Rare mutation of the PPOX gene in a patient with Porphyria Variegate: a case report in Peru

Introduction: Variegate porphyria (VP) is a rare disease, resulting from mutation of the protoporphyrinogen oxidase (PPOX) enzyme gene, and it is characterized by cutaneous manifestations and acute neuro-visceral symptoms. Case report: We describe the case of a 21-year-old woman from Peruvian highlands. The patient came to the emergency department for abdominal pain, quadriparesis and reddish urine. The patient also presented the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), motor neuropathy and respiratory failure. These clinical features were diagnosed as consequence of a porphyria crisis. The specific diagnosis was made with an elevated urinary porphobilinogen level (185.7 mg/24hours) and genetic analysis, which showed a rare pathogenic variant of the PPOX gene (nucleotide change: c.78C>A and protein change: p.Cys26*). The patient required intensive care until the administration of specific treatment with hemin. Conclusion: We report a case of VP with a pathogenic variant in the PPOX gene.Introducción: La porfiria variegada (PV) es una enfermedad rara, resultante de la mutación del gen de la enzima protoporfirinógeno oxidasa (PPOX), se caracteriza por manifestaciones cutáneas y síntomas neuroviscerales agudos. Reporte de caso: Describimos el caso de una mujer de 21 años de la sierra peruana. La paciente acudió al servicio de urgencias por dolor abdominal, cuadriparesia y orina rojiza. La paciente también presentó el síndrome de secreción inapropiada de hormona antidiurética (SIADH), neuropatía motora e insuficiencia respiratoria. Estas características clínicas fueron diagnosticadas como consecuencia de una crisis de porfiria. El diagnóstico específico se realizó con un nivel elevado de porfobilinógeno en orina (185,7 mg/24horas) y el análisis genético, evidenció un rara variante patogénica del gen PPOX (cambio de nucleótido: c.78C>A y consecuentemente cambio de proteína: p.Cys26*). La paciente requirió cuidados intensivos hasta la administración de un tratamiento específico con hemina. Conclusion: Reportamos un caso de VP con una rara variante mutagénica en el gen PPOX

Prevalence and factors associated with not receiving the booster dose of the COVID-19 vaccine in adults in Latin America and the Caribbean

"Background: Booster doses have been described as effective in reducing hospitalizations and deaths from the new variants. However, its coverage is heterogeneous in Latin America and the Caribbean (LAC), one of the regions most affected by the pandemic. We aimed to assess the factors associated with not receiving a coronavirus disease 2019 (COVID-19) vaccine booster dose in adults from LAC. Methods: We analyzed a secondary database compiled by the University of Maryland and Facebook assessing the global impact of COVID-19. We included Facebook users over 18 years of age who resided in LAC and responded to the survey between February 13, 2022, and March 14, 2022. We evaluated sociodemographic characteristics, comorbidities, food, and economic insecurity, mental health, and vaccination-related practices. We calculated crude (cPR) and adjusted (aPR) prevalence ratios with their respective 95% confidence intervals (95%CI). Results: The sample included 154,841 adults from 20 LAC countries. 33.7% (n = 46,459) reported not receiving the COVID-19 booster vaccine. Being under 75 years old, having a college, high school, pre-university, primary, or lower education, having no or 1 to 2 comorbidities, living in a town, having food insecurity, depressive symptoms, and having had COVID-19, were associated with a higher prevalence of not receiving the booster dose. In contrast, being female or non-binary and having anxiety symptoms were associated with a lower prevalence of not receiving the booster dose. Conclusions: Approximately three out of 10 adults surveyed in LAC reported not having received the booster vaccine. Authorities must design campaigns that promote receiving a booster dose considering the factors found.

