Cerebrospinal fluid shunting for the management of cryptococcal meningitis: a scoping review

Objective: This scoping review aimed to describe studies that evaluate the management of cryptococcal meningitis (CM) using cerebrospinal fluid (CSF) shunts, types of shunts used, and clinically relevant patient outcomes. Methods: We searched in the following databases: PubMed, Web of Science/Core collection, Embase, the Cochrane Library, and clinicaltrials.gov on 1 April 2022. We included two-arm and one-arm cohort studies that evaluated clinically relevant patient outcomes. Case reports were used to describe the type of CSF shunts used and the rationale behind its selection. The selection and extraction processes were independently performed by two authors. Results: This study included 20 cohort studies and 26 case reports. Only seven cohort studies compared two groups. Ventriculoperitoneal shunt was the most commonly used type of shunt (82.1%). The main indications for placing a shunt were persistently high opening pressure (57.1%) and persisting neurological symptoms or deterioration (54.3%). Cohort studies suggest that patients with shunt showed improvement in some outcomes such as neurological symptoms and hospital stay length. The most common shunt complications were post-operative fever (1–35.6%) and shunt obstruction (7–16%). Conclusion: CSF shunts may improve some clinically relevant outcomes in patients with CM, but the evidence is very uncertain.Revisión por pare

Asociación entre preocupación frente a la COVID-19, el apoyo social y el conocimiento sobre tuberculosis con el cumplimiento del tratamiento antituberculoso en Lima, Perú

Introducción. En el contexto de la pandemia por la COVID-19 es escasa la información de factores asociados al cumplimiento del tratamiento antituberculoso en las zonas de alta prevalencia de tuberculosis. Objetivo. Evaluar si existe asociación entre el apoyo social, la preocupación por el contagio de COVID-19 y el conocimiento de la tuberculosis, frente al incumplimiento del tratamiento antituberculoso. Materiales y métodos. Se trata de un estudio transversal de pacientes en tratamiento antituberculoso durante los meses de enero a marzo del 2022 en centros ubicados en áreas de alta prevalencia de tuberculosis en Lima. Se utilizó el cuestionario de Morisky Green-Levine para evaluar el cumplimiento del tratamiento como variable dependiente; las variables independientes se evaluaron usando el Medical Outcomes Study Social Support Survey para determinar el apoyo social percibido y la preocupación por la infección de COVID-19, y el test de Batalla para evaluar el conocimiento del paciente sobre su enfermedad. Se utilizó la regresión de Poisson con varianza robusta para determinar la asociación entre las variables. Resultados. De un total de 101 participantes (73,3 % hombres y edad media 35,1 ± 16 años), el 51,5 % no observaron el tratamiento antituberculoso. El nivel de preocupación medio o alto de contagiarse y desarrollar COVID-19 se asoció con una mayor prevalencia de incumplimiento del tratamiento (razón de prevalencia: 1,68; intervalo de confianza del 95 %: 1,09-2,57) (ajustada por las variables de confusión consideradas). Conclusiones. El incumplimiento del tratamiento antituberculoso es una condición frecuente entre los pacientes de una zona de alta prevalencia de tuberculosis en Lima especialmente entre aquellos con mayor preocupación al contagio por el virus de SARSCoV-2, causante de la COVID-19

Características clínicas y factores asociados a mortalidad en pacientes adultos hospitalizados por COVID-19 en un hospital público de Lima, Perú.

