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  • Respiratory, Cardiac, and Neuropsychiatric Manifestations of Postacute Sequelae of Coronavirus Disease 2019 in Lima, Peru

    Rahman, Rifat S.; Tovar, Marco A.; Peinado, Jesús; Palomino, J. Santiago; Ramirez, Claudio; Llanos-Zavalaga, Fernando; Peralta, Ernesto; Valderrama, Gissela; Ramos Cordova, Lourdes B.; Sanchez Cortez, Lucero I.; Rodriguez, German; Lahood, Allison N.; Franke, Molly F.; Mitnick, Carole D.; Lecca, Leonid; Velásquez, Gustavo E. (Oxford University Press, 2023-07-01)
    Background: Few studies have examined the burden of postacute sequelae of coronavirus disease 2019 (COVID-19) (PASC) in low- and middle-income countries. We sought to characterize PASC with self-reported questionnaires and clinical examinations of end-organ function in Lima, Peru. Methods: From January to July 2021, we recruited participants at least 8 weeks after COVID-19 diagnosis from a case registry in Lima, Peru. We evaluated participants for PASC with questionnaires, neuropsychiatric evaluations, chest X-ray, spirometry, electrocardiogram, and echocardiogram. We used multivariable models to identify risk factors for PASC. Results: We assessed 989 participants for PASC at a median 4.7 months after diagnosis. Clinically significant respiratory symptoms were reported by 68.3% of participants, particularly those who had been severely ill during acute COVID-19, and were associated with cardiac findings of ventricular hypertrophy or dilation on echocardiogram. Neuropsychiatric questionnaires were consistent with depression in 20.7% and cognitive impairment in 8.0%. Female sex and older age were associated with increased risk of respiratory (adjusted odds ratio [aOR], 2.36 [95% confidence interval {CI}, 1.69-3.31] and aOR, 1.01 [95% CI, 1.00-1.03], respectively) and neuropsychiatric sequelae (aOR, 2.99 [95% CI, 2.16-4.18] and aOR, 1.02 [95% CI, 1.01-1.03], respectively). Conclusions: COVID-19 survivors in Lima, Peru, experienced frequent postacute respiratory symptoms and depression, particularly among older and female participants. Clinical examinations highlighted the need for cardiopulmonary rehabilitation among persons with severe COVID-19; psychosocial support may be required among all COVID-19 survivors.
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  • Diversity and dissemination of viruses in pathogenic protozoa

    Heeren, Senne; Maes, Ilse; Sanders, Mandy; Lye, Lon Fye; Adaui, Vanessa; Arevalo, Jorge; Llanos-Cuentas, Alejandro; Garcia, Lineth; Lemey, Philippe; Beverley, Stephen M.; Cotton, James A.; Dujardin, Jean Claude; Van den Broeck, Frederik (Nature Research, 2023-12-01)
    Viruses are the most abundant biological entities on Earth and play a significant role in the evolution of many organisms and ecosystems. In pathogenic protozoa, the presence of viruses has been linked to an increased risk of treatment failure and severe clinical outcome. Here, we studied the molecular epidemiology of the zoonotic disease cutaneous leishmaniasis in Peru and Bolivia through a joint evolutionary analysis of Leishmania braziliensis and their dsRNA Leishmania virus 1. We show that parasite populations circulate in tropical rainforests and are associated with single viral lineages that appear in low prevalence. In contrast, groups of hybrid parasites are geographically and ecologically more dispersed and associated with an increased prevalence, diversity and spread of viruses. Our results suggest that parasite gene flow and hybridization increased the frequency of parasite-virus symbioses, a process that may change the epidemiology of leishmaniasis in the region.
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  • Protocol for a Randomized Trial Comparing Intracranial Pressure Monitor?Based Management of Severe Pediatric Traumatic Brain Injury with Management Based on Imaging and Clinical Examination Without Intracranial Pressure Monitoring

