Recent Submissions

  • Analysis of symmetrical components and balanced earth faults in distribution transformers

    Munoz, Roberto Pfuyo; Said Pfuyo Osis, Roberto (Institute of Electrical and Electronics Engineers Inc., 2022-01-01)
    The objective of this study is to show the analysis and behavior of symmetrical components and balanced faults in power transformers. Thus, the symmetric component methods solve directly the distribution of voltages and currents, allowing the correct verification of the procedure and the influence of earth circuit faults with the neutral point in distribution transformers. Therefore, the symmetric component analysis procedure has an innovative contribution to the determination of problem solving that solves practical cases and allows to determine the unbalanced failure analysis.
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  • Utility of TG/HDL-c ratio as a predictor of mortality and cardiovascular disease in patients with chronic kidney disease undergoing hemodialysis: A systematic review

    Gonzáles-Rubianes, Diana Zolans; Figueroa-Osorio, Liz Katerin; Benites-Zapata, Vicente A.; Pacheco-Mendoza, Josmel; Herrera-Añazco, Percy (John Wiley and Sons Inc, 2022-04-01)
    The triglyceride/high-density cholesterol-lipoprotein (TG/HDL-c) is a biomarker of cardiovascular events and mortality. In hemodialysis patients, the evidence is controversial. A systematic review was carried out in the Medline, Scopus, Embase, Web of Science, and Pubmed databases to identify the relevant cohort studies on cardiovascular events and mortality in hemodialysis patients the role of TG/HDL-c as a risk factor. Four cohort-type studies were evaluated, with a total of 52,579 hemodialysis patients. Three studies conducted in Asian populations and one study in the United States had the highest percentage of the sample (50,673 patients). The elevated TG/HDL-c ratio is associated with better survival, and there is a consistent gradual inverse association between TG/HDL-c and mortality in all analysis subgroups. In the decile categorization of the exposure variable, a 21% decrease in the risk of cardiovascular mortality and a 15% decrease in all-cause mortality in the highest decile compared to the reference group (D10 aHR = 0.79; 95% CI: 0.69–0.91 and D10 aHR = 0.85; 95%CI: 0.78–0.92). Our results show that the TG/HDL-c ratio is a protective factor for cardiovascular outcomes and mortality in the American population and a risk factor for them in the population from Asia.
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  • Spanish version of Jenkins Sleep Scale in physicians and nurses: psychometric properties from a Peruvian nationally representative sample

    Villarreal-Zegarra, David; Torres-Puente, Roberto; Otazú-Alfaro, Sharlyn; Al-kassab-Córdova, Ali; Rey de Castro, Jorge; Mezones-Holguín, Edward (Elsevier Inc., 2022-06-01)
    Objective: To evaluate the psychometric properties of the Spanish version of Jenkins Sleep Scale with 4 items (JSS-4) of the Peruvian health system's (PHS) nurses and physicians. Methods: We carried out a psychometric study based on secondary analysis in a sample from a nationally representative survey that used acomplex sampling design. The participants were physicians and nurses aged 18–65 years, working in PHS private and public facilities, who have fulfilled all JSS-4 items. We performed a confirmatory factor analysis. Reliability was evaluated via two estimates - classic alpha (α) and categorical omega (ω) coefficients. Also, we tested the invariance across groups of variables. The convergent validity was evaluated based on the relation between JSS-4 and PHQ-2 using Pearson's correlation coefficient and effect size (Cohen's d). Also, we designed normative values based on percentiles. Results: We included 2100 physicians and 2826 nurses in the analysis. We observed that the unidimensional model has adequate goodness-of-fit indices and values of α and ω coefficients. No measurement invariance was found between the groups of professionals and age groups; however, invariance was achieved between sex, monthly income, work-related illness, and chronic illness groups. Regarding the relation with other variables, the JSS-4 has a small correlation with PHQ-2. Also, profession and age-specific normative values were proposed. Conclusion: JSS-4 Spanish version has adequate psychometric properties in PHS nurses and physicians.
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  • Detection of SARS-CoV-2 antibodies in febrile patients from an endemic region of dengue and chikungunya in Peru

