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.

ANÁLISIS DE MERCADO PARA UN GENERADOR DE HIDRÓGENO ADAPTADO A UN MOTOR DE DOS (2) TIEMPOS EN UNA BICICLETA EN LA CIUDAD DE BOGOTÁ

El hidrógeno (H2) supone la gran alternativa a los combustibles fósiles convencionales en la lucha por el cambio climático, puesto que producen emisiones contaminantes amigables con el medio ambiente y también por su eficacia: genera el triple de energía que otros combustibles, como la gasolina. En el presente trabajo se mostrará un análisis de mercado de un prototipo denominado "generador de hidrógeno (H2) para bicicleta” que será incorporado a un motor de dos (2) tiempos como alternativa de movilidad en la ciudad de Bogotá.En una primera fase se desarrolló el estudio de mercado inicial a partir de una muestra representativa de (384 encues- tas) y fuentes secundarias encontrando que son los jóvenes entre 18 a 25 años son los potenciales clientes que pudiesen adquirir el generador y adaptarlo a la bicicleta, que según el análisis estadístico representan el 48,7% del total de la población bogotana es decir un estimado de 2.450.198 personas.

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

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

[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.

Immune responses in COVID-19 and tuberculosis coinfection: A scoping review.

Background and aim: Patients with COVID-19 and tuberculosis coinfection are at an increased risk of severe disease and death. We therefore sought to evaluate the current evidence which assessed the immune response in COVID-19 and tuberculosis coinfection. Methods: We searched Pubmed/MEDLINE, EMBASE, Scopus, and Web of Science to identify articles published between 2020 and 2021. We included observational studies evaluating the immune response in patients with tuberculosis and COVID-19 compared to patients with COVID-19 alone. Results: Four cross-sectional studies (372 participants) were identified. In patients with asymptomatic COVID-19 and latent tuberculosis (LTBI), increased cytokines, chemokines, growth factors and humoral responses were found. In addition, patients with symptomatic COVID-19 and LTBI had higher leukocytes counts and less inflammation. Regarding patients with COVID-19 and active tuberculosis (aTB), they exhibited decreased total lymphocyte counts, CD4 T cells specific against SARS-CoV-2 and responsiveness to SARS-CoV-2 antigens compared to patients with only COVID-19. Conclusion: Although the evidence is limited, an apparent positive immunomodulation is observed in patients with COVID-19 and LTBI. On the other hand, patients with COVID-19 and aTB present a dysregulated immune response. Longitudinal studies are needed to confirm these findings and expand knowledge.

Factors Associated With Drug Consumption Without Scientific Evidence in Patients With Mild COVID-19 in Peru.

OBJECTIVE: This study aimed to evaluate the factors associated with the consumption of drugs without scientific evidence in patients with mild COVID-19 infection in Peru. METHODS: An analytical cross-sectional study was carried out including 372 adult patients with a history of mild COVID-19 disease. Factors associated with drug consumption were evaluated by Poisson regressions with robust variance adjustment using the bootstrapping resampling method. RESULTS: Seventy-two percent consumed some medication without scientific evidence, with antibiotics (71%) and ivermectin for human use (68%) being the most commonly used. Factors associated with the consumption of drugs to treat mild COVID-19 infection were thinking that the drugs are not effective (adjusted prevalence ratio, 0.55; 95% confidence interval, 0.41-0.74) and not being informed about the efficacy of the drugs (adjusted prevalence ratio, 0.48; 95% confidence interval, 0.36-0.65). CONCLUSIONS: Education of the population seems to be the main factor that increases the consumption of drugs without scientific evidence in the Peruvian population to treat mild COVID-19.

Factors associated with prevention practices against COVID-19 in the Peruvian population: Disparities between rural and urban areas.

OBJECTIVE: To determine the factors associated with prevention practices against COVID-19 in the Peruvian population according to rural vs. urban locations. METHODS: Analytical cross-sectional study, secondary analysis based on a previously collected database. A sample of individuals over 18 years of age, residing in Peru and with no history of COVID-19was evaluated. Factors associated with prevention practices were evaluated using Poisson regressions with variance adjustment by region cluster and stratified by rurality. RESULTS: Of 3231 participants included, 2741 (84.8%) were from urban areas and 490 (15.2%) from rural areas. The frequency of good prevention practices against COVID-19 was 27.8% in our total sample. In urban areas the frequency of good prevention practices was 28.8% and in rural areas it was 22.5%. Factors associated with prevention practices against COVID-19 in both urban and rural areas were male sex (urban: aPR 0.64, 95%CI 0.55-0.75; rural: aPR 0.66, 95%CI 0.54-0.80) and self-considering adequately carrying out prevention practices (urban: aPR 2.48, 95%CI 2.13-2.89; rural: aPR 2.70, 95%CI 2.27-3.19). CONCLUSION: The frequency of good prevention practices against COVID-19 was less than 30% in both urban and rural areas. There are differences in the factors associated with good preventive practice against COVID-19. Only sex and considering that preventive measures were adequately carried out were associated with good prevention practices in both areas. In view of this, prevention measures should be promoted taking into account cultural principles and considering geographical location in the face of present and future outbreaks or pandemics.

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

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

Global morbidity and mortality of central nervous system tuberculosis: a systematic review and meta-analysis.

BACKGROUND: Tuberculosis (TB) is the second most common cause of death due to a single infectious agent worldwide after COVID-19. Up to 15% of the cases are extrapulmonary, and if it is located in the central nervous system (CNS-TB), it presents high morbidity and mortality. Still, the global epidemiology of CNS-TB remains unknown. AIM: To estimate the global prevalence and incidence of CNS-TB based on the available literature. METHODS: We systematically searched in MEDLINE, Cochrane Central, Scopus, and LILACS databases (April 2020) and included observational studies evaluating the epidemiology of CNS-TB. Two independent researchers selected and assessed the quality of the studies and extracted relevant data. We performed random-effects model meta-analysis of proportions to estimate the pooled prevalence. The protocol of this study was registered in PROSPERO (CRD 42018103946). RESULTS: We included 53 studies from 28 countries, representing 12,621 patients with CNS-TB. The prevalence of CNS-TB was 2 per 100,000 inhabitants. According to the clinical setting, the prevalence of CNS-TB represented the 13.91% of all cases of meningitis and 4.55% of all cases of TB. The mortality was calculated by tuberculous meningitis due to the lack of data of other presentation, and it rose up to 42.12% in hospitalized patients. The burden of countries' TB, Human Development Index (HDI), and the prevalence of HIV were the most important prevalence moderators, especially in patients with TB. No data on incidence were found. CONCLUSION: The prevalence and mortality of CNS-TB remain high, and TB meningitis is the most frequent presentation. The highest prevalence was reported in developing countries, and its main moderators were the countries' HDI and HIV infection. Our study was limited by high heterogeneity, risk of bias, and potential data under registration from developing countries. The integration of CNS-TB early detection and management into national TB programs and population-based studies from developing countries are needed for better global estimation and response.

Factors associated with the consumption of chlorine dioxide to prevent and treat COVID-19 in the Peruvian population: a cross-sectional study.

BACKGROUND: Chlorine dioxide has been promoted as an alternative for the prevention and treatment of COVID-19, especially in Peru, despite the lack of evidence to support its efficacy. This study aimed to evaluate the factors associated with chlorine dioxide consumption in the Peruvian population. METHODS: Analytical cross-sectional study. An adult Peruvian population was evaluated where chlorine dioxide consumption was divided into two groups according to the purpose of use: as prevention (individuals without COVID-19 history) and as treatment (individuals with COVID-19 history). The associated factors in each group were evaluated using Poisson regressions with the bootstrapping resampling method. RESULTS: Of 3610 participants included, 3213 reported no history of COVID-19, and 397 had been infected. The prevalence of chlorine dioxide consumption to prevent or treat COVID-19 was 8 and 16%, respectively. Factors either positively or negatively associated with chlorine dioxide consumption for prevention were male sex (aPR: 1.36; 95% CI: 1.09-1.71), being an adult or older adult (aPR: 0.54; 95% CI: 0.35-0.82), having a health sciences student within the family unit (aPR: 1.38; 95% CI: 1.02-1.87), using medical information as the main source of information of COVID-19 (aPR: 0.57; 95% CI: 0.40-0.80), having comorbidities for COVID-19 (aPR: 1.36; 95% CI: 1.01-1.82), considering COVID-19 dangerous and deadly (aPR: 0.57; 95% CI: 0.45-0.74), using medications (aPR: 1.59; 95% CI: 1.25-2.06) and plants to prevent COVID-19 (aPR: 1.69; 95% CI: 1.21-2.36), considering chlorine dioxide ineffective (aPR: 0.18; 95% CI: 0.18-0.24), and being uninformed of its efficacy (aPR: 0.21; 95% CI: 0.16-0.28). In addition, factors associated with chlorine dioxide consumption for treatment were considering COVID-19 dangerous and deadly (aPR: 0.56; 95% CI: 0.33-0.96), considering chlorine dioxide ineffective (aPR: 0.22; 95% CI: 0.12-0.42), and being uninformed of its efficacy (aPR: 0.15; 95% CI: 0.07-0.32). CONCLUSIONS: The prevalence of chlorine dioxide consumption to treat COVID-19 was higher than prevent. It is important to apply information strategies, prioritizing population groups with certain characteristics that are associated with a higher consumption pattern.

Prevalence and Clinical Characteristics of SARS-CoV-2 Confirmed and Negative Kawasaki Disease Patients During the Pandemic in Spain.

Introduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain. Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1-May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV-) to those from the same period during 2018 and 2019 (PreCoV). Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period. Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified.