Tuberculosis sistémica con afectación cutánea en paciente pediátrico con inmunodeficiencia primaria

Background: Primary immunodeficiencies (PID) represent challenging pathologies in terms of diagnosis and treatment, with increased predisposition to recurrent respiratory and gastrointestinal infections. Case report: A paediatric patient with pathologic variants of genes IFNGR1 and TNFRSF13B, presented an atypical manifestation of tuberculosis, characterized by cutaneous lesions and lack of respiratory symptoms. Patient was initially treated for an atypical mycobacterial infection with partial favourable response. Following microbiological confirmation of Mycobacterium tuberculosis, a proper antibiotic regimen was initiated, resulting in complete recovery. Conclusion: PIDs increase the likelihood of atypical presentations of tuberculosis, complicating diagnosis and interfering with timely treatment. We report a case lacking the classic clinical criteria for immunodeficiency and with an atypical clinical presentation for M. tuberculosis infection, which led to a 2-month delay in the initiation of the most effective treatment.Introducción: Las inmunodeficiencias primarias (IDP) son patologías de difícil diagnóstico y manejo, que suelen predisponer a infecciones respiratorias y gastrointestinales recurrentes. Reporte de caso: Paciente pediátrico con antecedente variantes patológicas de los genes IFNGR1 y TNFRSF13B, desarrolla tuberculosis de presentación atípica, caracterizada por lesiones cutáneas y sin manifestaciones respiratorias. El manejo inicial como tuberculosis atípica tuvo respuesta favorable parcial. Tras confirmación microbiológica de Mycobacterium tuberculosis, se cambió a tratamiento específico con recuperación completa. Conclusión: Las IDP predisponen a una mayor frecuencia de presentaciones atípicas de tuberculosis, dificultando el diagnostico e interfiriendo con el manejo oportuno. En el caso reportado, la ausencia en el cumplimiento de criterios clásicos de inmunodeficiencia y una presentación clínica inusual para M. tuberculosis, generó un retraso de 2 meses en el inicio de tratamiento correcto

Sobrecarga del cuidador y apoyo social percibido en cuidadores de adultos mayores

Objective: To establish if there is an association between caregiver burden and perceived social support in caregivers of older adults. Material and methods: A correlational, cross-sectional study was carried out in a sample of 138 caregivers of older adults to whom the Zarit Scale and the Multidimensional Perceived Social Support Scale were applied. Results: Most caregivers (84,8%) bear overload; Social support predominates at a low level (69,9%). Conclusions: There is a mean inverse correlation (- 0,240) between caregiver burden and perceived social support in caregivers of older adults; it has been determined that the majority of caregivers (84,8%) bear an overload; In all the dimensions of Social Support, the Low level predominates, so that most caregivers perceive a low level of Social Support; there is an inverse correlation between the Overload variable and the Family Support dimension; there is no correlation between Overload and Support from Friends; and there is an inverse correlation between Overload and Support from Significant Others.Objetivo: Establecer si hay asociación entre la sobrecarga del cuidador y el apoyo social percibido en cuidadores de adultos mayores. Material y métodos: Se realizó un estudio correlacional, transversal, en una muestra de 138 cuidadores de adultos mayores a quienes se les aplicó la Escala de Zarit y la Escala Multidimensional Apoyo Social Percibido. Resultados: La mayoría de los cuidadores (84,8%) soportan sobrecarga; el apoyo social predomina en un nivel bajo (69,9%). Conclusiones: Existe correlación inversa media (- 0,240) entre la sobrecarga del cuidador y el apoyo social percibido en los cuidadores de adultos mayores; se ha determinado que la mayoría de los cuidadores (84,8%) soportan una sobrecarga; en todas las dimensiones de apoyo social predomina el nivel bajo, por lo que la mayoría de los cuidadores perciben un bajo nivel de apoyo social; existe correlación inversa entre la variable sobrecarga y la dimensión apoyo familiar; no existe correlación entre la sobrecarga y apoyo de amigos; y existe correlación inversa entre la sobrecarga y apoyo de otros significativos

Horas de sueño y su correlación con la presión arterial y el nivel de glicemia en ayunas en la población de Puerto Eten, Chiclayo