Cursos en línea abiertos y masivos: oportunidad de aprendizaje sobre salud global en Latinoamérica

Introducción. Los cursos en línea, masivos y abiertos, brindan la oportunidad de formar profesionales e investigadores en Latinoamérica sobre salud global. Objetivos. Determinar la oferta global de los cursos en línea, masivos y abiertos, sobre salud global y conocer las características de su contenido. Materiales y métodos. Se examinaron las plataformas especializadas en cursos en línea, masivos y abiertos, para recopilar aquellos sobre salud global. La búsqueda no tuvo restricción de tiempo y se realizó por última vez en noviembre de 2021. La estrategia de búsqueda solo incluyó el descriptor “global health”. Posteriormente, se obtuvieron las características del curso, su contenido y el dominio abordado de salud global. Estos datos fueron analizados descriptivamente, y se reportaron frecuencias absolutas y relativas. Resultados. La estrategia de búsqueda identificó 4.724 cursos en línea, masivos y abiertos. De ellos, solo 92 estaban relacionados con salud global. La mayoría de estos cursos (n=44; 47,8 %) se ofrecieron mediante la plataforma Coursera. Más de la mitad de los cursos (n=50; 54,4 %) fueron realizados por instituciones de Estados Unidos y en idioma inglés (n=90; 97,8 %). La mayor parte de los cursos se centró en la “globalización de la salud y la asistencia sanitaria” (n=24; 26,1 %), seguido de los dominios “fortalecimiento de capacidades” (n=16; 17,4 %), “carga global de enfermedad” y “determinantes sociales y ambientales de la salud” (n=15; 16,3 %). Conclusiones. Se encontró una importante oferta de cursos en línea, masivos y abiertos, sobre salud global. Estos cursos abordaron las competencias de la salud global que se requieren para los profesionales sanitarios

Prevalence and factors associated with adolescent pregnancy among sexually active adolescent girls in Peru: Evidence from Demographic and Family Health Survey, 2015-2019 [version 2; peer review: 1 approved, 2 approved with reservations]

Background: The objective of this study was to estimate the prevalence of adolescent pregnancy among sexually active adolescents, and identify the factors associated with this problem. Methods: A population-based analytical cross-sectional study was conducted using pooled data from the Demographic and Family Health Surveys of Peru, 2015-2019. A total sample of 8850 adolescent girls aged 12 to 19 years who reported a history of sexual intercourse were included. To identify factors related to adolescent pregnancy, the study employed adjusted prevalence ratios (aPR) with 95% confidence intervals (95% CI). The aPR were obtained from a multivariable logistic regression model. Results: The prevalence of adolescent pregnancy among sexually active adolescents in Peru was 30.9% (95%CI: 29.4–32.4%). In the multivariable analysis; being 17-19 years (aPR: 1.48; 95%CI :1.33–1.64), being married or cohabitant (aPR: 4.01; 95%CI: 3.48–4.61) and belonging to the Quechua ethnicity group (aPR: 1.16; 95%CI: 1.07–1.25), were associated with a higher prevalence. Conversely, the following factors were associated with a lower prevalence of pregnancy: being employed (aPR: 0.81; 95%CI: 0.76–0.86), being currently studying (aPR: 0.43; 95%CI: 0.38–0.49), belonging to the second (aPR: 0.91; 95%CI: 0.85–0.97), third (aPR: 0.81; 95%CI: 0.74–0.89), fourth (aPR: 0.79; 95%CI: 0.69–0.91) and fifth (aPR: 0.59; 95%CI: 0.47–0.75) wealth quintile, initiating sexual relations in middle adolescente (aPR: 0.76; 95%CI: 0.69–0.83) or  late adolescence (aPR: 0.40; 95%CI: 0.35–0.46), perceiving a future pregnancy as a problem (aPR: 0.77; 95%CI: 0.72–0.83) and having knowledge of the moment in the cycle when pregnancy can occur (aPR: 0.84; 95%CI: 0.77–0.92) Conclusions: Approximately three out of ten adolescents who initiated a sexual life had at least one pregnancy. Age, marital status, employment, education, wealth, ethnicity, age at first intercourse, knowledge of when in the cycle she may become pregnant, and perception of future pregnancy were associated with adolescent pregnanc

