Altitude and excess mortality during COVID-19 pandemic in Peru

We have read with interest the short communication published by Segovia-Juarez et al., 2020 in Respiratory Physiology & Neurobiology establishing that high altitude reduces the infection rate of COVID-19 but not the case fatality rate in the Peruvian setting. We support this hypothesis, however there could be an important number of under registered deaths on account of a low rate of diagnostic tests performed per inhabitant and mostly in symptomatic patients (Pasquariello and Stranges, 2020).Revisión por pare

Una mirada prospectiva de la industria Risaraldense camino a la industria 4.0 : plan tecnológico 2020–2030 Centro de Diseño e Innovación Tecnológico Industrial

Se presenta el plan tecnológico del Centro de Diseño e Innovación Tecnológico Industrial del SENA para la vigencia 2002 - 2030. Comprende el análisis y diagnóstico de la industria risaraldense, sus necesidades y tendencias, con enfoque a la industria 4.0. Se provee información para: identificar tecnologías y ocupaciones emergentes que permitan anticipar la definición de perfiles de instructores, determinar requerimientos de modernización de infraestructura física y tecnológica del Centro de formación, actualizar, crear o eliminar programas de formación, establecer el tipo de formación, servicios tecnológicos e innovación que el centro de formación ofrecerá en un horizonte de 10 años e identificar los proyectos y actores estratégicos para el centro de formación.The technological plan of the SENA Industrial Technological Design and Innovation Center for the period 2002-2030 is presented. It includes the analysis and diagnosis of the Risaralda industry, its needs and trends, with a focus on industry 4.0. Information is provided to: identify emerging technologies and occupations that allow anticipating the definition of instructor profiles, determine modernization requirements of the physical and technological infrastructure of the Training Center, update, create or eliminate training programs, establish the type of training, services technology and innovation that the training center will offer over a 10-year horizon and identify projects and strategic actors for the training center.Fase I: análisis y diagnóstico estratégico -- Análisis externo del centro de formación -- Análisis interno del centro de formación -- Seguimiento al plan tecnológico inmediatamente anterior -- Cruce DOFA -- Vigilancia científico -tecnológica y competitiva especialidad energía eléctrica -- Vigilancia científico -tecnológica y competitiva especialidad electrónica y automatización -- Vigilancia científico -tecnológica y competitiva especialidad Mecánica Industrial -- Vigilancia científico -tecnológica y competitiva especialidad Informática, diseño y desarrollo de software -- Vigilancia científico -tecnológica y competitiva especialidad materiales para la industria -- Vigilancia científico -tecnológica y competitiva especialidad Automotor -- Vigilancia científico -tecnológica y competitiva especialidad Textil, confección y diseño -- Vigilancia científico -tecnológica y competitiva especialidad construcción e infraestructura -- Vigilancia científico -tecnológica y competitiva servicios tecnológicos -- Fase II: formulación estratégica -- Mapa de trayectoria tecnológica -- Validación con expertos -- Construcción de escenarios -- Formulación estratégica -- Métodos prospectivos utilizados -- Formulación estratégica -- Fase III: recomendaciones estratégicas -- Recomendaciones estratégicas especialidad energía eléctrica -- Recomendaciones estratégicas especialidad electrónica y automatización -- Recomendaciones estratégicas especialidad mecánica industrial -- Recomendaciones estratégicas especialidad Informática, diseño y desarrollo de software -- Recomendaciones estratégicas especialidad materiales para la industria -- Recomendaciones estratégicas especialidad Automotor -- Recomendaciones estratégicas especialidad Textil, confección y diseño -- Recomendaciones estratégicas especialidad construcción e infraestructura -- Recomendaciones estratégicas Sennova -- Servicios tecnológicos -- Introducción e información general -- Planteamiento de la necesidad u oportunidad -- Objetivos -- Desarrollo de la vigilancia científico-tecnológica -- Resultados de vigilancia tecnológica con base en análisis de patentes -- Identificación de tecnologías y sublíneas tecnológicas -- Comportamiento de los aceros -- Vigilancia normativa y regulatoria -- Vigilancia tecnológica -- Vigilancia competitiva -- Vigilancia comercial -- Resultados -- Conclusiones y recomendacionesna556 página

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Leukocytoclastic vasculitis associated with nontyphoidal Salmonella in a patient infected with human immunodeficiency virus

A 27-year-old Peruvian woman living with human immunodeficiency virus (HIV) in clinical stage B3 and not on antiretroviral therapy presented with a ten-day history of fever, chills, night sweats and a two-day history of skin lesions. On physical examination, several erythematous-purplish lesions were found on the face and legs. Meningococcal infection was suspected and ceftriaxone was started. Blood culture grew nontyphoidal Salmonella enterica. A biopsy of the skin lesions showed leukocytoclastic vasculitis (LCV); therefore, corticosteroids were added. After two weeks of antibiotic and corticosteroid treatment, the lesions had resolved, but they recurred two days after treatment with prednisone was stopped. Corticosteroids and combination antiretroviral therapy were started simultaneously and the lesions resolved without recurrence. HIV infection has been associated with higher rates of skin lesions in salmonellosis. LCV has been described both in the setting of HIV infection and salmonellosis. However, our review of the literature found no previous cases of LCV in concurrent HIV and salmonellosis.Revisión por paresRevisión por pare

Associated factors to depression diagnosed during incarceration in Peruvian male prisoners: a sub-analysis of the national census of prison population

Purpose: Depression has become a major health concern, particularly in developing countries. This disorder is highly prevalent among certain vulnerable populations, such as prisoners. In Peru, prisons are overcrowded, and the health of prisoners is neglected. Thus, this study aims to estimate the prevalence of depression diagnosed during incarceration in male inmates from all Peruvian prisons and assess its associated factors. Design/methodology/approach: A cross-sectional study was conducted based on the secondary data analysis of the National Census of Prison Population 2016 in Peru. This study included records of prisoners who reported whether they were diagnosed with depression by a health-care professional after admission into the prisons. Descriptive, bivariate and multivariable analyses were performed. Findings: Of the 63,312 prisoners included in this study, 1,007 reported an in-prison diagnosis of depression by a health-care professional, which represents a prevalence of 1.59%. Substance use disorder (adjusted prevalence ratio [aPR] 3.10; 95% confidence interval [CI]: 1.91–5.03), hypertension (aPR 7.20; 95% CI: 6.28–8.24) and previous discrimination (aPR 1.97; 95% CI: 1.62–2.40) were strongly associated with depression, even when adjusting for multiple confounders. Other directly associated variables were, for example, violence during childhood, infrequent visits in prison and diabetes. Originality/value: The right of prisoners to adequate health care is being neglected in Peru. Mental health is a cornerstone of health quality. Acknowledging which factors are associated with depression in prison is important to implement strategies to improve the mental health of prisoners.Revisión por pare

Lateral amyotrophic sclerosis-like onset after combined antiretroviral treatment initiation

Motor neuron disease (MND) have an incidence of 2 in 100 000 persons, resulting in the death of 1 in every 500 people affected. The most common disease in MND spectrum is amyotrophic lateral sclerosis (ALS). We describe the case of an ALS-like syndrome in a HIV patient.This case report presents a 38 years old male from Peru with HIV who after 2 months of combined antiretroviral treatment (cART) initiation was admitted to the hospital for spastic paraplegia. On his first admission, rapid plasma reagent (RPR) was positive and he was treated for neurosyphilis and discharged. Nevertheless, one month after, he was admitted for the second time because paraplegia persisted. Laboratory tests, electromyography and imaging were performed, and ALS was diagnosed. Normally, HIV treated patient with ALS tend to have a better prognosis, however this was not the case.In this case report, we discuss possible association between ALS and immune reconstitution inflammatory syndrome in HIV patients