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

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

Factors associated with frequent marijuana consumption in young people before admission to juvenile detention centers in Peru

Marijuana is the most widely used illicit drug in the world, especially among young people. This study is relevant to policy makers because it expands the knowledge regarding drug use in vulnerable youth, al-lowing health authorities to reduce marijuana consumption via educa-tional, family, and governmental strategies and policies. The objective of this study was to determine the prevalence of frequent marijuana consumption and its associated factors in young people before admission to juvenile detention centers in Peru. The data was taken from the 2016 National Population Census of the Youth Diagnostic and Rehabilitation Centers in Peru. The final sample was made up of 1,848 people with ages between 14 and 22 years old, with a median age of 17 (95.6% males). The variable frequent marijuana consumption was de-fined as the use of marijuana at least once a week, prior to entering the center. The main factors associated with frequent marijuana use were male sex, running away from home before the age of 15, physi-cal abuse during childhood, having a family member who consumed alcohol or drugs frequently, and the presence of criminal gangs in the housing area. Additionally, it was found that living with parents up to a specific critical age decreases the probability of frequent use of marijuana in young people. These results could aid the development of strategies and public policies that help prevent the consumption of marijuana and other drugs from an early age.Revisión por pare

Associated factors to non-use of health care services by LGBTI Peruvian population. Analysis of the First Virtual Survey for LGBTI Population, 2017

Introducción: la población LGBTI busca atención médica con menor frecuencia y en etapas de enfermedad más avanzadas que la población general. Objetivos: identificar los factores asociados a la falta de búsqueda de atención médica en la población LGBTI en Perú en 2017. Metodología: se realizó un estudio observacional transversal analítico de fuente secundaria usando los datos de la Primera Encuesta Virtual para Personas LGBTI, 2017 en Perú. Se elaboró un modelo de regresión de Poisson con varianza robusta para estimar las razones de prevalencias cruda y ajustada. Resultados: se incluyeron 5 646 participantes en el estudio. El 15.85% no buscó atención médica. El 74.04% vivía en Lima y Callao. El 29.84% no contaba con seguro de salud, mientras que el 46.42% refirió problemas de salud mental. Se encontró que la falta de búsqueda de atención médica fue más frecuente entre quienes viven en la región Centro, comparado con Lima (RP: 1.38, IC95%: 1.10-1.74, p = 0.006); quienes refirieron problemas de salud mental, comparado con tener problemas relacionados a enfermedades crónicas (RP: 8.81, IC95%: 6.10-12.71, p < 0.001); y los que no pueden expresar su sexualidad sin temor (RP: 1.23, IC95%: 1.08-1.39, p = 0.001). Conclusión: la falta de búsqueda de atención médica entre las personas LGBTI se asoció a vivir en la región Centro, padecer algún problema de salud mental y no poder expresar la sexualidad sin temor.Background: LGBTI population use health care services less frequently and in more severe disease stages than general population. Aim: to describe factors associated with non-use of health care services by LGBTI population in Peru in 2017. Methods: we performed a cross-sectional analytical study using data from the First Virtual Survey for LGBTI Population, 2017 in Peru. We designed a Possion regression model with robust variance to estimate the crude and adjusted prevalence ratio. Results: we included 5 646 participants. 15.85% did not use health care services. 74.04% lived in Lima and Callao. 29.84% did not have any health insurance, while 46.42% referred mental health problems. The outcome was more frequent in participants that came from the Central region of Peru (PR: 1.38, CI95%: 1.10-1.74, p 0.006); those who referred mental health problems (PR: 8.81, CI95%: 6.10-12.71, p < 0.001); and in those who felt they could not express their sexuality without fear (PR: 1.23, CI95%: 1.08-1.39, p 0.001). Conclusion: non-use of health care services by LGBTI Peruvian population was associated with living in the Central region of Peru, having mental health problems and not being able to express one’s sexuality without fear.Tesi

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

Unmasked immune reconstitution inflammatory syndrome towards B-cell non-Hodgkin lymphoma during treatment of esophageal actinomycosis in a patient with advanced HIV: a case report

Background: Actinomycosis is an unusual chronic bacterial infection, even rarer in people living with HIV. It is not considered an AIDS-defining disease. However, the role in co-presentation or overlap with other opportunistic conditions of advanced HIV is unknown. Case presentation: A 49-year-old Peruvian male presented with a 4-month history of dysphagia, odynophagia, hyporexia and wasting. He underwent an upper digestive endoscopy, in which ulcers with a necrotic center were observed, therefore, the initial diagnostic assumption was esophageal cancer. Subsequent pathology report excluded neoplasms and confirmed the diagnosis of actinomycosis. Serology for human immunodeficiency virus was requested, yielding a positive result. Antimicrobial treatment with amoxicillin and antiretroviral therapy were indicated, with slow clinical improvement. After 4 months, epigastric discomfort presented, for which a new upper digestive endoscopy was performed, revealing a deep gastric ulcer, which was compatible with diffuse large B-cell non-Hodgkin lymphoma. Conclusion: Esophageal actinomycosis in people living with HIV is very rare. We suggest HIV-associated immunosuppression is not enough to allow for actinomycosis to develop, and masked underlying entities should be sought. The existence of such entities in people living with HIV should raise awareness of the possibility of unmasked immune reconstitution inflammatory syndrome once treatment has started.Revisión por pare

Factors associated with unwanted additional fertility: secondary analysis of DHS 2018 in Peru