The COVID-19 pandemic has deeply affected the national health system in Peru, and despite the many strategies implemented to control the epidemic, the collapse of the sanitary system was imminent. We performed a retrospective cohort from the clinical records of adult patients with COVID-19 admitted in Hospital Cayetano Heredia (Lima, Peru), between March and June 2020. A total of 369 patient charts were included for analysis; 241 (65.31%) were male and the median age was 59 years (IQR: 49-68). Most patients (68.56%) reported at least one comorbidity; more frequently: obesity (42.55%), diabetes mellitus (21.95%), and hypertension (21.68%). The median duration of symptoms prior to hospital admission was 7 days (IQR: 5-10). Reported in-hospital mortality was 49.59%. By multiple Cox regression, oxygen saturation (SaO2) level at admission was the main predictor of patient mortality, with SaO2 levels of 84-80% and 90%. Additionally, older age (>60 years old) was associated with 1.9 times greater mortality. Our study finds SaO2 at admission and older age to be independent predictors of in-hospital mortality. These findings suggest a delay in early detection of hypoxemia in the community, therefore, we propose the implementation of monitoring for hypoxemia among outpatients with COVID-19 as well as appropriate and timely oxygen therapy in admission

Oxygen saturation as a predictor of mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru.

INTRODUCTION: Peru is among the top ten countries with the highest number of coronavirus disease 2019 (COVID-19) cases worldwide. The aim of the study was to describe the clinical features of hospitalized adult patients with COVID-19 and to determine the prognostic factors associated with in-hospital mortality. METHODS: We conducted a retrospective cohort study among adult patients with COVID-19 admitted to Hospital Cayetano Heredia; a tertiary care hospital in Lima, Peru. The primary outcome was in-hospital mortality. Multivariate Cox proportional hazards regression was used to identify factors independently associated with in-hospital mortality. RESULTS: A total of 369 patients (median age 59 years [IQR:49-68]; 241 (65.31%) male) were included. Most patients (68.56%) reported at least one comorbidity; more frequently: obesity (42.55%), diabetes mellitus (21.95%), and hypertension (21.68%). The median duration of symptoms prior to hospital admission was 7 days (IQR: 5-10). Reported in-hospital mortality was 49.59%. By multiple Cox regression, oxygen saturation (SaO2) values of less than 90% on admission correlated with mortality, presenting 1.86 (95%CI: 1.02-3.39), 4.44 (95%CI: 2.46-8.02) and 7.74 (95%CI: 4.54-13.19) times greater risk of death for SaO2 of 89-85%, 84-80% and 90%. Additionally, age >60 years was associated with 1.88 times greater mortality. CONCLUSIONS: Oxygen saturation below 90% on admission is a strong predictor of in-hospital mortality in patients with COVID-19. In settings with limited resources, efforts to reduce mortality in COVID-19 should focus on early identification of hypoxemia and timely access to hospital care

Propuesta de lineamientos de gestión ambiental para la correcta vinculación entre la visión de la minería al 2030 con respecto a la nueva política del ambiente al 2030 en el perú

