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Impact of climate change on the health of peruvians: challenges and strategies for a comprehensive response. 气候变化对秘鲁人健康的影响:全面应对的挑战和战略
Q3 Medicine Pub Date : 2023-04-01 DOI: 10.17843/rpmesp.2023.402.12998
Luciana Blanco-Villafuerte, Stella M Hartinger
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引用次数: 0
Comparison of mortality in patients on chemotherapy or immunotherapy during and before COVID-19 pandemic. Multicenter matched cohort study in Argentina. COVID-19大流行期间和之前化疗或免疫治疗患者死亡率的比较阿根廷多中心匹配队列研究
Q3 Medicine Pub Date : 2023-04-01 DOI: 10.17843/rpmesp.2023.402.12519
Boris Itkin, Samanta Straminsky, Hernán Cáceres, Mariana Onassis, Agustín Emilio García, Laura Avanzi, Lucia Kaminszczik, Richard Serna Sejas, Mara Rapaccioli, Gustavo Billordo, Damián Lavaccara, Julián Lanzavecchia, Luz Gibbons, Eugenia Settecase, Ariel Bardach

Objectives.: Motivation for the study. The impact of the COVID-19 pandemic on the risk of death in cancer patients on chemotherapy and immunotherapy is controversial. Published studies mainly compared patients on anti-cancer therapy to those off treatment or COVID-19 positive cancer patients to COVID-19 negative ones. Few studies were conducted in developing countries. Main findings. Mortality didn't increase in unvaccinated outpatients on active intravenous oncology treatment during the COVID-19 pandemic. Implications. This is the first propensity score-matched cohort study evaluating the impact of the COVID-19 pandemic on the population of unvaccinated oncology patients receiving intravenous anticancer therapy. . To compare all-cause mortality of unvaccinated oncology patients who received chemotherapy or immunotherapy during the pandemic with those treated before the pandemic.

Materials and methods.: We conducted a cohort study in four tertiary hospitals in Argentina. Outpatients with a solid neoplasm of any stage under-going cytotoxic or intravenous immunotherapy were eligible. The pandemic cohort was enrolled during the initial phase of the outbreak and compared with a pre-pandemic cohort using propensity score matching (PSM). Subjects were matched for age, sex, health insurance, risk factors for severe COVID-19 complications, performance status, cancer type and treatment, line of treatment, and body mass index. All-cause mortality was estimated for both cohorts after 6 months of follow-up.

Results.: A total of 169 patients were recruited between April and August 2020 for the pandemic cohort and 377 for the pre-pandemic cohort in the same months of 2019; 168 patients were matched. After PSM, all-cause mortality was 17.9% in the pandemic cohort and 18.5% in the pre-pandemic cohort; the Relative Risk was 0.97 (95 % confidence interval: 0.61-1.52; p=0.888). In the pandemic cohort, 30/168 patients died, but none from COVID-19.

Conclusions.: Our findings show that the mortality rate of unvaccinated ambulatory patients on active intravenous oncology treatment during the COVID-19 pandemic did not increase.

目标。比较在大流行期间接受化疗或免疫治疗的未接种疫苗的肿瘤患者与在大流行前接受治疗的患者的死亡率。材料和方法。我们在阿根廷的四家三级医院进行了一项队列研究。接受细胞毒性或静脉免疫治疗的任何阶段的实体瘤门诊患者都符合条件。大流行队列在疫情爆发的初始阶段登记,并使用倾向评分匹配(PSM)与大流行前的队列进行比较。受试者的年龄、性别、健康保险、严重新冠肺炎并发症风险、表现状况、癌症和治疗类型、治疗线和体重指数进行匹配。在6个月的随访后,对两组患者的全因死亡率进行了评估。后果在2020年4月至8月期间招募的169名疫情患者和2019年同期招募的377名疫情前患者中,168人匹配。PSM后,全因死亡率在大流行中为17.9%,在大流行前队列中为18.5%,风险比:0.97(95%置信区间:0.61-1.52,p=0.888)。在大流行队列中,30/168名患者死亡,其中无一人死于新冠肺炎感染。结论。我们未能证明暴露于新冠肺炎大流行的未接种疫苗、接受主动静脉注射抗癌治疗的流动患者的死亡率增加。
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引用次数: 0
Serological surveillance of parasitic zoonoses in 13 highlands regions of Peru: Period 2016-2019. 2016-2019年秘鲁山区13个地区寄生虫人畜共患病血清学监测
Q3 Medicine Pub Date : 2023-04-01 DOI: 10.17843/rpmesp.2023.402.12472
Isidro Antitupa, Nury Jakeline Vargas-Mayuri, Jhon Vicent Mayo, Luis Arturo Estares-Porras, William Marcelino Quispe Paredes, Elizabeth Luz Sánchez, Gilmer Solis-Sánchez

Objectives.: Motivation for the study. To understand the characteristics and distribution of the main parasitic zoonoses in Peru and to generate data for decision making in surveillance, prevention and control. Main findings. These parasitic zoonoses are distributed in areas of extreme poverty in the central and southern highlands of Peru. Fascioliasis seropositivity was found to be higher than for echinococcosis and cysticercosis. In addition, sociodemographic characteristics and lifestyle habits influence the transmission of these zoonoses. Implications. An active search for these zoonoses should be carried out in other risk areas with similar epidemiological characteristics to determine the prevalence of each of these zoonoses and implement multisectoral prevention and control programs. . To determine seropositivity to anti-IgG antibodies against Echinococcus granulosus, Fasciola hepatica and Taenia solium cysticercus infection and to describe the characteristics of the infected patients in 13 regions of the Peruvian highlands between 2016 and 2019.

Materials and methods.: Cross-sectional, observational study, in which we analyzed 7811 epidemiological records of laboratory-based surveillance of parasitic zoonoses from 2016 to 2019. Diagnosis was established by detecting IgG type anti-E. granulosus, F. hepatica and T. solium cysticercus antibodies using native antigens by enzyme-linked immunosorbent assay (ELISA) and Immunoblot. We evaluated the difference in the frequency of the cases according to identified characteristics using Pearson's chi-square test and Fisher's exact test.

Results.: Seropositivity was 7.9% for fascioliasis, 4.9% for cystic echinococcosis, and 2.3% for T. solium cysticercus. These rates were higher in Cerro de Pasco for cystic echinococcosis (24.5%), in Ayacucho for T. solium cysticercus (4.5%) and in Puno for fascioliasis (40.6%). Regarding the sociodemographic characteristics, we found a statistically significant difference in the frequency of cases for all zoonoses according to age group, occupation, and region of residence. We also found a difference with the consumption of vegetables in emollients, and between clinical-epidemiological characteristics and having a family history of parasitic zoonoses.

Conclusions.: From the 7811 samples, we found that these parasitic zoonoses are distributed in 13 regions of the Peruvian highlands, and represent a major health problem, with frequencies that change according to different characteristics.

目的:确定2016年至2019年秘鲁山区颗粒棘球绦虫、肝片吸虫、猪带绦虫囊尾蚴的血清阳性率和与寄生虫性人畜共患病相关的特征。材料和方法:分析了2016-2019年期间国家卫生研究所在秘鲁山区13个地区开展的人畜共患病流行病学监测活动中评估的7811份报告。每一份报告都包括一份流行病学数据表,其中载有社会人口信息、习俗和活动特征、生活方式和流行病学信息。通过酶联免疫吸附试验(ELISA)和Western blotting,使用天然抗原,通过存在抗Solium颗粒E、肝F和囊尾蚴的IgG抗体来获得诊断。与这些人畜共患病存在相关的特征是通过皮尔逊卡方检验进行的。结果:包虫病血清阳性率为7.9%,包虫病为4.9%,猪囊尾蚴病为2.3%;这些频率在Cerro de Pasco的包虫病(24.5%)、Ayacucho的囊尾蚴病(4.5%)和Puno的筋膜病(40.6%)中最高。在社会人口学特征中,根据年龄组、职业和居住地区,所有人畜共患病在生活方式与食用润肤剂中的蔬菜有关,在流行病学特征与体重减轻有关方面,都有统计学意义的联系。结论:这些人畜共患病的发现频率及其分布是这些疾病是一个重要健康问题的指标,具有相关的共同特征。
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引用次数: 0
Postpartum-acquired hemophilia A: case report. 产后获得性血友病A 1例
Q3 Medicine Pub Date : 2023-04-01 DOI: 10.17843/rpmesp.2023.402.12593
Carlos H Contreras-Pizarro, Gloria Chumpitaz-Anchiraico, Rosario Ticona Sanjínez, Carlos Peña-Diaz

Objectives.: Acquired hemophilia A is a rare bleeding disorder worldwide, characterized by the presence of inhibitory autoantibodies directed against a coagulation factor, most often factor VIII. There are several possible causes, and it can occur during the postpartum period. We present the case of a 34-year-old female patient with back pain, hematuria and a right gluteal hematoma, with no previous history of bleeding. She was transferred to the emergency department due to the extension of the hemorrhagic manifestations. Diagnosis was confirmed with the coagulation profile, mixing test and the assessment of factor VIII inhibitor tier. The case highlights the importance of considering this condition in a postpartum patient with persistent postoperative bleeding, extensive hematoma and no history of previous bleeding.

获得性A型血友病在世界范围内是一种罕见的出血性疾病,其特征是存在针对凝血因子的抑制自身抗体,通常是因子VIII。病因多种多样,包括产后。本研究的目的是评估一种被称为血小板计数的血小板计数方法的有效性,该方法是一种基于血小板计数的血小板计数方法。由于出血表现的延伸,它被转移到紧急服务。辅助凝血谱检查、混合试验和VIII因子抑制剂滴度测量证实了诊断。在这种情况下,手术伤口出血持续,广泛血肿,既往无出血史的产后患者应考虑这种病理。
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引用次数: 0
Characteristics of pediatric patients hospitalized with COVID-19 during the third wave (omicron variant) at a referral hospital in Peru. 秘鲁一家转诊医院第三波(欧姆变异)期间因COVID-19住院的儿科患者的特征
Q3 Medicine Pub Date : 2023-04-01 DOI: 10.17843/rpmesp.2023.402.12409
Giancarlo Alvarado-Gamarra, Vanessa Zarate-Campos, Jimena A Saavedra Díaz, Renato M Sánchez Julca, Andrea Tahua Vega, Aida Borcic, Alvaro Taype-Rondan, Luis Miguel Franchi Prato, Claudio F Lanata, Jesús Dominguez-Rojas, Raquel Garcés-Ghilardi, Matilde Estupiñan-Vigil

Objectives.: Motivation for the study. There are few reports on the clinical experience of the population infected with the omicron variant of COVID-19 in Latin America, particularly in pediatric population. Main findings. There was a rapid increase in the number of hospitalizations compared to previous waves, mainly due to respiratory conditions; most patients progressed favorably. Antibiotics and corticosteroids were the most used drugs. Implications. Studying the characteristics of children hospitalized during the third wave of COVID-19 in Peru may increase the knowledge of how the omicron variant affects this population group, which will allow comparisons with possible new waves or diseases.

这项研究的目的是描述在Edgardo Rebagliati Martins国家医院(HNERM)(秘鲁利马)第三波(omicron变体)期间住院的新型冠状病毒19儿科患者(28天至14岁)的特征。在这一回顾性队列中,回顾了2022年1月至4月初在HNREM接受治疗的122名儿科患者的临床病史(55%为男性,中位年龄为5岁),第一个月为77.9%,其中一半有一些合并症。他们主要因呼吸困难、失代偿综合征和脱水住院。6.6%的人接受了重症监护,4.9%的人接受了有创机械通气,5.7%的人需要一些血管活性物质,1.6%的人死亡。使用最多的药物是抗生素(43.4%)和皮质类固醇(27.1%)。总之,与前几波相比,住院人数迅速增加,其中大多数都有良好的发展,并且大量使用抗生素。
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引用次数: 0
Cyclone "Yaku" and Leptospira serovars in La Libertad, Peru. 气旋 "Yaku "与秘鲁拉利伯塔德的钩端螺旋体血清型。
Q3 Medicine Pub Date : 2023-01-01 DOI: 10.17843/rpmesp.2023.404.13261
Percy Asmat, Manuel Hidalgo, Cynthia Ramos, Pedro Lezama-Asencio, Víctor Fernández-Gómez
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引用次数: 0
Molecular detection of the natural infection by trypanosomatid parasites in Didelphis marsupialis from a rural area in northern Colombia. 对哥伦比亚北部农村地区Didelphis marsupialis锥虫自然感染的分子检测。
Q3 Medicine Pub Date : 2023-01-01 Epub Date: 2023-06-23 DOI: 10.17843/rpmesp.2023.401.11573
Marlon M Ardila, Yoselin Villadiego, Leidi Herrera, Wendy Zabala-Monterroza, Alveiro Pérez-Doria

We studied the prevalence of infection by trypanosomatid parasites in Didelphis marsupialis and its relationship with morphological/age aspects in a rural area of El Carmen de Bolivar, Colombia. Five visits were made to the Vereda El Alférez; each of which lasted three consecutive nights. During these visits, Tomahawk® traps were installed in the peridomestic and wild ecotopes of the Vereda El Alférez. Body measurements, sex and age were determined from the collected animals. Blood was extracted by cardiopuncture, after sedation, in order to obtain total deoxyribonucleic acid (DNA) and amplify the conserved region of the kinetoplast minicircle DNA (kDNA) of parasitic trypanosomatids. The association between morphological parameters of didelphids and their frequency of infection by parasitic trypanosomatids was determined by binomial regression. Thirty D. marsupialis specimens (60.0% females and 40.0% males/66.7% adults and 33.3% juveniles) were collected. Molecular diagnosis revealed a frequency of trypanosomatid parasite infection of 46.7%. Stage (p=0.024) was a determinant for infection. We discuss the role of D. marsupialis as a potential reservoir of parasitic trypanosomatids in the Vereda El Alférez.

我们在哥伦比亚 El Carmen de Bolivar 的一个农村地区研究了大羚羊锥体虫寄生虫的感染率及其与形态/年龄的关系。我们对 Vereda El Alférez 进行了五次访问,每次访问连续三个晚上。访问期间,在 Vereda El Alférez 的近郊和野生生态区安装了 Tomahawk® 诱捕器。对采集到的动物进行了身体测量、性别和年龄测定。为了获得总脱氧核糖核酸(DNA)并扩增寄生锥虫的动粒体小圆DNA(kDNA)保守区,在镇静后通过心脏穿刺提取血液。通过二项式回归法确定了双翅目蚜虫的形态参数与寄生锥虫感染频率之间的关系。共收集到 30 份马氏囊蝶标本(雌性占 60.0%,雄性占 40.0%/成虫占 66.7%,幼虫占 33.3%)。分子诊断显示,锥虫寄生虫感染率为 46.7%。阶段(p=0.024)是感染的决定因素。我们讨论了 D. marsupialis 作为 Vereda El Alférez 的潜在锥虫寄生库的作用。
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引用次数: 0
Recurrent laryngeal papillomatosis with pulmonary involvement: case report. 复发性喉乳头状瘤病伴肺部受累:病例报告。
Q3 Medicine Pub Date : 2023-01-01 Epub Date: 2023-06-23 DOI: 10.17843/rpmesp.2023.401.12169
Enrique Zumaeta-Saavedra, Christian Chiara-Chilet, Julio Maquera-Afaray, Medalit Luna-Vilchez

Recurrent respiratory papillomatosis is a neoplastic disease caused by the human papillomavirus and characterized by the growth of exophytic proliferative lesions affecting the mucosa of the respiratory tract. This condition has a bimodal age distribution; the juvenile form affects those under 20 years of age, is more aggressive and presents multiple papillomatous lesions and high frequency of recurrence, compared to the adult form. Pulmonary involvement is rare and challenging to treat. We present the case of a 13-year-old male with a history of laryngeal papillomatosis since the age of two years. The patient showed respiratory distress and multiple stenosing nodules in the larynx and trachea, as well as several pulmonary cysts identified on chest CT. The patient underwent excision of the papillomatous lesions and tracheostomy. Then, the patient received a single dose of intravenous bevacizumab 400 mg and respiratory therapies with favorable evolution, without recurrences during follow-up.

复发性呼吸道乳头状瘤病是一种由人类乳头状瘤病毒引起的肿瘤性疾病,其特点是呼吸道粘膜出现外生性增殖性病变。这种疾病的发病年龄呈双峰分布;与成人型相比,青少年型的患者年龄在 20 岁以下,更具侵袭性,表现为多发性乳头状瘤病变,复发率高。肺部受累罕见,治疗难度大。本病例为一名 13 岁男性,自两岁起就患有喉乳头状瘤病。患者出现呼吸困难,喉部和气管有多个狭窄结节,胸部 CT 还发现多个肺囊肿。患者接受了乳头状瘤病灶切除术和气管造口术。随后,患者接受了单剂量静脉注射贝伐单抗 400 毫克和呼吸疗法,病情发展良好,随访期间没有复发。
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引用次数: 0
Diagnostic performance of the time to positivity of blood cultures to distinguish true bacteremia from contaminants based on an automated system. 基于自动系统的血液培养阳性时间诊断性能,以区分真正的菌血症和污染物。
Q3 Medicine Pub Date : 2023-01-01 DOI: 10.17843/rpmesp.2023.404.12724
Aracely Laque-Ale, Miguel Hueda-Zavaleta, Juan Carlos Gómez de la Torre, Luis Alvarado, José Alonso Cáceres Del Águila

Objective.: To determine the diagnostic performance of blood culture positivity times for distinguishing true bacteremia from contaminants in the automated "BACT/ALERT®" system.

