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Objetivo: Describir las características clínicas y epidemiológicas y el impacto de las medidas no farmacológicas (MNF) en la evolución de la epidemia por COVID-19 en pobladores de una región de gran altura del Perú. Materiales y métodos: El estudio fue desarrollado en el distrito de Lircay, a 3278 m s. n. m., provincia de Angaraes, departamento de Huancavelica, entre el 31 de marzo del 2020 y el 31 de enero del 2021 (periodo de la cuarentena). La Oficina de Informática del Hospital Minsa II-1 de Lircay proporcionó el total de los registros de pacientes con diagnóstico de COVID-19, que se empleó en el periodo de estudio mencionado. Se evaluaron las características clínicas y epidemiológicas y el impacto de las MNF mediante la determinación de la transmisibilidad del virus por medio del número efectivo de reproducción (Rt). Resultados: Se estudiaron 1404 pacientes con diagnóstico de COVID-19 del distrito de Lircay, quienes se atendieron en el Hospital Minsa II-1 de Lircay. La mediana de edad fue de 33 años (RIQ: 24,0-45,0), el 10,7 % fueron adultos mayores y el 70 % no reportó comorbilidades al momento del diagnóstico. El 2,16 % de los participantes tuvo un cuadro moderado o grave, y se presentó con más frecuencia en varones (p < 0,001); asimismo, las comorbilidades asociadas significativamente fueron la obesidad (p < 0,001) y la hipertensión arterial (p = 0,004). La tasa de letalidad promedio fue de 0,9 %, sin embargo, en casos moderados-graves alcanzó el 26,7 % (p < 0,001); la población adulto mayor fue la más afectada. La cuarentena focalizada como MNF determinó un Rt de 2,98 (IC 95 %: 1,54-5,14) en el mes de julio, y el cese de la cuarentena más la reactivación económica determinó un Rt de 9,94 (IC 95 %: 4,19-19,45) en el mes de diciembre. Después del periodo de las festividades navideñas, se instauró la cuarentena focalizada y, 14 días después, se observó una reducción del Rt hasta en 0,79 (IC 95 %: 0,41-1,36). Conclusiones: En esta región de gran altura, la tasa de letalidad global por COVID-19 fue baja; esto podría relacionarse con las características de la población (menor edad y baja prevalencia de comorbilidades). Aparentemente, la cuarentena resultó ser una medida efectiva para el control de la transmisibilidad del SARS-CoV-2.

Objective: To describe the clinical and epidemiological characteristics and the impact of non-pharmacological measures (NFMs) on the evolution of the COVID-19 pandemic among residents of a high-altitude region of Peru. Materials and methods: The study was conducted in the district of Lircay (3,278 m a.s.l.), province of Angaraes, department of Huancavelica, between March 31, 2020, and January 31, 2021 (lockdown period). The Information Technology Department at Hospital Lircay MINSA II-1 provided all COVID-19 patient records used during the aforementioned period of time. The clinical and epidemiological characteristics and the impact of NFMs were evaluated by determining the transmissibility of the virus using the effective reproduction number (Rt). Results: A total of 1,404 COVID-19 patients from the district of Lircay, who were treated at Hospital Lircay MINSA II-1, were studied. The median age was 33 years (IQR: 24.0-45.0); 10.7 % were older adults and 70 % reported no comorbidities at diagnosis. Out of all participants, 2.16 % had a moderate or severe condition, being more frequent in males (p < 0.001). Moreover, the significantly associated comorbidities were obesity (p < 0.001) and hypertension (p = 0.004). The average case fatality rate was 0.9 %; however, in moderate-severe cases, it reached 26.7 % (p < 0.001), and the elderly population was the most affected one. The lockdown, understood as an NFM, generated an Rt of 2.98 (95 % CI: 1.54-5.14) in July, and the end of the lockdown plus the economic recovery generated an Rt of 9.94 (95 % CI: 4.19-19.45) in December. After Christmas, focused lockdown was introduced and, 14 days later, an Rt reduction of up to 0.79 (95 % CI: 0.41-1.36) was observed. Conclusions: In this high-altitude region, the COVID-19 overall case fatality rate was low; this could be related to the characteristics of the population (young age and low prevalence of comorbidities). Lockdown apparently proved to be an effective measure for controlling SARS-CoV-2 transmissibility.

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Introducción: La expansión acelerada del SARS-CoV-2 trajo consigo una crisis mundial, y una serie de estudios y recomendaciones para manejarlo; mientras que estudios previos a la pandemia, evidencia elevada prevalencia de automedicación en estudiantes universitarios. Objetivo: Identificar la frecuencia y características de automedicación contra la COVID-19 con fármacos y/o plantas medicinales en los estudiantes de la Universidad Nacional de la Amazonía Peruana (UNAP), Iquitos, Loreto-Perú, durante la primera ola por COVID-19. Material y Métodos: Se realizó un estudio descriptivo de corte transversal en 338 estudiantes mediante una encuesta semiestructurada ad-hoc con preguntas distribuidas en 3 dimensiones: características sociodemográficas, características de COVID-19 y características del uso de fármacos/plantas medicinales. Resultados: El promedio de la edad fue 22,39 años (DE ± 5,59), predomino el sexo femenino con 61,2 % (n=207), el 55,3% (n=187) presentaron síntomas sugestivos de COVID-19. Además, el 76,9% (n=260) utilizaron medicación, distribuido de mayor a menor 65,4 % (n=170) fármacos y plantas, 25,8 % (n=67) solo plantas, y 8,8 % (n=23) solo fármacos; incurrieron en automedicación el 79,2% (n=206). Los principales fármacos empleados fueron dexametasona, paracetamol, azitromicina, e ivermectina. Las plantas medicinales principalmente empleadas fueron eucalipto, kion, manzanilla y matico. Se presentó probable asociación a la automedicación con antecedente de síntomas sugestivos de COVID-19 (p=0.001, IC 95%), y contacto de COVID-19 (p=0,011, IC 95%). Conclusión: Entre los estudiantes de una universidad de la Amazonía Peruana, se identificó elevada prevalencia y los factores asociados a la automedicación con fármacos y plantas medicinales.

Introduction: The accelerated spread of SARS-CoV-2 brought about a worldwide crisis, and a series of studies and recommendations to manage it. Before the pandemic, studies evidence a high prevalence of self-medication in university students. Objective: To identify the frequency and characteristics of self-medication against COVID-19 with drugs and/or medicinal plants in students of the National University of the Peruvian Amazon (UNAP), Iquitos, Loreto-Peru, during the first wave of COVID-19. Material and Methods: A descriptive cross-sectional study was conducted on 338 students using a semi-structured ad-hoc survey with questions distributed in 3 dimensions: sociodemographic characteristics, characteristics of COVID-19, and characteristics of the use of drugs/medicinal plants. Results: The mean age was 22.39 years (SD ± 5.59), female sex predominated with 61.2 % (n=207), and 55.3 % (n=187) presented symptoms suggestive of COVID-19. In addition, 76.9% (n=260) used medication, distributed from highest to lowest 65.4% (n=170) drugs and plants, 25.8% (n=67) only plants, and 8.8% (n=23) only drugs; 79.2% (n=206) used self-medication. The main drugs used were dexamethasone, paracetamol, azithromycin, and ivermectin. The main medicinal plants used were eucalyptus, kion, chamomile, and matico. There was a probable association between self-medication and a history of symptoms suggestive of COVID-19 (p=0.001, 95% CI), and COVID-19 contact (p=0.011, 95% CI). Conclusion: Among students of a university in the Peruvian Amazon, a high prevalence and factors associated with self-medication with drugs and medicinal plants were identified.

