Recent Submissions

  • Whole genome analysis of extensively drug resistant Mycobacterium tuberculosis strains in Peru

    Santos-Lazaro, David; Gavilan, Ronnie G.; Solari, Lely; Vigo, Aiko N.; Puyen, Zully M. (Nature Research, 2021-12-01)
    Peru has the highest burden of multidrug-resistant tuberculosis in the Americas region. Since 1999, the annual number of extensively drug-resistant tuberculosis (XDR-TB) Peruvian cases has been increasing, becoming a public health challenge. The objective of this study was to perform genomic characterization of Mycobacterium tuberculosis strains obtained from Peruvian patients with XDR-TB diagnosed from 2011 to 2015 in Peru. Whole genome sequencing (WGS) was performed on 68 XDR-TB strains from different regions of Peru. 58 (85.3%) strains came from the most populated districts of Lima and Callao. Concerning the lineages, 62 (91.2%) strains belonged to the Euro-American Lineage, while the remaining 6 (8.8%) strains belonged to the East-Asian Lineage. Most strains (90%) had high-confidence resistance mutations according to pre-established WHO-confident grading system. Discordant results between microbiological and molecular methodologies were caused by mutations outside the hotspot regions analysed by commercial molecular assays (rpoB I491F and inhA S94A). Cluster analysis using a cut-off ≤ 10 SNPs revealed that only 23 (34%) strains evidenced recent transmission links. This study highlights the relevance and utility of WGS as a high-resolution approach to predict drug resistance, analyse transmission of strains between groups, and determine evolutionary patterns of circulating XDR-TB strains in the country.
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  • Genotype-specific prevalence of human papillomavirus infection in asymptomatic Peruvian women: a community-based study

    del Valle-Mendoza, Juana; Becerra-Goicochea, Lorena; Aguilar-Luis, Miguel Angel; Pinillos-Vilca, Luis; Carrillo-Ng, Hugo; Silva-Caso, Wilmer; Palomares-Reyes, Carlos; Taco-Masias, Andre Alonso; Aquino-Ortega, Ronald; Tinco-Valdez, Carmen; Tarazona-Castro, Yordi; Sarmiento-Ramirez, Cynthia Wendy; Del Valle, Luis J. (BioMed Central Ltd, 2021-12-01)
    Objective: To determine the general and genotype-specific prevalence of HPV and to identify potential risk factors for the infection in a population-based screening of Peruvian women. Results: A total of 524 samples were analyzed by PCR and a total of 100 HPV positive samples were found, of which 89 were high-risk, 19 were probably oncogenic, 9 were low-risk and 27 other HPV types. The 26–35 and 36–45 age groups showed the highest proportion of HPV positive samples with a total of 37% (37/100) and 30% (30/100), respectively. Moreover, high-risk HPV was found in 33.7% of both groups and probably oncogenic HPV in 52.6% and 31.6%, respectively. High-risk HPV were the most frequent types identified in the population studied, being HPV-52, HPV-31 and HPV-16 the most commonly detected with 17.6%, 15.7% y 12.9%, respectively. Demographic characteristics and habits were assessed in the studied population. A total of 62% high-risk HPV were detected in married/cohabiting women. Women with two children showed the highest proportion (33.8%) of high-risk HPV, followed by women with only one child (26.9%). Those women without history of abortion had a higher frequency of high-risk HPV (71.9%), followed by those with one abortion (25.8%).
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  • Spread of the fascioliasis endemic area assessed by seasonal follow-up of rDNA ITS-2 sequenced lymnaeid populations in Cajamarca, Peru

