Association between self-reported evidence-based medicine competencies and prescribing of drugs without scientific evidence against mild COVID-19 among recently graduated physicians in Peru.

Objective: To evaluate the association between self-rated evidence-based medicine (EBM) competencies and the prescription of drugs without scientific evidence against mild COVID-19 (present with any of the signs and symptoms of COVID-19 but who do not have shortness of breath, dyspnea, or abnormal chest imaging) among recently graduated physicians in Peru. Methods: We conducted an analytical cross-sectional study where we evaluated a non-probability sample of recently graduated physicians during June and July 2021 (end of second wave of COVID-19 in Peru). Self-rated EBM competencies were assessed by four domains (formulation of a clinical question, search, analysis, and application) using a Likert scale with scores from zero to four ("Very inadequate" = 0, to "Very Adequate" = 4), it was considered as "Adequate" if the score was three or four. In addition, the variable "General competence on EBM" was rated as "Adequate" if in all domains evaluated it presented an adequate self-rating. For the outcome, drug prescription, we considered the use of ivermectin, azithromycin, other antibiotics, hydroxychloroquine, dexamethasone, and anticoagulants (drugs with no efficacy demonstrated for patients with mild COVID-19). To assess the association, we used Poisson regression models with robust variances and obtaining crude (cPR) and adjusted (aPR) prevalence ratios with their 95% confidence intervals (95%CI). Results: Of a total of 239 physicians included 70.7% prescribed at least one drug without scientific evidence. A total of 51.1% reported adequate ratings in all evaluated domains of EBM. Self-rating the "Clinical Question Formulation" competency as adequate was associated with a lower frequency of prescribing medications for mild COVID-19 (aPR: 0.93; 95% CI: 0.91-0.95). While self-rating as adequate the competency of "Identify possible implications of investigations" was associated with an increase in the prescription of such drugs (aPR: 1.14; 95% CI: 1.09-1.20). Additionally, self-rating all domains as adequate were associated with less prescription (aPR: 0.93; 95% CI: 0.90-0.96). Conclusion: Seven out of ten recently graduated physicians prescribed some type of medication without scientific evidence to treat patients with mild COVID-19. Having adequate self-perceived EBM competencies was associated with a lower frequency of prescribing medications without scientific evidence to manage patients with mild COVID-19.

Differences in the evolution and management of acute appendicitis in patients with COVID-19: a case-control study.

BACKGROUND: The COVID-19 pandemic has generated uncertainty about the management of appendicitis. AIM: The aim of this study was to evaluate differences in the evolution and treatment of acute appendicitis in patients with COVID-19 infection compared to patients without the infection. METHODS: A case-control study of adult patients hospitalized for acute appendicitis was performed, having as cases those who presented COVID-19. Data were extracted from the medical records. The logistic regression model was used to calculate crude (cOR) and adjusted odds ratios (aOR) with their respective 95% confidence intervals (95% CI). RESULTS: We evaluated 38 cases and 76 controls, the mean age of the patients was 38.2 years (± 16.8), of whom 55.3% were women. Multivariate analysis showed, in cases, a lower probability of intraoperative findings (aOR: 0.21; 95% CI: 0.05-0.90) and a surgery time of more than 60 min (aOR: 0.21; 95% CI: 0.06-0.80), while there was a greater probability of management by open surgery (aOR: 3.83; 95% CI: 1.42-10.32) and a hospitalization time of more than 3 days after surgery (aOR: 3.33; 95% CI: 1.34-8.26). CONCLUSION: Significant differences were observed in terms of intraoperative findings, type of surgery, intraoperative time, and hospitalization time in patients with acute appendicitis and COVID-19.

ANTECEDENTES: La pandemia de COVID-19 ha generado incertidumbre sobre el manejo de la apendicitis. OBJETIVO: Evaluar las diferencias en la evolución y el tratamiento de la apendicitis en pacientes con COVID-19 en comparación con los pacientes sin la infección. MÉTODOS: Se realizó un estudio de casos y controles de pacientes adultos hospitalizados por apendicitis aguda, teniendo como casos aquellos que presentaron COVID-19. Los datos se extrajeron de las historias clínicas. Se utilizó el modelo de regresión logística para calcular las odds ratios (OR) crudas y ajustadas con sus respectivos intervalos de confianza del 95% (IC 95%). RESULTADOS: Se evaluaron 38 casos y 76 controles, la edad media de los pacientes fue de 38.2 años (± 16.8), de los cuales el 55,3% eran mujeres. El análisis multivariante mostró, en los casos, una menor probabilidad de hallazgos intra operatorios (ORa: 0,21; IC 95%: 0.05-0.90) y un tiempo de cirugía superior a 60 min (ORa: 0.21; IC 95%: 0.06-0.80), mientras que hubo una mayor probabilidad de manejo mediante cirugía abierta (ORa: 3.83; IC 95%: 1.42-10.32) y un tiempo de hospitalización superior a tres días tras la cirugía (ORa: 3.33; IC 95%: 1.34-8.26). CONCLUSIONES: Se observaron diferencias significativas en cuanto a los hallazgos intraoperatorios, el tipo de cirugía, el tiempo intraoperatorio y el tiempo de hospitalización en pacientes con apendicitis aguda y COVID-19.

Association between prehospital medication and fatal outcomes in a cohort of hospitalized patients due to coronavirus disease-2019 in a referral hospital in Peru.

BACKGROUND: To explore the association between the use of prehospital medications and the development of fatal outcomes in patients who required hospitalization due to coronavirus disease-2019 (COVID-19). METHODS: This retrospective cohort study included adult patients who were hospitalized due to COVID-19. Demographic, clinical, and laboratory data, prehospital medication history, and fatal outcome development (use of high-flow oxygen therapy, intensive care unit [ICU] admission, or mortality) were extracted from the medical records of patients who were admitted due to COVID-19 to the Carlos Seguín Escobedo National Hospital of Arequipa, Peru during July to September 2021, the period after the second wave of COVID-19 cases in Peru. Survival was analyzed using the Cox proportional hazards model, and crude hazard ratios and adjusted hazard ratios (aHR) with their respective 95% confidence intervals (95% CI) were calculated. RESULTS: A total of 192 patients were evaluated, of whom 62% were males and 46.9% did not require oxygen support at admission. Additionally, 64.6% used nonsteroidal anti-inflammatory drugs, 35.4% used corticosteroids, 28.1% used macrolides or ceftriaxone, 24.5% used ivermectin, and 21.9% used warfarin before hospitalization. Of the patients, 30.2% developed a fatal outcome during follow-up. The multivariate analysis revealed that prehospital corticosteroid use was independently associated with the fatal outcome due to COVID-19 with an aHR = 5.29 (95%CI: 1.63-17.2). CONCLUSION: Prehospital corticosteroid use was associated with a 5-fold increased risk of fatal outcome development.

[Parents' perceptions and intention to vaccinate their children under 12 years of age against COVID-19: a cross-sectional study in Peru]. / Percepciones e intención de los padres de vacunar a sus hijos bajo 12 años de edad contra la COVID-19: estudio transversal en Perú.

BACKGROUND: Despite the proven efficacy and safety of COVID-19 vaccines, pediatric vaccination coverage remains low in many countries. There are still doubts and fears in parents about vaccination in their children under 12 years of age. AIM: To evaluate the perceptions and intention of parents to vaccinate their children under 12 years of age. METHODS: Analytical cross-sectional study based on an online survey that evaluated the parents' perceptions regarding the risk of COVID-19 infection, the need for a vaccine, and the vaccine adverse events in their children under 12 years. We assessed the factors associated with the intention to vaccinate through crude (cPR) and adjusted prevalence rates (aPR), with confidence interval of 95% (CI 95%). RESULTS: 83.5% of respondents had the intention to vaccinate their children under 12 years of age. In the multivariate analysis, the factors associated with a decrease in the intention to vaccinate were to believe that the vaccine was not necessary (aPR 0.65; 95% CI 0.44 - 0.94), that it would not protect (aPR: 0.14; 95% CI 0.03 - 0.63), it would not be safe (aPR: 0.80; 95% CI 0.70 - 0.92) and it would cause long-term side effects (aPR: 0.92; 95% CI 0.85 - 1.00). On the other hand, living on the highlands or jungle was associated with an increase in the intention. CONCLUSION: In Peru, 16.5% of parents would not vaccinate their children under 12 years of age, because they perceived that the vaccine was not necessary and would not protect against COVID-19. In addition, they expressed concerns about the development of possible adverse events.

Prevalence and factors associated with not receiving the booster dose of the COVID-19 vaccine in adults in Latin America and the Caribbean.

BACKGROUND: Booster doses have been described as effective in reducing hospitalizations and deaths from the new variants. However, its coverage is heterogeneous in Latin America and the Caribbean (LAC), one of the regions most affected by the pandemic. We aimed to assess the factors associated with not receiving a coronavirus disease 2019 (COVID-19) vaccine booster dose in adults from LAC. METHODS: We analyzed a secondary database compiled by the University of Maryland and Facebook assessing the global impact of COVID-19. We included Facebook users over 18 years of age who resided in LAC and responded to the survey between February 13, 2022, and March 14, 2022. We evaluated sociodemographic characteristics, comorbidities, food, and economic insecurity, mental health, and vaccination-related practices. We calculated crude (cPR) and adjusted (aPR) prevalence ratios with their respective 95% confidence intervals (95%CI). RESULTS: The sample included 154,841 adults from 20 LAC countries. 33.7% (n = 46,459) reported not receiving the COVID-19 booster vaccine. Being under 75 years old, having a college, high school, pre-university, primary, or lower education, having no or 1 to 2 comorbidities, living in a town, having food insecurity, depressive symptoms, and having had COVID-19, were associated with a higher prevalence of not receiving the booster dose. In contrast, being female or non-binary and having anxiety symptoms were associated with a lower prevalence of not receiving the booster dose. CONCLUSIONS: Approximately three out of 10 adults surveyed in LAC reported not having received the booster vaccine. Authorities must design campaigns that promote receiving a booster dose considering the factors found.

Factors Associated with Not Receiving a Booster Dose of COVID-19 Vaccine in Peru.

To determine the factors associated with not receiving the booster dose for COVID-19 in Peru, a cross-sectional study by secondary analysis of a University of Maryland and Facebook survey database assessing the global impact of COVID-19 was conducted. Data of Peruvian users of this social network over 18 years of age who answered the survey between 13 February 2022 and 14 April 2022 were analyzed. We evaluated the association between sociodemographic characteristics, comorbidities, and history of COVID-19 with having received a booster dose for COVID-19. Crude (cPR) and adjusted (aPR) prevalence ratios with their respective 95% confidence intervals (95%CI) were calculated. A sample of 20,814 adults, 21.5% of whom reported not receiving the booster dose, was analyzed. People under 75 years of age had a higher prevalence of not having received the booster dose. Likewise, having a university education (aPR = 1.03; 95%CI: 1.02-1.05), secondary, or pre-university education (aPR = 1.07; 95%CI: 1.05-1.09), or having a primary level or less (aPR = 1.11; 95%CI: 1.05-1.18), were associated with a higher prevalence of not receiving the booster, compared to individuals with a postgraduate education. Being employed (aPR = 1.01; 95%CI: 1.00-1.02), having had COVID-19 (aPR = 1.03; 95%CI: 1.01-1.04) and living in a town (aPR = 1.05; 95%CI: 1.02-1.07) or in a rural area (aPR = 1.06; 95%CI: 1.03-1.10), compared to living in the city, had a similar association. On the contrary, the female gender was associated with a lower prevalence of not receiving the booster (aPR = 0.97; 95%CI: 0.96-0.99). Sociodemographic characteristics and a history of having had COVID-19 were associated with the probability of not having received the booster dose for COVID-19 in the Peruvian population.

Exploratory analysis of internet search trends during the COVID-19 outbreak

ABSTRACT Coronavirus disease 2019 has put the world in a health emergency. Searching for information on the Internet largely reflects people's interest in this pandemic. Objective: Conduct an exploratory analysis of Internet search trends during the 2019 coronavirus disease outbreak. Methods: Google Trends was used to provide data on the relative volume of Google searches for terms related to 2019 coronavirus disease. The evaluation period was from January 01 to May 17, 2020. Results: The search term used to know this pandemic was "coronavirus", the most searched symptom was "fever", followed by "sore throat"and "cough", in addition, the interest of users to know the transmission routes of the acute respiratory syndrome coronavirus 2. As for preventive measures, the most searched term was "stay home", followed by "facial masks", "social distancing"and "washing hands". Conclusions: The results confirmed interest in COVID-19 via Internet. Using information from people's Internet search interest could help formulate health policies to better control the 2019 coronavirus disease outbreak. RESUMEN La enfermedad del coronavirus 2019 ha puesto al mundo en una emergencia sanitaria. La búsqueda de información en Internet refleja en gran medida el interés de la gente por esta pandemia. Objetivo: Realizar un análisis exploratorio de las tendencias de búsqueda en Internet durante el brote de la enfermedad por coronavirus de 2019. Métodos: Google Trends se utilizó para proporcionar datos sobre el volumen relativo de búsquedas en Google de términos relacionados con la enfermedad del coronavirus del año 2019. El período de evaluación fue del 1ro. de enero al 17 de mayo de 2020. Resultados: El término de búsqueda utilizado para conocer esta pandemia fue "coronavirus", el síntoma más buscado fue "fiebre", seguido de "dolor de garganta"y "tos";además, el interés de los usuarios por conocer las vías de transmisión del síndrome respiratorio agudo del coronavirus 2. En cuanto a las medidas preventivas, el término más buscado fue "quedarse en casa", seguido de "máscaras faciales", "distanciamiento social"y "lavarse las manos". Conclusiones: Los resultados confirmaron el interés en el COVID-19 a través de Internet. El uso de información del interés de búsqueda de las personas en Internet podría ayudar a formular políticas de salud para controlar mejor el brote de la enfermedad del coronavirus del año 2019.