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Human Leukocyte Antigen (HLA)-G participates in several biological processes, including reproduction, vascular remodeling, immune tolerance, and hypoxia response. HLA-G is a potential candidate gene for high altitude adaptation since its expression is modulated in both micro and macro environment under hypoxia and constant cellular stress. Besides the promoter region, the HLA-G 3'untranslated region (UTR) influences HLA-G expression patterns through several post-transcriptional mechanisms. Currently, the 3'UTR genetic diversity in terms of altitude adaptation of Native American populations is still unexplored, particularly at high altitude ecoregions. Here, we evaluated 288 Native Americans from 9 communities located in the Andes [highland (HL); ≥2,500 m (range = 2,838-4,433 m)] and 8 populations located in lowland (LL) regions [<2,500 m (range = 80-431 m); Amazonian tropical forest, Brazilian central plateau, and Chaco] of South America. In total, nine polymorphic sites and ten haplotypes were observed. The most frequent haplotypes (UTR-1, UTR-2, and UTR-3) accounted for âˆ¼ 77% of haplotypes found in LL, while in the HL, the same haplotypes reach âˆ¼ 93%. Also, a remarkable high frequency of putative ancestral UTR-5 haplotype was observed in LL (21.5%), while in HL UTR-2 reaches up to 47%. Further, UTR-2 frequency positively correlates with altitude-related variables, while a negative correlation for UTR-5 was observed. From an evolutionary perspective, we observed a tendency towards balancing selection in HL and LL populations thus suggesting that haplotypes of ancient and more derived alleles may have been co-opted for relatively recent adaptations such as those experienced by modern humans in the highland and lowland of South America. We also discuss how long-term balancing selection can be a reservoir of genetic variants that can be positively selected. Finally, our study provides some pieces of evidence that HLA-G 3'UTR haplotypes may have contributed to high altitude adaptation in the Andes.

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In the context of the current COVID-19 pandemic, higher morbidity and mortality have been reported in older adults. This age group presents physiological changes and its own clinical conditions such as frailty, dementia, among others. OBJECTIVE: To describe the characteristics of COVID-19 patients, both over and under 80 years old, by conducting a systematic review of the literature describing case reports, and to summarize and critically assess these characteristics. METHODS: Systematic review. The study was registered on the Registry of Health Research Projects (PRISA) of the Peruvian National Institute of Health (code EI00000631). Five electronic databases (Scopus, PubMed, PubMed Central, LILACS, and SCIELO) were systematically searched during the period between December 31, 2019 and April 16, 2020. The search focused on case reports, case studies, and case series of older people with COVID-19 infection aged over or under 80 years. When selecting the cases, priority was given to clinical and epidemiological profile, laboratory and imaging patterns, and comprehensive geriatric evaluation. RESULTS: 1,149 articles were identified; after applying the filters, a total of 15 publications of case reports and complete records of 27 older adults were obtained. The most frequent age group was between 60 to 69 years old. There is little literature regarding case reports of older adults aged over 80 years. The most frequent parameters were hypertension, fever, cough, respiratory distress, ground-glass opacification in chest radiography and tomography. Furthermore, decrease in PaO2/FiO2 ratio and lymphocytes, and increase in C-reactive protein and Interleukin 6 were observed. CONCLUSIONS: This systematic review found little available information of patients under 80 years old, and far less for those over 80 years old, and an absence of comprehensive geriatric assessment.

No contexto da atual pandemia de covid-19, maior morbidade e mortalidade têm sido relatadas em idosos. Sabe-se que essa faixa etária apresenta alterações fisiológicas e condições clínicas próprias, como fragilidade, demência, entre outras. OBJETIVO: Descrever as características de pacientes com covid-19, maiores e menores de 80 anos, por meio de uma revisão sistemática da literatura que descreve relatos de casos, e resumir e avaliar criticamente essas características. MÉTODO: Revisão sistemática. O estudo foi registrado no Registro de Projetos de Pesquisa em Saúde (PRISA) do Instituto Nacional de Saúde do Peru (código EI00000631). Local: cinco bases de dados eletrônicas (Scopus, PubMed, PubMed Central, LILACS e SCIELO) foram sistematicamente pesquisadas entre 31 de dezembro de 2019 e 16 de abril de 2020. A busca se concentrou em relatos de caso, estudos de caso e séries de casos mais antigos pessoas com infecção por SARS-CoV-2 com mais e menos de 80 anos. Na seleção dos casos, a prioridade foi dada ao perfil clínico e epidemiológico, padrões laboratoriais e de imagem, e avaliação geriátrica abrangente. RESULTADOS: Foram identificados 1.149 artigos. Após a aplicação dos filtros, obteve-se um total de 15 publicações de relatos de caso e registros completos de 27 idosos. A faixa etária mais frequente foi de 60 a 69 anos. Há pouca literatura sobre relatos de casos de adultos com mais de 80 anos. Os parâmetros mais frequentes foram hipertensão, febre, tosse, dificuldade respiratória, vidro fosco na radiografia e tomografia de tórax. Também foram observados diminuição da PaO2 / FiO2 e linfócitos, e aumento da proteína C reativa e Interleucina 6. CONCLUSÕES: Esta revisão sistemática encontrou poucas informações disponíveis sobre pacientes com menos de 80 anos, em quantidade ainda menor para aqueles com mais de 80 anos, além de uma ausência de avaliação geriátrica abrangente.

