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Objectives This study evaluated the association between non-medical switching of prescription medications (NMSPM) with brand-name drugs and out-of-pocket spending (OPS) on drugs among Peruvian adults. Methods We conducted a secondary analysis of the National Survey of User Satisfaction Health using an analytical cross-sectional design. We included 3155 adults who went to drugstores and pharmacies with prescriptions. The independent variable was the self-reported NMSPM. The outcomes were brand-name drug purchase and OPS on drugs. We calculated crude and adjusted prevalence ratios (PR) with their respective 95% confidence intervals (CIs), and the OPS on drugs was analysed using linear regression with crude and adjusted β and their 95% CIs. Key findings The rate of NMSPM was 6.7%, the proportion of brand-name drug purchases was 55.7% and the average spending on drugs was US$1.73. In the adjusted analysis, the proportion of brand-name drug purchases with NMSPM was higher than without (73.3% versus 54.5%; P < 0.001), with a statistically significant association (adjusted PR = 1.38; 95% CI = 1.29 to 1.47; P < 0.001), and the association between NMSPM and OPS on drugs was statistically significant (adjusted β = 0.23; 95% CI = 0.16 to 0.30; P < 0.001). Conclusions There is a greater probability of brand-name drug purchases and OPS on drugs when NMSPM exists among adults who go to drugstores and pharmacies in Peru.

Background/Aims: Endoscopic submucosal dissection (ESD) is the preferred technique for treating early gastric cancer (EGC). However, very few studies have been conducted in South America. This study aimed to assess the efficacy and safety of ESD for EGC.Methods: We analyzed data from a prospective cohort from 2013 to 2020. A total of 152 superficial gastric neoplasms that fulfilled the absolute or expanded criteria for ESD were included. Outcomes were en bloc, R0, and curative resection rates, incidence of adverse events, and length of procedure.Results: The age of the enrolled patients was 68.4±11.3 years. The number of included patients based on the absolute and expanded indications was 150 and 2, respectively. En bloc, R0, and curative resections were achieved in 98.0%, 96.1%, and 89.5% of the cases, respectively. Bleeding and perforation were reported in 5.9% and 6.6% of the cases, respectively. Histopathological examination revealed lowgrade dysplasia, high-grade dysplasia, well-differentiated adenocarcinoma, and poorly differentiated adenocarcinoma in 13, 20, 117, and 2 cases, respectively.Conclusions: Our study shows that ESD performed by properly trained endoscopists in reference centers is safe and effective, with comparable therapeutic outcomes to those reported in the Eastern series.

Spirulina is a cyanobacterium rich in proteins, polyunsaturated fatty acids, and bioactive compounds, such as C-phycocyanin, which has anti-inflammatory and antioxidant properties and possible lipid and glucose metabolism effects. This systematic review aimed to analyze the effects of spirulina on lipid profile, glucose metabolism, and anti-inflammatory markers (CRD42018097156). After systematically searching for randomized controlled trials evaluating spirulina supplementation in adults with obesity, diabetes, or dyslipidemia on Scopus, Embase, PubMed/MEDLINE, Web of Science, and Cochrane Library databases and assessing the risk of bias (Rob 2.0), a random-effects meta-analysis (Mean Difference, CI 95%) was conducted on seven selected articles (n = 338). We found that spirulina supplementation significantly reduced the triglycerides (TG) (mean difference (MD): −15.34 mg/dL; 95% CI: −29.76 to −0.91) and total cholesterol (TC) levels (MD: −11.83 mg/dL; 95% CI: −20.56 to −3.10). However, low-density lipoprotein cholesterol (LDL-C) (MD: −7.80 mg/dL; 95% CI: −16.94 to 1.33), fasting blood glucose (FBS) (MD: −3.38 mg/dL; 95% CI: −9.88 to 3.12), and glycosylated hemoglobin (HbA1c) (MD: −0.27%; 95% CI: −0.94 to 0.39) levels were not significantly reduced. High-density lipoprotein cholesterol (HDL C) (MD: 0.73 mg/dL; 95% CI: −2.49 to 3.94) was also increased but not significantly. Spirulina supplementation resulted in a decrease in TG and TC levels; it improved the lipid profile of patients with type 2 diabetes, metabolic syndrome, overweight, or obesity, showing its significant role as an adjuvant treatment.

Aim: To evaluate the efficacy of prophylactic homeopathic treatment of swine diarrhea to achieve a satisfactory balance between weight gain and cost. Methods: Escherichia coli (E. coli) was isolated from 4 piglets with diarrhea, their clinical signs were used to select the adequate homeopathic medicine China officinalis (Chin). Newborn piglets were divided in 4 groups (n=11 or 12): control group treated with the routinely used antimicrobial agent (ceftiofur 4 mg 1 ml/piglet for 3 days); one group with homeopathic medicine Chin 30 cH; one group treated with biotherapy prepared from locally isolated E. coli; and one group was treated with association of Chin and biotherapy. All isolated samples of E. coli were subjected to polymerase chain reaction (PCR) to identify virulence factors in each group. Results:There was no difference in the number of animals with diarrhea between groups treated with homeopathic medicine and control; weight gain was greater in groups treated with homeopathic medicine alone and associated with biotherapy compared to control (p

Introducción: El linfoma de células T intestinal epiteliotrópico monomórfico es una neoplasia derivada de linfocitos intraepiteliales. La etiología es desconocida, pero se ha asociado a enfermedad celíaca o a síndrome de malabsorción, aunque en la actualidad se considera un linfoma esporádico. La histopatología se caracteriza por linfocitos de tamaño intermedio a pequeño, con mínimo pleomorfismo, que generalmente expresan CD8 y CD56. Reporte de caso: Mujer de 60 años con un cuadro de dispepsia de larga evolución, ingresada por dolor abdominal agudo, diarrea, nausea, vómito bilioso y pérdida de peso. En los estudios se determinó anemia microcítica hipocrómica y desequilibrio hidroelectrolítico. Se evidenció por tomografía de abdomen una lesión nodular esplénica y engrosamiento concéntrico segmentario de yeyuno e íleon distal asociado a la presencia de líquido libre en cavidad abdominal. Evolución: Se realizó una laparotomía exploratoria con resección de yeyuno-transverso anastomosis latero-lateral, en patología se deteminó la presencia de 3 tumores: a nivel de yeyuno de 16x8.5x6 cm, en el íleon distal de 13x6.5x3 cm y en el ciego de 5x4x2cm con histología de linfoma no Hodgkin T de alto grado, intestinal primario, de tipo monomórfico epiteliotrópico (MEITL). Fue dada de alta en mejores condiciones diez días después. Dos semanas luego del alta desarrollo sepsis de foco urinario, deshidratación por síndrome de intestino corto, hiperamonemia y neumonía de focos múltiples con derrame pleural bilateral. Falleció al sexto día de hospitalización. Conclusiones: En conclusión, el MEITL es una neoplasia agresiva primaria intestinal de reciente identificación y pobre pronóstico. No se conocen en su totalidad los mecanismos moleculares y genéticos asociados a esta entidad. El caso presentado demostró un curso clínico similar al reportado en la literatura.

The absorbed dose of radiopharmaceuticals is estimated in adults with suspected pulmonary embolism explored by ventilation/perfusion studies. For pulmonary ventilation studies 81mKr, 133Xe, 99mTc (Technegas)-aerosol and 99mTc (DTPA)-aerosol are used. For perfusion agents, 99mTc(MAA), 99mTc (MSA) (macroaggregates and albumin microspheres) are used. For the dose calculation, the MIRD methodology and the anthropomorphic representation of the biokinetic organs of Cristy-Eckerman are used. In ventilation/perfusion studies, the lowest dose absorbed by the lungs with suspected embolism is due to 81mKr/ 99mTc (MSA), and the highest dose is due to 99mTc (Technegas)/99mTc (MAA) calculated for activities of 150 MBq for perfusion agents and 40 MBq for ventilation agents.

Using protective mechanical ventilation strategies with low tidal volume is usually accompanied by an increment of respiratory rate to maintain adequate alveolar ventilation. However, there is no robust data that support the safety of a high respiratory rate concerning ventilator-induced lung injury. Several experimental animal studies have explored the effects of respiratory rate over lung physiology, using a wide range of frequencies and different models. Clinical evidence is scarce and restricted to the physiological impact of increased respiratory rate. Undoubtedly, the respiratory rate can influence respiratory mechanics in various ways as a factor of multiplication of the power of ventilation, and gas exchange, and also on alveolar dynamics. In this narrative review, we present our point of view over the main experimental and clinical evidence available regarding the effect of respiratory rate on ventilator-induced lung injury development.

Juglone derivatives like 2-(4-hydroxyphenyl) amino-1,4-naphthoquinone (Q7) are used as antitumor agents, and act through reactive oxygen species (ROS) generation. Such may lead to abnormal lipid metabolism and ROS dysregulation. The objective of this study was to evaluate the effect of ascorbate on the metabolism of lipids and carbohydrates following Q7-induced oxidative stress. Male Wistar rats were administered Q7 (10 mg/Kg) and/or ascorbate (500 mg/Kg) orally for 20 days. Rats treated with Q7 showed an increase in serum triglycerides, VLDL cholesterol and lipid peroxidation levels. When Q7 treatment was followed up by ascorbate (500 mg/Kg) administration, we observed a reduction in serum triglycerides, VLDL cholesterol and lipid peroxidation. The oral administration of ascorbate reduced the Q7-induced increases in lipids, and postprandial glycemia. This could be associated with the redox activity of ascorbate that reduced the oxidative stress induced by Q7. We thus conclude that ascorbate modulates the Q7-induced increase of lipid and carbohydrate metabolism.

O crescimento populacional das últimas décadas tem sido acompanhado por mudanças na incidência de algumas patologias como é o câncer. A população idosa apresenta características específicas associadas com a idade, que devem ser consideradas. O câncer de mama (CM) é o tipo mais frequente no sexo feminino, com uma alta prevalência em idosas. O objetivo deste trabalho foi discutir os fatores associados ao tratamento do CM em idosas, buscado apontar as dificuldades e limitações enfrentadas por essas pacientes. Para isso, foi realizada uma revisão de literatura através de levantamento de dados de artigos científicos publicados nos últimos cinco anos. A alta incidência de CM em idosas pode ser relacionada com o envelhecimento da população e as mudanças de hábitos de vida da sociedade moderna, no entanto, essa parcela da população não é considerada para o rastreamento, acarretando demora do diagnóstico. Apesar de que as estratégias terapêuticas disponíveis para o CM são altamente eficientes, o diagnóstico precoce ainda é uma das ferramentas mais eficazes e está diretamente relacionado às chances de cura. As dificuldades para a atenção básica, tempo para realização de exames e consultas compromete, significativamente, a sobrevida dessas pacientes. Assim, é possível concluir que é fundamental o conhecimento das características particulares das pacientes com CM idosas considerando hábitos e fatores hereditários. Esse conjunto de informações podem auxiliar no diagnóstico precoce e orientar durante a definição da melhor estratégia de tratamento melhorando, assim, o prognóstico para essas pessoas. Palavras-chave: Idosas. Câncer de Mama. Tratamento. Prognóstico. Abstract The population growth of the last decades has been accompanied by changes in the incidence of some pathologies such as cancer. The elderly population has specific characteristics associated with age that must be considered. Breast cancer (BC) is the most common type of cancer in women, with a high prevalence in elderly women. The aim of this study was to discuss the factors associated with BC’s treatment in elderly women, and the difficulties and limitations faced by these patients. To this end, a literature review was carried out through data collection of scientific articles published in the last five years. The BC high incidence in elderly women can be related to the population aging and the changes in lifestyle habits of modern society, however this portion of the population is not considered for screening, resulting in a delay in BC’s diagnosis. Although the therapeutic strategies available for BC are highly efficient, early diagnosis is still one of the most effective tools and is directly related to the chances of a cure. Difficulties in primary care, time for exams and medical appointment affect the survival of those patients. Thus, it is possible to conclude that it is essential to know the features associated to the BC elderly patients, considering hereditary habits and factors. This set of information can assist in early diagnosis and guide during the definition of the best treatment strategy, leading to an improvement on patients’ prognosis. Keywords: Elderly. Breast Cancer. Treatment. Prognosis.

El estudio tuvo como objetivo determinar la resistencia transmitida (RT) del virus de la inmunodeficiencia humana (VIH) en pacientes procedentes de nueve departamentos del Perú. Para ello, se realizó un estudio descriptivo en 132 adultos que aceptaron participar mediante un consentimiento informado. Se colectaron muestras de sangre para realizar el recuento de células CD4/CD8, determinar la carga viral y la genotipificación del VIH. Se recabó información socioepidemiológica de los participantes mediante encuestas. Los resultados revelaron una frecuencia de RT de 9,8% (13/132). Los resultados del estudio ayudarán a mejorar los programas de intervención y monitoreo de la resistencia a los antirretrovirales en el país.

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (a novel coronavirus), which was first identified amid an outbreak of respiratory illness cases in Wuhan, China and declared a global health emergency, is currently considered an additional challenge in the management of patients with breast cancer (BC). Cancer patients are more vulnerable to becoming infected with severe acute respiratory syndrome coronavirus 2 and are more likely to suffer additional complications that can increase mortality. Identifying those BC patients who require more urgent therapy than others in the current situation is essential. These recommendations are based on and have been adapted from those similarly published by international scientific societies for BC management. They are divided mainly by clinical stage (early, advanced), subtype [luminal, human epidermal growth factor receptor 2 (HER2), triple-negative], or type of medical treatment and setting (neoadjuvant, adjuvant, metastatic). Recommendations for HER2 and triple-negative subtypes are similar, whereas in luminal subtype there are various options of management. The objective is to adapt guidelines to local context through relevant decision-makers, avoiding duplication of efforts and optimizing use or resources. We hope that these recommendations will help medical oncologists provide the best quality care to BC patients during the COVID-19 pandemic with information tailored to our healthcare system. AIM To establish and adapt recommendations from those published by international scientific societies for BC management. METHODS The Peruvian Society of Medical Oncology developed a consensus and propose here a manuscript with recommendations for oncological medical treatment of BC during the COVID-19 pandemic. The Peruvian Society of Medical Oncology invited a panel of experts and opinion leaders on BC working in major health care systems around Peru. Panel experts selected three international clinical practice guidelines (National Comprehensive Cancer Network, European Society for Medical Oncology, Spanish Foundation Research Group in Breast Cancer), considering that these are more representative in COVID-19 management. Also, the panel agreed to include at least one European and American clinical practice guideline. RESULTS Recommendations about BC management during the COVID-19 pandemic were divided mainly by clinical stage (early, advanced), subtype (luminal, HER2, triple-negative), or type of medical treatment and setting (neoadjuvant, adjuvant, metastatic). Recommendations for HER2 and triple-negative subtypes were similar between clinical practice guidelines, whereas in luminal subtype there were various options of management. One hundred twelve recommendations were reviewed, adapted, and voted. A consensus was made in order to provide best decisions of management, avoid duplication of efforts, and optimize medical resources, considering health care system reality. These recommendations are not intended to replace clinical judgment. CONCLUSION Most of recommendations are similar, mainly in high-risk subtypes (HER2, triple-negative). Certain societies adapt them to deal with different situations involving the best decision in the management of BC patients.

Background Brazilian blood banks encourage donors to report postdonation information (PDI) regarding conditions that would lead to deferral in an attempt to retrieve distributed nonconforming blood. Objectives This study evaluated the profile of donors reporting PDI, the impact on transfusion safety, and the possible impact on the discard of blood products. Subjects and methods We analyzed 115 consecutive PDIs between May 2014 and July 2015, a period comprising two dengue-like syndrome (DLS) outbreaks. Results These PDIs accounted for 87,780 blood donations. The average time for PDIs since donation was 4 (0-23) days and 190 blood components were discarded. DLS accounted for 21.7% of the PDIs analyzed; 11 of the 23 samples tested were nucleic acid test (NAT) positive for dengue and 2 positive for Zika virus (ZIKV). Six of these PDIs were reported after blood components have been transfused: After NAT testing, one of these recipients was diagnosed with dengue and another one with ZIKV infection, both possible transfusions transmitted but without clinical consequences. Conclusion The high number of recovered blood components due to PDI suggests that PDI remains a great ally in the fight against transfusion-transmitted infections and may be particularly useful during outbreaks of emerging potentially blood-borne pathogens.

A systematic review of the literature was performed in order to organize, evaluate, and select evidences available about the safety and efficacy of minimally invasive percutaneous arthrodesis with percutaneous pedicle screws in the treatment of patients with degenerative disc disease (and other spinal pathologies) as compared to conventional arthrodesis. PubMed, EMBASE and Cochrane Library databases were consulted to locate clinical trials and case reports/case series published in English between 2014 and 2019. After selection according to the inclusion/exclusion criteria, 21 of the 197 articles identified were chosen for a complete reading and used for the present review. Although the level of evidence of most of the studies included made the demonstration of efficacy and superiority among the surgical techniques reviewed difficult, the findings related to the minimally invasive procedure indicate a safe and reliable approach for the treatment of lumbar diseases. Level of evidence II; Systematic review of literature. RESUMO A revisão sistemática da literatura foi realizada com o objetivo de organizar, avaliar e selecionar evidências a respeito da segurança e eficácia da artrodese percutânea minimamente invasiva com parafusos pediculares percutâneos no tratamento de pacientes com doença degenerativa de disco (e outras patologias da coluna), em comparação com a artrodese convencional. Foram consultadas as bases de dados PubMed, EMBASE e Biblioteca Cochrane para localizar ensaios clínicos e relatos/séries de casos publicados em inglês entre 2014 e 2019. Dentre 197 estudos identificados, depois de seleção usando critérios de inclusão/exclusão, 21 artigos foram escolhidos para leitura na íntegra e usados na presente revisão. Apesar do nível de evidência da maioria dos estudos incluídos dificultar a demonstração de eficácia e superioridade entre as técnicas cirúrgicas revisadas, os achados referentes ao procedimento minimamente invasivo apontam para uma abordagem segura e confiável para o tratamento de doenças lombares. Nível de evidência II; Revisão sistemática da literatura. RESUMEN La revisión sistemática de la literatura fue realizada con el objetivo de organizar, evaluar y seleccionar evidencias al respecto de la seguridad y eficacia de la artrodesis percutánea mínimamente invasiva con tornillos pediculares en el tratamiento de pacientes con enfermedad degenerativa de disco (y otras patologías de la columna) en comparación con la artrodesis convencional. Fueron consultadas las bases de datos PubMed, EMBASE y Biblioteca Cochrane para localizar ensayos clínicos y relatos/series de casos publicados en inglés entre 2014 y 2019. Entre 197 estudios identificados, después de selección usando criterios de inclusión/exclusión, fueron escogidos 21 artículos para lectura integral y usados en la presente revisión. A pesar de que el nivel de evidencia de la mayoría de los estudios incluidos dificulte la demostración de eficacia y superioridad entre las técnicas quirúrgicas revisadas, los hallazgos referentes al procedimiento mínimamente invasivo apuntan hacia un abordaje seguro y confiable para el tratamiento de enfermedades lumbares. Nivel de evidencia II; Revisión sistemática de la literatura.

Background: Inflammation plays a key role in atherosclerotic plaque destabilization and adverse cardiac remodeling. Recent evidence has shown a promising role of colchicine in patients with coronary artery disease. We evaluated the efficacy and safety of colchicine in post–acute myocardial infarction (MI) patients.Methods: We searched five electronic databases from inception to January 18, 2021, for randomized controlled trials (RCTs) evaluating colchicine in post–acute MI patients. Primary outcomes were cardiovascular mortality and recurrent MI. Secondary outcomes were all-cause mortality, stroke, urgent coronary revascularization, levels of follow-up high-sensitivity C-reactive protein (hs-CRP), and drug-related adverse events. All meta-analyses used inverse-variance random-effects models.Results: Six RCTs involving 6,005 patients were included. Colchicine did not significantly reduce cardiovascular mortality [risk ratio (RR), 0.91; 95% confidence interval (95% CI), 0.52–1.61; p = 0.64], recurrent MI (RR, 0.87; 95% CI, 0.62–1.22; p = 0.28), all-cause mortality (RR, 1.06; 95% CI, 0.61–1.85; p = 0.78), stroke (RR, 0.28; 95% CI, 0.07–1.09; p = 0.05), urgent coronary revascularization (RR, 0.46; 95% CI, 0.02–8.89; p = 0.19), or decreased levels of follow-up hs-CRP (mean difference, −1.95 mg/L; 95% CI, −12.88 to 8.98; p = 0.61) compared to the control group. There was no increase in any adverse events (RR, 0.97; 95% CI, 0.89–1.07; p = 0.34) or gastrointestinal adverse events (RR, 2.49; 95% CI, 0.48–12.99; p = 0.20). Subgroup analyses by colchicine dose (0.5 vs. 1 mg/day), time of follow-up (30 days) showed no changes in the overall findings.Conclusion: In post–acute MI patients, colchicine does not reduce cardiovascular or all-cause mortality, recurrent MI, or other cardiovascular outcomes. Also, colchicine did not increase drug-related adverse events.

Herd immunity is considered to be a relevant aspect of COVID-19 epidemiology. In this regard, seroprevalence studies are essential for understanding how far countries and regions are from that potential point. This study analyzed seroprevalence data in nine studies from South America, which is a region that has been badly affected by COVID-19. Seroprevalence values ​​were high, with percentages up to 70.0% (95% CI 67.0-73.4%) in Iquitos, Peru. A meta-analysis of such data enabled a pooled seroprevalence to be obtained, estimated at 33.6% (95% CI 28.6-38.5%). Despite this, the COVID-19 pandemic in South America continues to significantly affect countries such as Brazil, Colombia, and Peru.

Undifferentiated pleomorphic sarcoma (UPS) is a high-grade neoplasm that is usually located in the extremities and retroperitoneum. In the past, UPS was considered the most common soft tissue sarcoma in adults; due to improvements in diagnostic techniques, most cases have been reclassified as other lineage-specific tumors. Gnathic bones are rarely affected, and the clinicopathological characteristics of this neoplasm when diagnosed in the jaw remain to be better described. In this report, we present a rare case of mandibular UPS affecting an 88-year-old female who demonstrated a painful swelling on the right side of the mandible that was accompanied by a pathological fracture. Microscopic examination revealed a pleomorphic spindle-cell neoplasm with mitotic figures and necrosis. The patient underwent surgery and adjuvant radiotherapy but experienced metastasis after 12 months of follow-up and died. Diagnosis of UPS is challenging, and oral pathologists must be aware of this entity when dealing with aggressive undifferentiated neoplasms.

Background Idiopathic ventral spinal cord herniation (ISCH) is a rare disease; however, it is an important differential diagnosis. Its treatment presents some controversies. Case Description We report on a 55-year-old woman who had been presenting with relevant back pain and leg weakness for the past 3 years and urinary incontinence for the past 3 months. Clinical examination disclosed paresis on the right inferior limb and right foot, as well as a T6-level painful hypoesthesia. Magnetic resonance imaging disclosed a T4/T5 ISCH. The patient underwent surgical decompression. During the procedure, we opened the arachnoid and cut the dentate ligaments of the spine, which considerably improved the mobility and safety of the procedure. In the early follow-up, our patient presented a partial improvement regarding the paresis grades and hypoesthesia pain relief on the left side. A video showing the surgical procedure and case evolution is presented. We also assembled literature reviews to compare our case with others. ISCH is becoming a more recognized cause of progressive thoracic myelopathy. However, this condition is still frequently misdiagnosed. Magnetic resonance imaging is the key for diagnosis. The objective of surgical treatment is to prevent myelopathy progression. The technique presented in this report is an appropriate surgical option, once it is a safer way to identify and treat the defect. The neurologic condition usually improves greatly after surgical treatment, especially when the patient presents positive predictive factors. Conclusions ISCH is being more recognized. The technique presented is an appropriate surgical option.

Objetivos: Estimar la asociación entre tener conocimientos acerca del cáncer de cuello uterino (CaCu) y realizarse una prueba de Papanicolaou (PAP) en mujeres peruanas mayores de 30 años. Materiales y métodos: Se realizó un análisis secundario de la Encuesta Demográfica y de Salud Familiar de los años 2015 al 2017. El nivel conocimiento fue evaluado utilizando las preguntas: ¿considera usted que el cáncer se puede prevenir?, ¿alguna vez ha oído hablar del CaCu?, ¿alguna vez ha oído hablar del virus del papiloma humano (VPH)? y ¿considera que el VPH puede causar CaCu? La variable dependiente fue la realización de un PAP en los dos últimos años. Para estimar la asociación se utilizaron modelos lineales generalizados de la familia Poisson crudos y ajustados. La medida de asociación fue la razón de prevalencia ajustada (RPa) con sus respectivos intervalos de confianza al 95% (IC 95%). Resultados: Se analizaron datos de 21 563 mujeres. La prevalencia de haberse realizado un PAP en los últimos dos años fue 52,4%. Se encontró que, quienes respondieron que se puede prevenir el cáncer (RPa = 1,09; IC 95%: 1,01-1,17), que habían oído hablar del CaCu (RPa = 1,27; IC 95%: 1,14-1,40) o del VPH (RP 1,20; IC 95%:1,13-1,28) o que respondieron que el VPH podía causar CaCu (RPa = 1,21; IC 95%: 1,11-1,33) tuvieron una mayor prevalencia de haberse realizado un PAP en los últimos dos años. Conclusiones: Tener conocimientos sobre CaCu y VPH se asoció con haberse realizado un PAP en los últimos dos años.

Introduction We describe a 35-year-old male patient showing a myeloid sarcoma (MS) of the tongue as the first manifestation of acute promyelocytic leukemia (APL). The MS can appear in all parts of the human body, but it is extremely rare in the tongue. Clinical case The main symptoms were a pain in the tongue, asthenia, gingivorrhagia, fever. We found a tumor in the tongue, which was irregular in size and located in the posterior region of the right lateral edge of the tongue. The diagnosis of MS was made by the anatomopathological and immunohistochemical study, while the definite diagnosis of APL was confirmed by the molecular test. The treatment of APL was based on the administration of trans-retinoic acid 45 mg/m2 daily continuously and daunorubicin 60 mg/m2 every other day for 4 doses, with a favorable therapeutic response to APL and MS. Conclusion Promyelocytic myeloid cells can infiltrate many organs extramedullary, such as the tongue, and this might precede bone marrow infiltration. The early identification of myeloid sarcoma allows to carry out an early treatment of the APL.

RESUMO A osteonecrose dos maxilares associada ao uso de bisfosfonatos (OMMBF) e uma complicacao bastante investigada e na pratica clinica alguns exames tem sido recomendados para analise da acao dos bisfosfonatos no tecido osseo, como o telopeptideo carboxi-terminal do colageno tipo I (CTX) e exames imaginologicos, como a radiografia panorâmica. O objetivo deste trabalho foi correlacionar os resultados do exame CTX e de alteracoes radiograficas em pacientes usuarios de bisfosfonatos, portadores ou nao de OMMBF. O estudo foi retrospectivo, com prontuarios apresentando um exame CTX e uma radiografia panorâmica. Um examinador realizou a coleta das seguintes informacoes: genero, idade, doenca sistemica, tipo de medicamento, tempo de uso e forma de administracao, valor de CTX. De acordo com a presenca ou nao de OMMBF, os pacientes foram divididos em dois grupos: Grupo 1: com OMMBF e Grupo 2: sem OMMBF. Alem disso, a analise das radiografias panorâmicas foi feita por sextantes, observando a presenca de area osteolitica, alveolo fantasma, esclerose ossea, espessamento da lâmina dura e alteracoes no canal mandibular. Vinte pacientes foram incluidos na analise seguindo os criterios de inclusao. Considerando os valores do CTX dos tres grupos de estudo, o teste ANOVA nao apontou diferenca significativa entre os grupos (p=0,534). Tambem foi realizada a correlacao entre os grupos e o numero de alteracoes radiograficas da mesma maneira: os pacientes sem OMMBF (G2) receberam valor 1, os pacientes que desenvolveram OMMBF (G1B) receberam valor 2 e os pacientes com OMMBF (G1A) receberam valor 3; resultando r= 0,799, portanto correlacao positiva forte. Atraves deste estudo pode ser concluido que o exame CTX nao se mostrou indicador da OMMBF e as alteracoes radiograficas foram importantes indicadores da acao do bisfosfonato no tecido osseo.

Introduction Working conditions can contribute to the development of lifestyle-related diseases among teachers, including obesity and tinnitus. Describing tinnitus in relation to characteristics and comorbidities can help the treatment and prognosis of teachers affected by this symptom. Objective To verify a possible association between tinnitus complaint and body mass index (BMI) in teachers. Methods Cross-sectional study with a sample of teachers who responded to the Visual Analog Scale (VAS) and to the Tinnitus Handicap Inventory (THI). The BMI (kg/m2) was calculated based on self-reported body weight (in kilograms) divided by height (in meters squared). Nonparametric statistics were applied adopting a significance level Results A total of 83 teachers were assessed, with a mean age 48 ± 9.7 years old; 63.9% (n= 53) were females; 44.6% were eutrophic (n = 37), and 16.9% (n = 14) were obese. Of the total, 19.3% (n = 16) reported tinnitus. No differences were found between the groups and BMI (p > 0.05), although there was a significant difference between the Tinnitus and No Tinnitus groups for age (p Conclusion There was a moderate correlation between tinnitus parameters and BMI indicating that, as the BMI increased, so did the impact of tinnitus in the lives of the teachers. Body mass index should be considered a factor in tinnitus assessment and rehabilitation process.

Made available in DSpace on 2022-04-29T08:36:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-03-01 Tuberculosis remains one of the most important infectious diseases with well-known zoonotic nature that affect humans, wildlife, and domestic animals, including goats. Nonetheless, no intradermal tuberculin test has been standardized for caprine diagnosis of tuberculosis. The present study investigated the intradermal comparative cervical tuberculin test (ICCTT) in the diagnosis of tuberculosis among 60 goats from farms with history of tuberculosis. The cutoff applied to goats was based on a study where goats had been experimentally infected with Mycobacterium bovis and Mycobacterium avium. Clinical examination, bacteriological culture, and histopathological staining were assessed to the diagnosis. Isolates compatible with mycobacteria were subjected for molecular diagnosis based on gyrB-restriction fragment length polymorphism (RFLP) analysis and PCR restriction-enzyme analysis (PRA) of hsp65 gene by BstEII and HaeIII, namely PRA-hsp65 assay. From all goats, 60% (n = 36/60), 3.3% (n = 2/60), and 36.7% (n = 22/60) showed positive, inconclusive, and negative reactions, respectively. Out of 36 goats with ICCTT positive, 75% (n = 27/36) had isolation of mycobacteria and were detected M. bovis by gyrB-RFLP. Molecular diagnosis and histopathological findings compatible with tuberculosis showed 86.1% (n = 31/36) concordance with the ICCTT. When compared ICCTT with M. bovis isolation, gyrB-RFLP, and histopathology, the better arithmetic means of sensitivity and specificity were 2.5 mm for ICCTT compared with M. bovis isolation and gyrB-RFLP, and 4.55 mm when compared with histopathology. Both receiver operating characteristic (ROC) curves presented statistical significance (P < 0.001). The identification of other mycobacteria, e.g., M. kansasii, M. flavescens, M. avium, M. florentinum, M. lentiflavum, M. simiae, and Corynebacterium pseudotuberculosis, not influenced positive results in ICCTT. The concordance between bacteriological, histopathological, and molecular identification with ICCTT findings indicate that the tuberculin test may be used as a valuable tool for diagnosis of caprine tuberculosis and reinforce the importance of association of methods to diagnostic of the disease from animal origin. Coordination of Sustainable Rural Development Secretariat of Agriculture and Supply of State of São Paulo, SP Animal Pathology Department School of Veterinary Medicine and Animal Sciences University of São Paulo-USP, SP Department of Preventive Veterinary Medicine and Animal Science USP, SP Biological Institute of São Paulo Secretariat of Agriculture and Supply of State of São Paulo, SP Tuberculosis and Mycobacteriosies Laboratory Adolfo Lutz Institute, SP Departament of Clinics USP, SP Veterinary Medicine Academic Unit Federal University of Campina Grande UFCG, PB Department of Animal Production and Preventive Veterinary Medicine School of Veterinary Medicine and Animal Sciences São Paulo State University-UNESP, SP Department of Animal Production and Preventive Veterinary Medicine School of Veterinary Medicine and Animal Sciences São Paulo State University-UNESP, SP

El carcinoma de pene es un tumor que representa aproximadamente el 1% de los tumores del varón. La variedad verrucoso es poco frecuente, agresivo localmente aunque de manera lenta, no metastizante, y exige un diagnostico estricto anatomopatológico. Se presenta a un paciente de 72 años de edad con lesión en pene de 4 años de evolución. A la biopsia carcinoma verrucoso. Se le realizó penectomía parcial con bordes libres de carcinoma en la pieza operatoria. El acudir el paciente tempranamente a la consulta, la sospecha clínica, la biopsia y el tratamiento oportuno pueden salvar la vida al paciente. Trujillo Escuela Profesional de Medicina Revisión por pares

Introduction: This study investigated the applicability of the Subjective Global Nutritional Assessment (SGNA) tool to evaluate the nutritional status of pediatric cancer patients. Methods: This was a multicenter, observational cohort study of infants, children, and adolescents diagnosed with malignant tumors. Participants were evaluated at the moment they were diagnosed with a malignant tumor (EV1) and at the third month of treatment (EV2). Objective data were collected and the SGNA questionnaire was applied. Correlation between the methods was performed using the Kendall test. Results: We evaluated 216 patients at EV1 and 172 patients at EV2. During EV1, 7% of patients presented with some degree of malnutrition, according to objective measures, and 35.7% according to the SGNA. During EV2, they presented 6.4% and 26.8%, respectively. The SGNA showed ability to diagnose more malnutrition than objective indicators and the agreement found between both methods was moderate and weak. We observed a significant correlation between the SGNA and the nutritional indicators (p =

COVID-19 (coronavirus disease 2019) may present variable symptoms among infected individuals, with chronic disease patients appearing as the group most susceptible to present severe pulmonary infection, while having a higher risk of developing complications from the disease. This study demonstrates the relationship between the manifestation of COVID-19 and the presence of chronic miasmatic disease, based on the works of Samuel Hahnemann. The reaction of the individual who previously presented chronic miasmatic disease, when in contact with the stimulus of the epidemic disease, depends on the type of response that the organism was generating in the face of the pre-existing situation: if it is an intense reaction and greater than that which the stimulus of COVID-19 can generate, this individual will not develop the severe form of the epidemic disease; if the reaction is less than that generated by COVID-19, more intense symptoms may appear. Understanding that the presence of a chronic miasmatic disease interferes with the manifestation of COVID-19, which may have repercussions on other organs, can change how one must act on the treatment, as this can alter the individual's health status.

IntroductionAdolescents living with HIV (ALWH) face an elevated risk of poor health outcomes when transitioning into adult-oriented care; however, evidence-based interventions to support ALWH during this high-risk period are lacking, especially in Latin America. We conducted a pilot study of a community-based intervention designed to improve outcomes among ALWH transitioning to adult HIV care in Lima, Peru.MethodsFrom October 2019 to January 2020, we enrolled adolescents transitioning to adult HIV care, either due to a recent diagnosis or having aged out of their pediatric clinic. ALWH previously lost from care during the transition process were also invited to participate. The nine-month intervention consisted of (1) logistical, adherence and social support delivered by entry-level health workers who accompanied adolescents during their transition to adult HIV care and (2) group sessions to improve health-related knowledge, skills and social support. We assessed intervention feasibility and effectiveness in improving medication adherence, psycho-social outcomes, and transition readiness after 6, 9, and 12 months.ResultsWe enrolled 30 ALWH, ages 15-21 years; 11 were recently diagnosed and 19 had been living with HIV since infancy or early childhood. Participants included ten men who have sex with men, four young pregnant women and six adolescents who were previously lost during the transition to adult HIV care. Intervention participation was high with 90% of ALWH attending at least one in-person social support session and all attending at least one live online session. No ALWH withdrew from the intervention, study, or antiretroviral therapy. In transition readiness, we observed within-person improvements related to personal health (+1.9 points, pConclusionWe identified a community-based intervention that is feasible and potentially effective for bridging the transition to adult HIV care among a diverse group of ALWH in Peru. A larger-scale effectiveness evaluation, including biological endpoints, is warranted.

El objetivo de la investigación fue determinar el diagnóstico y la prevalencia de la Disfunción Temporomandibular (DTM), en el Hospital General María Auxiliadora, Lima, 2019. Material y métodos: Trabajo descriptivo, prospectivo, longitudinal y al azar. La muestra se constituyó con 76 pacientes, aplicándose los Criterios de Investigación para Diagnóstico de Desórdenes Témporo-Mandibulares(RDC/TDM). Resultados: Encontramos, que 73.7% fue del sexo femenino, especialmente en el grupo etario de 30-39 años (35.6%). La etiología de la DTM, es multifactorial y está relacionada a factores estructurales, funcionales y psicológicos. En el diagnóstico de DTM, la cefalea (38.1%) fue el principal síntoma y el dolor a la palpación de la articulación témporomandibular (51.4%), fue el signo destacado en el examen clínico, especialmente, en el sexo femenino (38.2%). El trastorno mixto de Ansiedad-Depresión, fue el cuadro clínico, de alteración del estado de salud mental más frecuente (50.0%), asociado a DTM, predominando en el sexo femenino (38.2%). La combinación de exámenes clínico-otorrinolaringológico, permitió el diagnóstico de DTM, en 77.6% de pacientes. Conclusión: Los pacientes con cuadros clínicos de DTM, que cursan con cefalea y concomitantemente con Ansiedad-Depresión, requieren un manejo terapéutico integral y precoz, para restituirlos a su ambiente de trabajo y mejorar su productividad laboral; la DTM, debería ser considerada, como una causa frecuente de cefalea.

Objective: To describe the clinical, laboratory and treatment characteristics of COVID-19 patients and to determine the factors associated with mortality during hospital stay. Materials and Methods: Retrospective cohort study of adult COVID-19 inpatients. The clinical, laboratory and treatment data were obtained from the medical records of patients from the Hospital Nivel III Daniel Alcides Carrión in Tacna. For the survival analysis we used the Cox proportional hazards model, and we calculated crude and adjusted hazard ratios (HR) with 95% confidence intervals (95% CI). Results: We evaluated 351 patients; 74.1% of them were men. The most common comorbidities were obesity (31.6%), hypertension (27.1%) and diabetes mellitus (24.5%). The median time of hospitalization was 8 days (IQR: 4-15). From the total of patients, 32.9% died during follow-up. The multivariate analysis showed an increased risk of dying associated with the following: age ≥65 years, HR = 3.55 (95% CI: 1.70-7.40); increase in lactate dehydrogenase 720 U/L, HR = 2.08 (95% CI: 1.34-3.22); and oxygen saturation less than 90%, mainly when it was less than 80%, HR = 4.07 (95% CI: 2.10-7.88). In addition, the use of colchicine during treatment showed a protective effect, HR = 0.46 (95% CI: 0.23-0.91). Conclusions: Risk factors for mortality due to COVID-19 included being older than 65 years, having oxygen saturation less than 90%, and elevated lactate dehydrogenase 720 U/L; colchicine treatment could improve the prognosis of patients. Objetivo: Describir las características demográficas, clínicas, laboratoriales y de tratamiento de pacientes hospitalizados por la COVID-19 y determinar los factores de riesgo de mortalidad hospitalaria. Materiales y métodos: Estudio de cohorte retrospectivo de pacientes adultos hospitalizados por la COVID-19. Se extrajeron datos demográficos, clínicos, laboratoriales y de tratamiento de las historias clínicas de pacientes que ingresaron al Hospital III Daniel Alcides Carrión de Tacna. Para el análisis de supervivencia se empleó el modelo de riesgos proporcionales de Cox y se calcularon los cocientes de riesgo instantáneos (HR) crudos y ajustados con sus respectivos intervalos de confianza al 95% (IC 95%). Resultados: Se evaluó a 351 pacientes, el 74,1% eran hombres; las comorbilidades más comunes fueron obesidad (31,6%), hipertensión (27,1%) y diabetes mellitus (24,5%). La mediana de tiempo de hospitalización fue 8 días (RIC: 4-15). El 32,9% falleció durante el seguimiento. El análisis multivariado mostró un aumento del riesgo de morir asociado a la edad ≥65 años, HR = 3,55 (IC 95%: 1,70-7,40); al incremento de lactato deshidrogenasa 720 U/L, HR = 2,08 (IC 95%: 1,34-3,22); y a la saturación de oxígeno por debajo del 90%, principalmente cuando fue menor al 80%, HR = 4,07 (IC 95%: 2,10-7,88). Además, el uso de colchicina en el tratamiento tuvo un efecto protector, HR = 0,46 (IC 95%: 0,23-0,91). Conclusiones: Los factores de riesgo de muerte por la COVID-19 incluyeron ser mayor de 65 años, tener saturación de oxígeno menor de 90% y elevación del lactato deshidrogenasa 720 U/L; el tratamiento con colchicina podría mejorar el pronóstico de los pacientes.

Overuse of antibiotics during the Coronavirus Disease 2019 (COVID-19) pandemic could increase the selection of extensively resistant bacteria (XDR). However, it is unknown what impact they could have on the evolution of patients, particularly critically ill patients. This study aimed to evaluate the characteristics and impact of ICU-acquired infections in patients with COVID-19. A retrospective cohort study was conducted, evaluating all patients with critical COVID-19 admitted to the intensive care unit (ICU) of a hospital in Southern Peru from 28 March 2020 to 1 March 2021. Of the 124 patients evaluated, 50 (40.32%) developed a healthcare-associated infection (HAI), which occurred at a median of 8 days (IQR 6–17) after ICU admission. The proportion of patients with HAI that required ceftriaxone was significantly higher, the same was true for the use of dexamethasone. Forty bacteria isolations (80%) were classified as XDR to antibiotics, with the most common organisms being Acinetobacter baumannii (54%) and Pseudomonas aeruginosa (22%), 33% (41/124) died at the ICU during the follow-up. In the adjusted analysis, healthcare-associated infection was associated with an increased risk of mortality (aHR= 2.7, 95% CI: 1.33–5.60) and of developing acute renal failure (aRR = 3.1, 95% CI: 1.42–6.72). The incidence of healthcare infection mainly by XDR pathogens is high in critically ill patients with COVID-19 and is associated with an increased risk of complications or death.

Background : Influenza remains a common cause of morbidity and mortality worldwide, and viral subtype-related differences in disease outcomes have been documented. Objective : To characterize the survival experience of adult inpatients with influenza virus-associated pneumonia by viral subtype during five consecutive flu seasons. Method : We performed a retrospective cohort study; data from 4,678 adults were analyzed using the Kaplan-Meier method. A multivariate Cox proportional hazard regression model was fitted. Results : The overall in-hospital mortality rate was 25.0 per 1,000 hospital days. The survival probabilities from pneumonia patients went from 93.4% (95% CI 92.6-94.1%) by day three to 43.3% (95% CI 39.2-47.4%) by day 30 from hospital admission. In general, the lowest survival rates were observed in patients with AH1N1 infection. In multiple models, after adjusting for comorbidities and when compared with A non-subtyped virus, pneumonia patients with AH3N2 or B strains had a significantly decreased risk of a non-favorable disease outcome. The association of other strains was not significant. Conclusions : Our findings suggest that the survival of inpatients with influenza virus-associated pneumonia varies according to the pathogenic viral subtype; the lowest survival rates were observed in patients with AH1N1 infection. This effect was independent of the patients' gender, age, and the analyzed underlying health conditions.

Congenital generalized lipodystrophy (CGL) is an autosomal recessive rare disease, with a worldwide prevalence of around 1 in every 12 million people. There are several case reports of patients with CGL in Piura, a region in northern Peru; however its regional prevalence is unknown. The objective was to determine the prevalence of CGL in the region of Piura, Peru during the years 2000-2017. A descriptive, observational study was carried out. A search of clinical histories of patients with the diagnosis of CGL attended between 2000 and 2017 in the pediatric and endocrinology services of the reference hospitals of the department of Piura and in the genetic and endocrinology services of the "Instituto Nacional de Salud del Niño". A patient was considered to have CGL if they met the clinical criteria and or if they had a molecular diagnosis, in addition to patients with CGL from the department of Piura reported in previous publications. A total of 23 cases of CGL were found in Piura, the highest prevalence was in 2014 with 1.2 per 100,000 people, and by 2017 the prevalence was 0.86 per 100,000 people. In conclusion, the department of Piura has a high prevalence of CGL.

Objective: To evaluate the performance of an instrument for predicting chronic chikungunya arthritis (CCA) in adult patients. Methods: A diagnostic test study was conducted and data from 217 confirmed cases of chikungunya virus (CHIKV) illness were analyzed. Two chronic chikungunya arthralgia scales (3-item CCAS-3 and 4-item CCAS-4) were constructed. Results: Modest performance of the CCAS-3 scale was documented at the two given cut-off points. A CCAS-4 score ≥3 showed high sensitivity and specificity for predicting the persistence of CCA at 12 months after acute disease. Conclusions: If replicated in other populations, these results could be useful in the medical management of patients with symptomatic CHIKV infection. Keywords: Chikungunya virus, Arthralgia, Chronic pain, Predictive value of tests

Resumen Introducción. En la tuberculosis multirresistente, el abandono del tratamiento constituye un grave problema de salud pública que afecta la calidad de vida de los pacientes, sus familias y la comunidad. El enfrentarlo supone una carga para los sistemas sanitarios debido a que provoca fuentes de transmisión libre en la comunidad e incrementa la prevalencia y la mortalidad. De ahí, la necesidad de investigar los factores asociados con esta situación. Objetivo. Determinar los factores de riesgo asociados con el abandono del tratamiento en pacientes con tuberculosis multirresistente en la región de Callao (Perú). Materiales y métodos. Se hizo un estudio analítico de casos y controles (80 casos y 180 controles) en tratamiento entre el 1° enero del 2010 y el 31 diciembre del 2012. Los factores se determinaron mediante regresión logística, y se calcularon los odds ratios (OR) y los intervalos de confianza (IC) del 95 %. Resultados. En el análisis multivariado se determinaron los siguientes factores de riesgo: no tener conocimiento de la enfermedad (OR=23,10; IC95%: 3,6-36,79; p=0,002); no creer en la curación (OR=117,34; IC95%: 13,57-124,6; p=0,000); no tener apoyo social (OR=19,16; IC95%: 1,32-27,77; p=0,030); no considerar adecuado el horario de atención (OR=78,13; IC95%: 4,84-125,97; p=0,002), y no recibir los resultados de laboratorio (OR=46,13; IC95%: 2,85-74,77; p=0,007). Conclusión. Los servicios de salud deben esforzarse en la determinación precoz de las condiciones que podrían convertirse en factores de riesgo, lo cual ayudaría a implementar preventivamente intervenciones efectivas, rápidas y de alto impacto. Abstract Introduction: In the context of multidrug-resistant tuberculosis, abandonment of therapy represents a serious public health problem that affects the quality of life of patients, families, and communities. Managing this phenomenon places a burden on health systems since it causes free sources of transmission in the community, thereby increasing prevalence and mortality. Thus, there is a need to study factors associated with this problem. Objective: This study sought to identify risk factors associated with the abandonment of therapy by patients with multidrug-resistant tuberculosis in the Peruvian region of Callao. Materials and methods: We conducted an analytical case-control study (cases=80; controls=180) in patients under treatment from January 1st, 2010, to December 31, 2012. Risk factors were identified using logistic regression; odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: The multivariate analysis identified the following risk factors: Being unaware of the disease (OR=23.10; 95% CI 3.6-36.79; p=0.002); not believing in healing (OR=117.34; 95% CI 13.57-124.6; p=0.000); not having social support (OR=19.16; 95% CI 1.32-27.77; p=0.030); considering the hours of attention to be inadequate (OR=78.13; 95% CI 4.84-125.97; p=0.002), and not receiving laboratory reports (OR=46.13; 95% CI 2.85-74.77; p=0.007). Conclusion: Health services must focus on the early detection of conditions that may represent risk factors to proactively implement effective, rapid and high-impact interventions.

Propósito de la revisión: el objetivo de la revisión es delinear el rol del Manejo Quirúrgico del carcinoma metastásico primario de cabeza y cuello. Buscamos reportes en indicaciones, posibles hallazgos y subsecuentes tratamientos. Recientes hallazgos: La punción aspirativa con aguja fina, permite diferenciar la etiología de los nódulos del cuello: melanoma, carcinoma tiroideo, linfoma y otros tumores indiferenciados. La medición de tiroglobulina ayuda a diferenciar una neoplasia de tiroides. El nivel ganglionar afectado I al III incluye el protocolo de paratiroidectomia, amigadalectomía. El nivel ganglionar IV y V el primario es infraclavicular. Extracto: El cáncer metastásico de primario oculto es una neoplasia con confirmación histológica pero con lesión primaria desconocida. Su manejo es controversial y en la mayoría de los casos insuficiente para llegar al diagnóstico, incluso con la autopsia. La aproximación inicial comprende una serie de exámenes de laboratorio e imágenes de alta complejidad que incluyen la tomografía por emisión de positrones con el test de la Flúor 2-Deoxi Glucosa (FDG-PET/CT), los estudios de anatomía patológica son el segundo paso dentro del manejo estándar e incluyen la Punción y Aspiración con Aguja fina (PAAF). La microscopia tradicional no es suficiente para identificar el tumor primario, las tinciones inmunohistoquímicas aunque no son especificas ni sensibles ayudan con ese propósito y aún más la microscopia electrónica. La biopsia o procedimientos más agresivos como la amigdalectomía son conductas a seguir si aún no se ha logrado el diagnóstico. Se presenta una revisión del estado del arte del manejo del Carcinoma Metastásico de Primario Desconocido de Cabeza y Cuello.

Deferasirox is an oral iron chelator with established dose-dependent efficacy for the treatment of iron overload secondary to transfusion. However, there is few data reporting the use of Desferasirox in adult patients with sickle cell disease (SCD) and transfusional iron overload.We conducted a prospective, single center, nonrandomized study from January 2014 to March 2015 in Campinas, Brazil. Seven patients (five women, median age 50 y.o.) who were followed up on regular transfusion program were treated with a single daily dose of deferasirox (median dose 20 mg/kg). They were monitored for clinical symptoms, renal function and hepatotoxicity.One patient discontinued the study due to lack of compliance. Two patients reported mild to moderate adverse events (gastrointestinal disturbances). Five patients had the drug discontinued due to worsening of renal function. One patient had the drug discontinued due to severe hepatotoxicity that evolved to death; no patient finished the study.

The current COVID-19 (coronavirus disease 2019) epidemic has proved challenging due to its high impact on physical and mental health. According to Hahnemann, the founder of homeopathy, in an epidemic the most severe symptoms of the clinical condition presented by the population in question should be the basis for selecting the medication that is as similar as possible to them, and which should be administered to individuals who have been exposed to the disease but have not yet developed it. This medicine is called the genus epidemicus. This study aims to demonstrate the reasoning used to propose the homeopathic medicine Antimonium tartaricum (Ant-t) as a genus epidemicus in the COVID-19 epidemic. It was decided to develop the reasoning based on the respiratory symptoms described in the epidemiological bulletins presented by the Health Surveillance Secretariat of the Ministry of Health of Brazil, as these symptoms are the most serious of the disease. After repertorization, it was confirmed in the Materia Medica that Ant-t has a high degree of similarity with these respiratory symptoms, including the most serious situations, of COVID-19. Homeopathic Ant-t is thus a possible prophylactic genus epidemicus in the COVID-19 epidemic; further studies are needed to test this conclusion.

Introduction: The high transmissibility and lethality of the novel coronavirus SARS-CoV-2 (COVID-19) have been catastrophic. Acute kidney injury (AKI) is one of the frequent complications in patients with respiratory insufficiency caused by the virus. The pathogenic mechanism is based on the binding of its S-proteins to the angiotensin-converting enzyme (ACE) receptors, which will trigger a cellular damage. A podocyte and tubular compromise are found in the kidneys which can lead to tubular necrosis and the consequent AKI. Objectives: The objective of this report is to identify the main risk factor to develop AKI in patients infected with SARS-CoV-2 with critical acute respiratory distress. Patients and Methods: We performed this report study, collecting data from 48 ICU patients. Data from 13 of them who developed AKI and needed renal replacement therapy (RRT)were analyzed. Clinical characteristics and laboratory findings were reported using STATA 10.0. Results: AKI was present in 27.08% of patients, mostly male (92.3%) with a mean age of 63.8 years old. Hypertension, diabetes and obesity were the main comorbidities in those patients. Additionally, the meantime between admission and AKI diagnosis was 2.69 days. All patients showed fibrinogen, D-dimer, ALT and values above normal range. Mortality was seen in 61.5% of patients. Conclusion: This report tries to show AKI as an important clinical manifestation in critically ill patients infected with SARS-CoV-2, with high mortality. Further studies are needed to demonstrate if there are independent risk factors. Revisión por pares

Primary squamous cell carcinoma of the colon is extremely rare. The etiology is poorly understood, and currently, there are different hypotheses about the origin of this malignant neoplasm. Here, we report a case of an 87-year-old male with a moderately-differentiated nonkeratinizing squamous cell carcinoma of the colon.

Background: Peru was one of the countries with the highest COVID-19 mortality worldwide during the first stage of the pandemic. It is then relevant to evaluate the risk factors for mortality in patients hospitalized for COVID-19 in three hospitals in Peru in 2020, from March to May, 2020. Methods: We carried out a retrospective cohort study. The population consisted of patients from three Peruvian hospitals hospitalized for a diagnosis of COVID-19 during the March-May 2020 period. Independent sociodemographic variables, medical history, symptoms, vital functions, laboratory parameters and medical treatment were evaluated. In-hospital mortality was assessed as the outcome. We performed Cox regression models (crude and adjusted) to evaluate risk factors for in-hospital mortality. Hazard ratios (HR) with their respective 95% confidence intervals (95% CI) were calculated. Results: We analyzed 493 hospitalized adults; 72.8% (n=359) were male and the mean age was 63.3 ± 14.4 years. COVID-19 symptoms appeared on average 7.9 ± 4.0 days before admission to the hospital, and the mean oxygen saturation on admission was 82.6 ± 13.8. While 67.6% (n=333) required intensive care unit admission, only 3.3% (n=16) were admitted to this unit, and 60.2% (n=297) of the sample died. In the adjusted regression analysis, it was found that being 60 years old or older (HR=1.57; 95% CI: 1.14-2.15), having two or more comorbidities (HR=1.53; 95% CI: 1.10-2.14), oxygen saturation between 85-80% (HR=2.52; 95% CI: 1.58-4.02), less than 80% (HR=4.59; 95% CI: 3.01-7.00), and being in the middle (HR=1.65; 95% CI: 1.15-2.39) and higher tertile (HR=2.18; 95% CI: 1.51-3.15) of the neutrophil-to-lymphocyte ratio, increased the risk of mortality. Conclusions: The risk factors found agree with what has been described in the literature and allow the identification of vulnerable groups in whom monitoring and early identification of symptoms should be prioritized in order to reduce mortality.

Objective: To assess the association between NLR and PLR with all-cause mortality in Peruvian patients with CKD Methods: We conducted a retrospective cohort study in adults with CKD in stages 1 to 5. The outcome variable was mortality and as variables of exposure to NLR and PLR. Both ratios were categorized as high with a cut-off point of 3.5 and 232.5; respectively. We carried out a Cox regression model and calculated crude and adjusted hazard ratios (HR) with their 95% confidence interval (95%CI). Results: We analyzed 343 participants with a median follow-up time of 2.45 years (2.08-3.08). The frequency of deaths was 17.5% (n=60). In the crude analysis, the high NLR and PLR were significantly associated with all-cause mortality (HR=2.01; 95% CI:1.11-3.66) and (HR=2.58; 95% CI:1.31-5.20). In the multivariate model, after adjusting for age, sex, serum creatinine, CKD stage, albumin and hemoglobin, the high NLR and PLR remained as an independent risk factor for all-cause mortality, (HR=2.10; 95% CI:1.11-3.95) and (HR=2.71; 95% CI:1.28-5.72). Conclusion: Our study suggests the relationship between high NLR and PLR with all-cause mortality in patients with CKD.

Background Common variable immunodeficiency is the most prevalent symptomatic primary immunodeficiency in adults. Affected patients fail to mount an appropriate humoral response against community acquired infectious diseases and recent reports have provided data supporting the increased susceptibility of these patients to severe SARS-CoV-2 infections. In this context, the infusion of COVID-19 convalescent plasma could represent an effective therapeutic strategy. Case presentation 25-year old woman diagnosed with common variable immunodeficiency in 2013, developed severe COVID-19 that rapidly progressed to pneumonia presenting with multiple bilateral lung opacities that were both central and peripheral and presented as ground-glass and consolidation types involving all lobes, bilaterally. As blood oxygen saturation decayed and lung abnormalities were not responsive to large spectrum antibiotics and corticosteroids, patient was placed on mechanical ventilation and compassionate-use of approved COVID-19 convalescent donor plasma was introduced. The patient presented a rapid response to the approach and mechanical ventilation could be interrupted 24 h after first dose of COVID-19 convalescent donor plasma. As a whole, the patient received four doses of 200 mL convalescent plasma during a period of 6 days. There was rapid improvement of clinical status, with interruption of supplemental oxygen therapy after 6 days and reduction of lung abnormalities as evidence by sequential computed tomography scans. Conclusions This is a single patient report that adds to other few reports on common variable immunodeficiency and agammaglobulinemia, suggesting that COVID-19 convalescent donor plasma could be a valuable therapeutic approach to treat patients affected by dysgammaglobulinemias and presenting severe COVID-19.

Background: Neutrophil-to-lymphocyte ratio (NLR) is an accessible and widely used biomarker. NLR may be used as an early marker of poor prognosis in patients with COVID-19. Methods: We conducted a systematic review and meta-analysis. Observational studies that reported the association between baseline NLR values (i.e. at hospital admission) and severity or all-cause mortality in COVID-19 patients were included. The quality of the studies was assessed using the Newcastle-Ottawa scale (NOS). Random effects models and inverse variance method were used for meta-analyses. The effects were expressed as odds ratios (OR) and their 95% confidence intervals (CI). Small study effects were assessed with the Egger’s test. Results: Twenty studies, 19 cohorts and one case-control were included. An increase of one unit of NLR was associated with a higher odds of COVID-19 severity (OR 6.6, 95% CI: 4.71 - 7.19; p

Resumen Objetivo: El objetivo del estudio fue describir las características clínicas, laboratoriales y de tratamiento en pacientes hospitalizados por COVID-19 y determinar los factores de riesgo para mortalidad hospitalaria. Métodos: Estudio de cohorte retrospectivo de pacientes adultos hospitalizados por COVID-19. Se extrajeron datos clínicos, laboratoriales y de tratamiento de historias clínicas de pacientes que ingresaron al Hospital Nivel III Daniel Alcides Carrión-Tacna. El análisis de supervivencia empleó el modelo de riesgos proporcionales de Cox y se calcularon Hazard Ratio (HR) crudos y ajustados con sus respectivos intervalos de confianza al 95% (IC95%). Resultados: Se evaluó a 351 pacientes, el 74.1% eran hombres, las comorbilidades más comunes fueron obesidad (31,6%), hipertensión (27.1%) y diabetes mellitus (24.5%). La mediana de tiempo de hospitalización fue 8 días (RIC: 4-15). El 32.9% falleció durante el seguimiento. El análisis multivariado mostró un aumento del riesgo de morir asociada a edad >=65 años HR=3.55 (IC95%:1.70-7.40), incremento de lactato deshidrogenasa >720 U/L HR=2.08 (IC95%:1.34-3.22), y la saturación de oxígeno menor de 90%, principalmente cuando fue menor de 80% HR=4.07 (IC95%:2.10-7.88). Además, dentro del tratamiento, colchicina mostró un efecto protector HR=0.46 (IC95%:0.23-0.91). Conclusiones: Los factores de riesgo para mortalidad por COVID-19 incluyeron ser mayor de 65 años, tener saturación de oxígeno menor de 90% y elevación del lactato deshidrogenasa >720 U/L; el tratamiento con colchicina podría mejorar el pronóstico de los pacientes.

Brazil has a herd of over 9 million goats, and the northeast of Brazil is home to over 93% of this herd. Caprine mycoplasmosis are widely disseminated worldwide, being highly contagious with high rates of morbidity and mortality, causing considerable economic loss to goat herders. In addition, there has been a lack of research using molecular testing to monitor the health and detect Mollicutes in this herd in Brazil. Therefore, the aim of this study is to associate animal management with the presence of the caprine origin Mollicutes in goats, in the southwest region of the state of Bahia, Brazil. A cross-sectional study was conducted on twelve farms, and statistical analyses were performed to identify associations between the presence of Mollicutes and the management of goats. Molecular testing identified Mollicutes class, Mycoplasma agalactiae (Ma) and M. conjunctivae (Mc), in the samples analyzed. Statistical associations were observed between animals from intensive livestock facilities and the presence of Mollicutes in nasal samples and dairy ranch animals and the presence of Mollicutes in ocular samples and animals from extensive ranching sites and positive results of Mollicutes in genital samples. We conclude that mycoplasmas are present in goat herds in the southwestern region of Bahia, which supports the need for more focused studies of mycoplasmas throughout the country. Our research also demonstrated the presence of two important opportunistic bacteria, Mc and Ma, and, to the best of our knowledge, this is the first time that M. conjunctivae was detected in Brazilian goats by molecular testing. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s42770-021-00517-z.

The relationship between the recent Zika virus (ZIKV) outbreak and the increase in the incidence of microcephaly in newborns prompted the declaration of a public health emergency in many countries. As ZIKV was identified in the blood of healthy blood donors and survives blood processing techniques and storage conditions, its transmission through transfusion was plausible and raised concerns about the safety of blood inventories and recipients at risk, such as immunosuppressed patients and pregnant women. This chapter provides an updated review of the prevalence of ZIKV infection in blood donors and transfusion recipients around the world and discusses the possible measures for preventing its transfusion transmission, including the clinical and laboratory screening of potential donors and the inactivation of pathogens in blood components. The coordination of research and public policy efforts against the threat of new emerging pathogens is also discussed.

Summary Introduction Rapid functional assays have been proposed to overcome the limitations of washed platelet assays in the work-up of patients with suspected heparin-induced thrombocytopenia (HIT). Data on the diagnostic accuracy are, however, scarce and conflicting. We aimed to study the diagnostic accuracy of a rapid, flow cytometer-based assay and to explore sources of variability. Material and methods Frozen serum samples of 103 consecutive patients, evaluated for suspected HIT at our institution in 2017, and characterized with 4Ts score, IgG-PF4/heparin ELISA (GTI), HemosIL®Acustar (IgG), as well as heparin-induced platelet activation test (HIPA), were further tested using HIT Confirm, determining P-selectin release of donor platelets after incubation with patient's serum. The diagnosis of HIT was defined as a positive HIPA result. Results HIT was confirmed in 15 out of 103 patients corresponding to a prevalence of 14.6%. HIT Confirm was positive in 11 patients (10.7%), negative in 88 patients (85.4%), and inconclusive in 4 patients (3.9%). According to the intention-to-diagnose principle, the number of true positives was 9, the number of true negatives 83, the number of false negatives was 6, the number of false positives 5. This corresponds to a sensitivity of 60.0%, and a specificity of 94.3%. Modifications of the test did not improve sensitivity. Conclusions The rapid, flow cytometer-based assay HIT Confirm is able to verify HIT in positive patient samples but cannot rule-out HIT in clinical practice. Other rapid functional assays shall be studies in appropriately designed diagnostic accuracy studies.

Background: Neutrophil-to-lymphocyte ratio (NLR) is an accessible and widely used biomarker. NLR may be used as an early marker of poor prognosis in patients with COVID-19. Objective: To evaluate the prognostic value of the NLR in patients diagnosed with COVID-19. Methods: We conducted a systematic review and meta-analysis. Observational studies that reported the association between baseline NLR values (ie, at hospital admission) and severity or all-cause mortality in COVID-19 patients were included. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS). Random effects models and inverse variance method were used for meta-analyses. The effects were expressed as odds ratios (ORs) and their 95% confidence intervals (CIs). Small study effects were assessed with the Egger's test. Results: We analysed 61 studies (n = 15 522 patients), 58 cohorts, and 3 case-control studies. An increase of one unit of NLR was associated with higher odds of severity (OR 6.22; 95%CI 4.93 to 7.84; P

Introduction Cutaneous malignant melanoma (CMM) incidence has risen rapidly in the last 50 years. Poor progression and high mortality characterize CMM, making a thorough understanding of progression and associated factors essential for optimizing care. Aims We assessed the association between the Neutrophil-to-Lymphocyte Ratio (NLR) and mortality in adults with CMM from an entirely mixed-race Hispanic population during 12 consecutive years of extensive follow-up. Material & Methods We performed a retrospective cohort study in a tertiary hospital in Peru. NLR was categorized with a cutoff value higher or equal than 3. We collected demographic variables, laboratory results and treatments at baseline of follow-up. Cox regression analysis was performed, and we calculated crude and adjusted hazard ratios (HR) and their 95% confidence interval (95%CI). Results The analysis was from 615 CMM cases, and there were 378 deaths. Most melanomas (63.6%) were acral lentiginous. The crude analysis showed that high NLR is a risk factor for mortality, HR = 2.52; 95%CI (2.03–3.14). High NRL ratio remains statistically significant after adjusting for confounding variables, aHR = 1.61; 95%CI (1.16–2.24). Other risk factors for mortality were clinical stages III and IV, older than 60 years, females and greater Breslow thickness. Conclusions We concluded that high NRL ratio is a risk factor for mortality and should be monitored in every patient who is diagnosed with malignant melanoma during their first blood count. It should then be carried out in follow-up controls for patients of clinical stage III and IV only, or in patients who present a relapse.