Objetivo: Determinar la asociación entre los factores sociodemográficos y reproductivos, y la fecundidad adicional no deseada (FAND) en el Perú según la Encuesta Demográfica y de Salud Familiar (ENDES) del 2018. Materiales y métodos: Se realizó un estudio observacional, analítico transversal, a partir de la ENDES del Perú del año 2018. La FAND es una variable que se creó a partir de la diferencia numérica entre la fecundidad obtenida y la fecundidad deseada. Se categorizó la variable FAND en dos categorías: la diferencia numérica positiva correspondió a presencia de FAND; y la diferencia numérica negativa o nula correspondió a ausencia de FAND. Se realizó una regresión de Poisson, tanto cruda como ajustada. Resultados: Se analizaron los datos de 6944 mujeres entre 40 y 49 años, con una edad promedio de 44,3. Se halló una prevalencia de FAND de 72,5% (IC95%: 70,4%-74,4%). En el modelo ajustado, se observó que pertenecer al quintil superior de riqueza (RPa: 0,80; IC95%: 0,69-0,93) disminuía la probabilidad de FAND con respecto al quintil intermedio. Por otro lado, provenir del ámbito rural (RPa: 1,07; IC95%: 1,01-1,14), aumenta la probabilidad de FAND con respecto al provenir del ámbito urbano. Conclusiones: La prevalencia de FAND en mujeres peruanas de 40 a 49 años que participaron de la ENDES 2018 es alta. Provenir del área rural aumenta la probabilidad de FAND; y el pertenecer al quintil superior de riqueza, la disminuye.Objectives: To establish sociodemographic and reproductive factors associated with unwanted additional fertility (UAF) in Peru, as measured in the 2018 Demographic and Health Survey (DHS). Methods: An observational, analytical cross-sectional study was carried out based on Peru’s 2018 DHS. UAF is a variable that was created by subtracting the desired fertility from the obtained fertility. Then, it was categorized as present (positive) or absent (negative or null). Multivariable analysis was done through a Poisson regression, both crude and adjusted. Results: This study included 6944 women between 40 and 49 years old, with a mean age of 44,3. We found a prevalence of UAF of 72,5% (CI95%: 70,4%-74,4%), mainly in the coastal region and in urban areas. In the adjusted model it was found that, belonging to the top welfare quintile (aPR: 0,85; CI95%: 0,76-0,95) was associated with less probability of UAF when compared with the intermediate quintile. On the other hand, coming from rural areas (aPR: 1,07; CI95%: 1,01-1,14), was associated with increased UAF risk. Conclusions: The prevalence of UAF in Peruvian women from 40 to 49 years old who responded to DHS 2018 is high. Coming from rural areas is associated with a higher chance of UAF, whereas belonging to the top welfare quintile is associated with lower UAF probability.Trabajo de investigació

sj-docx-2-tai-10.1177_20499361241228666 – Supplemental material for Cerebrospinal fluid shunting for the management of cryptococcal meningitis: a scoping review

Supplemental material, sj-docx-2-tai-10.1177_20499361241228666 for Cerebrospinal fluid shunting for the management of cryptococcal meningitis: a scoping review by Gonzalo Cornejo-Venegas, Xosse Carreras, Andrea S. Salcedo, David R. Soriano-Moreno, Jorge L. Salinas and Jorge Alave in Therapeutic Advances in Infectious Disease</p

sj-docx-1-tai-10.1177_20499361241228666 – Supplemental material for Cerebrospinal fluid shunting for the management of cryptococcal meningitis: a scoping review

Supplemental material, sj-docx-1-tai-10.1177_20499361241228666 for Cerebrospinal fluid shunting for the management of cryptococcal meningitis: a scoping review by Gonzalo Cornejo-Venegas, Xosse Carreras, Andrea S. Salcedo, David R. Soriano-Moreno, Jorge L. Salinas and Jorge Alave in Therapeutic Advances in Infectious Disease</p

Lepra: sospecha diagnóstica en área no endémica. Serie de casos y revisión de la literatura

ABSTRACT Leprosy (Hansen’s disease) is a chronic granulomatous condition caused by Mycobacterium leprae, a microorganism that affects the skin and Schwann’s cells. Making a diagnosis of this condition is difficult in non-endemic areas because of low clinical suspicion. During the 2012-2019 time period, three cases of Hansen’s disease were diagnosed and treated in the ID service of Dos de Mayo Hospital. The average time history of the disease was 4 years. Patients started their condition with the appearance of pruriginous papular lesions affecting specific body regions, progressing to generalized nodular lesions. Paresthesia and tactile, thermal, pain, and vibratory hypoesthesia were found. These manifestations later progressed to anesthesia. Diagnosis was made through bacilloscopy in lymphatic fluid and skin node biopsy. Clinical features for each patient are also described. We emphasize the importance of clinical suspicion for diagnosing this unattended disease in non-endemic areas.RESUMEN La lepra es una enfermedad crónica granulomatosa causada por el bacilo Mycobacterium Leprae que afecta piel y células de Schwann. En zonas no endémicas el diagnóstico de lepra suele ser dificultoso debido a la baja sospecha clínica. Durante el periodo de 2012 al 2019, se diagnosticaron y trataron tres casos de lepra en el servicio de infectología del Hospital Nacional Dos de Mayo. El tiempo de enfermedad promedio fue 4 años. Los pacientes iniciaron con pápulas pruriginosas en regiones corporales específicas, progresando a nódulos generalizados. Se constató parestesia e hipoestesia táctil, térmica, dolorosa y vibratoria; las cuales progresaron a anestesia. El diagnóstico se realizó mediante baciloscopía en secreción linfática y biopsia de nódulos cutáneos. Se describen las características clínicas de cada uno de los pacientes. Se remarca la importancia de la sospecha diagnóstica de esta entidad desatendida en áreas no endémicas