    Chesnut, Randall; Temkin, Nancy; Pridgeon, James; Sulzbacher, Stephen; Lujan, Silvia; Videtta, Walter; Moya-Barquín, Luis; Chaddock, Kelley; Bonow, Robert; Petroni, Gustavo; Guadagnoli, Nahuel; Hendrickson, Peter; Ramírez Cortez, Grimaldo; Carreazo, Nilton Yhuri; Vargas Aymituma, Alcides; Anchante, Daniel; Caqui, Patrick; Ramírez, Alberto; Munaico Abanto, Manuel; Ortiz Chicchon, Manuel; Cenzano Ramos, José; Mazate-Mazariegos, Analy; Castro Darce, María Del Carmen; Sierra Morales, Roberto; Brol Lopez, Pedro; Menendez, Willy; Posadas Gutierrez, Sofía; Kevin, Vicente; Mazariegos, Andrea; De Leon, Elie; Rodas Barrios, Rodolfo Enrique; Rodríguez, Sandra; Flores, Sandra; Alvarado, Ovidio; Guzman Flores, Luis José; Moisa Martinez, Melvin; Gonzalez, Pablo (Wolters Kluwer Medknow Publications CODEN NRSRD, 2023-07-06)
    BACKGROUND AND OBJECTIVES: Traumatic brain injury (TBI) is a major global public health problem. It is a leading cause of death and disability in children and adolescents worldwide. Although increased intracranial pressure (ICP) is common and associated with death and poor outcome after pediatric TBI, the efficacy of current ICP-based management remains controversial. We intend to provide Class I evidence testing the efficacy of a protocol based on current ICP monitor-based management vs care based on imaging and clinical examination without ICP monitoring in pediatric severe TBI. METHODS: A phase III, multicenter, parallel-group, randomized superiority trial performed in intensive care units in Central and South America to determine the impact on 6-month outcome of children aged 1-12 years with severe TBI (age-Appropriate Glasgow Coma Scale score ?8) randomized to ICP-based or non-ICP-based management. EXPECTED OUTCOMES: Primary outcome is 6-month Pediatric Quality of Life. Secondary outcomes are 3-month Pediatric Quality of Life, mortality, 3-month and 6-month Pediatric extended Glasgow Outcome Score, intensive care unit length of stay, and number of interventions focused on treating measured or suspected intracranial hypertension. DISCUSSION: This is not a study of the value of knowing the ICP in sTBI. This research question is protocol-based. We are investigating the added value of protocolized ICP management to treatment based on imaging and clinical examination in the global population of severe pediatric TBI. Demonstrating efficacy should standardize ICP monitoring in severe pediatric TBI. Alternate results should prompt reassessment of how and in which patients ICP data should be applied in neurotrauma care.
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  • Association between supplementation with vitamin A, iron and micronutrients with adequate psychomotor development in children from 9 to 36 months in Peru

    Chaponan-Lavalle, Andres; Randich, Karla Hernandez; Araujo-Castillo, Roger V. (Elsevier B.V., 2023-11-01)
    Background: Worldwide, it is estimated that 52.9 million children <5 years of age experience delayed psychomotor development, which is associated with multiple factors. Our primary objective is to evaluate whether there is an association between supplementation with Vitamin A, Iron, and Micronutrients and Adequate Psychomotor Development in children aged 9–36 months at the national level in Peru. Methods: The study was an observational, analytical, cross-sectional study based on the secondary analysis of the Demographic and Family Health Survey databases from 2018 to 2020. The independent variables include the consumption of Vitamin A, Iron, and Micronutrients. The dependent variables encompass Motor Development in children aged 9–18 months, Psychological Development in children aged 9–18 months, and Psychological Development in children aged 19–36 months. Results: The study included a total of 24 838 participants. In the adjusted regression model, the factors associated with adequate motor development between 9 and 18 months of age were: region of residence, overcrowding, and exclusive breastfeeding. For adequate cognitive development between 9 and 18 months of age, the associated factors were: vitamin A consumption, mother's education, child sex, delivery complications, and complete vaccinations. Regarding adequate psychological development in children aged 19–36 months, the associated factors were: mother's education, maternal employment, child sex, and birth weight. Conclusions: There was no association found between nutritional supplementation and adequate development, except for the relationship between Vitamin A consumption and adequate psychological development in children aged 9–18 months. Therefore, further research, such as cohort studies and clinical trials, is suggested to corroborate this association.
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  • Impact of the national vaccination campaign against COVID-19 on patient attendance to the emergency department of the Pediatric Emergency Hospital

    Stramandinoli, Angela; Galdos-Bejar, Marcelo; Llave-Sangiacomo, Barbara; Diaz-Alvites, Ana Lucia; Carreazo, Nilton Yhuri (Medical Body of the Almanzor Aguinaga Asenjo National Hospital, 2023-01-01)
    Objective: To analyze the variation in attendance and diagnoses after the national vaccination campaign against COVID-19 in the pediatric emergency department. The study: Analytical retrospective cross-sectional study. Pediatric emergency department visits were compared between epidemiological weeks 1 and 52 of the years 2020 and 2021, analyzing sociodemographic characteristics, condition and diagnosis. Chi-square was used for bivariate analysis. Findings: A 77.8% increase was found in the number of attentions during the year 2021 compared to 2020. There was a 4% increase in infectious diseases and a 9.2% increase in respiratory diseases. In addition, a decrease of 8.7% was observed in gastrointestinal diseases. Conclusion: The results indicate that after the start of the national vaccination campaign, there was a significant increase in the number of patients compared to 2020, mainly for respiratory and infectious or parasitic diseases.
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  • Epidemiology of neurocognitive disorders in adults from urban-marginalized areas: a door-to-door population-based study in Puente Piedra, Lima, Peru

    Herrera-Perez, Eder; Custodio, Nilton; Diaz, Monica; Montesinos, Rosa; Chang, Alexandra; Villafuerte, Mirla; Lanata, Serggio (Frontiers Media SA, 2023-01-01)
    Background: In Latin America (LA), the prevalence of dementia is expected to triple to 150 million people by 2050. The 2020 Lancet Commission report identified several modifiable dementia risk factors, yet few social and environmental factors, most relevant to vulnerable regions of LA, were highlighted in this report. We sought to assess the epidemiology of neurocognitive disorders (NCD) in Puente Piedra, one of the most socially and economically vulnerable districts of Lima, the capital of Peru. Methodology: This was a cross-sectional door-to-door observational study that used two-stage household sampling. One young adult (30–59 years) and one older adult (>60 years) per household were enrolled. We collected demographic, clinical, and neurocognitive data. Addenbrooke’s Cognitive Examination (young adults) and the RUDAS-PE (older adults) were used, classifying participants as cognitively normal, possible mild NCD, or possible major NCD. Results: We enrolled 247 participants (median age 46 years; 67% female). One-fourth had not completed secondary school and more than 50% completed only secondary school. Most participants were housewives (46%) and 21% did not have health insurance. The overall prevalence of possible NCD was 30% (25.6 and 41.8% among younger adults and older adults, respectively). Among younger adults, those ages 55–59 years more frequently had NCD (70%) compared to younger age ranges. Among older adults, only 3 subjects (4.5%) had major NCD. Conclusion: We found a high frequency of possible NCDs in a socially and economically vulnerable community in Lima, Peru, with younger adults showing levels of NCD higher than expected. Our findings support the need for health systems to incorporate cognitive screenings programs for NCD in younger ages. Future research on NCD would include younger populations, particularly in vulnerable communities.
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  • Child maltreatment and resilience in adulthood: a protocol for a systematic review and meta-analysis

    Fares-Otero, Natalia E.; O, Jiaqing; Spies, Georgina; Womersley, Jacqueline S.; Gonzalez, Carolina; Ayas, Görkem; Mossie, Tilahun Belete; Carranza-Neira, Julia; Estrada-Lorenzo, Jose Manuel; Vieta, Eduard; Schalinski, Inga; Schnyder, Ulrich; Seedat, Soraya (Taylor and Francis Ltd., 2023-01-01)
    Background: Although child maltreatment (CM) has been linked to health problems and poor psychosocial functioning, not all individuals exposed to CM develop or experience negative consequences later in life. This suggests that some individuals show resilience after being exposed to CM. However, conclusions have been limited by inconsistent findings across different CM subtypes and resilience domains. Objective: To develop a protocol for conducting a systematic review and meta-analysis to quantify associations between CM (overall and its subtypes) and resilience (global and its multiple domains) in adulthood, and to examine moderators and mediators of these associations. Method: PubMed, PsycINFO, Embase, Scopus, and Web of Science will be searched to identify relevant studies on the association between CM (exposure) and resilience (outcome) in adults (≥ 18 years). Data will be screened and extracted by at least two independent reviewers. The methodological quality of the included studies will be independently assessed with a modified version of the Newcastle–Ottawa Scale (NOS). If deemed viable, a meta-analysis will be conducted using a random effects model. Heterogeneity of evidence will be estimated with the I2 statistic, and publication bias will be assessed. The effects of potential moderators (e.g. timing and severity of CM, age, sex, family cohesion, socio-economic status, country/region) will be analysed using meta-regression and subgroup analyses, and meta-analytical structural equation modelling will be employed to synthesise indirect mediation effects. Candidate moderators and mediators (e.g. genetic factors, brain functioning, attachment style, personality traits, physical activity, and social support) will be also examined qualitatively. Conclusions: This protocol will facilitate a systematic review and meta-analysis that has the potential to enhance our knowledge about the association between CM exposure in early life and resilience in adulthood. Understanding associations and underlying mechanisms between CM and resilience is potentially important in informing prevention and interventions to sustain health and improve outcomes among adults with a history of CM. PROSPERO registration: CRD42023394120.
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  • Considerations in Forehead Reduction for Men

    Núñez-Castañeda, José Miguel; Chang-Grozo, Silvana Lucia (Thieme Medical Publishers, Inc. CODEN FPSUE, 2023-01-01)
    Although frontal prominence is an infrequent benign defect that causes no sequelae, it gives the patient distress due to its unaesthetic visual aspect. Proper surgical recontouring of the forehead can radically change one's appearance. In consequence, different techniques have been proposed for its management and correction. The aim of this study is to describe a surgical algorithm to treat male patients with forehead reduction to soften the forceful look. An observational cross-sectional study was conducted at the head and neck surgery ward of a general hospital between 2019 and 2022. We performed 35 forehead reduction operations on male patients. The median age was 29 years (range, 26-32 years). The forehead reduction procedures performed was categorized as follows: 27 anterior table osteotomy and 8 anterior table osteotomy contouring. Median forehead reduction was 2.7 mm (range, 2-3.2 mm). The average medical follow-up for patients was 6 months, with an interval ranging from 4 to 8 months. Surgery of the forehead in properly selected male patients is sufficiently safe that it can be done for entirely aesthetic reasons. The choice of surgical technique depends on the presence or absence of the pneumatized frontal sinus. If the frontal sinus is not pneumatized, an anterior table contouring is performed and if the frontal sinus is pneumatized, an anterior table osteotomy is preferred.
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  • Relationship between dyslipidemia and diabetic retinopathy in type II diabetic patients: A case-control study in Peru

