing before eating 7.9 (3.6-17.1), handwashing after eating 1.9 (1.7-3.66), six or more people in the household 3.9 (1.9-7.9), feces disposal in open areas 3.3 (1.7-6.2) and a lower socioeconomic level 2.6 (1.3-5.4). Multivariate analysis did not find any association. Conclusions: Enterobiasis prevalence is high in the population studied, and the risk factors are similar to the local antecedents. It is urgent to develop health prevention and promotion programs about the topic to reduce this problem(AU)

Evaluación del rendimiento diagnóstico de un nomograma de predicción de preeclampsia / Evaluation of the diagnostic performance of a preeclampsia prediction nomogram

OBJETIVO: Determinar el rendimiento diagnóstico de un nomograma de predicción de preeclampsia en gestantes atendidas en el Hospital Nacional Dos de Mayo en Lima, Perú de enero de 2016 a julio de 2019. MÉTODO: Estudio de tipo pruebas diagnósticas. Se contó con una muestra de 513 pacientes; de ellas, 225 con diagnóstico de preeclampsia y 288 sin dicho diagnóstico. El análisis de los datos obtenidos se realizó en STATA v.14 y se determinaron la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo. RESULTADOS: Se analizó la curva ROC y se encontró un área bajo la curva de 0,91 (intervalo de confianza del 95%: 0,89-0,93), obteniendo 187 puntos como valor de corte de mejor rendimiento diagnóstico, con una sensibilidad del 81,33% y una especificidad del 85,76%. CONCLUSIONES: El nomograma de predicción de preeclampsia tiene un buen rendimiento diagnóstico para las gestantes atendidas en el servicio de ginecología y obstetricia del Hospital Nacional Dos de Mayo.

OBJECTIVE: Determine the diagnostic performance of a preeclampsia prediction nomogram in pregnant women attended at the Dos de Mayo National Hospital during the period from January 2016 to July 2019. METHOD: Study of diagnostic tests. There was a sample of 513 patients, 225 patients with a diagnosis of pre-eclampsia and 288 patients without such diagnosis were selected. The analysis of the data obtained was carried out in STATA v.14, obtaining the values of sensitivity, specificity, PPV and NPV. RESULTS: The ROC curve was analyzed obtaining an AUC of 0.91 (95% CI: 0.89 - 0.93), obtaining 187 points as the cut-off point for the best diagnostic performance, with a sensitivity of 81.33% and a specificity of 85.76%. CONCLUSIONS: The preeclampsia prediction nomogram has a good diagnostic performance for pregnant women attended at the Gynecology and Obstetrics service of the Dos de Mayo National Hospital.

[Characteristics associated with pre travel medical consultation in tourists visiting Cuzco, Peru]. / Características asociadas a la consulta pre viaje en turistas que visitan Cusco, Perú.

BACKGROUND: International tourism is increasing. Preventive Medicine remains important, especially the Pre-Travel Consultation (PTC). OBJECTIVE: To determinate, the characteristics of tourists associated with PTC in tourists at Cuzco, Peru. METHODS: A cross-sectional, analytical study, a secondary analysis of data from a database generated by survey of foreign tourists who visited Cuzco, in the waiting room of the airport was performed. The main variable was to have had a PTC at the tourist's country of residence, the area of residence was categorized according to health/risk of acquiring infectious diseases as traveler's diarrhea during their stay. These and other variables were analyzed and statistical association with generalized linear models were done. RESULTS: Of the 1827 tourists, 875 (48%) were men, with a median age of 33 years (range 18-88 years); 42% had a PTC. In the multivariate analysis, it was found that a PTC lower frequency was associated with male gender (aPR: 0.84; 95% CI: 0.75-0.94), and a higher frequency was associated with have born (aPR: 1.77; 95% CI: 1.39-2.27) and reside in an area of low risk of acquiring infectious diseases (aPR: 1.95; 95% CI: 1.26-3.00), adjusted for the history of a disease. CONCLUSIONS: Sex, region of birth and residence of tourists (as risk of acquiring infectious diseases) are associated with having a PTC. These findings may serve the health and government attending tourists who come to our country.