Abstract This article seeked to establish the essential environmental management guidelines that must be taken into account to link the 05 attributes of the Mining Vision to 2030 (VM to 2030) with the alternative solutions to the "Causes of the Public Problem" that determined the decrease in goods and services provided by ecosystems that affect the development of people and the environmental sustainability of the new National Environmental Policy to 2030 in Peru (PNA to 2030) taking into account the criteria of political, social, administrative and efficiency. For this, 04 management guidelines are proposed which will allow establishing the necessary bridge that makes an imperative link between both documents viable, especially the PNA to 2030, since it is a mandatory regulatory document approved via supreme decrete (D.S.) No. 023-2021-MINAM. These environmental management guidelines are as follows: the value of water resources in the production chain of mining exploitation, the reduction of mining environmental liabilities, a new strategy for the eradication of illegal mining in Peru and the improvement of community relations both for new mining projects as well as mining operations that are underway in Peru. Subsequently, these 04 guidelines will be analyzed in detail to first verify the current situation in their management and from there establish feasibility criteria (political, social, administrative and effectiveness) that allow laying the foundations of the generation of real solution alternatives to the problems of the mining activity, in such a way that they can make possible the proposal of a MV by 2030 with real expectations of compliance, aligning its attributes with the 06 “Causes of the Public Problem” (loss of diversity deterioration of environmental quality, increased risks and impacts from natural and man-made hazards in a context of climate change, weak environmental governance, increased production processes of goods and services that are neither eco-efficient nor sustainable, and non-sustainable environmental behaviors of the community. citizenship) that establishes the new PNA to 2030. Finally, a discussion will be held on these guidelines that will serve as guidelines to establish the most important elements that contribute to the work of facing the challenges and requirements of the VM to 2030, emphasizing the effectiveness of its attributes that seek that the actions of the vision generate measurable impacts, in addition to the need to adapt it to the PNA by 2030 in a context and approach required for the systematization process that is required to account for the progress of the priority objectives of the policy in the monitoring and control stages ; which already has it structured with those responsible and compliance goals year after year until 2030.  El presente artículo busca establecer los lineamientos de gestión ambiental esenciales que se deben tener en cuenta para vincular los 05 atributos de la Visión de la Minería al 2030 (VM al 2030) con las alternativas de solución a las “Causas del Problema Público” que determinó la disminución de los bienes y servicios que proveen los ecosistemas que afectan el desarrollo de las personas y la sostenibilidad ambiental de la nueva Política Nacional del Ambiente al 2030 en el Perú (PNA al 2030) teniendo en cuenta los criterios de viabilidad política, social, administrativa y eficacia. Para ello proponemos 04 lineamientos de gestión que permitirán instaurar el puente necesario que haga viable una vinculación imperiosa entre ambos documentos, sobre todo la PNA al 2030, ya que es un documento normativo de obligatorio cumplimiento aprobado vía D.S. N° 023-2021-MINAM. Dichos lineamientos de gestión ambiental son los siguientes: el valor del recurso hídrico en la cadena productiva de la explotación minera, la reducción de pasivos ambientales mineros, una nueva estrategia para la erradicación de la minería ilegal en el Perú y la mejora de las relaciones comunitarias tanto para los nuevos proyectos mineros, así como de las operaciones mineras que están en ejecución en el Perú. Seguidamente, estos 04 lineamientos serán analizados de forma detallada para verificar en primer término cuál es la situación actual en la gestión de los mismos y a partir de allí establecer criterios de viabilidad (política, social, administrativa y eficacia) que permitan sentar las bases de la generación de alternativas de solución real a los problemas de la actividad minera, de tal forma que puedan hacer posible la propuesta de una VM al 2030 con expectativas reales de cumplimiento alineando sus atributos con las 06 “Causas del Problema Público” (pérdida de la diversidad biológica, deterioro de la calidad ambiental, incremento de riesgos e impactos ante peligros de origen natural y antrópicos en un contexto de cambio climático, débil gobernanza ambiental, aumento de procesos productivos de bienes y servicios no ecoeficientes ni sostenibles y comportamientos ambientales no sostenibles de la ciudadanía) que establece la nueva PNA al 2030. Finalmente, se realizará la discusión sobre estos lineamientos que servirán como directrices para establecer los elementos más importantes que aporten en el trabajo de enfrentar los retos y los requerimientos de la VM al 2030, enfatizando en la eficacia de sus atributos que busca que las acciones de la visión generen impactos medibles, además de la necesidad de adecuarla a la PNA al 2030 en un contexto y enfoque requerido al proceso de sistematización que se demanda para dar cuenta de los avances de los objetivos prioritarios de la política en las etapas de seguimiento y control; que ya la tiene estructurada con responsables y metas de cumplimiento año a año hasta el 2030

Factors associated with the intention to participate in COVID-19 vaccine clinical trials: A cross-sectional study in Peru

Objective: To evaluate the factors associated with the intention to participate in COVID-19 vaccine clinical trials in the Peruvian population. Methods: Cross-sectional study and secondary analysis of a database that involved Peruvian population during September 2020. The Poisson regression model was used to estimate the associated factors. Results: Data from 3231 individuals were analyzed, 44.1% of whom intended to participate in COVID-19 vaccine clinical trials. Factors associated with the outcome were being male (RPa: 1.25; 95% CI: 1.15–1.35), being from the highlands region (RPa: 1.18; 95% CI: 1.09–1.28) or jungle (RPa: 1.30; 95% CI: 1.15–1.47), having a relative that is a healthcare professional (PRa: 1.16; 95% CI: 1.06–1.28), using a medical source of information (PRa: 1.28; 95% CI: 1.17–1.41), and trusting in the possible effectiveness of vaccines (PRa: 1.40; 95% CI: 1.29–1.51). The main reason for not participating in the trial was the possibility of developing side effects (69.80%). Conclusion: There is an urgent need to generate a perception of safety in COVID-19 vaccine clinical trials, to increase the population's intention to participate in these studies, and to provide evidence-based information about the vaccine.Revisión por pare

Percepciones e intención de los padres de vacunar a sus hijos menores de 12 años contra la COVID-19: Estudio transversal en Perú

Objectives: To evaluate the perceptions and intention of parents to vaccinate their children under 12 years of age. Methodology: Analytical cross-sectional study based on an online survey that collected the parents’ perception on the risk of their children getting COVID-19, on the need of vaccination and on the development of adverse events related to the vaccine. We evaluated the factors associated with the intention to vaccinate through crude (cPR) and adjusted prevalence rates (aPR), with confidence interval of 95% (CI 95%) Results: 83.5% of respondents had the intention of vaccinating their children under 12 years of age. In the multivariate analysis, the factors associated with an decrease in the intention to vaccinate were to think that the vaccine is not necessary (aPR 0.65; 95% CI 0.44 – 0.94), that it would not protect (aPR: 0.14; 95% CI 0.03 – 0.63) , that it would not be safe (aPR: 0.80; 95% CI 0.70 – 0.92) and that it would cause long-term side effects (aPR: 0.92; 95% CI 0.85 – 1.00). On the other hand, living on the highlands or jungle was associated with an increase on the intention. Conclusions: In Peru, 16.5% of parents would not vaccinate their children under 12 years of age, because they perceive that the vaccine is not necessary and would not protect against COVID-19. In addition, they expressed concerns about the development of possible adverse events.Objetivos: Evaluar las percepciones e intención de los padres de vacunar a sus hijos menores de 12 años en Perú. Metodología: Estudio transversal analítico a partir de una encuesta en línea (25 de noviembre al 6 de diciembre del 2021) para padres de niños menores de 12 años que recopiló la percepción sobre el riesgo de contagio por COVID-19 en sus hijos, sobre la necesidad de vacunación y sobre los eventos adversos relacionados con la vacuna. Evaluamos los factores asociados a la intención de vacunación mediante razones de prevalencia crudas (RPc) y ajustadas (RPa) con intervalos de confianza al 95% (IC 95%). Resultados: El 83.5% de los padres tenían la intención de vacunar a sus hijos menores de 12 años. En el análisis multivariado, los factores asociados a una disminución de la intención de vacunación fueron pensar que la vacuna no es necesaria (RPa: 0.65; IC 95% 0.44 – 0,94), que no protegería (RPa: 0.14; IC 95% 0.03 – 0.63), que no sería segura (RPa: 0.80; IC 95% 0.70 – 0.92) y que ocasionaría efectos negativos a largo plazo (RPa: 0.92; IC 95% 0.85 – 1.00). Por otro lado, residir en la Selva (RPa: 1.09; IC 95%: 1.03 – 1.15) o en la Sierra (RPa: 1.06; IC 95%: 1.00 – 1.11) se asoció a una mayor prevalencia de intención. Conclusiones: En Perú, un 16.5% de padres no vacunaría a sus hijos menores de 12 años, ya que perciben que la vacuna no es necesaria y no protegería contra la COVID-19, además de tener la preocupación de posibles eventos adversos