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El objetivo de este trabajo fue conocer la frecuencia y la manera en que las plantas medicinales son empleadas por las gestantes del Centro de Salud Viña Alta del distrito de La Molina. En el estudio participaron veintiuna gestantes, quienes respondieron una encuesta, validada por expertos, sobre el uso de plantas medicinales. Se demostró que el 86,00 % de las gestantes utilizaron plantas medicinales, y que 67,00 % no consultó con un médico sobre su empleo. La manera más frecuente de consumo de las plantas medicinales fue la vía oral, en forma de infusiones. Las plantas medicinales más utilizadas fueron manzanilla, perejil, eucalipto, boldo, aloe, menta y ruda; y algunas de ellas mostraron efecto teratogénico, estimulante uterino, abortivo, entre otros. Es necesario conocer la cantidad real y la manera más frecuente en que las gestantes consumen las plantas medicinales, con la finalidad de clasificar estos productos de acuerdo al nivel de seguridad que ofrecen y promover el uso racional de la medicina tradicional para contribuir en la salud pública.

This research aimed to find out the frequency and ways of using medicinal plants by pregnant women treated at the Centro de Salud Viña Alta, located in La Molina district. Twenty-one (21) pregnant women voluntarily participated in the study, where they were administered an expert-validated survey regarding the use of medicinal plants. The results showed that 86 % of the pregnant women used medicinal plants and 67 % did not ask their doctor before using them. The most frequent way of using the medicinal plants was by oral intake as herbal teas. The most widely used medicinal plants were chamomile, parsley, eucalyptus, boldo, aloe, mint and rue, some of which produced a teratogenic effect, uterine stimulant action, abortifacient effect, among others. It is necessary to know the actual quantity and most frequent way of using medicinal plants by pregnant women to classify these products as for its safety level and promote the rational use of traditional medicine to contribute to public health.

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ABSTRACT. In the context of the current COVID-19 pandemic, higher morbidity and mortality have been reported in older adults. This age group presents physiological changes and its own clinical conditions such as frailty, dementia, among others. Objective: To describe the characteristics of COVID-19 patients, both over and under 80 years old, by conducting a systematic review of the literature describing case reports, and to summarize and critically assess these characteristics. Methods: Systematic review. The study was registered on the Registry of Health Research Projects (PRISA) of the Peruvian National Institute of Health (code EI00000631). Five electronic databases (Scopus, PubMed, PubMed Central, LILACS, and SCIELO) were systematically searched during the period between December 31, 2019 and April 16, 2020. The search focused on case reports, case studies, and case series of older people with COVID-19 infection aged over or under 80 years. When selecting the cases, priority was given to clinical and epidemiological profile, laboratory and imaging patterns, and comprehensive geriatric evaluation. Results: 1,149 articles were identified; after applying the filters, a total of 15 publications of case reports and complete records of 27 older adults were obtained. The most frequent age group was between 60 to 69 years old. There is little literature regarding case reports of older adults aged over 80 years. The most frequent parameters were hypertension, fever, cough, respiratory distress, ground-glass opacification in chest radiography and tomography. Furthermore, decrease in PaO2/FiO2 ratio and lymphocytes, and increase in C-reactive protein and Interleukin 6 were observed. Conclusions: This systematic review found little available information of patients under 80 years old, and far less for those over 80 years old, and an absence of comprehensive geriatric assessment.