    Bardales-Valdivia, J. N.; Bargues, M. D.; Hoban-Vergara, C.; Bardales-Bardales, C.; Goicochea-Portal, C.; Bazán-Zurita, H.; Del Valle-Mendoza, J.; Ortiz, P.; Mas-Coma, S. (Elsevier B.V., 2021-12-01)
    Fascioliasis is a worldwide emerging snail-borne zoonotic trematodiasis with a great spreading capacity linked to animal and human movements, climate change, and anthropogenic modifications of freshwater environments. South America is the continent with more human endemic areas caused by Fasciola hepatica, mainly in high altitude areas of Andean regions. The Peruvian Cajamarca area presents the highest human prevalences reported, only lower than those in the Bolivian Altiplano. Sequencing of the complete rDNA ITS-2 allowed for the specific and haplotype classification of lymnaeid snails collected in seasonal field surveys along a transect including 2007–3473 m altitudes. The species Galba truncatula (one haplotype preferentially in higher altitudes) and Pseudosuccinea columella (one haplotype in an isolated population), and the non-transmitting species Lymnaea schirazensis (two haplotypes mainly in lower altitudes) were found. Climatic seasonality proved to influence G. truncatula populations in temporarily dried habitats, whereas L. schirazensis appeared to be more climatologically independent due to its extreme amphibious ecology. Along the southeastern transect from Cajamarca city, G. truncatula and L. schirazensis shared the same site in 7 localities (46.7% of the water collections studied). The detection of G. truncatula in 11 new foci (73.3%), predominantly in northern localities closer to the city, demonstrate that the Cajamarca transmission risk area is markedly wider than previously considered. Lymnaea schirazensis progressively increases its presence when moving away from the city. Results highlight the usefulness of lymnaeid surveys to assess borders of the endemic area and inner distribution of transmission foci. Similar lymnaeid surveys are still in need to be performed in the wide northern and western zones of the Cajamarca city. The coexistence of more than one lymnaeid transmitting species, together with a morphologically indistinguishable non-transmitting species and livestock movements inside the area, conform a complex scenario which poses difficulties for the needed One Health control intervention.
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  • Sexual health norms and communication patterns within the close social networks of men who have sex with men and transgender women in Lima, Peru: a 2017 cross-sectional study

    Ayer, Amrita; Segura, Eddy R.; Perez-Brumer, Amaya; Chavez-Gomez, Susan; Fernandez, Rosario; Gutierrez, Jessica; Suárez, Karla; Lake, Jordan E.; Clark, Jesse L.; Cabello, Robinson (BioMed Central Ltd, 2021-12-01)
    Background: Social networks, norms, and discussions about sexual health may inform sexual practices, influencing risk of human immunodeficiency virus (HIV) or sexually transmitted infection (STI) acquisition. To better understand social networks of Peruvian men who have sex with men (MSM) and transgender women (trans women), we examined key social network members (SNMs), participant perceptions of these network members’ opinions toward sexual health behaviors, and associations between network member characteristics and condomless anal intercourse (CAI). Methods: In a 2017 cross-sectional study, a convenience sample of 565 MSM and trans women with HIV-negative or unknown serostatus was asked to identify three close SNMs; describe discussions about HIV and STI prevention with each; and report perceived opinions of condom use, HIV/STI testing, and partner notification of STIs. Generalized estimating equations evaluated relationships between SNM characteristics, opinions, and discussions and participant-reported CAI. Results: Among participants who identified as MSM, 42.3% of key SNMs were perceived to identify as gay. MSM “never” discussed HIV and STI prevention concerns with 42.4% of heterosexual SNMs, but discussed them “at least once weekly” with 16.9 and 16.6% of gay- and bisexual- identifying SNMs, respectively. Among participants who identified as trans women, 28.2% of key SNMs were perceived as heterosexual; 25.9%, as bisexual; 24.7%, as transgender; and 21.2%, as gay. Trans women discussed HIV/STI prevention least with cis-gender heterosexual network members (40.2% “never”) and most with transgender network members (27.1% “at least once weekly”). Participants perceived most of their close social network to be completely in favor of condom use (71.2% MSM SNMs, 61.5% trans women SNMs) and HIV/STI testing (73.1% MSM SNMs, 75.6% trans women SNMs), but described less support for partner STI notification (33.4% MSM SNMs, 37.4% trans women SNMs). Most participants reported CAI with at least one of their past three sexual partners (77.5% MSM, 62.8% trans women). SNM characteristics were not significantly associated with participant-reported frequency of CAI. Conclusions: Findings compare social support, perceived social norms, and discussion patterns of Peruvian MSM and trans women, offering insight into social contexts and sexual behaviors. Trial registration: The parent study from which this analysis was derived was registered at (Identifier: NCT03010020) on January 4, 2017.
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  • Comprehensive virtual screening of 4.8 k flavonoids reveals novel insights into allosteric inhibition of SARS-CoV-2 M<sup>PRO</sup>