Producción científica en Scopus de los institutos de salud especializados públicos de Perú, 2010-2022

Objective: To evaluate the scientific production of Peruvian health institutes in Scopus, 2010-2022. Methods: We conducted a Bibliometric study in Scopus during September 2022, in 14 public specialized health institutes of Peru. We included original studies with at least one author from one of the institutes. Results: The institutes included published between 0 and 347 original articles (H-index between 0 and 51). The institutes in the city of Lima were the ones with the highest production. In the seven institutes with the highest production, the percentage of articles with a corresponding author from the institute evaluated ranged from 22.3% to 36.7%, and the percentage of studies that reported being financed by the institute ranged from 0% to 11.6%. Conclusion: The scientific production of the evaluated institutes was heterogeneous, with a predominance of those located in Lima. The institutes rarely participated in the financing of the published studies.Objetivo: Evaluar la producción científica de los institutos de salud de Perú en Scopus, 2010-2022. Métodos: Estudio bibliométrico realizado en Scopus durante septiembre del 2022, en 14 institutos de salud especializados públicos de Perú. Incluimos estudios originales que tuvieran al menos un autor de alguno de los institutos. Resultados: Los institutos incluidos publicaron entre 0 y 347 artículos originales (H-index entre 0 y 51). Los institutos de la ciudad de Lima fueron los que tuvieron mayor producción. En los siete institutos con mayor producción, el porcentaje de artículos con autor corresponsal del instituto evaluado varió entre 22.3% y 36.7%, y el porcentaje de estudios que declararon ser financiados por el instituto varió entre 0% y 11.6%. Conclusión: La producción científica de los institutos evaluados fue heterogénea, a predominio de aquellos ubicados en Lima. Los institutos raramente participaron en el financiamiento de los estudios publicados

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

Análisis exploratorio de las tendencias de búsqueda en internet durante el brote de la COVID-19

Coronavirus disease 2019 has put the world in a health emergency. Searching for information on the Internet largely reflects people's interest in this pandemic. Objective: Conduct an exploratory analysis of Internet search trends during the 2019 coronavirus disease outbreak. Methods: Google Trends was used to provide data on the relative volume of Google searches for terms related to 2019 coronavirus disease. The evaluation period was from January 01 to May 17, 2020. Results: The search term used to know this pandemic was “coronavirus”, the most searched symptom was “fever”, followed by “sore throat” and “cough”, in addition, the interest of users to know the transmission routes of the acute respiratory syndrome coronavirus 2. As for preventive measures, the most searched term was “stay home”, followed by “facial masks”, “social distancing” and “washing hands”. Conclusions: The results confirmed interest in COVID-19 via Internet. Using information from people's Internet search interest could help formulate health policies to better control the 2019 coronavirus disease outbreak

Asociación entre la pandemia de covid-19 y las tendencias de búsqueda en internet en Latino América

La enfermedad COVID-19 ha puesto en emergencia sanitaria al mundo. La búsqueda de información a través de internet refleja en gran medida el interés de las personas acerca de esta pandemia. El presente estudio tuvo como objetivo determinar la asociación entre el volumen relativo de búsqueda del término combinado [coronavirus + covid-19 + "nuevo coronavirus" + covid + SARS-CoV-2] y el número de casos confirmados y de muertes diarias por la COVID-19. Se utilizó Google TrendsTM para proporcionar datos sobre el volumen relativo de búsqueda en Google de los términos seleccionados y compararlos con el número de casos confirmados y de muertes diarias por la COVID-19 en los 10 países más afectados de Latinoamérica, reportados por el panel de control de la Organización Mundial de la Salud. El período de evaluación fue del 01 de enero al 14 de junio del año 2020. Para obtener la asociación de las variables cuantitativas se utilizó el coeficiente de correlación de Spearman, con un nivel de significancia (p≤ 0,05). Se encontró una correlación positiva y significativa (p< 0,001) entre el volumen relativo de búsqueda del término combinado con el número de casos confirmados y de muertes cada día por la COVID-19. Por lo tanto, se puede utilizar un modelo basado en el interés de búsqueda en internet para predecir el desarrollo y el momento pico del brote de la COVID-19