    Paucar-Huamani, Milssa; Abado, Karla; Carreazo, Nilton Yhuri; Huamani-Leandro, Milssa (Medical Body of the Almanzor Aguinaga Asenjo National Hospital, 2023-01-01)
    Background: Diabetic retinopathy (DR) is a primarily asymptomatic microvascular complication. Even though it is preventable, it is the first cause of irreversible blindness among working-age adults. Due to recent meta-analysis results, dyslipidemia is an inconclusive risk factor; therefore, the importance of accomplishing our study in the Peruvian population. Objective: Evaluate the relationship between dyslipidemia and DR in type II diabetic patients of the Ophthalmology area from the Edgardo Rebagliati Martins National Hospital in Lima-Peru, from 2018 to 2020. Methods: Case-control study, 219 cases and 219 controls were included. Diabetic patients will be classified based on the presence or absence of DR lesions on the ocular fundus determined by the specialist. Lipids parameters (triglyceride, LDL, HDL, total cholesterol) and other variables were recollected and analyzed in STATA 14. Multivariate logistic regression was used to obtain a crude and adjusted Odds Ratio. Results: Dyslipidemia (OR 2.7, p=0.03), elevated triglycerides (OR 1.0044, p=0.03), and low HDL cholesterol (OR 2.16, p=0.03) were significantly associated with DR. Conclusion: Dyslipidemia is an independent risk factor for DR in type II diabetic patients. This result emphasizes the importance of evaluating a lipid panel in diabetic patients.
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  • Atypical perianal and buttocks epidermal-dermal necrosis in Human Monkeypox. Histopathological study of the lesion in Peru

    Terry Castellano, Luis E.; Gonzáles, Víctor Delgado; Terry Ulloa, Luis Saúl J. (Universidad Nacional Mayor de San Marcos, Facultad de Medicina, 2023-01-01)
    We report the histopathological study of a large, black, crusted lesion with symmetrical distribution in both buttocks and perineum, never described, in a man who has sex with men (MSM) and proctitis associated with Human Monkey Pox Virus (hMPXV) and HIV-AIDS infection never treated. A 39-year-old male, homosexual, HIV-AIDS without Highly Active Antiretroviral Therapy (HAART), was admitted to a hospital in Lima, Peru, with papulopustular lesions on the body and perianal area. Days later, a large, crusty, black lesion with a symmetrical distribution appeared on the buttocks and perineum. The tissue culture was negative. Wedge biopsy of the lesion showed typical MPXV cytopathogenics lesions in addition to fibrin micro thrombosis in the underlying papillary dermis. The histopathological findings of the scabby and black lesion are the classic ones described by Stagles, except for the phenomenon of fibrin micro thrombosis in the papillary dermis, a novel cytopathogenic effect of MPXV with clinical relevance (epidermal-dermal necrosis).
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  • The short-form of the Cyberchondria Severity Scale (CSS-12): Adaptation and validation of the Spanish version in young Peruvian students

    Robles-Mariños, Rodrigo; Alvarado, Germán F.; Maguiña, Jorge L.; Bazo-Alvarez, Juan Carlos (Public Library of Science CODEN POLNC, 2023-10-01)
    Background Cyberchondria is defined as the increase in health-related anxiety or anguish associated with excessive or repeated online searches for health-related information. Our objective was to cross-culturally adapt and validate the CSS-12 scale for Peruvian Spanish speakers, to determine whether the Bifactor model works as well in our population as in previous studies’ and to explore whether the Bifactor-ESEM is a more suitable model. Methods We performed a cultural adaptation using the Delphi method and a validation study on medical students between 2018 and 2019. Reliability was evaluated by using Cronbach’s alpha (α) and McDonald’s omega (Ω) for internal consistency, and Pearson’s r and intraclass correlation coefficient (ICC), for test-retest reliability. We evaluated construct validity by contrasting four measurement models for the CSS-12 and the convergent validity against health anxiety. Results The Spanish CSS-12 showed excellent reliability (α = .93; Ω = .93; ICC = .93; r = .96). The Bifactor ESEM model showed the best fit, supporting a unidimensional measure of the general cyberchondria. This measure was positively associated with health anxiety (r = .51). Conclusions The Spanish CSS-12 provides a valid and reliable unidimensional measure of cyberchondria, which is distinguishable from the more general health anxiety. This can be applied to similar populations and future research. The Bifactor-ESEM model appears to offer a more accurate and realistic representation of the multifaceted nature of cyberchondria. We provide a free-to-use form of the Spanish CSS-12 as supplemental material.
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  • Relationship between Duffy Genotype/Phenotype and Prevalence of Plasmodium vivax Infection: A Systematic Review

    Picón-Jaimes, Yelson Alejandro; Lozada-Martinez, Ivan David; Orozco-Chinome, Javier Esteban; Molina-Franky, Jessica; Acevedo-Lopez, Domenica; Acevedo-Lopez, Nicole; Bolaño-Romero, Maria Paz; Visconti-Lopez, Fabriccio J.; Bonilla-Aldana, D. Katterine; Rodriguez-Morales, Alfonso J. (Multidisciplinary Digital Publishing Institute (MDPI), 2023-10-01)
    The Duffy protein, a transmembrane molecule, functions as a receptor for various chemokines and facilitates attachment between the reticulocyte and the Plasmodium Duffy antigen-binding protein. Duffy expression correlates with the Duffy receptor gene for the chemokine, located on chromosome 1, and exhibits geographical variability worldwide. Traditionally, researchers have described the Duffy negative genotype as a protective factor against Plasmodium vivax infection. However, recent studies suggest that this microorganism’s evolution could potentially diminish this protective effect. Nevertheless, there is currently insufficient global data to demonstrate this phenomenon. This study aimed to evaluate the relationship between the Duffy genotype/phenotype and the prevalence of P. vivax infection. The protocol for the systematic review was registered in PROSPERO as CRD42022353427 and involved reviewing published studies from 2012 to 2022. The Medline/PubMed, Web of Science, Scopus, and SciELO databases were consulted. Assessments of study quality were conducted using the STROBE and GRADE tools. A total of 34 studies were included, with Africa accounting for the majority of recorded studies. The results varied significantly regarding the relationship between the Duffy genotype/phenotype and P. vivax invasion. Some studies predominantly featured the negative Duffy genotype yet reported no malaria cases. Other studies identified minor percentages of infections. Conversely, certain studies observed a higher prevalence (99%) of Duffy-negative individuals infected with P. vivax. In conclusion, this systematic review found that the homozygous Duffy genotype positive for the A allele (FY*A/*A) is associated with a higher incidence of P. vivax infection. Furthermore, the negative Duffy genotype does not confer protection against vivax malaria.
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  • Pneumonia Mortality Trends in Children under 5 Years of Age in the Context of Pneumococcal Conjugate Vaccination in Peru, 2003–2017

    Sanchez, Carlos A.; Lozada-Urbano, Michelle; Best-Bandenay, Pablo (MDPI, 2023-11-01)
    Worldwide, conjugated pneumococcal vaccines (PCVs) have proven effective against invasive pneumococcal disease, but non-invasive pneumonia is a major cause of mortality in young children and serotypes vary geographically, affecting effectiveness. We analyze nationwide death certificate data between 2003–2017 to assess the impact of PCVs on pneumonia mortality among young children from Peru. We report descriptive statistics and perform timeseries analysis on annual mortality rates (AMRs) and monthly frequencies of pneumonia deaths. Children under 5 years of age accounted for 6.2% (n = 10,408) of all pneumonia deaths (N = 166,844), and 32.3% (n = 3363) were children between 1–4 years of age, of which 95.1% did not report pneumonia etiology. Comparing periods before and after PCV introduction in 2009, mean AMRs dropped 13.5% and 26.0% for children between 1–4 years of age (toddlers/preschoolers), and children under 1 year of age (infants), respectively. A moderate correlation (Spearman’s r = 0.546, p < 0.01) in the monthly frequency of pneumonia deaths was estimated between both age groups. Quadratic regression suggests a change in direction around 2005 (highest pneumonia mortality) for both age groups, but percentage change analysis identified an inflection point in 2013 for infants only, not for toddlers/preschoolers, suggesting that the impact of PCVs might be different for each age group.
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  • Frequency, inequalities and spatial distribution of oral health services utilization in Peruvian children under twelve years of age: a population-based comparative analysis of the years 2017 and 2021

    Azañedo, Diego; Hernández-Vásquez, Akram; Visconti-Lopez, Fabriccio J.; Turpo Cayo, Efrain Y. (BioMed Central Ltd, 2023-12-01)
    Background: Oral diseases pose a significant public health challenge among Peruvian children. However, oral health services utilization among them is marked by inequalities, which may have been exacerbated by the COVID-19 pandemic. The objective was to compare the frequency, inequalities, determinants of inequality, and spatial distribution in oral health services utilization in Peruvian children under 12 years of age in 2017 and 2021. Methods: Comparative secondary data analysis from the Demographic and Family Health Survey (ENDES) for the years 2017 (38,787 minors) and 2021 (36,729 minors). Age-adjusted prevalence ratios (PR) with 95% confidence intervals (CI) were calculated to assess the change in oral health services utilization in the last 12 months between the years 2017 and 2021, stratifying by demographic and socioeconomic covariates. Inequality was assessed by decomposing the Erreygers Concentration Index (ECI) and calculating the percentage contribution to inequality of the independent variables. Spatial analysis was performed using spatial autocorrelation methods, Hot Spot Analysis, Cluster and Outlier analysis, Inverse Distance Weighting, ordinary Kriging, and Kulldorff analysis. Results: The probability of Peruvian children under 12 years of age using oral health services in the last 12 months was reduced by 45% in 2021 compared to 2017. The ECI identified a significant reduction in oral health services utilization inequalities at the national level (Diff: -0.0963; p < 0.001). The main contributor to inequality was higher tutor education level (55.2% in 2017 and 82.7% in 2021). In the comparison of spatial distribution, there was a greater dispersion of the conglomerates in which the use of oral health services is concentrated in 2021. Conclusions: The frequency of oral health services utilization in the Peruvian children under 12 years of age was halved between 2017 and 2021. This problem is transversal to the entire population at the demographic and socioeconomic level. The key factor contributing to inequalities in the utilization of oral health services was the higher educational attainment of caregivers or guardians. Despite the improvement observed in inequalities and spatial distribution of the concentration of oral health services utilization, it is necessary to keep monitoring these patterns to guide decision-making.
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  • Prospective cohort study of incidence and risk factors for catheter-associated urinary tract infections in 145 intensive care units of 9 Latin American countries: INICC findings

    Yin, Ruijie; Jin, Zhilin; Lee, Brandon Hochahn; Alvarez, Gustavo Andres; Stagnaro, Juan Pablo; Valderrama-Beltran, Sandra Liliana; Gualtero, Sandra Milena; Jiménez-Alvarez, Luisa Fernanda; Reyes, Lidia Patricia; Henao Rodas, Claudia Milena; Gomez, Katherine; Alarcon, Johana; Aguilar Moreno, Lina Alejandra; Bravo Ojeda, Juan Sebastian; Cano Medina, Yuliana Andrea; Chapeta Parada, Edwin Giovannny; Zuniga Chavarria, Maria Adelia; Quesada Mora, Ana Marcela; Aguirre-Avalos, Guadalupe; Mijangos-Méndez, Julio Cesar; Sassoe-Gonzalez, Alejandro; Millán-Castillo, Claudia Marisol; Aleman-Bocanegra, Mary Cruz; Echazarreta-Martínez, Clara Veronica; Hernandez-Chena, Blanca Estela; Jarad, Rajab Mohamed Abu; Villegas-Mota, Maria Isabel; Montoya-Malváez, Mildred; Aguilar-de-Moros, Daisy; Castaño-Guerra, Elizabeth; Córdoba, Judith; Castañeda-Sabogal, Alex; Medeiros, Eduardo Alexandrino; Fram, Dayana; Dueñas, Lourdes; Carreazo, Nilton Yhuri; Salgado, Estuardo; Rosenthal, Victor Daniel (Springer Science and Business Media Deutschland GmbH, 2023-12-01)
    Purpose: Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in Latin American Countries. Methods: From 01/01/2014 to 02/10/2022, we conducted a prospective cohort study in 145 ICUs of 67 hospitals in 35 cities in nine Latin American countries: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Peru. To estimate CAUTI incidence, we used the number of UC-days as the denominator, and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: gender, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, UC-type, hospitalizationtype, ICU type, facility ownership, and time period. Results: 31,631 patients, hospitalized for 214,669 patient-days, acquired 305 CAUTIs. The pooled CAUTI rate per 1000 UC-days was 2.58, for those using suprapubic catheters, it was 2.99, and for those with indwelling catheters, it was 2.21. The following variables were independently associated with CAUTI: age, rising risk 1% yearly (aOR = 1.01; 95% CI 1.01–1.02; p < 0.0001 female gender (aOR = 1.28; 95% CI 1.01–1.61; p = 0.04), LOS before CAUTI acquisition, rising risk 7% daily (aOR = 1.07; 95% CI 1.06–1.08; p < 0.0001, UC/DU ratio (aOR = 1.14; 95% CI 1.08–1.21; p < 0.0001, public facilities (aOR = 2.89; 95% CI 1.75–4.49; p < 0.0001. The periods 2014–2016 and 2017–2019 had significantly higher risks than the period 2020–2022. Suprapubic catheters showed similar risks as indwelling catheters. Conclusion: The following CAUTI RFs are unlikely to change: age, gender, hospitalization type, and facility ownership. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.
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  • The Chikungunya virus: A reemerging cause of acute febrile illness in the high jungle of northern Peru

