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INTRODUCTION: Depression is prevalent among aging people living with HIV (PLWH) worldwide. We sought to identify depression risk factors among a group of middle-aged and older PLWH in Lima, Peru. MATERIALS AND METHODS: We assessed risk factors for depression among PLWH over age 40 receiving care in an HIV clinic in Lima, Peru. The Patient Health Questionnaire-9 (PHQ-9) was administered. We performed descriptive statistics and logistic regression analyses. RESULTS: Mean age was 51.7 ± 7.7 years with 15.3% females. One-quarter of participants had depression with higher frequency in females. Risk factors that significantly increased the risk of depression included female sex (adjusted prevalence ratio [aPR] = 2.19 [95%CI 1.07-4.49]), currently smoking (aPR = 2.25 [95%CI 1.15-4.43]), and prior opportunistic infection (aPR = 2.24 [95%CI 1.05-4.76]). DISCUSSION: Our study demonstrates that PLWH who are female, current smokers, or had an opportunistic infection have higher risk of depression. Identifying PLWH at-risk for depression is key to early mental health interventions.
Factors affecting depression in older people with HIV in PeruIntroductionDepression is common in older people living with HIV (PLWH) worldwide. We identified depression risk factors among a group of middle-aged and older PLWH in Lima, Peru.Materials and MethodsWe assessed risk factors for depression among PLWH over age 40 receiving care in an HIV clinic in Lima, Peru. The Patient Health Questionnaire-9 (PHQ-9) was administered.ResultsMean age was 51.7 ± 7.7 years with 15.3% females. One-quarter of participants had depression with higher frequency in females. Risk factors that significantly increased the risk of depression included female sex (adjusted prevalence ratio [aPR] = 2.19 [95%CI 1.07-4.49]), currently smoking (aPR = 2.25 [95%CI 1.15-4.43]), and prior opportunistic infection (aPR = 2.24 [95%CI 1.05-4.76]).DiscussionOur study demonstrates that PLWH who are female, current smokers, or had an opportunistic infection have higher risk of depression. Identifying PLWH at-risk for depression is key to early treatment or interventions that can improve mental health in PLWH in Peru.
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Depressão , Infecções por HIV , Humanos , Feminino , Peru/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Infecções por HIV/complicações , Depressão/epidemiologia , Idoso , Prevalência , Adulto , Estudos Transversais , Fumar/epidemiologia , Fatores Sexuais , Modelos LogísticosRESUMO
Introduction: Transplacental infections are frequent, especially in developing countries, where limited screening is performed to find infectious agents in the pregnant population. We aim to determine the clinical and epidemiological characteristics and seroinfection of antibodies against Toxoplasma, parvovirus B19, T. pallidum, and HIV in pregnant women who attended the Motupe Health Center in Lambayeque, Peru during July-August 2018. Methods: A descriptive cross-sectional study was conducted in 179 pregnant women interviewed with a standardized questionnaire. ELISA was used to determine antibodies to Toxoplasma and parvovirus B19. The detection of syphilis and HIV was conducted using immunochromatography, while the detection of hepatitis B was conducted using FTA-ABS and immunofluorescence, respectively. Results: Of 179 pregnant women, syphilis and HIV infections routinely included in the screening of pregnant women presented a seroinfection of 2.2 and 0.6%, respectively. Toxoplasmosis seroinfection was 25.1%, while IgM antiparvovirus B19 was 40.8%, revealing that pregnant women had an active infection at the time of study. Conclusion: The level of seroinfection of toxoplasmosis reveals the risk to which pregnant women who participated in the study are exposed. The high seroinfection of parvovirus B19 could explain the cases of spontaneous abortion and levels of anemia in newborn that have been reported in Motupe, Lambayeque, Peru. However, future causality studies are necessary to determine the significance of these findings.
