Mental Disorders and Level of Resilience in Eight High-Altitude Cities of Peru during the Second Pandemic Wave: A Multicenter Population-Based Study.

COVID-19 has led us to take preventive measures, such as social isolation, to reduce the high transmissibility of the disease. This could have affected the mental health of various population groups and the development of resilience as a mitigator. A cross-sectional analytical study was conducted with 700 participants from eight cities. The dependent variables were depression, anxiety, and post-traumatic stress disorder (PTSD). The independent variable was resilience. Generalized logistic regressions were used to identify the associations between the variables. The population consisted mostly of university students (65.0%); the rest of the population was distributed among workers of public or private institutions, housewives, and others (35.0%). High prevalences of anxiety (72.7%), depression (64.1%), and PTSD (15.1%) were found, as well as a median (interquartile range) resilience score of 24 points was determined. Factors associated with a high prevalence of PTSD were having lost employment and having a family member who died from COVID-19. For depression, associated factors were severe food insecurity and hypersomnia. For anxiety, associated factors were were having a deceased family member with COVID-19 and mild food insecurity. Our results show that, during the pandemic, the general population had a higher prevalence of mental disorders. In addition, anxiety was the most prevalent of the dependent variables. Special attention should be paid to the factors influencing the development of mental disorders and mental health prevention and promotion programs should be established.

Moderating role of compassion in the link between fear of Coronavirus disease and mental health among undergraduate students.

Background: The societal challenges presented by fear related to the coronavirus disease (COVID-19) pandemic may present unique challenges for an individual's mental health. However, the moderating role of compassion in the relationship between fear of COVID-19 and mental health has not been well-studied. The present study aimed to explore the association between fear of COVID-19 and mental health, as well as test the buffering role of compassion in this relationship. Methods: The participants in this study were 325 Iranian undergraduate students (228 females), aged 18-25 years, who completed questionnaires posted on social networks via a web-based platform. Results: The results showed that fear of COVID-19 was positively related with physical symptoms, social function, depressive symptoms, and anxiety symptoms. The results also showed that compassion was negatively associated with physical symptoms, social function, depressive symptoms, and anxiety symptoms. The interaction-moderation analysis revealed that compassion moderated the relationship between fear of COVID-19 and subscale of mental health. Conclusion: Results highlight the important role of compassion in diminishing the effect of fear of COVID-19 on the mental health (physical symptoms, social function, depressive symptoms, and anxiety symptoms) of undergraduate students.

Prevalence and Factors Associated with Eating Disorders in Military First Line of Defense against COVID-19: A Cross-Sectional Study during the Second Epidemic Wave in Peru.

Few studies have evaluated eating disorders in military personnel engaged in defense activities during the COVID-19 pandemic. We aimed to determine the prevalence and factors associated with eating disorders in military personnel from Lambayeque, Peru. A secondary data analysis was performed among 510 military personnel during the second epidemic wave of COVID-19 in Peru. We used the Eating Attitudes Test (EAT-26) to assess eating disorders. We explored associations with insomnia, food insecurity, physical activity, resilience, fear to COVID-19, burnout syndrome, anxiety, depression, post-traumatic stress and selected sociodemographic variables. Eating disorders were experienced by 10.2% of participants. A higher prevalence of eating disorders was associated with having 7 to 12 months (PR: 2.97; 95% CI: 1.24-7.11) and 19 months or more (PR: 2.62; 95% CI: 1.11-6.17) working in the first line of defense against COVID-19, fear of COVID-19 (PR: 2.20; 95% CI: 1.26-3.85), burnout syndrome (PR: 3.73; 95% CI: 1.90-7.33) and post-traumatic stress (PR: 2.97; 95% CI: 1.13-7.83). A low prevalence of eating disorders was found in the military personnel. However, prevention of this problem should be focused on at-risk groups that experience mental health burdens.

The impact of aerosol box on tracheal intubation during the COVID-19 pandemic: a systematic review.

INTRODUCTION: This study aimed to summarize the effect of the aerosol box on tracheal intubation in patients with COVID-19. AREAS COVERED: According to the PRISMA guidelines, a systematic search was performed to identify relevant literature on the 'impact of the aerosol box on tracheal intubation during the COVID-19 pandemic' in different electronic databases up to March 2021. Based on a set of predefined inclusion and exclusion criteria, 447 articles were screened. Finally, 20 articles were included in the current systematic review. The findings showed that the use of aerosol box during intubation could reduce droplet contamination on the healthcare workers but not necessarily aerosols. An increase in the time of intubation with the aerosol box was also observed in 9 out of 12 studies (75%); however, three studies reported no significant difference in the time of intubation with and without the aerosol box. Most studies (8 out of 9, 89%) were also shown that intubation with the aerosol box may lead to more difficulty. EXPERT OPINION: The proceduralist and other healthcare workers involved in airway management of COVID-19 infected patients should decide whether to apply the aerosol box with caution, balancing between benefits and risks, especially in difficult airway circumstances.

Association between Working Time and Burnout Syndrome in Peruvian Military during the Second Epidemic Wave of COVID-19.

There is scant evidence on the impact of the COVID-19 pandemic on burnout in front-line military personnel and how working time may influence on this condition. We aimed to determine the association between working time and Burnout syndrome in military personnel. A cross-sectional study was conducted using secondary data among 576 military personnel from Lambayeque, Peru during the second wave of COVID-19 in 2021. We used the Maslach Burnout Inventory instrument to measure Burnout Syndrome. We evaluated its association with work time, measured as the number of months that the military member worked during the pandemic. The prevalence of burnout syndrome was 9%. Of the total sample, 39.1% and 10.3% presented depersonalization and emotional exhaustion, respectively. Military personnel working for more than 18 months had a 104% higher prevalence of Burnout syndrome (PR: 2.04, 95%CI: 1.02-4.10). Exposure to a prolonged work time during the pandemic increased the prevalence of Burnout syndrome in military personnel. This information helps to understand the potential effects of the pandemic on this population and provides insight into the time the military members would need rest to prevent Burnout syndrome.

Suicide Risk in Military Personnel during the COVID-19 Health Emergency in a Peruvian Region: A Cross-Sectional Study.

Military personnel represent a frontline group exposed to multiple stressors. These factors have increased during the COVID-19 pandemic, predisposing to the development of suicidal risk (SR). Given the few studies conducted in this population, we evaluated the prevalence of SR and its associated factors during the health emergency. A cross-sectional survey study was conducted in person among 514 participants in Lambayeque, Peru in 2021. The outcome was SR, and the exposures were depression (PHQ-9), anxiety (GAD-7), PTSD (PCL-C), and other sociodemographic variables. The prevalence of SR was 14.0% (95% CI: 11.12-17.31%) and was significantly higher in people with a family history of mental health (PR: 2.16; 95% CI: 1.13-4.15) and in those with moderate clinical insomnia (PR: 2.21; 95% CI: 1.19-4.12). Military personnel with high resilience had a lower prevalence of SR (PR: 0.54, CI: 0.31-0.95). Anxiety was associated with a higher prevalence of SR (PR: 3.27; 95% CI: 1.76-6.10). Our findings show that at least 1 out of 10 military personnel are at risk of suicide. Special attention should be paid to the associated factors to develop interventions and reverse their consequences. These results may be useful in policy implementation and general statistics of SR in the local and regional context.

Clinical-epidemiologic variation in patients treated in the first and second wave of COVID-19 in Lambayeque, Peru: A cluster analysis.

OBJECTIVES: To identify differences in the clinical and epidemiologic characteristics of patients during the first and second waves of the COVID-19 pandemic at the EsSalud Lambayeque health care network, Peru. METHODS: An analytical cross-sectional study of 53,912 patients enrolled during the first and second waves of COVID-19 was conducted. Cluster analysis based on clustering large applications (CLARA) was applied to clinical-epidemiologic data presented at the time of care. The two pandemic waves were compared using clinical-epidemiologic data from epidemiologic surveillance. RESULTS: Cluster analysis identified four COVID-19 groups with a characteristic pattern. Cluster 1 included the largest number of participants in both waves, and the participants were predominantly female. Cluster 2 included patients with gastrointestinal, respiratory, and systemic symptoms. Cluster 3 was the "severe" cluster, characterized by older adults and patients with dyspnea or comorbidities (cardiovascular, diabetes, obesity). Cluster 4 included asymptomatic, pregnant, and less severe patients. We found differences in all clinical-epidemiologic characteristics according to the cluster to which they belonged. CONCLUSION: Using cluster analysis, we identified characteristic patterns in each group. Respiratory, gastrointestinal, dyspnea, anosmia, and ageusia symptoms were higher in the second COVID-19 wave than the first COVID-19 wave.

Prevalence and Associated Factors of Depression, Anxiety, and Stress in University Students in Paraguay during the COVID-19 Pandemic.

We aimed to determine the prevalence of depression, anxiety, and stress in university students in Paraguay during the COVID-19 pandemic. A cross-sectional study was conducted among 293 students from four universities in Paraguay in 2021. The DASS-21 mental health scale was used to measure the outcomes (depression, anxiety, and stress) and evaluate their association with socio-educational variables. A total of 77.1% of the participants were women and 136 (46.4%) were between 21 and 25 years old. The prevalence of depression, anxiety, and stress was 74.7%, 87.4%, and 57%, respectively. We found that being a woman and studying at a public university was positively associated with depression, anxiety, and stress. Receiving COVID-19 training increases the prevalence of mental health problems. In conclusion, high levels of anxiety, depression, and stress were found in university students during the COVID-19 pandemic. Being a woman, studying at a public university, and receiving training on COVID-19 were factors associated with a higher prevalence of presenting all the mental health problems evaluated. Furthermore, students aged 31 and over had a higher prevalence of depression and stress.

Self-medication in hospitalized patients with COVID-19: A cross-sectional study in northern Peru.

Introduction: This study aimed to identify factors associated with self-medication in patients with COVID-19. Methods: A cross-sectional study was conducted using medical records of patients with COVID-19 who self-medicated before admission to a hospital in Piura, Peru. Prevalence ratios and 95% confidence intervals were estimated using generalized linear models with Poisson distribution family, log link function, and robust variance. Results: Out of 301 patients, 165 (54.8%) self-medicated before hospital admission, being more frequent self-medication with ivermectin (85.5%) and azithromycin (71.5%). The frequency of self-medication in those aged between 30-59 years was 2.53-fold higher than in those between 18-29 years. Male patients, dyslipidemia, smoking, and hepatic steatosis were associated with self-medication. Clinical characteristics associated with self-medication were fever, cough, headache, anosmia, dysgeusia, nausea/vomiting, and gastroesophageal reflux. Conclusions: A high frequency of self-medication before hospital admission was observed in Peruvian patients with COVID-19, mainly of drugs without proven efficacy.

COVID-19 Vaccine Effectiveness at a Referral Hospital in Northern Peru: A Retrospective Cohort Study.

COVID-19 vaccines have achieved a significant reduction in mortality, yet objective estimates are needed in specific settings. We aimed to determine the effectiveness of COVID-19 vaccination at a referral hospital in Lambayeque, Peru. We conducted a retrospective cohort study from February to September 2021. We included hospitalized patients with COVID-19, whose data were stored in NotiWeb, a patient data system of the Peruvian Ministry of Health. We applied a propensity score-weighting method according to baseline characteristics of patients, and estimated hazard ratios (HR) using Cox regression models. Of 1553 participants, the average age was 55 years (SD: 16.8), 907 (58%) were male, and 592 (38%) deceased at 28-day follow-up. Before hospital admission, 74 (4.8%) had been immunized with at least one vaccine dose. Effectiveness against death in vaccinated patients was 50% at 90-day follow-up (weighted HR 0.50, 95% CI 0.28-0.89). Our results support the effectiveness of COVID-19 vaccination against death and provide information after early immunization in Peru.

Association between chronic kidney disease and mortality in patients with a confirmed COVID-19 diagnosis.

Objective: To determine the association between chronic kidney disease (CKD) and mortality in persons with a confirmed coronavirus disease 2019 (COVID-19) diagnosis. Methods: Cross-sectional secondary baseline study. The study population consisted of 243,065 patients confirmed to have COVID-19 during May-December 2020. Stata 16.0 was used for statistical analysis, Chi-square test was used for bivariate analysis, and Poisson regression with robust variances was used for multiple analysis. Results: The prevalence of patients with a confirmed COVID-19 diagnosis who had CKD and died was 1.42 times the prevalence of mortality in those without CKD. The comorbidities combined with CKD that presented the highest probability of mortality were diabetes mellitus and hypertension. Conclusions: CKD is associated with a high mortality rate in patients with a confirmed COVID-19 diagnosis. Patients with CKD, diabetes mellitus, and arterial hypertension have a higher prevalence of mortality than those without comorbidities.

Impact of the COVID-19 pandemic on the incidence of dengue fever in Peru.

Dengue virus and severe acute respiratory syndrome coronavirus 2 coexist in dengue-endemic countries; therefore, the adoption of preventive measures is essential to control the spread of both viruses. We conducted an ecological study to compare the temporal patterns of the incidence of dengue before and during the Coronavirus disease 2019 (COVID-19) pandemic in Peru. A time-series analysis comparing the incidence of dengue using a Student's t test with variance correction was performed. Poisson regression was applied to determine the incidence rate ratio (IRR) of dengue before and during the COVID-19 pandemic. The incidence of dengue was found to be increased in all endemic regions of Peru during the COVID-19 pandemic, with the highest incidences registered in Ica (IRR = 90.14), Huánuco (IRR = 38.6), and Ucayali (IRR = 23.78), with the exception of Piura (IRR = 0.83). The highest increases in the number of dengue cases per million inhabitants were in Ucayali (393.38), Tumbes (233.19), Ica (166.08), and Loreto (129.93). The gradient of dengue cases was positive in all endemic regions during the COVID-19 pandemic. The number of dengue cases per million increased during the COVID-19 pandemic throughout Peru and in several endemic regions, with the exception of Piura.

Neuropsychiatric Symptoms in Patients With Alzheimer's Disease During SARS-COV-2 Pandemic in Peru.

To evaluate neuropsychiatric symptoms in patients with Alzheimer's disease (AD) and their association with cognition and functionality during lockdown of the COVID-19's first wave. We included 91 patients and caregivers of people with AD from a memory clinic. The RUDAS, M@T, and CDR were administered to patients and NPI/ADCS-ADL to caregivers. Baseline and lockdown measurements scales were analyzed to compare the frequencies at baseline versus lockdown and conditional Odds Ratio (ORc) was calculated for the neuropsychiatric symptoms. During the pandemic, significant increase in the number of cases was observed in depression (23%), agitation (36.8%), aberrant motor activity (12%), sleep disorders (26.3%), and appetite change (12.1%). In worsening of pre-existing symptoms, the most frequent were delusions (75%), followed by sleep disorders (71.7%). Lockdown induces a rapid increase of neuropsychiatric symptoms affecting cognitive symptoms and functionality of Peruvian patients with AD.

Pityriasis rubra pilaris post-infection due COVID-19: case report.

CASE DESCRIPTION: 32-month-old boy, IgG positive for SARS-CoV-2, presented to the emergency department with dermatologic lesions. CLINICAL FINDINGS: Four days before admission, he presented skin eruptions with redness and pruritus on hands and feet. Generalized papular erythema was evidenced, upper extremities with diffuse erythematosquamous plaques, palmoplantar keratoderma, so he was evaluated by a dermatologist who diagnosed pityriasis rubra pilaris. TREATMENT AND OUTCOME: rehydrating cream, cetirizine 0.5 mg/kg/day every two days, and prednisolone 2 mg/kg/day in the morning. He was discharged after 14 days, the patient presented clinical improvement, but the erythematous lesion persisted on the trunk and extremities. In the evaluation, after three months, the patient did not show the described lesions, evidencing an improvement and clinical resolution of the dermatological problems. CLINICAL RELEVANCE: We report a patient with pityriasis rubra piloris associated with a post-infection by SARS-CoV-2 that had not been described before.

SARS-CoV-2 seroprevalence study in Lambayeque, Peru. June-July 2020.

BACKGROUND: Estimating the cumulative prevalence of SARS-COV-2 will help to understand the epidemic, contagion, and immunity to COVID-19 in vulnerable populations. The objective is to determine the extent of infection in the general population and the cumulative incidence by age group. METHODS: It was carried out with a longitudinal analytical study, in the population of the Lambayeque region, located in the north of Peru. The selection was carried out in multistages (districts, area, household, and finally choosing the interviewee within the house). Seroprevalence was estimated as a positive result of the rapid test whether it was positive IgM or positive IgG. An adjustment was made for the sampling weights used. RESULTS: The seroprevalence found in the region was 29.5%. Young people between 21 and 50 years old presented the highest seroprevalence frequencies. A total of 25.4% were asymptomatic. The most frequent complaint was dysgeusia and dysosmia (85.3% and 83.6%). Dysosmia (PR = 1.69), chest pain (PR = 1.49), back pain (PR = 1.45), cough (PR = 1.44), fever (PR = 1.41), general malaise (PR = 1.27) were associated factors with the higher the frequency of seropositivity for SARS-CoV-2. Reporting of complete isolation at home decreased the frequency of positivity (PR = 0.80), however, reporting having ARI contact (PR = 1.60), having contact with a confirmed case (PR = 1.51), and going to market (PR = 1.26) increased the frequency of positivity for SARS-CoV-2. CONCLUSION: These results suggest that Lambayeque is the region with the highest seroprevalence in the world, well above Spain, the United States and similar to a study in India.