    Tarazona-Castro, Yordi; Troyes-Rivera, Lucinda; Martins-Luna, Johanna; Cabellos-Altamirano, Felipe; Aguilar-Luis, Miguel Angel; Carrillo-Ng, Hugo; Del Valle, Luis J.; Kym, Sungmin; Miranda-Maravi, Sebastian; Silva-Caso, Wilmer; Levy-Blitchtein, Saul; del Valle-Mendoza, Juana (Public Library of Science, 2022-04-01)
    Introduction The rapid expansion of the novel SARS-CoV-2 virus has raised serious public health concerns due to the possibility of misdiagnosis in regions where arboviral diseases are endemic. We performed the first study in northern Peru to describe the detection of SARSCoV-2 IgM antibodies in febrile patients with a suspected diagnosis of dengue and chikungunya fever. Materials and methods A consecutive cross-sectional study was performed in febrile patients attending primary healthcare centers from April 2020 through March 2021. Patients enrolled underwent serum sample collection for the molecular and serological detection of DENV and CHIKV. Also, serological detection of IgM antibodies against SARS-CoV-2 was performed. Results 464 patients were included during the study period, of which (40.51%) were positive for one pathogen, meanwhile (6.90%) presented co-infections between 2 or more pathogens. The majority of patients with monoinfections were positive for SARS-CoV-2 IgM with (73.40%), followed by DENV 18.09% and CHIKV (8.51%). The most frequent co-infection was DENV + SARS-CoV-2 with (65.63%), followed by DENV + CHIKV and DENV + CHIKV + SARSCoV-2, both with (12.50%). The presence of polyarthralgias in hands (43.75%, p<0.01) and feet (31.25%, p = 0.05) were more frequently reported in patients with CHIKV monoinfection. Also, conjunctivitis was more common in patients positive for SARS-CoV-2 IgM (11.45%, p<0.01). The rest of the symptoms were similar among all the study groups. Conclusion SARS-CoV-2 IgM antibodies were frequently detected in acute sera from febrile patients with a clinical suspicion of arboviral disease. The presence of polyarthralgias in hands and feet may be suggestive of CHIKV infection. These results reaffirm the need to consider SARS-CoV-2 infection as a main differential diagnosis of acute febrile illness in arboviruses endemic areas, as well as to consider co-infections between these pathogens. Copyright:
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  • Using machine learning to identify important predictors of COVID-19 infection prevention behaviors during the early phase of the pandemic

    van Lissa, Caspar J.; Stroebe, Wolfgang; vanDellen, Michelle R.; Leander, N. Pontus; Agostini, Maximilian; Draws, Tim; Grygoryshyn, Andrii; Gützgow, Ben; Kreienkamp, Jannis; Vetter, Clara S.; Abakoumkin, Georgios; Abdul Khaiyom, Jamilah Hanum; Ahmedi, Vjolica; Akkas, Handan; Almenara, Carlos A.; Atta, Mohsin; Bagci, Sabahat Cigdem; Basel, Sima; Kida, Edona Berisha; Bernardo, Allan B.I.; Buttrick, Nicholas R.; Chobthamkit, Phatthanakit; Choi, Hoon Seok; Cristea, Mioara; Csaba, Sára; Damnjanović, Kaja; Danyliuk, Ivan; Dash, Arobindu; Di Santo, Daniela; Douglas, Karen M.; Enea, Violeta; Faller, Daiane Gracieli; Fitzsimons, Gavan J.; Gheorghiu, Alexandra; Gómez, Ángel; Hamaidia, Ali; Han, Qing; Helmy, Mai; Hudiyana, Joevarian; Jeronimus, Bertus F.; Jiang, Ding Yu; Jovanović, Veljko; Kamenov, Željka; Kende, Anna; Keng, Shian Ling; Thanh Kieu, Tra Thi; Koc, Yasin; Kovyazina, Kamila; Kozytska, Inna; Krause, Joshua; Kruglanksi, Arie W.; Kurapov, Anton; Kutlaca, Maja; Lantos, Nóra Anna; Lemay, Edward P.; Jaya Lesmana, Cokorda Bagus; Louis, Winnifred R.; Lueders, Adrian; Malik, Najma Iqbal; Martinez, Anton P.; McCabe, Kira O.; Mehulić, Jasmina; Milla, Mirra Noor; Mohammed, Idris; Molinario, Erica; Moyano, Manuel; Muhammad, Hayat; Mula, Silvana; Muluk, Hamdi; Myroniuk, Solomiia; Najafi, Reza; Nisa, Claudia F.; Nyúl, Boglárka; O'Keefe, Paul A.; Olivas Osuna, Jose Javier; Osin, Evgeny N.; Park, Joonha; Pica, Gennaro; Pierro, Antonio; Rees, Jonas H.; Reitsema, Anne Margit; Resta, Elena; Rullo, Marika; Ryan, Michelle K.; Samekin, Adil; Santtila, Pekka; Sasin, Edyta M.; Schumpe, Birga M.; Selim, Heyla A.; Stanton, Michael Vicente; Sultana, Samiah; Sutton, Robbie M.; Tseliou, Eleftheria; Utsugi, Akira; Anne van Breen, Jolien; van Veen, Kees; Vázquez, Alexandra; Wollast, Robin; Wai-Lan Yeung, Victoria; Zand, Somayeh (Cell Press, 2022-04-08)
    Before vaccines for coronavirus disease 2019 (COVID-19) became available, a set of infection-prevention behaviors constituted the primary means to mitigate the virus spread. Our study aimed to identify important predictors of this set of behaviors. Whereas social and health psychological theories suggest a limited set of predictors, machine-learning analyses can identify correlates from a larger pool of candidate predictors. We used random forests to rank 115 candidate correlates of infection-prevention behavior in 56,072 participants across 28 countries, administered in March to May 2020. The machine-learning model predicted 52% of the variance in infection-prevention behavior in a separate test sample—exceeding the performance of psychological models of health behavior. Results indicated the two most important predictors related to individual-level injunctive norms. Illustrating how data-driven methods can complement theory, some of the most important predictors were not derived from theories of health behavior—and some theoretically derived predictors were relatively unimportant.
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  • Diagnosis of a duodenal-colonic cyst with inflammatory content derived of a metastatic gallbladder adenocarcinoma: a case report