    Jiménez-Avalos, Gabriel; Vargas-Ruiz, A. Paula; Delgado-Pease, Nicolás E.; Olivos-Ramirez, Gustavo E.; Sheen, Patricia; Fernández-Díaz, Manolo; Quiliano, Miguel; Zimic, Mirko; Agurto-Arteaga, Andres; Antiparra, Ricardo; Ardiles-Reyes, Manuel; Calderon, Katherine; Cauna-Orocollo, Yudith; de Grecia Cauti-Mendoza, Maria; Chipana-Flores, Naer; Choque-Guevara, Ricardo; Chunga-Girón, Xiomara; Criollo-Orozco, Manuel; De La Cruz, Lewis; Delgado-Ccancce, Elmer; Elugo-Guevara, Christian; Fernández-Sanchez, Manolo; Guevara-Sarmiento, Luis; Gutiérrez, Kristel; Heredia-Almeyda, Oscar; Huaccachi-Gonzalez, Edison; Huerta-Roque, Pedro; Icochea, Eliana; Isasi-Rivas, Gisela; Juscamaita-Bartra, Romina A.; Licla-Inca, Abraham; Montalvan, Angela; Montesinos-Millan, Ricardo; Núñez-Fernández, Dennis; Ochoa-Ortiz, Adiana; Páucar-Montoro, Erika; Pauyac, Kathy; Perez-Martinez, Jose L.; Perez-M, Norma; Poma-Acevedo, Astrid; Quiñones-Garcia, Stefany; Ramirez-Ortiz, Ingrid; Ramos-Sono, Daniel; Rios-Angulo, Angela A.; Rios-Matos, Dora; Rojas-Neyra, Aldo; Romero, Yomara K.; Salguedo-Bohorquez, Mario I.; Sernaque-Aguilar, Yacory; Soto, Luis F.; Tataje-Lavanda, Luis; Ticona, Julio; Vallejos-Sánchez, Katherine; Villanueva-Pérez, Doris; Ygnacio-Aguirre, Freddy (Nature Research, 2021-12-01)
    SARS-CoV-2 main protease is a common target for inhibition assays due to its high conservation among coronaviruses. Since flavonoids show antiviral activity, several in silico works have proposed them as potential SARS-CoV-2 main protease inhibitors. Nonetheless, there is reason to doubt certain results given the lack of consideration for flavonoid promiscuity or main protease plasticity, usage of short library sizes, absence of control molecules and/or the limitation of the methodology to a single target site. Here, we report a virtual screening study where dorsilurin E, euchrenone a11, sanggenol O and CHEMBL2171598 are proposed to inhibit main protease through different pathways. Remarkably, novel structural mechanisms were observed after sanggenol O and CHEMBL2171598 bound to experimentally proven allosteric sites. The former drastically affected the active site, while the latter triggered a hinge movement which has been previously reported for an inactive SARS-CoV main protease mutant. The use of a curated database of 4.8 k flavonoids, combining two well-known docking software (AutoDock Vina and AutoDock4.2), molecular dynamics and MMPBSA, guaranteed an adequate analysis and robust interpretation. These criteria can be considered for future screening campaigns against SARS-CoV-2 main protease.
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  • Intracystic Glucose Levels Appear Useful for Diagnosis of Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis

    Guzmán-Calderón, Edson; Md, Belen Martinez Moreno; Casellas, Juan A.; Aparicio, José Ramón (Springer, 2021-01-01)
    Background: Carcinoembryonic antigen (CEA) in the pancreatic cystic fluid is the most important biomarker for differentiating mucinous from non-mucinous pancreatic cystic lesions (PCLs). However, recent studies have shown that glucose levels in pancreatic cystic fluid can discriminate mucinous from non-mucinous cysts. Aims: To perform a meta-analysis to determine the utility of intracystic fluid glucose of pancreatic mucinous cysts compared with intracystic CEA. Methods: We conducted a systematic review of the literature in the PubMed, OVID Medline, and Cochrane databases. This meta-analysis considers studies published up to October 2020. Results: Six studies comprising 506 patients were selected; 61.2% of the population was female. Of the 480 PCLs, 287 (59.7%) were mucinous. Pooled sensitivity and specificity of cystic fluid glucose levels for mucinous PCLs were 91% and 85%, respectively. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 6.33 and 0.11, respectively. Pooled diagnostic odds ratio (DOR) was 60.94. The pooled area under the summary receiver operating characteristic (SROC) curve was 0.959. Pooled sensitivity and specificity of pancreatic cystic fluid CEA levels were 61% and 93%. The PLR and NLR were 8.51 and 0.40, respectively. Pooled DOR was 23.52, and the pooled area under the SROC curve was 0.861. Conclusion: Glucose has become a useful method and appears to be better than CEA for differentiating between mucinous PCLs and non-mucinous PCLs. We suggest that the analysis of glucose in PCLs be routinely performed for the differential diagnosis of these lesions.
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  • Prognostic value of neutrophil-to-lymphocyte ratio in COVID-19 patients: A systematic review and meta-analysis

