A cross-sectional study to assess the level of satisfaction with virtual education in Peruvian medical students

"Objectives: Education has totally changed in the context of the pandemic. Therefore, the objective of the present study was to evaluate the factors associated with the level of satisfaction with virtual education in Peruvian medical students during COVID-19. Methods: Analytical and cross-sectional study, based on an online survey of students nationwide. We use previously validated instruments to measure the level of satisfaction and stress (EPP-10-c) of students with virtual education. For the associated factors, adjusted prevalence ratios (PR) were estimated using Poisson regression. Results: Of the 1,878 students surveyed, the median age was 21 years, 57.8% (1,086) were women, 34.8% (654) had a high level of satisfaction with virtual education and 10.7% (202) presented high levels of stress. The factors associated with a low level of satisfaction were attending the fifth year of study, the partial and non-virtual adaptation of the university to virtual education, and a high level of stress. On the other hand, the factors associated with a high level of satisfaction were the education platform used and the study method used. Conclusion: Seven out of 10 students presented a low level of satisfaction with virtual education, 1 out of 10 presented a high level of stress. The factors associated with the low level of satisfaction were attending the fifth year of study, the non-virtual and partial adaptation of the university to virtual education, and the high level of stress.

Características metodológicas de las evaluaciones de tecnologías sanitarias elaboradas en Perú, 2019-2021

Background: Limitations have been reported to comply with good methodological practices in the development of health technology assessments (HTA). Therefore, the objective of the present study was to describe the methodological characteristics of the HTAs carried out in Peru, between 2019-2021. Methods: Descriptive study. We are looking for Peruvian institutions that prepare HTAs whose reports are accessible to the public. We collected the total number of HTAs produced by these institutions per year, and we collected the characteristics of the HTAs produced during the 2019-2021 period. Results: Three Peruvian institutions developed at least three public HTAs between 2019-2021: The Institute for the Evaluation of Technologies in Health and Research (IETSI) (n=142), the Unit for the Analysis and Generation of Evidence in Public Health (UNAGESP) (n=60), and the National Institute of Neoplastic Diseases (INEN) (n=40). The HTAs of UNAGESP did not reach a decision, while 35.9% of those of IETSI and 70.0% of those of INEN concluded in favor of the evaluated technology. All STDs explained the methodology used and performed systematic searches. However, few presented the risk of bias assessment of the included studies (17.4%), the certainty of the evidence (4.6%), or the benefits and harms per outcome (14.4%). None of the HTAs carried out cost studies or made explicit the methodology used to reach the decision. Conclusions: The HTAs evaluated presented favorable methodological aspects and certain shortcomings (in topics such as the report in the evaluation of risk of bias and certainty of the evidence, presentation of benefits and harms by outcome, and explanation of the methodology used to make decisions).Introducción: Se han reportado limitaciones para cumplir con buenas prácticas metodológicas en el desarrollo de evaluaciones de tecnologías sanitarias (ETS). Por ello, el objetivo del presente estudio fue describir las características metodológicas de las ETS elaboradas en Perú, entre 2019-2021. Métodos: Estudio descriptivo. Buscamos las instituciones peruanas que elaboren ETS cuyos informes sean accesibles al público. Recolectamos el número total de ETS que elaboraron estas instituciones por año, y recolectamos las características de las ETS elaboradas durante el periodo 2019-2021. Resultados: Tres instituciones peruanas elaboraron al menos tres ETS públicas entre 2019-2021: El Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) (n=142), la Unidad de Análisis y Generación de Evidencias en Salud Pública (UNAGESP) (n=60), y el Instituto Nacional de Enfermedades Neoplásicas (INEN) (n=40). Las ETS de UNAGESP no brindaron una decisión, mientras que 35,9% de las de IETSI y 70,0% de las de INEN concluyeron a favor de la tecnología evaluada. Todas las ETS explicaron la metodología usada y realizaron búsquedas sistemáticas. Sin embargo, pocas presentaron la evaluación de riesgo de sesgo de los estudios incluidos (17,4%), la certeza de la evidencia (4,6%), o los beneficios y daños por desenlace (14,4%). Ninguna ETS realizó estudios de costos ni explicitó la metodología usada para llegar a la decisión. Conclusiones: Las ETS evaluadas presentaron aspectos metodológicos favorables y ciertas falencias (en temas como el reporte en la evaluación de riesgo de sesgo y certeza de la evidencia, presentación de beneficios y daños por desenlace, y explicitación de la metodología usada para tomar decisiones)