    Vargas-García, Elsa K.; García-Saravia, José L.; Fernández-Aristi, Augusto R.; Cáceres- Bedoya, María A. (Permanyer Publications, 2022-03-01)
    The existence of a cystic mass which walls originated from a metastatic gallbladder adenocarcinoma is infrequent. We present the case of 68-year-old male that present to the emergency department with abdominal distention, hyporexia and jaundice. Upon exploratory laparotomy, a duodeno-colonic cyst with walls formed by metastatic cells derived from a Gallbladder Adenocarcinoma. Metastatic disease from a gallbladder adenocarcinoma to transverse colon and duodenum formed adherences between both organs, leading to the formation of cystic mass. Cancer cells have multiple adaptation mechanisms in order to survive harsh environments.
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  • Depression symptoms and mortality in elderly peruvian navy veterans: a retrospective cohort study

    Astorga-Aliaga, A.; Díaz-Arroyo, F.; Carreazo, N. Y.; Caballero, K. C.; Rodríguez-Cuba, M. A.; Runzer-Colmenares, F.; Parodi-García, J. (Pleiades journals, 2022-03-01)
    Abstract: Our study was design to determine the association between depressive symptoms and mortality in adults over 60 years old Navy Peruvian Veterans. We performed a retrospective cohort study based on a previous cohort study. A total of 1681 patients over 60 years old were included between 2010–2015. Demographic information, self-reported information about falls, physical frailty assessment, tobacco consumption, hypertension, Type 2 Diabetes Mellitus, Chronic Obstructive Pulmonary Disease and was collected. Depression was assessed by the short form of the Geriatric Depression Scale. We found that depressive symptoms were present in 24.9% of the participants and 40.5% of them died. Mortality risk in patients with depressive symptoms, physical frailty, and male sex was: RR of 23.1 (95% CI: 11.7–45.7), 3.84 (95% CI: 2.16–6.82), and 1.37 (95% CI: 1.07–1.75) respectively. We concluded that depressive symptoms in Peruvian retired military personnel and their immediate relatives are high and are significatively associated with mortality. Also, being male and frail was associated with an increased risk of death. This reinforces that early detection and assessment of depressive symptoms could be an opportunity to improve the health status of older adults.
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  • Exploring contextual differences for sexual role strain among transgender women and men who have sex with men in Lima, Peru

    Satcher, Milan F.; Segura, Eddy R.; Silva-Santisteban, Alfonso; Reisner, Sari L.; Perez-Brumer, Amaya; Lama, Javier R.; Operario, Don; Clark, Jesse L. (Springer, 2022-01-01)
    Sexual and gender politics inform relational expectations surrounding sexual experiences of Peruvian transgender women (TW) and men who have sex with men (MSM). We used the framework of sexual role strain, or incongruence between preferred sexual role and actual sexual practices, to explore potential conflicts between personally articulated identities and externally defined norms of gender and sexuality and its potential to increase HIV/STI risk. Cross-sectional individual- and dyad-level data from 766 TW and MSM in Lima, Peru were used to assess the partnership contexts within which insertive anal intercourse was practiced despite receptive role preference (receptive role strain), and receptive anal intercourse practiced despite insertive role preference (insertive role strain). Sexual role strain for TW was more common with non-primary partners, while for MSM it occurred more frequently in the context of a primary partnership. Receptive role strain was more prevalent for TW with unknown HIV status (reference: without HIV) or pre-sex drug use (reference: no pre-sex drug use). For homosexual MSM, receptive role strain was more prevalent during condomless anal intercourse (reference: condom-protected) and with receptive or versatile partners (reference: insertive). Among heterosexual or bisexual MSM, insertive role strain was more prevalent with insertive or versatile partners (reference: receptive), and less prevalent with casual partners (reference: primary). Our findings suggest TW and MSM experience different vulnerabilities during sexual role negotiation with different partner-types. Future studies should explore the impact of sexual role strain on condom use agency, HIV/STI risk, and discordances between public and private presentations of gender and sexual orientation.
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  • Low sexual function is associated with menopausal status in mid-aged women with human immunodeficiency virus infection

    Mezones-Holguín, Edward; Arriola-Montenegro, José; Cutimanco-Pacheco, Víctor; Al-Kassab-Córdova, Ali; Niño-García, Roberto; Zeta, Ludwing A.; Urrunaga-Pastor, Diego; Blümel, Juan E.; Chedraui, Peter; Pérez-López, Faustino R. (NLM (Medline), 2022-01-14)
    OBJECTIVE: To assess the association between menopausal status and female sexual function among mid-aged women with human immunodeficiency virus (HIV) infection. METHODS: We carried out a cross-sectional study of 221 sexually active HIV-infected women ages 40 to 59 years, based on a secondary analysis of a three-hospital survey in Lima, Perú. We classified menopausal status according to Stages of Reproductive Aging Workshop criteria (STRAW+10); this exposure variable was categorized as binary (non-postmenopausal and postmenopausal) and-for exploratory analysis-as multinomial (pre-, peri-, and postmenopausal). We defined low sexual function (LSF) using the 6-item Female Sexual Function Index (total score ≤19). Socio-demographic and clinical variables were assessed, including age, used highly active antiretroviral therapy scheme, disease duration, depressive symptoms, and co-morbidities. We performed Poisson generalized linear models with a robust variance to estimate 95% confidence interval (CI), crude prevalence ratios (cPRs), and adjusted prevalence ratios (aPRs) by epidemiological and statistical approaches using nonparametric method of bias-corrected and accelerated bootstrap resampling with 1,000 repetitions. RESULTS: Studied women had a median age of 47.0 years (interquartile range: 7.5); 25.3% were premenopausal, 25.8% were perimenopausal, and 48.9% were postmenopausal. Also, 64.3% had LSF. The frequency of LSF was 53.6% in non-postmenopausal and 75.0% in postmenopausal women. Postmenopausal status was associated with LSF in both the crude (cPR = 1.39; 95% CI: 1.13-1.71) and the adjusted regression models (aPR = 1.38; 95% CI: 1.12-1.71). CONCLUSIONS: HIV-infected postmenopausal women have a higher prevalence of LSF than those non-postmenopausal ones, even when adjusting for multiple potential confounders.
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  • Head-to-head comparison between endoscopic ultrasound guided lumen apposing metal stent and plastic stents for the treatment of pancreatic fluid collections: A systematic review and meta-analysis

    Guzmán-Calderón, Edson; Chacaltana, Alfonso; Díaz, Ramiro; Li, Bruno; Martinez-Moreno, Belen; Aparicio, José Ramón (John Wiley and Sons Inc, 2022-02-01)
    Background/Aims: Peripancreatic fluid collections (PFCs) result from acute or chronic pancreatic inflammation that suffers a rupture of its ducts. Currently, there exists three options for drainage or debridement of pancreatic pseudocysts and walled-off necrosis (WON). The traditional procedure is drainage by placing double pigtail plastic stents (DPPS); lumen-apposing metal stent (LAMS) has a biflanged design with a wide lumen that avoids occlusion with necrotic tissue, which is more common with DPPS and reduces the possibility of migration. We performed a systematic review and meta-analyses head-to-head, including only studies that compare the two main techniques to drainage of PFCs: LAMS vs DPPS. Methods: We conducted a systematic review in different databases, such as PubMed, OVID, Medline, and Cochrane Databases. This meta-analysis considers studies published from 2014 to 2020, including only studies that compare the two main techniques to drainage of PFCs: LAMS vs DPPS. Results: Thirteen studies were included in the meta-analyses. Only one of all studies was a randomized controlled trial. These studies comprise 1584 patients; 68.2% were male, and 31.8% were female. Six hundred sixty-three patients (41.9%) were treated with LAMS, and 921 (58.1%) were treated with DPPS. Six studies included only WON in their analysis, two included only pancreatic pseudocysts, and five studies included both pancreatic pseudocysts and WON. The technical success was similar in patients treated with LAMS and DPPS (97.6% vs 97.5%, respectively, P =.986, RR = 1.00 [95% CI 0.93-1.08]). The clinical success was similar in both groups (LAMS: 90.1% vs DPPS: 84.2%, P =.139, RR = 1.063 [95% CI 0.98-1.15]). Patients treated with LAMS had a lower complication rate than the DPPS groups, with a significant statistical difference (LAMS: 16.0% vs DPPS: 20.2%, P =.009, RR = 0.746 [95% CI 0.60-0.93]). Bleeding was the most common complication in the LAMS group (33 patients, [5.0%]), whereas infection was the most common complication in the DPPS group (56 patients, [6.1%]). The LAMS migration rate was lower than in the DPPS (0.9% vs 2.2%, respectively, P =.05). The mortality rate was similar in both groups, 0.6% in the LAMS group (four patients) and 0.4% in the DPPS group (four patients; P =.640). Conclusion: The PFCs drainage is an indication when persistent symptoms or PFCs-related complications exist. EUS guided drainage with LAMS has similar technical and clinical success to DPPS drainage for the management of PFCs. The technical and clinical success rates are high in both groups. However, LAMS drainage has a lower adverse events rate than DPPS drainage. More randomized controlled trials are needed to confirm the real advantage of LAMS drainage over DPPS drainage.
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  • Mesenchymal stromal cells in ischemic brain injury

    Brooks, Beverly; Ebedes, Dominique; Usmani, Ahsan; Gonzales-Portillo, Joaquin Vega; Gonzales-Portillo, Daniel; Borlongan, Cesario V. (MDPI, 2022-03-01)
    Ischemic brain injury represents a major cause of death worldwide with limited treatment options with a narrow therapeutic window. Accordingly, novel treatments that extend the treatment from the early neuroprotective stage to the late regenerative phase may accommodate a much larger number of stroke patients. To this end, stem cell-based regenerative therapies may address this unmet clinical need. Several stem cell therapies have been tested as potentially exhibiting the capacity to regenerate the stroke brain. Based on the long track record and safety profile of transplantable stem cells for hematologic diseases, bone marrow-derived mesenchymal stromal cells or mesenchymal stromal cells have been widely tested in stroke animal models and have reached clinical trials. However, despite the translational promise of MSCs, probing cell function remains to be fully elucidated. Recognizing the multi-pronged cell death and survival processes that accompany stroke, here we review the literature on MSC definition, characterization, and mechanism of action in an effort to gain a better understanding towards optimizing its applications and functional outcomes in stroke.
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  • Rural–urban migration as a factor associated with physical and sexual intimate partner violence Peru 2015–2017: a secondary analysis of a national study

    Terrazas, Jorge; Blitchtein, Dora (BioMed Central Ltd, 2022-12-01)
    Background: Internal migration, a consequence of the demographic transition towards urbanization driven by globalization, represents a particular public health challenge. Change in residence from one sociocultural geographic context to another, with not only economic implications, but also changes in women’s long-established relationships of family interdependence, influences gender relations and can influence Intimate Partner Violence (IPV) against women. Different migratory trajectories may be related to IPV. The aim of this study was to identify the association between internal migration and physical and/or sexual violence against women in the last 12 months. Methods: A secondary analytical cross-sectional analysis of the publicly accessible 2015–2017 Demographic and Family Health Survey (DHS) was performed. The outcome variable was reported physical and/or sexual violence inflicted by the partner (IPV) during the last 12 months. Exposure variable was internal migration, operationalized from three questions: current place of residence, principal place of residence before 12 years of age and number of years of residence in the current place. Migrants were classified as those who reported having lived for 5 years or more in the current location and were categorized as rural-rural migrants, urban-urban migrants, urban–rural migrants and rural–urban migrants, recent migrants and nonmigrants those who resided in the same place all their lives. To identify the association between internal migration and physical violence, a generalized linear model (GLM) of the family and the log Poisson link log option was used, and the results are presented as prevalence ratios (PRs). A crude model and a model adjusted for confounding variables were performed. Results: Rural–urban migrant women had a 15.0% higher probability of experiencing IPV than nonmigrant women (PRa 1.15, 95% CI 1.03–1.29, p = 0.015), while the probability of experiencing IPV in the last 12 months for urban–rural, rural-rural,urban-urban migrantand recent migrant women was not significantly different from that of nonmigrant women. Conclusion: Rural–urban migration among women of childbearing age is a factor associated with a higher probability of IPV in the last 12 months. The identification of women with this rural–urban migration pattern could help prioritize those that may experience a greater probability of physical and/or sexual violence in Peru, it must be studied if this pattern is the same in other countries.
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  • Reply to “Conceptual interpretation and clinical applicability of A systematic review and meta-analysis about prognostic value of Apolipoproteins in COVID-19 patients”