    Ulloque-Badaracco, Juan R.; Ivan Salas-Tello, W.; Al-kassab-Córdova, Ali; Alarcón-Braga, Esteban A.; Benites-Zapata, Vicente A.; Maguiña, Jorge L.; Hernandez, Adrian V. (John Wiley and Sons Inc, 2021-01-01)
    Background: Neutrophil-to-lymphocyte ratio (NLR) is an accessible and widely used biomarker. NLR may be used as an early marker of poor prognosis in patients with COVID-19. Objective: To evaluate the prognostic value of the NLR in patients diagnosed with COVID-19. Methods: We conducted a systematic review and meta-analysis. Observational studies that reported the association between baseline NLR values (ie, at hospital admission) and severity or all-cause mortality in COVID-19 patients were included. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS). Random effects models and inverse variance method were used for meta-analyses. The effects were expressed as odds ratios (ORs) and their 95% confidence intervals (CIs). Small study effects were assessed with the Egger's test. Results: We analysed 61 studies (n = 15 522 patients), 58 cohorts, and 3 case-control studies. An increase of one unit of NLR was associated with higher odds of severity (OR 6.22; 95%CI 4.93 to 7.84; P <.001) and higher odds of all-cause mortality (OR 12.6; 95%CI 6.88 to 23.06; P <.001). In our sensitivity analysis, we found that 41 studies with low risk of bias and moderate heterogeneity (I2 = 53% and 58%) maintained strong association between NLR values and both outcomes (severity: OR 5.36; 95% CI 4.45 to 6.45; P <.001; mortality: OR 10.42 95% CI 7.73 to 14.06; P =.005). Conclusions: Higher values of NLR were associated with severity and all-cause mortality in hospitalised COVID-19 patients.
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  • Leptospirosis in febrile patients with suspected diagnosis of dengue fever

    del Valle-Mendoza, Juana; Palomares-Reyes, Carlos; Carrillo-Ng, Hugo; Tarazona-Castro, Yordi; Kym, Sungmin; Aguilar-Luis, Miguel Angel; Del Valle, Luis J.; Aquino-Ortega, Ronald; Martins-Luna, Johanna; Peña-Tuesta, Isaac; Verne, Eduardo; Silva-Caso, Wilmer (BioMed Central Ltd, 2021-12-01)
    Objective: This study was carried out to determine the prevalence of leptospirosis among febrile patients with a suspicious clinical diagnosis of dengue fever in northern Peru. Results: A total of 276 serum samples from patients with acute febrile illness (AFI) and suspected diagnosis for dengue virus (DENV) were analyzed. We identified an etiological agent in 121 (47.5%) patients, DENV was detected in 30.4% of the cases, leptospirosis in 11.2% and co-infection by both pathogens was observed in 5.9% of the patients. In this study the most common clinical symptoms reported by the patients were: headache 89.1%, myalgias 86.9% and arthralgias 82.9%. No differences in symptomatology was observed among the different study groups.
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  • First report of Myroides phaeus bacteraemia identified by Polymerase chain reaction and genetic sequencing

    Pérez-Lazo, G.; Morales-Moreno, A.; Soto-Febres, F.; Jove-Químper, H.; Morales-Castillo, L.; Palomares-Reyes, C.; Del Valle-Mendoza, J.; Aguilar-Luis, M.; Silva-Caso, W. (lsevier Ltd, 2020-01-01)
    We report the first case of Myroides phaeus isolated from blood, causing bacteremia in an immunocompromised patient using the automated MicroScan Walk Away 96 system, followed by bacterial identification by amplification-sequencing of the 16S rDNA. The sequences obtained were compared with the reference sequence of the BLAST ® platform - National Library of Medicine, USA, and the isolation was identified as Myroides phaeus strain with 99.67 % identity in Blast report. In the literature we did not find previous reported cases of infections by this bacterium, however its pathogenic role is still controversial; therefore, this isolation alerts us to carry out an exhaustive surveillance of other possible acquisition routes.
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  • Gut microbiota in hospitalized children with acute infective gastroenteritis caused by virus or bacteria in a regional Peruvian hospital