Materials and methods.: A cross-sectional, diagnostic test-type study was conducted from a database of blood culture samples processed between January 2016 and August 2021. All blood culture samples from patients with suspected bacteremia were included; blood culture samples were entered into the "BACT/ALERT®" system to differentiate true bacteremia from contaminants.

Results.: We obtained 33,951 blood cultures samples, of which 3875 were positive. Of the total number of positive blood cultures, 75.2% (n=2913) were true bacteremia and 24.8% (n=962) were contaminants. The median time to positivity in blood cultures with true bacteremia was significantly shorter (16.3 hours; IQR: 11.2 - 24.9) than the median time to positivity of blood cultures with contaminants (22.5 hours; IQR: 18.4 - 31.8; p<0.001). The positivity time showed the capacity to differentiate true bacteremia from contaminants, with an AUC-ROC of 0.73 (95%CI: 0.71 - 0.75), with 85% and 63% sensitivity and specificity respectively for the diagnosis of contaminants when the positivity time exceeds 16.5 hours. The use of antibiotics prior to sampling delayed the time to positivity, while having fever before sampling shortened the time to positivity.

Conclusions.: Our results show good diagnostic performance of blood culture positivity times to differentiate true bacteremia from contaminants using the "BACT/ALERT®" system when the positivity time was longer than 16.5 hours.

目的确定自动 "BACT/ALERT®"系统中血培养阳性时间的诊断性能,以区分真正的菌血症和污染物:根据 2016 年 1 月至 2021 年 8 月期间处理的血培养样本数据库开展了一项横断面诊断测试型研究。所有疑似菌血症患者的血培养样本均被纳入其中;血培养样本被输入 "BACT/ALERT®"系统,以区分真正的菌血症和污染物:我们获得了 33951 份血液培养样本,其中 3875 份呈阳性。在阳性血培养样本总数中,75.2%(n=2913)为真正的菌血症,24.8%(n=962)为污染物。真菌血症血培养阳性的中位时间(16.3 小时;IQR:11.2 - 24.9)明显短于污染物血培养阳性的中位时间(22.5 小时;IQR:18.4 - 31.8;p结论:我们的研究结果表明,当血培养阳性时间超过 16.5 小时时,使用 "BACT/ALERT®"系统区分真正的菌血症和污染物的诊断性能良好。
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引用次数: 0
Adaptation of food guideline messages for the visually impaired in Lima, Peru: a validation experience. 为秘鲁利马的视障人士改编食品指南信息:验证经验。
Q3 Medicine Pub Date : 2023-01-01 DOI: 10.17843/rpmesp.2023.404.12973
Mirko Lázaro-Serrano, César Domínguez-Curi

This article aims to describe the design and validation process of food guideline messages written in the braille reading and writing system for people with visual impairment. The process involved the following stages: i) design and elaboration of the material containing the food guideline messages, as well as its adaptation to the format; ii) technical validation with representatives of the National Council for the Integration of Persons with Disabilities (CONADIS); and iii) operational validation through focus groups with children, adolescents and adults with visual disabilities who can read braille. The participants agreed on the legibility, clarity and comprehension of the messages and approved the format of the material. Finally, it should be noted that the participation of key informants and people with visual impairment in all stages was important for the development of an informative material with healthy eating messages in braille.

本文旨在介绍用盲文读写系统为视障人士编写的食品指南信息的设计和验证过程。这一过程包括以下几个阶段:i) 设计和编写包含食品指南信息的材料,并对其格式进行调整;ii) 与国家残疾人融合委员会(CONADIS)的代表进行技术验证;iii) 通过与能够阅读盲文的视力残疾儿童、青少年和成人组成的焦点小组进行操作验证。与会者对信息的可读性、清晰度和理解力达成了一致意见,并批准了材料的格式。最后,应该指出的是,主要信息提供者和视力障碍者在各个阶段的参与对于编制盲文健康饮食信息资料非常重要。
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引用次数: 0
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Revista Peruana de Medicina de Experimental y Salud Publica
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