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Infecções por HIV , Parvovirus B19 Humano , Complicações Infecciosas na Gravidez , Sífilis , Toxoplasma , Toxoplasmose , Treponema pallidum , Humanos , Feminino , Gravidez , Peru/epidemiologia , Treponema pallidum/imunologia , Adulto , Estudos Transversais , Sífilis/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Toxoplasmose/epidemiologia , Toxoplasmose/imunologia , Infecções por HIV/epidemiologia , Toxoplasma/imunologia , Adulto Jovem , Parvovirus B19 Humano/imunologia , Anticorpos Antiprotozoários/sangue , Anticorpos Antivirais/sangue , Adolescente , Estudos SoroepidemiológicosRESUMO
Aim: We aimed to describe the neurosonological findings related to cerebral hemodynamics acquired using transcranial Doppler and to determine the frequency of elevated ICP by optic nerve sheath diameter (ONSD) measurement in patients with severe coronavirus disease (COVID-19) hospitalized in the intensive care unit of a national referral hospital in Peru. Methods: We included a retrospective cohort of adult patients hospitalized with severe COVID-19 and acute respiratory failure within the first 7 days of mechanical ventilation under deep sedoanalgesia, with or without neuromuscular blockade who underwent ocular ultrasound and transcranial Doppler. We determine the frequency of elevated ICP by measuring the diameter of the optic nerve sheath, choosing as best cut-off value a diameter equal to or >5.8 mm. We also determine the frequency of sonographic patterns obtained by transcranial Doppler. Through insonation of the middle cerebral artery. Likewise, we evaluated the associations of clinical, mechanical ventilator, and arterial blood gas variables with ONSD ≥5.8 mm and pulsatility index (PI) ≥1.1. We also evaluated the associations of hemodynamic findings and ONSD with mortality the effect size was estimated using Poisson regression models with robust variance. Results: This study included 142 patients. The mean age was 51.39 ± 13.3 years, and 78.9% of patients were male. Vasopressors were used in 45.1% of patients, and mean arterial pressure was 81.87 ± 10.64 mmHg. The mean partial pressure of carbon dioxide (PaCO2) was elevated (54.08 ± 16.01 mmHg). Elevated intracranial pressure was seen in 83.1% of patients, as estimated based on ONSD ≥5.8 mm. A mortality rate of 16.2% was reported. In the multivariate analysis, age was associated with elevated ONSD (risk ratio [RR] = 1.07). PaCO2 was a protective factor (RR = 0.64) in the cases of PI ≥ 1.1. In the mortality analysis, the mean velocity was a risk factor for mortality (RR = 1.15). Conclusions: A high rate of intracranial hypertension was reported, with ONSD measurement being the most reliable method for estimation. The increase in ICP measured by ONSD in patients with severe COVID-19 on mechanical ventilation is not associated to hypercapnia or elevated intrathoracic pressures derived from protective mechanical ventilation.
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Introduction: The pandemic of COVID-19 continues to impact people worldwide, with more than 755 million confirmed cases and more than 6.8 million reported deaths. Although two types of treatment, antiviral and immunomodulatory therapy, have been approved to date, vaccination has been the best method to control the spread of the disease. Objective: To explore factors associated with the intention to be vaccinated with the COVID-19 booster dose in Peru. Material and Methods: Cross-sectional study, using virtual and physical surveys of adults with two or more doses of COVID-19 vaccine, where the dependent variable was the intention to be vaccinated (IBV) with the booster dose. We calculated prevalence ratios with 95% confidence intervals, using generalized linear models of the Poisson family with robust varying, determining associations between sociodemographic, clinical, and booster dose perception variables. Results: Data from 924 adults were analyzed. The IBV of the booster doses was 88.1%. A higher prevalence was associated with being male (aPR = 1.05; 95% CI [1.01-1.10]), having a good perception of efficacy and protective effect (PR = 3.69; 95% CI [2.57-5.30]) and belonging to the health sector (PR = 1.10; 95% CI [1.04-1.16]). There was greater acceptance of the recommendation of physicians and other health professionals (aPR = 1.40; 95% CI [1.27-1.55]). Conclusions: Factors associated with higher IBV with booster dose include male gender, health sciences, physician recommendation, and good perception of efficacy.
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COVID-19 , Adulto , Humanos , Masculino , Feminino , COVID-19/epidemiologia , Vacinas contra COVID-19 , Estudos Transversais , Intenção , Peru/epidemiologiaRESUMO
Booster vaccines are a strategy to mitigate the conditions in the health, social, and economic fields that the COVID-19 pandemic has brought. A series of adverse effects have been observed since the first vaccination. The present investigation aims to describe the short-term adverse effects of the fourth dose against COVID-19 in adults older than 40 from a region of Peru. The study population was over 40 years of age at the COVID-19 vaccination center in Trujillo, Peru. A 21-day follow-up was conducted from vaccination with the fourth dose, considering sex, age, body mass index, comorbidities, history of COVID-19 infection, vaccination schedule, and simultaneous vaccination against influenza as variables of interest. Multinomial logistic regression with robust variance was used to estimate the risk ratio (RR). In total, 411 people were recruited, and it was found that 86.9% of the participants presented adverse effects after injection with the fourth dose of the vaccine against COVID-19. Pain at the injection site was the most reported symptom after 3 days. Assessment of adverse effects after 3 days found that age ≥ 60 years was associated with a lower likelihood of adverse effects compared to those younger than 60 years (RRc: 0.32; 95% CI: 0.0.18-0.59), males compared to females were associated with a lower likelihood of adverse effects (RRc: 0.54; 95% CI 0.30-0.98), being overweight (RRc: 2.34; 95% CI: 1.12-4.89), and last vaccine with Pfizer-BioN-Tech (RRc: 0.42; 95% CI: 0.18-0.96). Associated adverse effects are mild to moderate. Injection site pain and general malaise are the most frequent adverse effects.
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Introduction: During the COVID-19 pandemic, the mounting workload and heightened stress may contribute to exacerbated mental health challenges, including an increased fear of COVID-19, among military personnel. Despite the potential influence of these factors, there remains a scarcity of studies addressing mental health issues, particularly the fear of COVID-19, within this specific population. We aimed to determine the prevalence and factors associated with fear of COVID-19 among military members. Methods: A cross-sectional study was conducted between November 2 and 9, 2021, during the second wave of the COVID-19 pandemic in the Lambayeque region, Peru. The outcome variable was fear of COVID-19, assessed using the Fear of COVID-19 Scale. The association with resilience (Connor-Davidson Resilience Scale, abbreviated as CD-RISC), food insecurity (Household Food Insecurity Access Scale, abbreviated as HFIAS), physical activity (International Physical Activity Questionnaire-Short Form, abbreviated as IPAQ-S), eating disorder (Eating Attitudes Test-26, abbreviated as EAT-26), and other socio- demographic variables was assessed. Results: Among the 525 participants, the median age was 22, 95.8% were male, and 19.2% experienced fear of COVID-19. A higher prevalence of fear of COVID-19 was associated with age (PR=1.03; 95% CI: 1.01-1.06), religion (PR=2.05; 95% CI: 1.04-4.05), eating disorder (PR=2.95; 95% CI: 1.99-4.36), and having a relative with mental disorder (PR=2.13; 95% CI: 1.09-4.17). Overweight (PR=0.58; 95% CI: 0.37-0.90) and a high level of resilience (PR=0.63; 95% CI: 0.43-0.93) were associated with a lower prevalence of fear of COVID-19. Discussion: Two out of ten military personnel were afraid of COVID-19. Our results highlight the need for targeted interventions addressing the factors contributing to fear of COVID-19 among military personnel, emphasizing the significance of mental health support and preventive measures within this specific population.
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Aim: To evaluate the biochemical and hematological markers associated with the risk of death due to COVID-19 in a clinical cohort with a severe clinical profile. Methods: A retrospective study was conducted among 215 anonymized inpatient records from the Hospital Nacional Almanzor Aguinaga Asenjo, Peru, between April and June 2020. The association between biomarkers and death due to COVID-19 was assessed using Cox regression, with a multivariable modeling of 1) biochemical and 2) hematological markers. Kaplan-Meier analyses and time-dependent receiver operating characteristic curves were calculated for each associated biomarker (p < 0.05). Results: Data analysis of 215 inpatient records revealed an overall mortality rate of 51.30% (95% CI 44.70-58.50), a mean age of 63.90 ± 14.10 years, and a median oxygen saturation of 88% (interquartile range 82-92%). The best-fitted biochemical model included higher levels of C-reactive protein (CRP), D-dimer, fibrinogen, urea, and lactate dehydrogenase. Similarly, the best-fitted hematological model included higher absolute neutrophil and prothrombin time, and lower absolute platelet counts. The best area under the curve values in both models were found to be CRP and D-dimer values (>0.74) and the absolute neutrophil count (0.63). Conclusions: Some specific biochemical markers outperformed hematological markers. Evaluated hematological counts analyzed in multivariable models proved to be better markers and could be useful to discriminate COVID-19 patients at high risk of death.
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Tyrosine kinase inhibitors (TKIs) are the standard treatment for epidermal growth factor receptor mutant (EGFRm) advanced non-small cell lung cancer (NSCLC). Combining TKIs with an angiogenesis inhibitor has shown promise in pre-clinical studies. A systematic search of clinical trials found that combining erlotinib (a first-generation TKI) with bevacizumab or ramucirumab (angiogenesis inhibitors) improved progression-free survival (PFS) in EGFRm advanced NSCLC patients compared to TKI alone. However, no significant benefit in overall survival (OS) was observed in trials. Similar efficacy was seen in patients with specific EGFR mutations. Third generation TKIs were used as second-line therapy for patients with the T790M mutation. The combination treatment was associated with a higher incidence of severe adverse events. Overall, combining erlotinib or another TKI with an angiogenesis inhibitor is a safe and effective alternative for first-line treatment in EGFRm advanced NSCLC, particularly in countries without access to osimertinib and for patients with the EGFR L858R mutation.
