COVID-19 in Latin America and the Caribbean: Two years of the pandemic.

Worldwide, nations have struggled during the coronavirus disease 2019 (COVID-19) pandemic. However, Latin America and the Caribbean faced an unmatched catastrophic toll. As of March 2022, the region has reported approximately 15% of cases and 28% of deaths worldwide. Considering the relatively late arrival of SARS-CoV-2, several factors in the region were determinants of the humanitarian crisis that ensued. Pandemic unpreparedness, fragile healthcare systems, forthright inequalities, and poor governmental support facilitated the spread of the virus throughout the region. Moreover, reliance on repurposed and ineffective drugs such as hydroxychloroquine and ivermectin-to treat or prevent COVID-19-was publicised through misinformation and created a false sense of security and poor adherence to social distancing measures. While there were hopes that herd immunity could be achieved after the region's disastrous first peak, the emergence of the Gamma, Lambda, and Mu variants made this unattainable. This review explores how Latin America and the Caribbean fared during the first 2 years of the pandemic, and how, despite all the challenges, the region became a global leader in COVID-19 vaccination, with 63% of its population fully vaccinated

Pruebas de sensibilidad para Mycobacterium tuberculosis

Los regímenes de tratamiento no adecuado y los problemas de adherencia del paciente han ocasionado que las tasas de resistencia de Mycobacterium tuberculosis hayan aumentado en el mundo, originando así la aparición de las cepas multidrogo resistentes (MDR) y con resistencia extensa a drogas (XDR). El Perú presenta altas tasas de TB-MDR, y ya se han reportado casos de TB-XDR. Las pruebas de sensibilidad buscan detectar los casos con cepas resistentes, permitiendo otorgar el mejor tratamiento al paciente y evitando la propagación de la enfermedad a otras personas. Esta revisión de pruebas de sensibilidad dirigida al médico no especialista, se ha enfocado en las pruebas de sensibilidad disponibles según la Norma Técnica para el control de la Tuberculosis y otras que se encuentran en investigación

Tuberculosis Scientific Conferences in Peru: Sharing local evidence for local decisions.

INTRODUCTION: International conferences on tuberculosis (TB) have been held since the 19th century. In Peru, the TB Scientific Conferences have been held annually in Lima since 2013 as a means of developing a national TB research network and setting the stage for researchers and institutions to present and share new findings from studies conducted in Peru. METHODS: Systematization of information on speakers and presentations from TB Scientific Conferences in Peru. Presentation files and official agendas for the conferences from 2013 to 2019 were obtained from the Tuberculosis Prevention and Control Directorate's website. RESULTS: A total of 426 scientific presentations have been delivered by 230 speakers, with a steady annual increase. 37.1% of the talks were given by female speakers. To date, 61.4% of the research presented has been published. Out of all the studies, 10.9% (30/275) were part of international, multicentric research projects. Main research lines were epidemiology (40.1%), drug-resistance (29.6%) and treatment (22.1%). CONCLUSIONS: TB Scientific Conferences serve as a platform to share region-specific TB evidence between local stakeholders (health officials, academics, and others) who aim to facilitate the implementation of measures with the goal of reducing the national gaps towards the End TB Strategy goals

Acerca de “Mapeo político de la discriminación y homofobia asociadas con la epidemia de VIH en México”

Hemos leído con gran interés el artículo titulado “Mapeo político de la discriminación y homofobia asociadas con la epidemia de VIH en México”. Ante la situación actual planteada en México,presumimos que en otros países de Latinoamérica la realidad no es muy diferente debido a las características similares a nivel cultural y social..

Acerca de "Mapeo político de la discriminación y homofobia asociadas con la epidemia de VIH en México"

Cartas al EditorRevisión por pare

Magnitud y Factores asociados a complicaciones de diabetes tipo 2: Análisis de un Sistema de Vigilancia de Diabetes Mellitus

Background: Type 2 diabetes (DT2) complications has been increased the demand for specialized services in Peruvian Social Security(EsSalud), so it is necessary to determine the magnitude and factors associated with chronic complication due to DT2 in this population. Material and Methods: Cross-sectional study based on 7875 patients with DT2≥18 years attended by ambulatory care during 2016-2017, notified in the Diabetes Mellitus Surveillance System of EsSalud. Sociodemographic, clinical and comorbidity variables were evaluated using a bivariate analysis and Poisson regression model with robust variance to determine the prevalence ratio of chronic complication due to DT2. Results: The microvascular complication of DT2 was associated with male sex (PR=1.25; 95% CI:1.10-1.42; p<0.01), HbA1c>9.0% (PR=1.25; 95% CI:1.08-1.46; p<0.01), hypertension (PR=1.30; 95% CI: 1.14-1.49; p<0.01), anemia (PR=1.57; 95% CI: 1.31-1.88; p <0.01), thyroid disease (PR=1.48; 95% CI:1.07-2.03; p=0.02), cancer (PR=1.70; 95% CI: 1.26-2.30; p<0.01) and fatty liver (PR=1.78; 95% CI:1.28-2.48; p<0.01). Receiving education for DT2 self-care showed a negative association with microvascular complication (RR=0.84; 95% CI:0.73-0.96; p<0.01). DT2´s macrovascular complication was associated with male sex (PR=1.52; 95% CI:1.21-1.91; p <0.01), arterial hypertension (PR=2.72; 95% CI:1.90-3.91; p <0.01), anemia (PR=1.98; 95% CI:1.33-2.95; p<0.01) and fatty liver (PR=1.92; 95% CI:1.03-3.62; p=0.04), while education in DT2 showed a negative association (PR=0.47; 95% CI: 0.36-0.61; p <0,01). Conclusions: Education in DT2 showed an association consistently with the absence of micro and macrovascular complications, suggesting that it is an important preventive factor. We consider it necessary to evaluate the impact of education through appropriate designs.Introducción: Las complicaciones por diabetes tipo 2 (DT2) están incrementando la demanda de servicios especializados en la Seguridad Social Peruana por lo que se torna necesario determinar la magnitud y factores asociados a complicación crónica por DT2 en esta población. Material y Métodos: Estudio transversal-analítico basado en 7875 registros de pacientes con DT2 ≥ 18 años atendidos por consulta externa durante 2016-2017 y notificados en el Sistema de Vigilancia de Diabetes Mellitus de EsSalud. Se evaluaron variables sociodemográficas, clínicas y de comorbilidad mediante un análisis bivariado y un modelo de regresión de Poisson con varianza robusta para determinar la razón de prevalencia a complicación crónica por DT2. Resultados: La complicación microvascular de DT2 estuvo asociado a sexo masculino (RP=1,25; 95%IC: 1,10-1,42; p<0,01), HbA1c>9,0% (RP=1,25; 95%IC: 1,08-1,46; p<0,01), hipertensión arterial (RP=1,30; 95%IC: 1,14-1,49; p<0,01), anemia (RP=1,57; 95%IC: 1,31-1,88; p<0,01), enfermedad tiroidea (RP=1,48; 95%IC: 1,07-2,03; p=0,02), cáncer (RP=1,70; 95%IC: 1,26-2,30; p<0,01) e hígado graso (RP=1,78; 95%IC: 1,28-2,48; p<0,01). El recibir educación para el autocuidado de DT2 mostró asociación negativa con complicación microvascular (RP=0,84; 95%IC: 0,73-0,96; p<0,01). La complicación macrovascular de DT2 estuvo asociado a sexo masculino (RP=1,52; 95%IC: 1,21-1,91; p<0,01), hipertensión arterial (RP=2,72; 95%IC: 1,90-3,91; p<0,01), anemia (RP=1,98; 95%IC: 1,33-2,95; p<0,01) e hígado graso (RP=1,92; 95%IC: 1,03-3,62; p=0,04), mientras que la educación en DT2 mostró asociación negativa (RP=0,47; 95%IC: 0,36-0,61; p<0,01). Conclusiones: La educación en DT2 mostró asociación consistentemente con ausencia de complicación micro y macrovascular, sugiriendo ser un importante factor preventivo. Consideramos necesario evaluar el impacto de la educación mediante diseños apropiados

Impact of Reversion of Mycobacterium tuberculosis Immunoreactivity Tests on the Estimated Annual Risk of Infection

A key metric in tuberculosis epidemiology is the annual risk of infection (ARI), which is usually derived from tuberculin skin test (TST) and interferon-gamma release assay (IGRA) prevalence surveys in children. Deriving the ARI assumes that immunoreactivity is persistent over time; however, reversion of immunoreactivity has long been documented. Here we use a deterministic, compartmental model of Mycobacterium tuberculosis (Mtb) infection to explore the impact of reversion on ARI estimation using age-specific reversion probabilities for TST and IGRA. Using empirical data of TST reversion (22.2%/year for 0-19yo), the true ARI is 2-5 times higher than estimated from immunoreactivity studies in 8-12 year-olds. Applying empirical reversion probabilities for IGRA (9.9%/year for 12-18yo) showed a 1.5-2-fold underestimation. ARIs are increasingly underestimated in older populations, due to the cumulative impact of reversion on population reactivity over time. Declines in annual risk did not largely affect the results. Ignoring reversion leads to a stark underestimation of the true ARI in populations and our interpretation of Mtb transmission intensity. Future surveys should adjust for reversion probabilities and its cumulative effect with increasing age to provide a more accurate reflection of the burden and dynamics of Mtb infection

Integrating tuberculosis and COVID-19 molecular testing in Lima, Peru : a cross-sectional, diagnostic accuracy study

Integrated molecular testing could be an opportunity to detect and provide care for both tuberculosis and COVID-19. Many high tuberculosis burden countries, such as Peru, have existing GeneXpert systems for tuberculosis testing with GeneXpert Xpert MTB/RIF Ultra (Xpert Ultra), and a GeneXpert SARS-CoV-2 assay, GeneXpert Xpert Xpress SARS-CoV-2 (Xpert Xpress), is also available. We aimed to assess the feasibility of integrating tuberculosis and COVID-19 testing using one sputum specimen with Xpert Ultra and Xpert Xpress in Lima, Peru.Canadian Institutes of Health Researc

Hydroxychloroquine to prevent SARS-CoV-2 infection among healthcare workers: early termination of a phase 3, randomised, open-label, controlled clinical trial

OBJECTIVE: To assess the effectiveness and safety of hydroxychloroquine (HCQ) prophylaxis for the prevention of SARS-CoV-2 infection in healthcare workers (HCW) on duty during the COVID-19 pandemic. RESULTS: A total of 68 HCWs met the eligibility criteria were randomly allocated to receive HCQ (n = 36) or not (n = 32). There were no significant differences between groups in respects to age, gender, or medical history. Eight participants met the primary efficacy endpoint of SAR-CoV-2 infection during the study period; there was no difference in incidence of SARS-CoV-2 infections between both study arms (HCQ: 5 vs Control: 3, p = 0.538). The relative risk of SARS-CoV-2 infection in the HCQ arm was 1.69 compared to the control group (95%CI 0.41-7.11, p = 0.463); due to poor participant accrual, the resulting statistical power of the primary efficacy outcome was 11.54%. No serious adverse events occurred; however, two (2/36, 5.6%) participants no longer wished to participate in the study and withdrew consent due to recurring grade 1 and 2 adverse events. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04414241. (Registered on June 4, 2020)