Association between inadequate prenatal care and low birth weight of newborns in Peru: Evidence from a peruvian demographic and health survey

Objective: To assess the association between inadequate prenatal care (IPNC) and Low birth weight (LBW) in newborns of singleton gestation mothers in Peru. Methods: We performed a secondary analysis of data from the 2019 Demographic and Health Survey. We included a total of 10,186 women of reproductive age (15 – 49 years) who had given birth to a singleton child in the last 5 years. The dependent variable was LBW (< 2500 g). The independent variables were IPNC (inadequate: when at least one of the IPNC components was absent [number of PNC visits ≥ 6, first PNC visit during the first trimester, compliance with PNC visit contents, and PNC visits provided by trained health personnel]) and each of its components. We evaluated the association using logistic regression models to estimate crude odds ratios and adjusted odds ratios (aOR) and their respective 95% confidence intervals (95% CI). Results: We found that approximately six out of 100 live births had LBW and that seven out of 10 women had received IPNC. We observed that receiving IPNC (aOR: 1.39; 95% CI: 1.09 – 1.77) and having less than six prenatal control visits (aOR: 3.20; 95% CI: 2.48 – 4.13) were associated with higher odds of LBW regardless of the mother's age, educational level, occupation, wealth, region, rural origin, ethnicity, sex of the newborns, and place of delivery. While, regarding to the other PNC components, first prenatal control in the first trimester (aOR: 0.99; 95% CI: 0.76 – 1.28) and compliance with prenatal control contents (aOR: 1.07; 95% CI: 0.86 – 1.34), they were associated with lower and higher odds of LBW, respectively, regardless of the same adjustment variables, but it was not statistically significant. Conclusions: IPNC and having less than six PNC visits were associated with higher odds of LBW. Therefore, it is very important to implement strategies that ensure access to quality prenatal care is necessary to reduce the consequences of LBW

Association between intimate partner violence and pregnancy intention: evidence from the Peruvian demographic and health survey

Abstract Background Intimate partner violence (IPV) in Peru represents a significant public health challenge. IPV can influence women’s reproductive and social behaviors, undermining fertility control, and exacerbating unintended pregnancies. Our objective was to assess the association between IPV and pregnancy intention among Peruvian women of reproductive age. Methods We conducted a secondary analysis of Peru’s 2020 Demographic and Family Health Survey data. The independent variable in this study was IPV against women, which includes psychological IPV, sexual IPV, and physical IPV. If a respondent experienced any of these three forms of IPV, the IPV variable was labeled as “yes”; if none were present, it was labeled as “no”. The dependent variable was pregnancy intention (no vs. yes). We utilized a generalized linear model (GLM) from the Poisson family with a log link function to assess the relationship between IPV occurrences (total and each IPV type) and pregnancy intention. We report crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI). Results We analyzed data from 8466 women aged 15 to 49. The prevalence of any IPV was 49.6% (psychological IPV: 45.8%; physical IPV: 22.2%; and sexual IPV: 4.3%). Exposure to physical IPV (aPR: 1.05; 95% CI: 1.03–1.07), psychological IPV (aPR: 1.04; 95% CI: 1.02–1.06), and sexual IPV (aPR: 1.09; 95% CI: 1.04–1.13), as well as a history of any IPV (aPR: 1.05; 95% CI: 1.02–1.07), were associated with a higher probability of not intending to become pregnant. This association persisted after adjusting for confounders like age, marital status, educational attainment, education level of the child’s father, place of residence, wealth, ethnicity, and parity. Conclusion One in two Peruvian women reported experiencing IPV. An association was observed between IPV exposure and a higher probability of not holding an intention to become pregnant