RESUMO. No contexto da atual pandemia de covid-19, maior morbidade e mortalidade têm sido relatadas em idosos. Sabe-se que essa faixa etária apresenta alterações fisiológicas e condições clínicas próprias, como fragilidade, demência, entre outras. Objetivo: Descrever as características de pacientes com covid-19, maiores e menores de 80 anos, por meio de uma revisão sistemática da literatura que descreve relatos de casos, e resumir e avaliar criticamente essas características. Método: Revisão sistemática. O estudo foi registrado no Registro de Projetos de Pesquisa em Saúde (PRISA) do Instituto Nacional de Saúde do Peru (código EI00000631). Local: cinco bases de dados eletrônicas (Scopus, PubMed, PubMed Central, LILACS e SCIELO) foram sistematicamente pesquisadas entre 31 de dezembro de 2019 e 16 de abril de 2020. A busca se concentrou em relatos de caso, estudos de caso e séries de casos mais antigos pessoas com infecção por SARS-CoV-2 com mais e menos de 80 anos. Na seleção dos casos, a prioridade foi dada ao perfil clínico e epidemiológico, padrões laboratoriais e de imagem, e avaliação geriátrica abrangente. Resultados: Foram identificados 1.149 artigos. Após a aplicação dos filtros, obteve-se um total de 15 publicações de relatos de caso e registros completos de 27 idosos. A faixa etária mais frequente foi de 60 a 69 anos. Há pouca literatura sobre relatos de casos de adultos com mais de 80 anos. Os parâmetros mais frequentes foram hipertensão, febre, tosse, dificuldade respiratória, vidro fosco na radiografia e tomografia de tórax. Também foram observados diminuição da PaO2 / FiO2 e linfócitos, e aumento da proteína C reativa e Interleucina 6. Conclusões: Esta revisão sistemática encontrou poucas informações disponíveis sobre pacientes com menos de 80 anos, em quantidade ainda menor para aqueles com mais de 80 anos, além de uma ausência de avaliação geriátrica abrangente.

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RESUMEN Objetivo Indagar acerca de las principales indicaciones, propiedades y formas de uso del chuchuhuasi referidas por un grupo de curanderos de Santa María de Huachipa (Lima-Perú). Existen antecedentes de estudios de los usos medicinales del chuchuhuasi (Maytenus macrocarpa) en comunidades nativas de la Amazonía, tanto por el poblador como por indicación del terapeuta tradicional; sin embargo, las referencias del uso y propiedad medicinal del chuchuhuasi en la costa, y en la comunidad urbana son escasas. Materiales y métodos Diez curanderos participaron de forma voluntaria. Se aplicó un cuestionario (mediante entrevista) que indagó acerca del uso del chuchuhuasi (propiedades, efectos adversos, contraindicaciones y formas farmacéuticas). La participación se registró con videograbaciones y luego se transcribió; posteriormente, los datos se categorizaron mediante pares y se definieron por consenso. Resultados Las principales indicaciones de consumo de chuchuhuasi fueron los problemas respiratorios (80,00 %) y osteotendinosos. Las propiedades antiinflamatorias y afrodisíacas fueron las más relevantes; y como efecto adverso se reportó el mareo. El producto estaba contraindicado en gestantes, hipertensos y diabéticos. Además, las principales formas farmacéuticas de consumo fueron el macerado, la pomada y la infusión. Conclusiones Se encontró la referencia del uso del chuchuhuasi en un grupo de curanderos del distrito de Santa María de Huachipa (Lima-Perú). La indicación más importante de su empleo son los problemas respiratorios y se destaca su propiedad antinflamatoria.

ABSTRACT Objective To inquire the main conditions, properties and ways of consumption of chuchuhuasi from a group of folk healers of the district of Santa María de Huachipa (Lima - Peru). There are studies of the medicinal uses of chuchuhuasi (Maytenus macrocarpa) in native communities of the Amazon known by the inhabitants and indicated by folk healers. However, information on the medicinal uses and properties of chuchuhuasi on the coast and in urban communities is rare. Materials and methods Ten folk healers voluntarily participated in the study. An interview questionnaire was administered to inquire the use of chuchuhuasi (properties, adverse effects, contraindications and ways of consumption). The interview was recorded and then transcribed. Afterwards, the data was categorized by peers and defined by consensus. Results: The main conditions for consuming chuchuhuasi were respiratory tract (80 %) and osteotendinous junction problems. The most important properties of chuchuhuasi were its anti-inflammatory and aphrodisiac effects. Dizziness was reported as adverse effect. Chuchuhuasi was contraindicated in pregnancy, hypertension and diabetes. In addition, its main ways of consumption were as spirit, ointment and infusion. Conclusions Information on the medicinal uses of chuchuhuasi was obtained from a group of folk healers of the district of Santa María de Huachipa (Lima - Peru). The main condition for consuming chuchuhuasi was respiratory tract problems, and its anti- inflammatory properties were highlighted.