    Aguilar-Luis, Miguel Angel; Watson, Hugh; Tarazona-Castro, Yordi; Troyes-Rivera, Lucinda; Cabellos-Altamirano, Felipe; Silva-Caso, Wilmer; Aquino-Ortega, Ronald; Carrillo-Ng, Hugo; Zavaleta-Gavidia, Victor; Del Valle-Mendoza, Juana (Public Library of Science, 2023-12-01)
    Background The Chikungunya virus (CHIKV) is an emerging arthropod-borne virus (arbovirus) that causes undifferentiated acute febrile illness. Cases of CHIKV may be under-reported in Peru, given the various difficulties in diagnosing it, such as lack of diagnostic tests in remote areas, the passive nature of epidemiological surveillance, and co-circulation of other arthro-pod-borne pathogens. Therefore, a study was conducted in the high jungle of northern Peru to determine the prevalence of CHIKV among febrile patients and describe their clinical characteristics. Methods A cross-sectional study was conducted in the province of Jaen, Cajamarca, located in the high jungle of northern Peru. Patients attending primary healthcare centers within Cajamar-ca’s Regional Health Directorate were enrolled. The study took place from June 2020 through June 2021. Patients were eligible if they sought outpatient healthcare for a clinical diagnosis of acute febrile illness (AFI). Serum samples were collected from all patients, and the diagnosis of CHIKV was determined using real-time RT-PCR, as well as the detection of IgM antibodies by ELISA. A logistic regression model was employed to identify the risk factors for CHIKV, and the odds ratios (ORs) were calculated, along with their corresponding 95% confidence intervals (95% CI). Results A total of 1 047 patients with AFI were included during the study period. CHIKV was identified in 130 patients of 1 047 (12.4%). Among the CHIKV positive cases, 84 of 130 (64.6%) were diagnosed by RT-PCR, 42 of 130 (32.3%) by IgM ELISA detection, and 4 of 130 (3.1%) by both assays. The majority of patients with CHIKV infection fell within the 18–39 years age group (50.0%), followed by the 40–59 years age group (23.9%) and those with 60 years or older (10.8%). The most common clinical symptoms observed in patients with CHIKV infection were headache (85.4%), myalgias (72.3%), and arthralgias (64.6%). The highest number of positive CHIKV cases occurred in May (23.1%), followed by March (20.0%) and February (13.8%) of 2021. Conclusion The study reports a considerable frequency of CHIKV infections among patients with AFI from the high jungle of northern Peru. These findings highlight the importance of recognizing CHIKV as an ongoing pathogen with continuous transmission in various areas of Peru. It is crucial to enhance epidemiological surveillance by implementing reliable diagnostic tech-niques, as the clinical symptoms of CHIKV infection can be nonspecific.
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  • Psychological Impacts of Teaching Models on Ibero-American Educators during COVID-19

    Sato, Simone Nomie; Condes Moreno, Emilia; Villanueva, Adriana Rico; Orquera Miranda, Paulo; Chiarella, Pascual; Bermudez, Gloria; Aguilera, Jose Francisco Tornero; Clemente-Suárez, Vicente Javier (Multidisciplinary Digital Publishing Institute (MDPI), 2023-12-01)
    Educational systems globally, and notably in the Ibero-American context, underwent significant adaptations in response to the myriad challenges imposed by the COVID-19 pandemic. The pedagogical evolution unfolded through three discernible phases: predominantly online, hybrid, and ultimately, a return to face-to-face instruction. While these phases were universally apparent, cultural, socio-economic, and health disparities across regions subtly influenced the quality and experiential aspects of teaching and learning within these models. This study seeks to illuminate the psychological profiles and evaluative perspectives regarding teaching and learning quality among university educators during COVID-19’s tri-phase educational transformation. Engaging 601 university instructors from various Ibero-American countries, a comprehensive questionnaire mapped demographic, academic, and psychological landscapes across the pandemic’s distinctive epochs. The pivot to online educational methodologies, supplanting traditional modalities, permeated numerous facets of the educational endeavor, particularly impacting faculty life and wellbeing. Data underscored a prevalent sentiment of loneliness, indicative of broader mental health challenges, especially pronounced among educators in Latin American nations. Notwithstanding these hurdles, Latin American educators demonstrated a predilection towards online instruction, in stark contrast to their European peers, who exhibited a preference for in-person pedagogy. This study unveils the divergent pedagogical preferences and mental health challenges among university educators in the Ibero-American realm during COVID-19’s educational shifts, underlining the need for adaptable educational frameworks and robust mental health support, attuned to the region’s distinct socio-cultural and economic contexts.
    Acceso abierto
  • Socio-demographic, migratory and health-related determinants of food insecurity among Venezuelan migrants in Peru

    Al-Kassab-Córdova, Ali; Villarreal-Zegarra, David; Bendezu-Quispe, Guido; Robles-Valcárcel, Pamela; Herrera-Añazco, Percy; Benites-Zapata, Vicente A. (Cambridge University Press CODEN PHNUF, 2023-12-10)
    Objective: To evaluate the factors associated with food insecurity (FI) among Venezuelan migrants residing in Peru. Secondarily, to evaluate the psychometric properties of the Food Insecurity Experience Scale (FIES). Design: A cross-sectional study based on secondary data analysis of the 2022 Venezuelan Population Residing in Peru Survey (ENPOVE-2022, from the Spanish acronym) was conducted. FI was measured with the FIES, whose properties were tested using the Rasch model. Multinomial logistic regression was performed to estimate relative prevalence ratios with their corresponding 95 % confidence intervals. Setting: This survey was conducted in February and March 2022 in the eight cities most populated by Venezuelan migrants and refugees in Peru. Participants: Venezuelan migrants and refugees over the age of 18 years living in Peru. Results: A total of 7727 participants were included. Rasch reliability was adequate (0·73). The prevalence of mild, moderate and severe FI was 36·71 %, 31·14 % and 10·48 %, respectively. Being aged 25-34 and 35-44 years, unemployed, uninsured, having no formal education or secondary, illegal status, living in a dwelling with 2-4 and more than 4 people, presenting one or more than one chronic disease, residing in Peru for 0-6 months and perceived discrimination were associated with a higher probability of moderate FI. Furthermore, having secondary education, being unemployed, uninsured, never married, illegal, residing in Tumbes, presenting one or more than one chronic disease and perceived discrimination were significantly associated with severe FI. Conclusion: Four out of ten Venezuelan migrants residing in Peru presented moderate to severe FI. The FIES showed adequate psychometric properties. Differences in the socio-demographic, health and migratory factors associated with FI levels were found. Inter-sectoral and multi-sectoral interventions are needed and should be focused on addressing the determinants of FI.
    Acceso abierto
  • Sexual network characteristics and partnership types among men who have sex with men diagnosed with syphilis, gonorrhoea and/or chlamydia in Lima, Peru

    Freese, Jonathan; Segura, Eddy R.; Gutierrez, Jessica; Lake, Jordan E.; Cabello, Robinson; Clark, Jesse L.; Blair, Cherie (BMJ Publishing Group, 2023-12-14)
    Objectives Sexual networks are known to structure sexually transmitted infection (STI) transmission among men who have sex with men (MSM). We sought to estimate the risks of STI diagnosis for various partnership types within these networks. Methods Our cross-sectional survey analysed data from 1376 MSM screened for a partner management intervention in Lima, Peru. Participants were tested for HIV, syphilis, gonorrhoea (NG) and chlamydia (CT) and completed surveys on their demographics, sexual identity/role, HIV status, partnership types and sexual network from the prior 90 days. χ2 and Wilcoxon rank-sum tests compared participants without an STI to those diagnosed with (1) syphilis, (2) NG and/or CT (NG/CT) and (3) syphilis and NG/CT coinfection (coinfection). Results 40.8% (n=561/1376) of participants were diagnosed with an STI (syphilis: 14.9%, NG/CT: 16.4%, coinfection: 9.5%). 47.9% of all participants were living with HIV and 8.9% were newly diagnosed. A greater proportion of participants with syphilis and coinfection were living with HIV (73.5%, p<0.001; 71.0%, p<0.001) compared with those with NG/CT (47.8%) or no STI (37.8%). Participants with syphilis more often reported sex-on-premises venues (SOPVs) as the location of their last sexual encounter (51.7%, p=0.038) while those with NG/CT tended to meet their last sexual partner online (72.8%, p=0.031). Respondents with coinfection were the only STI group more likely to report transactional sex than participants without an STI (31.3%, p=0.039). Conclusions Sexual networks and partnership types of Peruvian MSM are associated with differential risks for STIs. Participants diagnosed with syphilis tended to meet single-encounter casual partners at SOPV, while MSM with NG/CT were younger and often contacted casual partners online. Coinfection had higher frequency of transactional sex. These findings suggest the potential importance of public health interventions through combined syphilis/HIV screening at SOPV, syphilis screening at routine clinic appointments for MSM living with HIV and directed advertisements and/or access to NG/CT testing through online platforms.
    Acceso restringido temporalmente
  • Impact of Virtuality and the Use of TIC by University Teachers in Times of the Covid 19 Pandemic

    Soto Carrión, Carolina; Jimenez Mendoza, Wilber; Jimenez Soto, Isabel Milagros (International Institute of Informatics and Cybernetics, 2023-01-01)
    The Covid19 pandemic has abruptly changed the way of teaching university teachers. Objective: to establish the impact of the change from face-to-face to virtuality in the teaching-learning process of university professors at the Technological University of the Andes, Abancay. Method: In the study, 151 teachers from the different careers and Faculties of the university participated, under a random shot. The intervening instrument has been a structured survey of 10 questions and a five-level scale and other closed ones sent by institutional emails, Results: The teachers of the Technological University of the Andes have not had any virtual means at the beginning of the pandemic and it was The change from face-to- face to virtuality had a great impact, with teachers who react quickly to the use of technologies (TIC) and some have been adapting with difficulty in subsequent months. Discussion: The university had difficulties at the beginning about the conditions and facilities for access to technological tools, connectivity, implementation, but there was a difficult but quick reaction from the teachers. Conclusions: University teachers after the start of the Covid19 pandemic, have adapted with many restrictions to the virtual modality, for having been a sudden, unexpected change Teachers have adopted virtual strategies with the use of Tic tools, accepting in a 41 % the Moodle system for the development of learning sessions at the University.
    Acceso restringido temporalmente

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