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Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Humanos , Angiogênese , Inibidores da Angiogênese/efeitos adversos , Inibidores da Angiogênese/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/genética , Receptores ErbB , Cloridrato de Erlotinib/efeitos adversos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/genética , Mutação , Inibidores de Proteínas Quinases/efeitos adversos , Inibidores de Proteínas Quinases/uso terapêuticoRESUMO
RESUMEN Objetivos: determinar el rendimiento diagnóstico de la biopsia por punción aspiración con aguja fina (PAAF) para el diagnóstico de nódulos tiroideos malignos. Materiales y métodos: estudio retrospectivo que evaluó las PAAF de tiroides realizadas en el Hospital Nacional Guillermo Almenara Irigoyen en Lima, Perú, durante un período de tres años. Se categorizó el diagnóstico citopatológico de las biopsias usando el sistema de Bethesda, se consideró las categorías V y VI como malignas y la categoría II como benigna. Se obtuvo solo una biopsia por paciente y se consideró el resultado con la categoría de Bethesda más alta. Todos los pacientes fueron sometidos a tiroidectomía y los resultados histopatológicos se categorizaron como malignos o benignos. Resultados: se incluyó a 173 pacientes con resultados citopatológicos de Bethesda II al VI. El diagnóstico citológico mostró que el 47,4% de los pacientes tenían Bethesda VI. El 59,5% de los nódulos tiroideos fueron malignos en la histopatología, siendo el carcinoma papilar el tipo más frecuente. El rendimiento diagnóstico de la PAAF fue alta cuando considera Bethesda V y VI como malignos, con una sensibilidad 91,92%, especificidad 71,67%, valor predictivo positivo 84,26%, valor predictivo negativo 84,31% y precisión de 84,28%, razón de verosimilitud positiva 3,39; pero mejoró significativamente cuando se consideró solo Bethesda VI como maligno, con sensibilidad del 90,7%, especificidad del 89,58%, precisión 90,3% y razón de verosimilitud positiva 8,71. Conclusiones : la PAAF tiene buen rendimiento. Este estudio demostró ser de gran utilidad en nuestro centro de salud para detectar errores y promover mejoras, así también como modelo para próximas investigaciones en diferentes establecimientos de salud.
ABSTRACT Objectives: To determine the diagnostic performance of fine needle aspiration biopsy (FNAB) for diagnosing malignant thyroid nodules. Methods: This is a retrospective study that assessed thyroid FNABs in Guillermo Almenara-Irigoyen National Hospital in Lima, Peru, during a three-year period. Cytopathologic diagnosis of biopsies was categorized using the Bethesda System, considering categories V and VI as malignant, and category II as benign. A single biopsy per patient was obtained, and results with the highest value in the Bethesda System were considered. All patients underwent thyroidectomy and histopathological results were characterized as malignant or benign. Results: One hundred and seventy-three patients were included in the study. Their cytopathology results were Bethesda II to VI. Cytological diagnosis showed that 47.4% of all patients were Bethesda VI. Nearly sixty percent (59.5%) of thyroid nodules were malignant in histopathology, and papillary carcinoma was the most frequent neoplasm. Diagnostic performance of FNAB was high when considering Bethesda V and VI as malignant, with 91.92% sensitivity, 71.67% specificity, 84.26 positive predictive value, 84.31% negative predictive value, and 84.28% precision. Positive verisimilitude rate was 3.39; but this significantly improved when only Bethesda VI was considered as malignant, with 90.7% sensitivity, 89.58% specificity, 90.3% precision, and 8.71 positive verisimilitude rate. Conclusion: FNAB showed good performance. This study proved to be quite useful in our healthcare facility for detecting errors and promote improvement, as well as a model for future research in different healthcare instances.
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Natural killer/T-cell lymphoma (NK/T-cellL) is an aggressive non-Hodgkin's lymphoma with limited treatment options for patients who experience disease progression or recurrence after second-line treatment. The use of new therapies, such as pembrolizumab, which involves immune checkpoint blockade mechanisms, is proposed. This systematic review followed the MOSE guidelines and searched PUBMED/MEDLINE, EMBASE, and Scopus databases. Fourteen articles were found, reporting on the use of pembrolizumab anti PD-1 in NK/T-cellL patients. The objective response rate was 84.50%, with disease-free survival ranging from two to 48 months. The complete response rate was 61.6%, and the quality of the reported studies was evaluated to be of high and moderate confidence bias levels in case reports and high bias in clinical trials. Pembrolizumab and others anti PD-1 are treatment options for refractory/recurrent NK/T-cellL, regardless of PD-L1 expression, with good short- and long-term results and low adverse events.