    Ulloque-Badaracco, Juan R.; Hernandez-Bustamante, Enrique A.; Herrera-Añazco, Percy; Benites-Zapata, Vicente A. (Elsevier Inc., 2022-03-01)
    Carta al editor
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  • Enhancing discovery of genetic variants for posttraumatic stress disorder through integration of quantitative phenotypes and trauma exposure information

    Maihofer, Adam X.; Choi, Karmel W.; Coleman, Jonathan R.I.; Daskalakis, Nikolaos P.; Denckla, Christy A.; Ketema, Elizabeth; Morey, Rajendra A.; Polimanti, Renato; Ratanatharathorn, Andrew; Torres, Katy; Wingo, Aliza P.; Zai, Clement C.; Aiello, Allison E.; Almli, Lynn M.; Amstadter, Ananda B.; Andersen, Soren B.; Andreassen, Ole A.; Arbisi, Paul A.; Ashley-Koch, Allison E.; Austin, S. Bryn; Avdibegović, Esmina; Borglum, Anders D.; Babić, Dragan; Bækvad-Hansen, Marie; Baker, Dewleen G.; Beckham, Jean C.; Bierut, Laura J.; Bisson, Jonathan I.; Boks, Marco P.; Bolger, Elizabeth A.; Bradley, Bekh; Brashear, Meghan; Breen, Gerome; Bryant, Richard A.; Bustamante, Angela C.; Bybjerg-Grauholm, Jonas; Calabrese, Joseph R.; Caldas-de-Almeida, José M.; Chen, Chia Yen; Dale, Anders M.; Dalvie, Shareefa; Deckert, Jürgen; Delahanty, Douglas L.; Dennis, Michelle F.; Disner, Seth G.; Domschke, Katharina; Duncan, Laramie E.; Džubur Kulenović, Alma; Erbes, Christopher R.; Evans, Alexandra; Farrer, Lindsay A.; Feeny, Norah C.; Flory, Janine D.; Forbes, David; Franz, Carol E.; Galea, Sandro; Garrett, Melanie E.; Gautam, Aarti; Gelaye, Bizu; Gelernter, Joel; Geuze, Elbert; Gillespie, Charles F.; Goçi, Aferdita; Gordon, Scott D.; Guffanti, Guia; Hammamieh, Rasha; Hauser, Michael A.; Heath, Andrew C.; Hemmings, Sian M.J.; Hougaard, David Michael; Jakovljević, Miro; Jett, Marti; Johnson, Eric Otto; Jones, Ian; Jovanovic, Tanja; Qin, Xue Jun; Karstoft, Karen Inge; Kaufman, Milissa L.; Kessler, Ronald C.; Khan, Alaptagin; Kimbrel, Nathan A.; King, Anthony P.; Koen, Nastassja; Kranzler, Henry R.; Kremen, William S.; Lawford, Bruce R.; Lebois, Lauren A.M.; Lewis, Catrin; Liberzon, Israel; Linnstaedt, Sarah D.; Logue, Mark W.; Lori, Adriana; Lugonja, Božo; Luykx, Jurjen J.; Lyons, Michael J.; Maples-Keller, Jessica L.; Marmar, Charles; Martin, Nicholas G.; Maurer, Douglas; Mavissakalian, Matig R. (Elsevier Inc., 2022-04-01)
    Background: Posttraumatic stress disorder (PTSD) is heritable and a potential consequence of exposure to traumatic stress. Evidence suggests that a quantitative approach to PTSD phenotype measurement and incorporation of lifetime trauma exposure (LTE) information could enhance the discovery power of PTSD genome-wide association studies (GWASs). Methods: A GWAS on PTSD symptoms was performed in 51 cohorts followed by a fixed-effects meta-analysis (N = 182,199 European ancestry participants). A GWAS of LTE burden was performed in the UK Biobank cohort (N = 132,988). Genetic correlations were evaluated with linkage disequilibrium score regression. Multivariate analysis was performed using Multi-Trait Analysis of GWAS. Functional mapping and annotation of leading loci was performed with FUMA. Replication was evaluated using the Million Veteran Program GWAS of PTSD total symptoms. Results: GWASs of PTSD symptoms and LTE burden identified 5 and 6 independent genome-wide significant loci, respectively. There was a 72% genetic correlation between PTSD and LTE. PTSD and LTE showed largely similar patterns of genetic correlation with other traits, albeit with some distinctions. Adjusting PTSD for LTE reduced PTSD heritability by 31%. Multivariate analysis of PTSD and LTE increased the effective sample size of the PTSD GWAS by 20% and identified 4 additional loci. Four of these 9 PTSD loci were independently replicated in the Million Veteran Program. Conclusions: Through using a quantitative trait measure of PTSD, we identified novel risk loci not previously identified using prior case-control analyses. PTSD and LTE have a high genetic overlap that can be leveraged to increase discovery power through multivariate methods. © 2021 Society of Biological Psychiatry
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  • Conceptual foundations of entrustable professional activities for health professional education in Latin America

    López, María José; Melo de Andrade, Marcus Vinicius; Domínguez Torres, Luis Carlos; Durán Pérez, Verónica Daniela; Durante, Eduardo; Francischetti, Ieda; Gutiérrez Barreto, Samuel Eloy; Gutiérrez Sierra, Manuel Eduardo; García Casallas, Julio César; Mora Melanchthon, Isabel Eugenia; Sánchez Mendiola, Melchor; ten Cate, Olle (Elsevier Espana S.L.U, 2022-01-01)
    The concept of entrustable professional activities emerged as an attempt to overcome some of the criticisms to the competency-based medical education approach; it has had a broad impact in practice and health professions education research. It has been disseminated internationally with its English acronym: EPA. This approach proposes to orient assessment and teaching to specific activities in the profession, which allows the integration of several competencies, and to determine which responsibilities can be entrusted to the trainee, in a gradual and explicit manner. The model assumes the definition of levels of supervision that allow progressive autonomy for each EPA, in students or residents, once they demonstrate the required competencies. Practice, supervision and feedback in real clinical scenarios are key to the development of autonomy in EPA performance. The dissemination of the EPA approach is still limited in Latin America, but it has the potential to create a significant contribution to curriculum design and evaluation, and to assessment practices of health professionals across their careers. It provides a deep review of the assumptions under which healthcare professional practice decisions are made, at under and postgraduate levels.
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  • Recurrence of urinary tract infections due to escherichia coli and its association with antimicrobial resistance

    Ormeño, Maria Angeles; Ormeño, Maria José; Quispe, Antonio M.; Arias-Linares, Miguel Angel; Linares, Elba; Loza, Felix; Ruiz, Joaquim; Pons, Maria J. (Mary Ann Liebert Inc., 2022-02-01)
    We analyzed the association between antibiotic resistance and recurrent urinary tract infection (rUTI) by Escherichia coli. Susceptibility levels to 14 antimicrobial agents and the presence of extended-spectrum β-lactamases (ESBL) were established using MicroScan. Incidences of multidrug resistant (MDR), extensively drug resistant (XDR), and ESBL-producer isolates as well as rUTIs were estimated. The time to recurrence was established adjusted for number of antibiotic-resistant families and MDR as predictors of interest, respectively. Overall, 8,553 urinary tract infection (UTI) cases related to E. coli, including 963 rITU, were analyzed with levels of resistance >30% in all cases, except for amikacin, nitrofurantoin, and carbapenems. The incidence of rUTI was of 11.3%, being 46.5%, 24.3%, and 42.5% for MDR, XDR, and ESBLs, respectively. Bivariate analysis showed that rUTI was associated with age, gender, resistance to specific antimicrobials, MDR, and XDR. The number of antibiotic families tested as resistant, MDR, XDR, gender, and age were associated with time to recurrence when adjusted for number of antibiotic families, and MDR, gender, and age were related when adjusted for MDR. High rates of antibiotic resistance to the usual antibiotics was observed in E. coli causing UTI, with female sex, age, and antibiotic resistance being risk factors for the development of rUTI.
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  • A randomised controlled trial to evaluate a medication monitoring system for TB treatment

    Acosta, J.; Flores, P.; Alarcón, M.; Grande-Ortiz, M.; Moreno-Exebio, L.; Puyen, Z. M. (International Union Against Tuberculosis and Lung Disease, 2022-01-01)
    BACKGROUND: Adherence to TB treatment and therefore treatment success could be improved using digital adherence technology. OBJECTIVE: To evaluate the effectiveness of a medication event reminder monitor system (MERM) on treatment success and treatment adherence in patients with drug-susceptible pulmonary TB in Perú. METHODS: This was an experimental, randomised, open-label, controlled study conducted among patients in the second phase of TB treatment. The intervention group received their medications through MERM with the support of a treatment monitor, whereas the control group used the usual strategy. Participants were followed until they completed the 54 doses of the second phase of treatment. RESULTS: The study included 53 patients in each group; four in the intervention group withdrew from the study. Treatment success was significantly more frequent in the MERM group (RR 1.15, 95% CI 1.02–1.30; P = 0.0322). There was no significant difference in the adherence outcomes; however, the percentage of patients who missed at least one dose and patients with more than 10% of total doses missed were lower in the intervention group. CONCLUSION: The use of MERM in the second phase of treatment showed a significant improvement in the treatment success rate in patients with drug-susceptible pulmonary TB.
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  • Comparison of cytokines levels among COVID-19 patients living at sea level and high altitude

    del Valle-Mendoza, Juana; Tarazona-Castro, Yordi; Merino-Luna, Alfredo; Carrillo-Ng, Hugo; Kym, Sungmin; Aguilar-luis, Miguel Angel; Del Valle, Luis J.; Aquino-Ortega, Ronald; Martins-Luna, Johanna; Peña-Tuesta, Isaac; Silva-Caso, Wilmer (BioMed Central Ltd, 2022-12-01)
    Background: At the end of 2019, a novel coronavirus denominated SARS-CoV-2 rapidly spread through the world causing the pandemic coronavirus disease known as COVID-19. The difference in the inflammatory response against SARS-CoV-2 infection among people living at different altitudes is a variable not yet studied. Methods: A descriptive cross-sectional study was performed in two Peruvian cities at different altitudes for comparison: Lima and Huaraz. Five important proinflammatory cytokines were measured including: IL-6, IL-2, IL-10, IFN-γ and TNF-α using ELISA assays. Results: A total of 35 COVID-19 patients and 10 healthy subjects were recruited from each study site. The mean levels of IL-6 (p < 0.03) and TNF-α (p < 0.01) were significantly different among the study groups. In the case of IL-6, patients from Lima had a mean level of 16.2 pg/ml (healthy) and 48.3 pg/ml (COVID-19), meanwhile, patients from Huaraz had levels of 67.3 pg/ml (healthy) and 97.9 pg/ml (COVID-19). Regarding TNF-α, patients from Lima had a mean level of 25.9 pg/ml (healthy) and 61.6 pg/ml (COVID-19), meanwhile, patients from Huaraz had levels of 89.0 pg/ml (healthy) and 120.6 pg/ml (COVID-19). The levels of IL-2, IL-10 and IFN-γ were not significantly different in the study groups. Conclusion: Patients with COVID-19 residing at high-altitude tend to have higher levels of inflammatory cytokines compared to patients living at sea level, particularly IL-6 and TNF-α. A better understanding of the inflammatory response in different populations can contribute to the implementation of therapeutic and preventive approaches. Further studies evaluating more patients, a greater variety of cytokines and their clinical impact are required.
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  • Prevalence of severe acute respiratory syndrome Coronavirus 2 antibodies among market and city bus depot workers in Lima, Peru

    Tovar, Marco; Peinado, Jesús; Palomino, Santiago; Llanos, Fernando; Ramírez, Claudio; Valderrama, Gisella; Calderón, Roger I.; Williams, Roger B.; Velásquez, Gustavo E.; Mitnick, Carole D.; Franke, Molly F.; Lecca, Leonid (NLM (Medline), 2022-01-29)
    We report severe acute respiratory syndrome coronavirus 2 antibody positivity among market and city bus depot workers in Lima, Peru. Among 1285 vendors from 8 markets, prevalence ranged from 27% to 73%. Among 488 workers from 3 city bus depots, prevalence ranged from 11% to 47%. Self-reported symptoms were infrequent.
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  • Psychiatric symptoms and insulinoma: A case report

    Cristina, Colán T.; Andrea, Gálvez G.; Carolina, Zevallos D. (Sociedad de Neurologia Psiquiatria y Neurocirugia, 2013-01-01)
    Introduction: Insulinomas are pancreatic endocrine neoplasms with a low incidence between 1-4 cases per million per year. Case description:'A female 49 years-old with neurological and psychiatric symptoms were treated for two years as a psychiatric patient. Presented a glucose value, which reflects hypoglycemia. The patient was operated with resolution of symptoms. Conclusion: Assess all patients with psychiatric symptoms and perform a complete medical history and laboratory findings, being the most opportune glucose.
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