Aceptación de la vacunación contra la COVID-19 durante la primera ola pandémica en Perú

Letter to the Editor (without abstract)Carta al editor ( Sin resumen

Timing of aneurysm treatment in subarachnoid hemorrhage and grade of functional capacity at discharge: a retrospective cohort study

Abstract Background Aneurysmal subarachnoid hemorrhage (SAH) is a vascular pathology with high morbidity and mortality that requires timely management to reduce the risk of complications. However, the ideal time for aneurysm clipping is still controversial. This study aimed to compare the degree of functional capacity at discharge of patients who underwent surgery for rupture of a cerebral aneurysm at different periods of time until surgery. Results 132 patients who underwent surgery for SAH due to aneurysm rupture were included. The mean age was 52.5 years and 69.7% of participants were female. At admission, 96.2% were given a score of 1–3 on the World Federation of Neurological Surgeons scale and 79.6% received a score of 1–2 on the Hunt Hess scale. 8.3% of cases underwent surgery within the first 3 days of bleeding. The average time from clinical manifestation to surgical intervention was 7.1 days. At discharge 77.27% of patients presented good functional capacity. After adjusting for confounders, multivariate analysis showed a trend towards increased, albeit not statistically significant, risk in patients undergoing surgery at between 4 and 10 days (RR = 2.95 95% CI 0.80–10.87) and at > 10 days after SAH (RR = 2.65. 95% CI 0.72–9.79). Conclusions Despite the trend towards a higher probability of presenting poor functional capacity at discharge in patients undergoing aneurysm clipping more than 3 days after SAH, the differences were not statistically significant. There is a need for prospective randomized studies evaluating the best time to clip aneurysms, since aneurysm clipping is still a routine procedure in many countries

Prescription, over-the-counter (OTC), herbal, and other treatments and preventive uses for COVID-19

The current COVID-19 pandemic has spread rapidly worldwide and has challenged fragile health care systems, vulnerable socioeconomic conditions, and population risk factors, and has led to an overwhelming tendency to misuse prescription drugs and self-medication with prescription drugs, over-the-counter (OTC) drugs, herbals products, and unproven chemicals as a desperate preventive or curative measure for COVID-19. In this chapter, we present the legislative differences between prescription drugs, OTC drugs, and herbals. Various approved and nonapproved prescription and OTC drugs as symptomatic treatment for COVID-19 are listed and evaluated based on their reported efficacy, safety, and toxicological profile. We also present the various herbal products that are currently studied and used as treatment and preventive for COVID-19. The efficacy, toxicology profile, safety, and legal issues of some speculative preventive and treatment options against COVID-19, such as Miracle Mineral Solution (MMS), chlorine dioxide solution (CDS), colloidal silver, and hydrogen peroxide is presented. The chapter also emphasizes the specific strategies that need to be implemented to guide the population in the effective and safe use of prescribed medications, such as the Medication Therapy Management or Pharmaceutical Care process. Finally, this chapter aims to provide a deeper insight into the lack of health literacy in the population and the effect that drug utilization research (DUR) has in the decision making of health authorities and general public. We aim to provide the current information about the various treatment and preventive options used for COVID-19

Assessment and management of asymptomatic COVID-19 infection: A systematic review

BACKGROUND COVID-19 can be asymptomatic in a substantial proportion of patients. The assessment and management of these patients constitute a key element to stop dissemination. AIM To describe the assessment and treatment of asymptomatic infection in patients with a confirmed diagnosis of COVID-19. METHODS We searched five databases and search engines for preprints/preproofs, up to August 22, 2020. We included cohort, cross-sectional, and case series studies, reporting the assessment and management of asymptomatic individuals. We extracted data on total discharges with negative PCR, length of hospitalization, treatment, and number of patients who remained asymptomatic. A random-effects model with inverse variance method was used to calculate the pooled prevalence. RESULTS 41 studies (nine cross-sectional studies, five retrospective studies and 27 reports/case series; 647 asymptomatic individuals), were included, of which 47% were male (233/501). The age of patients was between 1month and 73 years. In patients who became symptomatic, length of hospitalization mean was 13.6 days (SD 6.4). Studies used lopinavir/ritonavir, hydroxychloroquine plus ritonavir/lopinavir, hydroxychloroquine with and without azithromycin, ribavirin plus interferon and interferon alfa. The proportion of individuals who remained asymptomatic was 91% (463/588 patients; 95%CI: 78.3%-98.7%); and asymptomatic individuals discharged with negative PCR was 86% (102/124 individuals; 95%CI: 58.4%-100%). CONCLUSIONS There is no standard treatment for asymptomatic COVID-19 individuals. There are no studies of adequate design to make this decision. It has been shown that most asymptomatic individuals who were followed have recovered, but this cannot be attributed to standard treatment