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Introducción. La epidemiología del ántrax en Perú es poco conocida. Su alto potencial epidémico y epizoótico podría amenazar la salud pública, especialmente desde sus regiones endémicas. Objetivo. Caracterizar los casos de ántrax humano en Perú del 2015 al 2019. Métodos. Se realizó un estudio transversal retrospectivo, a partir de los datos del Sistema Nacional de Vigilancia Epidemiológica e investigaciones de brotes en Perú del 2015 al 2019. Resultados. 71 casos de ántrax humano fueron registrados, 34 % (n = 24) confirmados y66 % (n = 47) probables. Los más afectados fueron varones (55 %) y el grupo etario de 30 a 59 años (45 %). Los casos estuvieron distribuidos principalmente en la costa norte del país. La forma cutánea autolimitada en miembros superiores fue la presentación clínica más frecuente. El 94 % (n = 67) de los casos tuvieron contacto con ganado vacuno infectado. Conclusión. Los casos de ántrax humano en Perú fueron en su mayoría de la forma cutánea, que se presentaron por brotes focalizados en áreas con antecedentes de trasmisión zoonótica. Este reporte pretende aportar al conocimiento epidemiológico de esta enfermedad y servir como insumo en la implementación de medidas de prevención y control.
Introduction. The epidemiology of anthrax in Peru is poorly understood. Its high epidemic and epizootic potential could threaten public health, especially in its endemic regions. Objective. To characterize cases of human anthrax in Peru from 2015 to 2019. Methods. A retrospective cross-sectional study was carried out; based on data from the National Epidemiological Surveillance System and investigations of anthrax outbreaks from 2015 to 2019 in Peru. Results. 71 cases of human anthrax were registered, 34 % (n = 24)confirmed and 66 % (n = 47) probable. The most affected were males (55 %) and the age group from 30to 59 years (45 %), distributed mainly on the north coast of the country. The self-limited cutaneous form was the most frequent clinical presentation. 94% (n = 67) of the cases had contact with infected cattle. Conclusions. The cases of human anthrax in Peru appear as focalized outbreaks in areas with a history of zoonotic transmission. This report aims to contribute to the epidemiological knowledge of this disease and serve as input in the implementation of prevention and control measures.
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Señor editor: El exceso de muertes debido a la COVID-19 en Perú durante el 2020fueunodelosmáselevadosdelmundo,esto probablemente favorecido por la fragilidad del sistema salud y los determinantes sociales de este país. Si bien una de las principales estrategias para mitigar el impacto de esta enfermedad es la vacunación masiva, la falta de aceptación de la vacuna por parte de la población peruana podría ser uno de los mayores desafíos para lograr dicho objetivo.
Mr. Editor: The excess of deaths due to COVID-19 in Peru during 2020 was one of the highest in the world, probably favored by the fragility of the health system and the social determinants of this country. Although one of the main strategies to mitigate the impact of this disease is mass vaccination, the lack of acceptance of the vaccine by the Peruvian population could be one of the biggest challenges to achieve this goal.
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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.
Assuntos
Infecções Assintomáticas/terapia , Tratamento Farmacológico da COVID-19 , COVID-19/diagnóstico , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Azitromicina/uso terapêutico , Teste de Ácido Nucleico para COVID-19/métodos , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Hospitalização , Humanos , Hidroxicloroquina/uso terapêutico , Lactente , Lopinavir/uso terapêutico , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Ritonavir/uso terapêutico , SARS-CoV-2/isolamento & purificação , Adulto JovemRESUMO
Objetivos: Determinar la prevalencia y factores asociados al Síndrome de Fragilidad (SF) en adultos mayores residentes en el distrito de Chaglla-Huánuco, ubicado a 3000 msnm. Métodos: Estudio transversal analítico de adultos mayores de 60 años residentes en una comunidad rural de los andes peruanos. Para la evaluación de la variable dependiente se utilizó una versión modificada de los criterios de Fried. Los factores asociados al SF se calcularon mediante razones de prevalencia crudas y ajustadas con intervalos de confianza al 95% (IC95%), utilizando un modelo de regresión de Poisson múltiple con varianza robusta. Se consideró un valor p<0,05 como significativo. Resultados: Se estudiaron 233 adultos mayores (mediana: 74, rango intercuartílico: 70-79 años), 50,6% mujeres. La prevalencia del SF fue 72,1%. La presencia de depresión (RP=1,77; IC95%: 1,43-2,18, p<0,001) y el sexo femenino (RP=1,46; IC95%: 1,16-1,81, p=0,001), fueron factores asociados que aumentaban la prevalencia del SF. Conclusiones: La prevalencia del SF entre adultos mayores residentes en una comunidad rural andina fue alta. Los factores asociados con este diagnóstico fueron la presencia de depresión y el sexo femenino. Se requieren más estudios sobre este tema en poblaciones rurales de las grandes alturas.
Objectives: To determine the prevalence and factors associated with Frailty Syndrome (SF) in older adults residing in the district of Chaglla-Huánuco, located at 3000 meters above sea level. Methods: Analytical cross-sectional study of adults over 60 years of age living in a rural community in the Peruvian Andes. For the evaluation of the dependent variable, a modified version of Fried's criteria was used. The factors associated with SF were calculated using crude and adjusted prevalence ratios with 95% confidence intervals (95%CI), using a multiple Poisson regression model with robust variance. A p value <0.05 was considered significant. Results: 233 older adults were studied (median: 74, interquartile range: 70-79 years), 50.6% women. The prevalence of FS was 72.1%. The presence of depression (PR=1.77; 95%CI: 1.43-2.18, p <0.001) and female gender (PR=1.46; 95%CI: 1.16-1.81, p=0.001), were associated factors that increased the prevalence of FS. Conclusions: The prevalence of FS among older adults residing in a rural Andean community was high. The factors associated with this diagnosis were the presence of depression and female sex. More studies are required on this topic in rural populations in high altitudes.
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RESUMEN El presente artículo resume recomendaciones clínicas basadas en evidencia para la evaluación y el manejo de pacientes con Leucemia Linfoblástica Aguda (LLA) en EsSalud. Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 8 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios en PubMed y CENTRAL durante el 2019. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y el flujograma de evaluación y manejo. La presente GPC abordó 8 preguntas clínicas, divididas en cuatro temas: diagnóstico, medidas generales, manejo quimioterápico de LLA, y trasplante. En base a dichas preguntas se formuló 5 recomendaciones (3 recomendaciones fuertes y 2 recomendaciones condicionales), 20 puntos de buena práctica clínica, y 3 flujogramas.
ABSTRACT This paper summarizes the evidence-based clinical recommendations for the assessment and management of patients with acute lymphoblastic leukemia (ALL) in Peruvian Social Security (EsSalud). A guide writing team (GWT) was convened, which included specialized physicians and methodologists. The GWT asked 8 clinical questions to be responded by the Clinical Practice Guidelines (CPG). Detailed searches of systematic reviews and - when it was considered as pertinent - primary studied featured in PubMed and CENTRAL during 2019 were performed. Evidence for responding each of the proposed clinical questions was selected. Certainty of the evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In scheduled workshops, the GWT used the GRADE methodology for reviewing the evidence and propose recommendations, the points for good clinical practice, and the assessment and management flowcharts. This CPG worked on 8 clinical questions, which were divided in 4 topics: diagnosis, general measures, chemotherapy management for ALL, and transplantation. On the basis of these questions, 5 recommendations were formulated (3 strong recommendations and 2 conditional recommendations), 20 points for good clinical practice, and 3 flow charts.
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Objetivo: Describir la tendencia en el número de médicos que se titularon durante el periodo 2007-2016 en Perú, en forma general y en subgrupos de acuerdo a las características ligadas a la universidad en la que cursaron los estudios de pregrado. Materiales y métodos: Estudio descriptivo. Se obtuvo el listado de todos los médicos colegiados entre 2007-2016 por medio de la página web del Colegio Médico del Perú; mientras que la fecha de titulación y universidad de procedencia provino de la página web de la Superintendencia Nacional de Educación Superior Universitaria (SUNEDU). Para evaluar las tendencias, se utilizó la prueba de correlación de Spearman. Resultados: En el periodo de estudio se colegiaron 27 611 médicos a nivel nacional, con una tendencia anual creciente en la cantidad de médicos titulados (p<0,001). Entre los egresados de universidades peruanas, se encontró un incremento del número de médicos que estudiaron en universidades de Lima (p<0,001) y de la región costa (p<0,001). Adicionalmente, se evidenció un incremento en la cantidad de titulados provenientes de universidades privadas de Lima (p<0,001) y de provincias (p<0,001). Conclusiones: El número de médicos titulados aumenta anualmente, con predominio de aquellos provenientes de universidades de Lima, la costa y universidades privadas. Se evidencia la necesidad urgente de políticas que regulen este crecimiento, con la finalidad de evitar problemas de calidad educativa y empleabilidad.
Objective. To describe the trends in the number of physicians who graduated from 2007 to 2016 in Peru, both in a general manner as well as in subgroups based on the school they studied. Materials and Methods. This is a descriptive and retrospective study. A list of all physicians who graduated during the 2007-2016 period was obtained from the Peruvian College of Physicians website. Their graduating dates and the schools where they studied were obtained from the National University Education Superintendence (SUNEDU, according to its Spanish initials). Trends were assessed using the Spearman correlation test. Results: During the study period, 27,611 physicians graduated in Peru. There was an annual increase in the total number of graduates (p<0.001). Amongst graduates from Peruvian medical schools, there was an increase in the number of physicians who studied in Lima (p<0.001) and in the Peruvian coast (p<0.001). Also, there were a greater number of graduated physicians from Lima (p<0.001) and other provinces medical schools (p<0.001). Conclusions. The number of graduated physicians annually increases, particularly those who studied in Lima, the coast, and private medical schools. We evidence an urgent need for policies for regulating this growth, aiming to avoid employability and educational quality problems.