Hospitalization and mortality during the pandemic in chronic hemodialysis patients and the general population in Peru.

BACKGROUND: Patients with chronic kidney disease have a higher risk of severe disease and mortality from COVID-19 than the general population. OBJECTIVE: To compare hospitalization and mortality rates during the pandemic among chronic hemodialysis (HD) patients and the general population in Lima (Peru). METHODS: This retrospective cohort included an assessment of the database of chronic HD patients of the health service providers of the social health insurance benefit networks of Lima and Callao between 2019 and 2021. Hospitalization and mortality rates were obtained for every 1,000 individuals, and variations in the percentages of COVID-19 cases and deaths were calculated. These rates were compared with those of the general population data and standardized by age and sex. RESULTS: An average of 3,937 chronic HD patients were evaluated each month. Of these, 4.8% had COVID-19 and 64.97% were mild cases. The hospitalization rates per 1,000 patients were 19.5, 29.28, and 36.7 in 2019, 2020, and 2021, respectively. The mortality rates per 1,000 patients were 5.9, 9.74, and 11.49 in 2019, 2020, and 2021, respectively. When compared to the standardized general population, the peaks of both rates coincided with the plateaus of the waves during the pandemic. The hospitalization rate for COVID-19 was 12 times higher in HD patients than in the general population, and the mortality rate for COVID-19 was twice as high. CONCLUSION: HD patients had higher hospitalization and standardized mortality rates than the general population. Peaks in hospitalizations and mortality coincided with the plateaus of the first and second waves of the pandemic.

Sleep Disorders and Their Associated Factors during the COVID-19 Pandemic: Data from Peruvian Medical Students.

Background and objectives: Sleep disorders are a common public health problem among college students. The objective of this study was to evaluate sleep quality and its associated factors in medical students during the COVID-19 pandemic. Materials and Methods: Cross-sectional analytical study-we conducted a secondary analysis of the survey "Nomophobia in medical students in Peru" database between 2020 and 2021. Sleep disturbances were assessed using the Pittsburgh Sleep Quality Index (PSQI). To evaluate associated factors, crude and adjusted prevalence ratios (aPR) and their 95% confidence intervals (95% CI) were calculated. Results: We analyzed data from 3139 participants from 18 cities in Peru (61.1% were women, median age: 22 years). 43.4% had a quality of sleep that could require medical attention; the PSQI dimension with the highest score was daytime dysfunction. The poor sleep quality was associated with symptoms of anxiety (aPR: 1.48; 95% CI: 1.27-1.72), depression (aPR: 2.03; 1.72-2.39), or nomophobia (aPR: 1.28; 1.09-1.51). Conclusions: Sleep disorders were a common problem among Peruvian medical students and were associated with anxiety, depression, or nomophobia symptoms.

Fear of Death in Medical Students from a Peruvian University during the COVID-19 Pandemic.

Due to close contact with death, medical students may question their own and their patients' dying process, especially with the impact of the COVID-19 pandemic on the increase in deaths. This situation provokes fear and negative attitudes towards dealing with patients and their environment. This study aimed to assess the level of fear of death and associated factors in medical students at a Peruvian university. A cross-sectional analytical study was conducted during March 2021 in human medicine students from the first to the seventh year. A validated survey including the Collet-Lester fear-of-death scale was applied. Factors associated with the fear-of-death score were evaluated by calculating linear regression coefficients (ß). A total of 284 students were included. The median age was 22 years, and 58.1% were female. The mean Collet-Lester scale score was 2.79, and it was higher in the dimensions related to the death of others. Adjusted analysis showed that the score on this scale was lower in students aged 24-40 years compared to 17-21 years (ß: -0.25; 95% CI: -0.46 to -0.04) and those who had no religious beliefs (ß: -0.29; 95% CI: -0.53 to -0.04). In conclusion, fear of death was lower than reported in other investigations despite the COVID-19 situation, being much lower among older students and those without religious beliefs.

Characteristics and conflicting recommendations of clinical practice guidelines for COVID-19 management in children: A scoping review.

BACKGROUND: Clinical practice guidelines (CPGs) are statements that should be rigorously developed to guide clinicians' decision-making. However, given the scarce evidence for certain vulnerable groups like children, CPGs' recommendations formulation could be challenging. METHODS: We conducted a scoping review of CPGs for COVID-19 management in children. Documents were included if they claimed to be a "clinical practice guideline", published between January and October 2021, and described the process followed to issue their recommendations. We assessed the quality using the "Appraisal of Guidelines for Research and Evaluation II" (AGREE-II) and described how the recommendations were reached. RESULTS: We found five CPGs that fulfilled our inclusion criteria. The median score on the overall AGREE-II evaluation was 61% (range: 49%-72%), and the score on the third domain referred to the rigor of methodological development was 52% (range: 25%-88%). Recommendations for remdesivir, tocilizumab, and intravenous immunoglobulin were heterogeneous across CPGs (in favor, against, no recommendation), as well as the methodologies used to present the evidence, perform the benefits/harms balance, and issue the recommendation. CONCLUSIONS: Heterogeneous recommendations and justifications across CPGs were found in the three assessed topics. Future CPGs should describe in detail their evidence-to-decision process to issue reliable and transparent recommendations.

[Trends in drugs usage for COVID-19 during the first wave of the pandemic in a hospital in Lima, Peru]. / Tendencias en el uso de fármacos para la COVID-19 durante la primera ola de la pandemia en un hospital de Lima, Perú.

This study aimed to evaluate the pharmacological trends in patients with COVID-19 from a hospital in Peru during the first wave of the pandemic. Retrospective study conducted between April and September 2020. The medical records of patients hospitalized for COVID-19 pneumonia at the Dos de Mayo National Hospital (Lima, Peru) were reviewed. Of a total of 3103 patients, 381 medical records were included (77.4% male, median age: 44 years). The use of four prehospital drugs increased (azithromycin, ivermectin, corticosteroids, and ceftriaxone), while the in-hospital use of six drugs (ceftriaxone, azithromycin, hydroxychloroquine, ivermectin, corticosteroid pulse, and prophylactic anticoagulation) decreased and in-hospital anticoagulation use decreased. These findings suggest that the management of COVID-19 has varied during the first wave of the pandemic, typically increasing prehospital drug use and decreasing inpatient use.

Con el objetivo de evaluar las tendencias en el uso de fármacos en pacientes con la COVID-19 de un hospital del Perú durante la primera ola de la pandemia se realizó un estudio retrospectivo entre abril y septiembre del 2020. Se revisaron las historias clínicas de pacientes hospitalizados por neumonía por COVID-19 en el Hospital Nacional Dos de Mayo (Lima, Perú). De un total de 3103 pacientes, se incluyeron 381 historias clínica (77,4% varones y mediana de edad de 44 años). Se observó un incremento del uso de cuatro fármacos prehospitalarios (azitromicina, ivermectina, corticoides y ceftriaxona), y una disminución del uso de seis fármacos intrahospitalarios (ceftriaxona, azitromicina, hidroxicloroquina, ivermectina, pulso de corticoides y anticoagulación profiláctica); además, el uso de anticoagulación intrahospitalaria aumentó. Estos hallazgos sugieren que el manejo de la COVID-19 varió durante la primera ola de la pandemia, aumentando el uso de fármacos prehospitalarios y disminuyendo el uso de fármacos intrahospitalarios.

[Depression, stress and anxiety in students of human medicine in Ayacucho (Peru) in the context of the COVID-19 pandemic]. / Depresión, estrés y ansiedad en estudiantes de Medicina humana de Ayacucho (Perú) en el contexto de la pandemia por COVID-19.

OBJECTIVE: To evaluate rates of anxiety, depression and stress, as well as associated factors and changes in habits, among students of human medicine from the Universidad Nacional San Cristóbal de Huamanga [San Cristóbal of Huamanga University] (UNSCH), located in Ayacucho (Peru), in the context of the COVID-19 pandemic. METHODS: A cross-sectional study was conducted through a virtual survey. The Depression Anxiety Stress Scale-21 (DASS-21) was used. To evaluate associated factors, prevalence ratios (PR) were estimated using Poisson regression with robust variance. RESULTS: A total of 284 surveys were analysed (48.2% women; median age 22 years). Rates of (at least moderate) depression, anxiety and stress were 24.3%, 28.5% and 13.0%, respectively. Adjusted analyses found that having completed fewer years of study, being Catholic and having a chronic disease were associated with a higher rate of anxiety, while being of a younger age was associated with a higher rate of stress. The students reported mostly decreased physical activity, as well as increased Internet and social media use, hours of sleep, hours spent in front of a screen, food intake, and weight, during the COVID-19 pandemic. CONCLUSIONS: In the context of the pandemic, despite the changes in habits described, rates of depression, anxiety and stress were lower than in previous studies in students in the health sciences. The higher rate of anxiety was associated with being in an earlier academic year, Catholicism and chronic diseases, while the higher rate of stress was associated with being of a younger age.

Self-medication practices to prevent or manage COVID-19: A systematic review.

BACKGROUND: Previous studies have assessed the prevalence and characteristics of self-medication in COVID-19. However, no systematic review has summarized their findings. OBJECTIVE: We conducted a systematic review to assess the prevalence of self-medication to prevent or manage COVID-19. METHODS: We used different keywords and searched studies published in PubMed, Scopus, Web of Science, Embase, two preprint repositories, Google, and Google Scholar. We included studies that reported original data and assessed self-medication to prevent or manage COVID-19. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) modified for cross-sectional studies. RESULTS: We identified eight studies, all studies were cross-sectional, and only one detailed the question used to assess self-medication. The recall period was heterogeneous across studies. Of the eight studies, seven assessed self-medication without focusing on a specific symptom: four performed in the general population (self-medication prevalence ranged between <4% to 88.3%) and three in specific populations (range: 33.9% to 51.3%). In these seven studies, the most used medications varied widely, including antibiotics, chloroquine or hydroxychloroquine, acetaminophen, vitamins or supplements, ivermectin, and ibuprofen. The last study only assessed self-medication for fever due to COVID-19. Most studies had a risk of bias in the "representativeness of the sample" and "assessment of outcome" items of the NOS. CONCLUSIONS: Studies that assessed self-medication for COVID-19 found heterogeneous results regarding self-medication prevalence and medications used. More well-designed and adequately reported studies are warranted to assess this topic.

Association between hyperglycemia treatment and mortality in patients with diabetes and COVID-19 in a Peruvian hospital: A retrospective cohort study.

OBJECTIVE: To evaluate the association between hyperglycemia treatment and mortality in patients with diabetes and COVID-19 in a Peruvian hospital. METHODS: A retrospective cohort study was conducted between March and July 2020. Individual-level data were extracted from an implemented virtual platform. We included patients with type 2 diabetes hospitalized with COVID-19. The assessed outcome was in-hospital mortality. The Independent variable of interest was hyperglycemic treatment. We used Poisson regressions with robust variance to obtain crude and adjusted relative risks (RR) and their 95% confidence intervals (95% CI). RESULTS: Out of 1635 patients hospitalized for COVID-19 during the study period, 248 patients with diabetes mellitus were included. The majority were men (66.9%), the median age was 62 years. Ninety-seven patients died in the hospital (39.1%). The median glycemia on admission was 222.5 mg/dL. At 48 h after hospital admission, 125 patients (50.4%) received sliding scale insulin alone (SSI), 46 (18.5%) received a fixed-dose insulin regimen. In the adjusted analysis, the group with SSI at 48 h of hospitalization had higher mortality than those with fixed-dose insulin (adjusted RR: 1.69; 95% CI: 1.01 - 2.83), and those and who continued with SSI in the following days had higher mortality compared to the group that switched to fixed-dose insulin (adjusted RR: 1.64; 95% CI: 1.17 - 2.32). CONCLUSION: Among assessed patients with diabetes and COVID-19, more than a third died during hospitalization. Early and continuous use of the sliding scale was associated with higher mortality compared to fixed-dose insulin regimens.

Pulmonary Ultrasound in the Diagnosis and Monitoring of Coronavirus Disease (COVID-19): A Systematic Review.

The goal of this review was to systematize the evidence on pulmonary ultrasound (PU) use in diagnosis, monitorization or hospital discharge criteria for patients with coronavirus disease 2019 (COVID-19). Evidence on the use of PU for diagnosis and monitorization of or as hospital discharge criteria for COVID-19 patients confirmed to have COVID-19 by reverse transcription polymerase chain reaction (RT-PCR) between December 1, 2019 and July 5, 2020 was compared with evidence obtained with thoracic radiography (TR), chest computed tomography (CT) and RT-PCR. The type of study, motives for use of PU, population, type of transducer and protocol, results of PU and quantitative or qualitative correlation with TR and/or chest CT and/or RT-PCR were evaluated. A total of 28 articles comprising 418 patients were involved. The average age was 50 y (standard deviation: 25.1 y), and there were 395 adults and 23 children. One hundred forty-three were women, 13 of whom were pregnant. The most frequent result was diffuse, coalescent and confluent B-lines. The plural line was irregular, interrupted or thickened. The presence of subpleural consolidation was noduliform, lobar or multilobar. There was good qualitative correlation between TR and chest CT and a quantitative correlation with chest CT of r = 0.65 (p < 0.001). Forty-four patients were evaluated only with PU. PU is a useful tool for diagnosis and monitorization and as criteria for hospital discharge for patients with COVID-19.

Clinical recommendations for evaluation and risk management of COVID-19 in healthcare personnel in the Peruvian social insurance (EsSalud)

RESUMEN Actualmente estamos viviendo una pandemia de enfermedad causada por coronavirus (COVID-19). Un grupo vulnerable de ser infectado por este agente patógeno es el personal de salud. Por ello, el Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) del Seguro Social del Perú (EsSalud) ha emitido recomendaciones clínicas sobre la Evaluación de riesgo y manejo de personal de salud en el contexto de la pandemia de COVID-19, que resumiremos en el presente artículo. Se incluye un flujograma de evaluación y manejo, así como una tabla para determinar el riesgo de presentar infección por COVID-19. ABSTRACT We are currently experiencing a coronavirus disease (COVID-19) pandemic. A vulnerable group of being infected by this pathogenic agent is health personnel. For this reason, the Health Technology Assessment and Research Institute (IETSI in Spanish) of the Peruvian social insurance (EsSalud) has issued clinical recommendations on risk assessment and management of health care personnel in the context of the COVID-19 pandemic, which we will summarize in this paper. An evaluation and management flow chart are included, as well as a table to determine the risk of developing COVID-19 infection.

Evidence-based clinical decision making during the COVID-19 pandemic

RESUMEN La pandemia por COVID-19 nos presenta un contexto difícil para la toma de decisiones clínicas. En este escenario, el presente artículo tiene por objetivo explicar al personal de salud asistencial algunos conceptos fundamentales sobre la toma de decisiones basadas en evidencias con respecto a brindar o no cierta intervención. Para ello, primero se discutirá en qué casos realizar un proceso de toma de decisiones basadas en evidencias. Luego se aclararán ciertos conceptos previos (toma de decisiones en base a la plausibilidad fisiopatológica, las observaciones realizadas durante la práctica clínica, la evidencia de estudios clínicos;así como la influencia de la industria farmacéutica). Seguidamente, se presentan los pasos para tomar decisiones basadas en evidencias: Formular una pregunta, buscar los estudios que respondan a dicha pregunta, leer críticamente dichos estudios, entender la lógica de la toma de decisiones, prepararse para tomar la decisión, realizar el balance (entre los beneficios, daños y costos), realizar un proceso de toma de decisiones compartidas y reevaluar la evidencia. ABSTRACT The COVID-19 pandemic is a difficult scenario for clinical decision making. Therefore, this paper aims to explain healthcare practitioners some basic concepts about evidence-based decision making with respect on doing or not doing a given intervention. For this, firstly we will discuss in which cases an evidence-based decision making process in necessary. Then, some previous concepts will be clarified (decision making based on pathophysiological plausibility, observations made during clinical practice, clinical evidence, as well as the influence from the pharmaceutical industry). Afterwards steps for evidence-based decision making will be described: Asking a question, looking for references answering this question, critically assess such references, understand the underlying logic for decision making, prepare for decision- making, make a balance (benefit, harm, and cost), perform a shared decision making process and reassess the evidence.

Clinical recommendations for evaluation and risk management of COVID-19 in healthcare personnel in the Peruvian social insurance (EsSalud)

RESUMEN Actualmente estamos viviendo una pandemia de enfermedad causada por coronavirus (COVID-19). Un grupo vulnerable de ser infectado por este agente patógeno es el personal de salud. Por ello, el Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) del Seguro Social del Perú (EsSalud) ha emitido recomendaciones clínicas sobre la Evaluación de riesgo y manejo de personal de salud en el contexto de la pandemia de COVID-19, que resumiremos en el presente artículo. Se incluye un flujograma de evaluación y manejo, así como una tabla para determinar el riesgo de presentar infección por COVID-19. ABSTRACT We are currently experiencing a coronavirus disease (COVID-19) pandemic. A vulnerable group of being infected by this pathogenic agent is health personnel. For this reason, the Health Technology Assessment and Research Institute (IETSI in Spanish) of the Peruvian social insurance (EsSalud) has issued clinical recommendations on risk assessment and management of health care personnel in the context of the COVID-19 pandemic, which we will summarize in this paper. An evaluation and management flow chart are included, as well as a table to determine the risk of developing COVID-19 infection.