    Taco-Masias, Andre Alonso; Fernandez-Aristi, Augusto R.; Cornejo-Tapia, Angela; Aguilar-Luis, Miguel Angel; Del Valle, Luis J.; Silva-Caso, Wilmer; Zavaleta-Gavidia, Victor; Weilg, Pablo; Cornejo-Pacherres, Hernán; Bazán-Mayra, Jorge; Puyen, Zully M.; del Valle-Mendoza, Juana (PeerJ Inc., 2020-11-03)
    Background. Acute infective gastroenteritis (AIG) is a leading cause of mortality in children worldwide. In Peru, more than 40% of cases of AIG occurring in children under 5 years old. The disruption of the gut microbiota can increase risk for several health complications especially in patients with gastric infections caused by viruses or bacteria. Objective. The main objective of this study was to describe the prevalence of 13 representative bacteria from the gut microbiota (GM) in stools samples from children under 5 years of age with acute infective gastroenteritis. Results. The most commonly isolated bacteria from the GM were Firmicutes (63.2% 74/117) Bacteriodetes (62.4%; 73/117), Lactobacillus (59.8%; 70/117), Prevotella (57.2%; 67/117), Proteobacterium (53.8%; 63/117), regardless of the etiological agent responsible for the AIG. Interestingly, despite the high prevalence of Firmicutes, Bacteroidetes, Lactobacillus and Prevotella across all samples, a visible reduction of these agents was observed especially among patients with a single bacterial infection or even bacteria–bacteria coinfections when compared to viral etiologies. Patients with exclusive or mixed breastfeeding registered the highest amount of gut microbiota bacteria, in contrast to infants who received formula or were not breastfed.
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  • Prevalence of venous thromboembolism in admissions and readmissions with and without syncope: A nationwide cohort study

    Kadri, Amer N.; Zawit, Misam; Al-Adham, Raed; Hader, Ismail; Nusairat, Leen; Almahmoud, Mohamed F.; Senussi, Mourad; Altibi, Ahmed; Barakat, Amr; Hernandez, Adrian V.; Masri, Ahmad (Oxford University Press, 2021-01-01)
    Aims: The Pulmonary Embolism in Syncope Italian Trial reported 17.3% prevalence of pulmonary embolism (PE) in patients admitted with syncope. We investigated the prevalence of venous thromboembolism [VTE, including PE and deep vein thrombosis (DVT)] in syncope vs. non-syncope admissions and readmissions, and if syncope is an independent predictor of VTE. Methods and results: We conducted an observational study of index admissions of the 2013-14 Nationwide Readmission Database.
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  • Perception about chagas disease and the risk of oral transmission in Andoas, Loreto, Peru

    Cabrera, Rufino; Valderrama, Yadira; Meza, Juan Ramón (Instituto Nacional de Salud, 2020-01-01)
    Carta al editor.
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  • Let’s Talk About Sex: The Impact of Partnership Contexts on Communication About HIV Serostatus and Condom Use Among Men Who Have Sex with Men (MSM) and Transgender Women (TW) in Lima, Peru

    Ayer, Amrita; Perez-Brumer, Amaya; Segura, Eddy R.; Chavez-Gomez, Susan; Fernandez, Rosario; Arroyo, Cecilia; Barrantes, Alex; Lake, Jordan E.; Cabello, Robinson; Clark, Jesse L. (Springer, 2021-01-01)
    Sexual communication with partners informs risk assessment and sexual practices. We evaluated participant, partner, and network factors associated with communication about condom use and HIV serostatus and explored their relationships with condomless anal intercourse (CAI) among 446 men who have sex with men (MSM) and 122 transgender women (TW) in Lima, Peru. Generalized estimating equations assessed contextual influences on communication and practices with recent sexual partners. More frequent HIV communication was reported by MSM who: identified as heterosexual, compared to bisexual or gay; characterized partnerships as stable, compared to casual, anonymous, or commercial; or discussed HIV/STIs with close social contacts (p < 0.05). TW in concurrent partnerships discussed condom use more frequently than those in monogamous relationships (p < 0.05). Condom use discussions and alcohol use among MSM were associated with CAI (p < 0.05). Findings highlight complexity in sexual decision-making and call for further study of conversation content and practices to inform HIV prevention messaging.
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  • Electrohydraulic lithotripsy for the treatment of stone impacted in a lumen-apposing metal stent in a patient with endoscopic cholecystoduodenostomy

