Global Perspectives in AKI: Peru

Peru is a middle-income Latin American country with an estimated population of more than 31 million inhabitants.1 Although our country has experienced significant improvements in some social determinants of health, the main causes of death are still related to socioeconomic status, which means people with lower incomes have higher mortality rates because of less access to health care, education, basic services, and employment, among other aspects.1 There are other challenges in the Peruvian health system, such as its fragmented nature which makes it one of the most dysfunctional and unequal health systems in Latin America. For example, the Peruvian Ministry of Health (MINSA) covers 50% of the population through the Government health insurance, whereas approximately 20% of Peruvians have access to the Social Health Insurance (EsSalud).2 However, although the health system has improved in terms of health insurance outreach, it continues to be centralized and precarious and has structural and organizational problems that have an effect not only on health care coverage but also on its delivery and quality.2–5 In this context, along with the barriers to access basic health care services6 and the effects of climate change, the incidence of AKI is increasing in Peru and in other low- and middle-income countries.7 Despite the fact that AKI constitutes a public health burden of growing repercussion in Peru and surroundings, there are lack of public health data and policy, as well as suboptimal patient and provider education and clinical care. Herein, we describe important challenges and provide perspectives and possible solutions to improve AKI care in Peru

Vitamin B12, folate, and homocysteine in metabolic syndrome: a systematic review and meta-analysis

Background & aims: Metabolic syndrome (MetS) is associated with life-threatening conditions. Several studies have reported an association of vitamin B12, folic acid, or homocysteine (Hcy) levels with MetS. This systematic review and meta-analysis assessed the association of vitamin B12, folic acid, and Hcy levels with MetS. Methods: PubMed, Scopus, Embase, Ovid/Medline, and Web of Science were searched up to February 13, 2023. Cross-sectional, case-control, or cohort studies were included. A random-effects model was performed using the DerSimonian and Laird method to estimate the between-study variance. Effect measures were expressed as odds ratios (OR) with their corresponding 95% confidence intervals (95% CI). Between-study heterogeneity was evaluated using Cochran’s Q test and the I2 statistic. Results: Sixty-six articles (n = 87,988 patients) were included. Higher vitamin B12 levels were inversely associated with MetS (OR = 0.87; 95% CI: 0.81–0.93; p < 0.01; I2 = 90%). Higher Hcy levels were associated with MetS (OR = 1.19; 95% CI: 1.14–1.24; p < 0.01; I2 = 90%). Folate levels were not associated with MetS (OR = 0.83; 95% CI: 0.66–1.03; p = 0.09; I2 = 90%). Conclusion: Higher vitamin B12 levels were inversely associated with MetS, whereas higher Hcy levels were associated with MetS. Studies assessing the pathways underlying this association are requiredRevisión por pare

Self-Medication Practices, Use of Brand-Name, and Over-the-Counter Medicines by Peruvian Older Adults

Background Older adults are a particularly vulnerable group to drug use and self-medication. The aim of the study was to evaluate self-medication as a factor associated with the purchase of brand-name and over-the-counter (OTC) drugs in older adults in Peru. Methods A secondary analysis was performed using an analytical cross-sectional design of data from a nationally representative survey from 2014 to 2016. The exposure variable was self-medication, defined as the purchase of medicines without a prescription. The dependent variables were purchases of brand-name and OTC drugs, both as a dichotomous response (yes/no). Information of sociodemographic variables, health insurance, and the types of drugs purchased by the participants was collected. Crude prevalence ratios (PR) were calculated and adjusted using generalized linear models of the Poisson family, considering the complex sample of the survey. Results In this study, 1,115 respondents were evaluated, with a mean age of 63.8 years and a male proportion of 48.2%. The prevalence of self-medication was 66.6%, while the proportions of purchases of brand-name and OTC drugs were 62.4% and 23.6%, respectively. The adjusted Poisson regression analysis revealed an association between self-medication and the purchase of brand-name drugs (adjusted PR [aPR]=1.09; 95% confidence interval [CI]: 1.01–1.19). Likewise, self-medication was associated with the purchase of OTC medications (aPR=1.97; 95%CI: 1.55–2.51). Conclusions This study evidenced a high prevalence of self-medication in Peruvian older adults. Two-thirds of the surveyed people bought brand-name drugs, whereas one-quarter bought OTC drugs. Self-medication was associated with a greater likelihood of buying brand-name and OTC drugs

Principios éticos en el uso de las bases de datos en salud para la investigación

The generation of multiple personal and health data occurs within various processes related to health care services, health surveillance, scientific research, among others. These data can serve as sources of information for monitoring indicators related to individual and community health conditions, as well as for conducting research that can be used for health decision-making and the generation of public policies. However, it is necessary that the use of these health databases be under strict methodological and ethical parameters, so, in this article, we analyze general and methodological aspects of the use of health databases for research. We also identify the benefits, risks, ethical concerns, and recommendations for the appropriate use of health databases.La generación de múltiples datos personales y de salud se da dentro de diversos procesos relacionados a la atención en los servicios de salud, en la vigilancia sanitaria, en la investigación científica, entre otros. Estos datos pueden servir como fuentes de información para el seguimiento de los indicadores relacionados a las condiciones de salud individual y comunitaria, así como para realizar investigaciones que sirvan para la toma de decisiones en salud y la generación de políticas públicas. Sin embargo, es necesario que el uso de estas bases de datos de salud sea bajo estrictos parámetros metodológicos y éticos, por lo que, en este artículo, analizamos aspectos generales y metodológicos del uso de bases de datos en salud para la investigación. Así mismo, identificamos los beneficios, los riesgos, las preocupaciones éticas y recomendaciones para el uso adecuado de bases de datos en salud

Association between self-medication with antibiotics and purchase of brand-name drugs: Analysis of a national survey in Peru

Objectives To determine the association between self-medication with antibiotics (SMA) and purchase of brand-name drugs in Peru. Methods A secondary analysis was conducted using a nationally representative survey from 2014 to 2016. The exposure variable was self-medication (SM), which is defined as the purchase of drugs for self-administration without a medical prescription. The study outcome was the purchase of brand-name drugs (yes/no). Sociodemographic variables, such as health insurance and type of institution, were considered as confounders. To assess the association between SMA and the purchase of brand-name drugs, the crude prevalence ratios (cPR) and adjusted prevalence ratios (aPR) were calculated with their confidence intervals at 95% (95% CI) using a Poisson-type generalized linear model and considering the complex survey design. Key findings A total of 1862 participants were analysed; 54.4% of the participants were women with a mean age of 39.3 years. The prevalence rate of SMA was 54.3%, whereas that of the purchase of brand-name drugs was 55.3%. The adjusted Poisson regression analysis showed an association between SMA and the purchase of brand-name drugs (aPR = 1.28; 95% CI: 1.18–1.37; P < 0.001). Conclusions It was found that 5 of 10 respondents SMA. Approximately 6 of 10 respondents that SMA used brand-name drugs. SMA is associated with a higher probability of purchasing brand-name drugs

Prognostic factors and outcome of community-acquired pneumonia in hospitalized adult patients Estudio multicéntrico de factores pronósticos en adultos hospitalizados por neumonía adquirida en la comunidad

Background: Severity assessment of community-acquired pneumonia (CAP) patients allows the clinician to decide the place of management and guide empirical antimicrobial treatment. Aim: To assess admission prognostic factors and outcome of CAP in immunocompetent adult patients hospitalized in 21 medical centers in Chile. Material and methods: Prospective evaluation of non immunocompromised adults with CAP admitted to 21 Chilean hospitals between July and August, 1999. All patients were assessed on admission and followed until discharge or death. Results: During the study period, 1,194 patients (aged 68±17 years, 573 males) were evaluated. Seventy two percent had an underlying disease (especially chronic cardiovascular, neurological, respiratory diseases and diabetes mellitus), and 90% were treated with β-lactamic agents (especially a third generation cephalosporin or penicillin). Mean hospital length of stay was 11±9 days, 10% were admitted to Intermediate Care or Intensive Care Units (

Compositional shifts of alpine plant communities across the high Andes.

Climate change is transforming mountain summit plant communities worldwide,but we know little about such changes in the High Andes. Understanding large-scale patterns of vegetation changes across the Andes, and the factors driving these changes, is fundamental to predicting the effects of global warming. We assessed trends in vegetation cover, species richness (SR) and community-level thermal niches (CTN) and tested whether they are explained by summits´ climatic conditions and soil temperature trends. Using permanent vegetation plots placed on 45 mountain summits and soil temperature loggers situated along a ~6800 km N-S gradient, we measured species and their relative percentage cover and estimated CTN in two surveys (intervals between 5 and 8 years). We then estimated the annual rate of changes for the three variables and used generalized linear models to assess their relationship with annual precipitation, the minimum air temperatures of each summit and rates of change in the locally recorded soil temperatures. Over time, there was an average loss of vegetation cover (mean = −0.26%/yr), and a gain in SR across summits (mean = 0.38 species m2/yr), but most summits had significant increases in SR and vegetation cover. Changes in SR were positively related to minimum air temperature and soil temperature rate of change. Most plant communities experienced shifts in their composition by including greater abundances of species with broader thermal niches and higher optima. However, the measured changes in soil temperature did not explain the observed changes in CTN. Main conclusions: High Andean vegetation is changing in cover and SR and is shifting towards species with wider thermal niche breadths. The weak relationship with soil temperature trends could have resulted from the short study period that only marginally captures changes in vegetation through time.Fil: Cuesta, F.. Universidad de Las Américas.; EcuadorFil: Carilla, Julieta. Universidad Nacional de Tucumán. Instituto de Ecología Regional. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Ecología Regional; ArgentinaFil: LLambí, L. D.. Universidad de los Andes; ColombiaFil: Muriel, P.. Pontificia Universidad Católica del Ecuador; EcuadorFil: Lencinas, María Vanessa. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Austral de Investigaciones Científicas; ArgentinaFil: Meneses, R. I.. Universidad Católica del Norte; ChileFil: Feeley, K. J.. University of Miami; Estados UnidosFil: Pauli, H.. University Of Natural Resources And Life Sciences (boku);Fil: Aguirre, N.. Universidad Nacional de Loja; EcuadorFil: Beck, S.. No especifíca;Fil: Bernardi, A.. Universidad de Las Américas; Ecuador. Pontificia Universidad Católica del Ecuador; EcuadorFil: Cuello, S.. Universidad Nacional de Tucumán. Instituto de Ecología Regional. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Ecología Regional; ArgentinaFil: Duchicela, S. A.. Universidad de Las Américas; EcuadorFil: Eguiguren, P.. Universidad Nacional de Loja; EcuadorFil: Gamez, L. E.. Universidad de los Andes; ColombiaFil: Halloy, S.. No especifíca;Fil: Hudson, L.. No especifíca;Fil: Jaramillo, R.. Pontificia Universidad Católica del Ecuador; EcuadorFil: Peri, Pablo Luis. Universidad Nacional de la Patagonia Austral; Argentina. Instituto Nacional de Tecnología Agropecuaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ramírez, L .A.. Universidad de los Andes; ColombiaFil: Rosero Añazco, P.. Universidad de Las Américas; EcuadorFil: Thompson, N.. No especifíca;Fil: Yager, K.. State University of New York. Stony Brook University; Estados UnidosFil: Tovar, C.. No especifíca