Factors associated with the intention to participate in COVID-19 vaccine clinical trials: A cross-sectional study in Peru

Objective: To evaluate the factors associated with the intention to participate in COVID-19 vaccine clinical trials in the Peruvian population. Methods: Cross-sectional study and secondary analysis of a database that involved Peruvian population during September 2020. The Poisson regression model was used to estimate the associated factors. Results: Data from 3231 individuals were analyzed, 44.1% of whom intended to participate in COVID-19 vaccine clinical trials. Factors associated with the outcome were being male (RPa: 1.25; 95% CI: 1.15–1.35), being from the highlands region (RPa: 1.18; 95% CI: 1.09–1.28) or jungle (RPa: 1.30; 95% CI: 1.15–1.47), having a relative that is a healthcare professional (PRa: 1.16; 95% CI: 1.06–1.28), using a medical source of information (PRa: 1.28; 95% CI: 1.17–1.41), and trusting in the possible effectiveness of vaccines (PRa: 1.40; 95% CI: 1.29–1.51). The main reason for not participating in the trial was the possibility of developing side effects (69.80%). Conclusion: There is an urgent need to generate a perception of safety in COVID-19 vaccine clinical trials, to increase the population's intention to participate in these studies, and to provide evidence-based information about the vaccine.Revisión por pare

Prevention and control practices against Sars-Cov2 infection in the peruvian population

Objetive: To describe the prevention and control practices for the infection to SARS-COV2 in the Peruvian population. Material and Methods: Observational descriptive study. We evaluated a non-probabilistic sample of adult residents in some departments of Peru. Preventive practices were evaluated in people without a history of COVID-19 and control practices in people who had suffered it. Results: We evaluated 3630 Peruvians (mean age 25.4 ± 9.5), of that 3231 don't have a history of COVID-19 and 399 who had suffered it. The prevention and control practices that were realized often or always, with more frequencies, was the use of a mask when they go out home (97.9% vs 87.7), cover their nose or mouth when they sneeze (95.4% vs 89.9%), save the distance to other people in the street (91.4% vs 74.7%), wash their hands when they came home (92.5% vs 88.7%), and disinfect the objects and personal places (82.6% vs 77.4%). The 22.1% and 83.7%, the 59.7% and 80.2, and the 8.0% and 16.8% consumed some type of medicine, medicinal plant, and chlorine dioxide to prevent and control the infection, respectively. Conclusion: In general, less than 50% of the participants performed prevention and control practices against COVID-19 often or always.Revisión por pare

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

A molecular roadmap of the AGM region reveals BMP ER as a novel regulator of HSC maturation

In the developing embryo, hematopoietic stem cells (HSCs) emerge from the aorta-gonad-mesonephros (AGM) region, but the molecular regulation of this process is poorly understood. Recently, the progression from E9.5 to E10.5 and polarity along the dorso-ventral axis have been identified as clear demarcations of the supportive HSC niche. To identify novel secreted regulators of HSC maturation, we performed RNA sequencing over these spatiotemporal transitions in the AGM region and supportive OP9 cell line. Screening several proteins through an ex vivo reaggregate culture system, we identify BMP ER as a novel positive regulator of HSC development. We demonstrate that BMP ER is associated with BMP signaling inhibition, but is transcriptionally induced by BMP4, suggesting that BMP ER contributes to the precise control of BMP activity within the AGM region, enabling the maturation of HSCs within a BMP-negative environment. These findings and the availability of our transcriptional data through an accessible interface should provide insight into the maintenance and potential derivation of HSCs in culture.Peer reviewe

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

Introduction: The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods: A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results: None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR- 145 correlated with nadir CD4+ T cell count. Discussion: No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection

Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)