    Guzmán-Calderón, Edson; Martínez-Moreno, Belén; Casellas, Juan A.; Aparicio, José Ramó (2021-01-01)
    Resumen no disponible.
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  • Factors Associated with Health Anxiety in Medical Students at a Private University in Lima, Peru

    Robles-Mariños, Rodrigo; Angeles, Andrea I.; Alvarado, Germán F. (Elsevier Doyma, 2021-01-01)
    Introduction: There are few studies that examine the factors associated with the different levels of health anxiety in medical students. The objective was to determine the factors associated with the levels of health anxiety in medical students in 2018. Methods: An analytical cross-sectional study was carried out with 657 medical students from a private Peruvian university. Participants answered a questionnaire from which information was collected regarding levels of health anxiety (SHAI). For the analysis, linear regression was used to calculate crude and adjusted betas, and their 95% confidence intervals. Results: The mean health anxiety score was 14 ± 6.7. An association between health anxiety and the year of study is reported, with the second year showing the highest scores. In addition, an association between health anxiety and smoking is highlighted, as there are higher levels in occasional smokers, as well as a weak inverse correlation with age. No association was found with sex, place of birth, or having a first-degree relative that is a doctor or health worker. Conclusions: The present study showed that age, year of studies and smoking are associated with health anxiety levels. More studies are required, especially of a longitudinal nature.
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  • PrEP Awareness, Use, Intention to Use, and Information Source Among Geosocial Networking Application Users in Mexico in 2018–2019

    Blair, Kevin J.; Segura, Eddy R.; Garner, Alex; Lai, Jianchao; Ritterbusch, Amy; Leon-Giraldo, Sebastian; Guilamo-Ramos, Vincent; Lake, Jordan E.; Clark, Jesse; Holloway, Ian W. (Springer, 2021-01-01)
    Pre-exposure prophylaxis (PrEP) has limited availability across Latin America, though access is increasing. We explored PrEP uptake in Mexico via an online survey completed by Spanish-speaking, Hornet geosocial networking application (GSN app) users without HIV (n = 2020). Most (81.3%) had heard of PrEP, 3.5% were current users, and 34.2% intended to take PrEP within six months. Current PrEP use was associated with PrEP eligibility (aOR 26.07 [95%CI 13.05–52.09], p < 0.001), recent STI testing (aOR 3.79 [95%CI 1.10–13.11], p = 0.035), and recent chemsex (aOR 3.02 [95%CI 1.02–8.93], p = 0.046). Recent STI testing was associated with hearing about PrEP from a doctor (aOR 3.26 [95%CI 1.98–5.36], p < 0.001), and those who lived in large cities were less likely to have learned about PrEP via Hornet (aOR 0.52 [95%CI 0.32–0.85], p = 0.009). Interventions to increase PrEP uptake in Mexico should build upon existing health networks and utilize GSN apps for PrEP information dissemination, particularly in less populated areas.
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  • Novel 2019 coronavirus infection in children

    Llaque Quiroz, Patricia Beatriz (Instituto Nacional de Salud, 2020-01-01)
    COVID-19 is rarely reported in children and they are mildly affected in most cases. The most common clinical presentation of COVID-19 is cough, fever and sore throat; severe cases show tachypnea. The course of the disease is from one to two weeks. Laboratory findings are nonspecific; lymphopenia, elevation of C-reactive protein and procalcitonin have been described. Early chest X-ray is usually normal, and the most common tomographic findings are consolidations with halo, ground-glass opacities and tiny nodules which mainly affects subpleural areas. Management of the disease is supportive; in severe cases, it should be focused on respiratory support. It is recommended to limit the handling of respiratory secretions and to follow the same preventive measures provided to adults.
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  • Surgical Treatment and Reconstruction of Nasal Defects According to the Aesthetic Subunits Principles

    Núñez-Castañeda, José Miguel; Chang-Grozo, Silvana Lucia (Springer, 2021-01-01)
    The aim of this study was to determine the prevalence of nasal skin cancer, its location by facial aesthetic subunits and the type of reconstructive procedures performed for each nasal subunit after excision for nasal skin tumors. Observational cross-sectional study of all consecutive patients with the diagnosis of skin tumor located in the nasal unit, treated from 2018 to 2019 by the department of head and neck surgery of a general hospital. 60 patients were treated with nasal skin tumors excisions. A total of 52 patients (86,6%) had basal cell skin cancer, 7 (11,6%) had squamous cell skin cancer and 1 (1,6%) had melanoma. Fifty-nine patients (98.33%) presented a primary tumor and just 1 case (1,66%) recived a previous surgical treatment. Regardless of the type of tumor, the tip subunit was the most often involved with 29 (48,33%) cases in total. Despite of the nasal aesthetic subunit affected, the most frequent type of procedure used for reconstruction was the rotation or advancement flap, based on aesthetic nasal subunits, which was performed in 39 cases (65%). Nasal reconstruction after skin cancer can be very complex, especially since all patients have high expectations about the results. In order to achieve good results, there is a necessity for careful analysis of the defect, correct planning and excellent technical execution of the procedures Frequently, staged procedures will be needed to achieve an optimal result.
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  • Vasoactive agents for the management of acute variceal bleeding: A systematic review and meta-analysis

    Huaringa-Marcelo, Jorge; Huaman, Mariella R.; Brañez-Condorena, Ana; Villacorta-Landeo, Pamela; Pinto-Ruiz, Diego F.; Urday-Ipanaqué, Diana; García-Gomero, David; Montes-Teves, Pedro; Miranda, Adelina Lozano (Romanian Society of Gastroenterology, 2021-01-01)
    Background & Aims: Vasoactive agents with endoscopic therapy are used to treat acute variceal bleeding (AVB). There are two main groups of vasoactive agents: terlipressin and vasopressin (T-V), and octreotide and somatostatin (O-S). However, the benefit/harm balance is unclear. Our aim was to assess the efficacy and safety of T-V versus O-S for the management of AVB. Methods: We performed a systematic search for randomized controlled trials (RCTs) in PubMed, Scopus, and CENTRAL. Our main outcomes were mortality and adverse events. Secondary outcomes were bleeding control, rebleeding, blood transfusion, hospital stay. We evaluated the certainty of evidence using GRADE methodology. Results: We included 21 RCTs. The risk of mortality (RR: 1.01; 95%CI: 0.83-1.22), bleeding control (RR: 0.96; 95%CI: 0.91-1.02; I2=53%), early rebleeding (RR: 0.91; 95%CI: 0.66-1.24: I2=0%), late rebleeding (RR: 0.94; 95 CI: 0.56-1.60; I2=0%), blood transfusion (MD: 0.04; 95%CI:-0.31-0.39; I2=68%) and hospital stay (MD:-1.06; 95%CI:-2.80-0.69; I2=0%) were similar between T-V and O-S groups. Only 15 studies reported adverse events, which were significantly higher in the T-V compared to the O-S group (RR 2.39; 95%CI: 1.58-3.63; I2=57%). The certainty of evidence was moderate for the main outcomes, and low or very low for others. Conclusions: In cirrhotic patients with AVB, those treated with T-V had similar mortality risk compared to O-S. However, the use of T-V showed an increased risk of adverse events compared to O-S.
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  • Hepatocellular carcinoma in a woman with 34 weeks gestation and chronic hepatitis b

    Sato-Espinoza, Karina; Ferrer, Javier Díaz; Ventura, Yessica Mitzy Jaramillo (Sociedad Argentina de Gastroenterologia, 2021-01-01)
    A 24-year-old pregnant woman arrived at the emergency service at 34 weeks of gestational age with intermittent right upper abdominal pain. An abdominal ultrasound was performed showing signs of hepatopathy with multiple neo-formative nodules with mild ascites and fetal biometry confirmed at 34 weeks gestation. During her hospitalization, an emergency caesarean was induced with favorable result in the survival of the mother and the baby.
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