Objetivo: Correlacionar las horas de sueño con la presión arterial y el nivel de glicemia en ayunas en la población de Puerto Eten, Chiclayo. Material y métodos: Estudio transversal correlación. Se recolecto el consentimiento informado de 111 pobladores de Puerto Eten correspondiente al tamaño muestral calculado con EPIDAT 3 con los siguientes datos: coeficiente de correlación a detectar -0.242 (por antecedente), nivel de confianza del 95%, potencia 80%, a los cuales se les procedió a medir la presión arterial matutina y la glicemia en ayunas, los resultados se anotaron en una ficha de recolección de datos, junto con sus hábitos de sueño, referidos por el mismo participante y obtenido mediante entrevista. Resultados: La edad media fue 45,3 años, desviación estándar 12,87, rango 40, mínimo 20, máximo 60. Se encontraron las siguientes correlaciones entre las horas de sueño con: la presión arterial sistólica -0,460 con p-valor 0,001 (correspondiente a una correlación moderada), la presión arterial diastólica -0,336 con p-valor 0,001 (correspondiente a una moderada correlación), la glicemia -0,044 con p-valor 0,649 (no existe correlación estadísticamente significativa). Conclusiones: Existe una moderada correlación inversa entre las horas de sueños, con la presión arterial sistólica, Existe una baja correlación inversa entre las horas de sueños, con la presión arterial diastólica, No se halló relación estadísticamente significativa entres entre las horas de sueños y la Glicemia

Impacto científico y temático de la Rev. Cuerpo Méd. HNAAA: un análisis bibliométrico, 2011-2020

Introduction: Peru has several journals about biomedical areas, but a few serial publications are visible and indexing in different global indexing media. Objective: To analyze the main publication characteristics from Revista del Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo (Chiclayo) based on bibliometric methods. Methods: Descriptive study that analyzes 587 articles published by the journal from 2011 to 2020, based on bibliometric methods and indicators: citations, scientific impact and co-word analysis. Results: Original articles were the highest types of document published (60%; X̅=66). Published research articles on general medicine received more impact in previous years than the recents. Most frequent terms analyzed were studies about patients from hospitals in Chiclayo city (Lambayeque) with covid-19 clinical cases.  Conclusion: Revista del Cuerpo Médico HNAAA is emerging as an important scholarly publication to do visible local, national, and international production due to health subject coverage into medical specialties.Introducción: El Perú posee un gran número revistas de áreas biomédicas, pero solo algunas han logrado visibilizar e indizar sus publicaciones en diferentes medios de indización de alcance global. Objetivo: Analizar las características de publicación de la Revista del Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo (Chiclayo) a partir de indicadores bibliométricos. Métodos: Estudio descriptivo que analiza 587 registros bibliográficos de los artículos publicados en la revista durante 2011-2020, a partir de indicadores de impacto científico y análisis de términos. Resultados: La mayor producción de artículos corresponde a originales (60%; X̅=66). Los artículos publicados sobre medicina general obtuvieron más impacto en años anteriores. Los temas más frecuentes fueron estudios sobre pacientes de hospitales de Chiclayo, Lambayeque con casos de covid-19. Conclusiones: La Revista del Cuerpo Médico HNAAA se perfila como una publicación seriada de importancia para visibilizar la producción nacional y local por la cobertura temática en especialidades médicas de relevancia regional que publica

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Religious affiliation and the intention to choose psychiatry as a specialty among physicians in training from 11 Latin American countries

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.The worldwide scarcity of psychiatrists makes the identification of the factors associated with the intention to choose this specialty an important issue. This study aims to evaluate the association between religious affiliation and the intention to choose psychiatry as a specialty among medical students from 11 Latin American countries. We conducted a cross-sectional, multi-country study that included first- and fifth-year students of 63 medical schools in 11 Latin-American countries between 2011 and 2012. The main outcome and measures were the intention to pursue psychiatry as a specialty over other specialties (yes/no) and religious affiliation (without: atheist/agnostic; with: any religion). A total of 8308 participants were included; 53.6% were women, and the average age was 20.4 (SD = 2.9) years. About 36% were fifth-year students, and 11.8% were not affiliated with any religion. Only 2.6% had the intention to choose psychiatry; the highest proportion of students with the intention to choose psychiatry was among students in Chile (8.1%) and the lowest among students in Mexico (1.1%). After adjusting for demographic, family, academic as well as personal and professional projection variable, we found that those who had no religious affiliation were more likely to report the intention to become a psychiatrist [OR: 2.92 (95%CI: 2.14-4.00)]. There is a strong positive association between not having a religious affiliation and the intention to become a psychiatrist. The possible factors that influence this phenomenon must be evaluated in greater depth, ideally through longitudinal research.Revisión por pare

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted