Endophthalmitis secondary to donor to host infection in posterior lamellar keratoplasties: A systematic review.

Donor to host transmission of infectious agents is a well-recognized entity, more commonly related to Endothelial Keratoplasty (EK) than to Penetrating Keratoplasty (PK), that involves complications ranging from interface keratitis to endophthalmitis. A systematic review of the literature was conducted to identify the published articles until December 2020 reporting cases of endophthalmitis secondary to corneal graft contamination in posterior lamellar keratoplasties (DSAEK and DMEK) along with donor characteristics, microbiological profile, treatment and outcomes. Each identified article was assessed to meet donor to host infection criteria, defined as a post-procedural infection in which the same microbiological agent was identified in both the donor corneoscleral rim or preservation medium and receptor ocular tissue. From 23 research articles, eight reports of endophthalmitis in nine patients following DSAEK or DMEK secondary to donor to host infection fulfilled the inclusion criteria. The majority were male and the median age was 72.0 (45.0-81.0) years old. Indications of surgery were primarily pseudophakic bullous keratopathy and Fuchs dystrophy. A fungal pathogen was identified in eight of nine patients. All the cases underwent surgical management with lenticule removal or endothelial plaque aspiration. The final corrected distance visual acuity (CDVA) in all cases was 20/200 or better. Endophthalmitis after an EK procedure is a rare complication whose outcome depends on the aggressive and precocious treatment. Identification of early signs of interface keratitis and lenticule removal seems mandatory in patients undergoing DSAEK or DMEK to prevent further involvement of the globe.

Association Between Burnout and Intention to Emigrate in Peruvian health-care Workers.

BACKGROUND: Emigration of health-care workers is a problem within global health systems which affects many countries, including Peru. Several factors have caused health-care workers to emigrate, including burnout syndrome (BS). This study aims to identify the association between BS and its dimensions with the intention of physicians and nurses to emigrate from Peru in 2014. METHODS: A cross-sectional study, based on a secondary analysis of the National Survey of Health Users (ENSUSALUD - 2014) was conducted. Sampling was probabilistic, considering the 24 departments of Peru. We include the questionnaire for physicians and nurses, accounting for 5062 workers. BS was measured by the Maslach Burnout Inventory-Human Services Survey. Adjusted odds ratio (OR) was calculated using multiple logistic regression. RESULTS: Of the study population, 44.1% were physicians, 37.7% males, and 23.1% were working in Lima. It was found that 2.8% [95% confidence interval (CI): 2.19-3.45] of health-care workers had BS. The overall prevalence of intention to emigrate among health-care workers was 7.4% (95% CI: 6.36-8.40). Association was found between BS and intention to emigrate in Peruvian health-care workers (OR = 2.15; 95% CI: 1.05-4.40). Emotional exhaustion was the BS dimension most associated with intention to emigrate (OR = 1.80; 95% CI: 1.16-2.78). CONCLUSION: Physicians and nurses from Peru who suffered from BS were more likely to have intention to emigrate. Policies should be established to reduce BS as a strategy to control "brain drain" from health-care workers of Peru.

Publication of Abstracts with Peruvian Affiliation Presented to the Annual Meeting of the American Society of Tropical Medicine and Hygiene 2006-2010.

Peruvian research output is one of the lowest in South America and is limited to the work of a small group of institutions and related to few subjects, such as infectious diseases. We determined the proportion of subsequent publication and its associated factors of the abstracts with Peruvian affiliation presented to the American Society of Tropical Medicine and Hygiene annual meetings between 2006 and 2010. Approximately 27% (79/296) of abstracts were published within 6 years of presentation, with a median time to publication of 16 months (interquartile range: 9-28). In the adjusted analysis, abstracts with a higher proportion of authors from Peruvian institutions were less likely to be published (risk ratio: 0.5; 95% CI: 0.3-0.8). In conclusion, one of four of the analyzed abstracts was published. Even though this proportion is higher than that in other meetings in Peru and South America, publication rates -especially among Peruvian-only collaborations- still need to be improved.

[Associated Factors with Burnout Syndrome In Physicians and nurses from Peru, 2014]. / Factores asociados con el síndrome de Burnout en médicos y enfermeras, Perú 2014.

Aim: To identify factors associated to burnout syndrome (BS) in health workers from Peru in 2014 Methods: A cross-sectional study by secondary analysis of the Peruvian National Survey of Users of Health in 2014 was conducted. BS was measured using the Maslach Burnout Inventory - Human Services Survey (MBI-HSS). A descriptive analysis was performed, also bivariate and multivariate analysis were performed calculating p values and crude and adjusted OR by logistic regression. Results: Prevalence of BS in health professionals was 2.8% and associated variables were: gender, time in the health, working hours and total monthly income. Conclusions: We found that factors associated with SB on health workers of Peru in 2014 were gender, time in the health sector, working hours and the total monthly income.

Objetivo: Identificar los factores asociados al Síndrome de Burnout (SB) en trabajadores de salud del Perú en el año 2014. Métodos: Estudio transversal analítico mediante un análisis secundario de la Encuesta Nacional de Usuarios de Salud del año 2014 en Perú. El SB fue medido mediante el Maslach Burnout Inventory - Human Services Survey (MBI-HSS). Se realizó un análisis descriptivo, también un análisis bivariado y multivariado calculando los valores de p y los OR crudos y ajustados mediante Regresión Logística. Resultados: La prevalencia del SB en los profesionales de la salud fue 2,8%, encontrándose asociadas las variables: género, tiempo en el sector salud, horas de trabajo e ingreso mensual total. Conclusiones: Se encontró que los factores asociados al SB en el personal de Perú en el año 2014 fueron el género, el tiempo en el sector salud, las horas de trabajo y el ingreso mensual total.

[Prevalence of burnout syndrome in peruvian physicians and nurses, ENSUSALUD 2014]. / Prevalencia del síndrome de burnout en médicos y enfermeras del Perú, ENSUSALUD 2014.

Objectives To estimate the prevalence of burnout syndrome (BOS) in Peruvian physicians and nurses in 2014 according to different cutoff points established in the literature. Materials and methods This was a cross-sectional and descriptive study based on the National Survey on User Satisfaction of Health Services for 2014 (ENSUSALUD-2014), which features two-stage probability sampling. BOS was identified by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) using different cutoff points to establish prevalence, including default values, terciles, and quartiles. Results Of the 5062 health professionals, 62.3% were women, 44.0% were physicians, 46.0% belonged to the MINSA, and 23.1% worked in Lima. The overall BOS prevalence was 2.8% (95% CI, 2.4-3.2), when default values were used; the prevalence was 7.9% (95% CI, 7.3-8.6) when quartiles were used as cutoff points and 12.5% (95% CI, 11.4-13.6) when terciles were used as cutoff points. The prevalence was higher in doctors than in nurses, regardless of the cutoff point used (3.7% vs. 2.1% using default values, 10.2 vs. 6.1% using quartiles, and 16.2 vs. 9.5% using terciles). Conclusions The prevalence of BOS in health workers differs within the same population when different cutoff points are used. The use of default values is recommended by the instrument author until specific cut-points for our country are obtained.

Prevalencia del síndrome de burnout en médicos y enfermeras del Perú, ENSUSALUD 2014 / Prevalence of burnout syndrome in peruvian physicians and nurses, ENSUSALUD 2014

RESUMEN Objetivos Estimar la prevalencia del síndrome de burnout(SB) en los médicos y enfermeras del Perú en el año 2014, según los diferentes puntos de corte establecidos en la literatura. Materiales y métodos Estudio transversal y descriptivo basado en la Encuesta Nacional de Satisfacción de Usuarios en Salud del año 2014 (ENSUSALUD-2014) que cuenta con un muestreo probabilístico bietápico. El SB fue identificado mediante el Maslach Burnout Inventory -Human Services Survey (MBI-HSS) utilizando diferentes puntos de corte para establecer su prevalencia: valores predeterminados, terciles y cuartiles. Resultados De los 5062 profesionales de salud, 62,3% eran mujeres, 44,0% eran médicos, 46,0% pertenecían al MINSA y 23,1% laboraban en Lima. Se obtuvo una prevalencia global del SB de 2,8% (IC95%: 2,19-3,45) usando valores predeterminados; 7,9% (IC95%: 6,93-8,95) para puntos de corte según cuartiles; y 12,5% (IC95%:11,29-13,77) usando terciles. La prevalencia es mayor en médicos que en enfermeras, independientemente del punto de corte usado (3,7% vs 2,1% en valores predeterminados; 10,2 vs 6,1% con cuartiles, y 16,2 vs 9,5% mediante terciles). Conclusiones La prevalencia del síndrome en personal sanitario es distinta en una misma población, según se utilicen los distintos puntos de corte descritos. Se recomienda el uso de los valores predeterminados por el creador del instrumento, hasta obtener puntos específicos para nuestro país.

ABSTRACT Objectives To estimate the prevalence of burnout syndrome (BOS) in Peruvian physicians and nurses in 2014 according to different cutoff points established in the literature. Materials and methods This was a cross-sectional and descriptive study based on the National Survey on User Satisfaction of Health Services for 2014 (ENSUSALUD-2014), which features two-stage probability sampling. BOS was identified by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) using different cutoff points to establish prevalence, including default values, terciles, and quartiles. Results Of the 5062 health professionals, 62.3% were women, 44.0% were physicians, 46.0% belonged to the MINSA, and 23.1% worked in Lima. The overall BOS prevalence was 2.8% (95% CI, 2.4-3.2), when default values were used; the prevalence was 7.9% (95% CI, 7.3-8.6) when quartiles were used as cutoff points and 12.5% (95% CI, 11.4-13.6) when terciles were used as cutoff points. The prevalence was higher in doctors than in nurses, regardless of the cutoff point used (3.7% vs. 2.1% using default values, 10.2 vs. 6.1% using quartiles, and 16.2 vs. 9.5% using terciles). Conclusions The prevalence of BOS in health workers differs within the same population when different cutoff points are used. The use of default values is recommended by the instrument author until specific cut-points for our country are obtained.

Successful management of grade III coronary perforation after percutaneous angioplasty in a high-risk patient: a case report.

Coronary perforation is a rare complication in patients undergoing percutaneous coronary angioplasty. The mortality of this complication varies depending on factors related to the patient and the procedure performed, reaching 44% in patients with Ellis type III perforation. We report the case of an 81 year old male with multiple cardiovascular risk factors, who underwent percutaneous angioplasty for unstable angina management. The patient developed grade III coronary perforation in the anterior descending artery, which was successfully managed with balloon inflation to 6 atmospheres for 10 minutes twice in the affected area, with an interval of 5 minutes between each dilatation. The patient improved and was discharged.

La perforación coronaria es una complicación rara en los pacientes sometidos a angioplastia percutánea coronaria. La mortalidad de esta complicación es variable, dependiendo de factores relacionados al paciente y al procedimiento realizado. Alcanza el 44% en pacientes con perforación tipo III, según la escala de Ellis. Presentamos el caso de un varón de 81 años con múltiples factores de riesgo cardiovascular, a quien se le realizó una angioplastia percutánea para manejo de un síndrome isquémico coronario agudo sin elevación del segmento ST (SICA STNE) de alto riesgo. El procedimiento se complicó con una perforación coronaria grado III en la arteria descendente anterior, la cual fue manejada exitosamente con dilatación de balón a 6 atmósferas por 10 minutos en dos oportunidades en la zona afectada, con intervalo de 5 minutos entre insuflaciones. El paciente evolucionó favorablemente y fue dado de alta.

Factores de riesgo para el abandono del tratamiento de tuberculosis pulmonar sensible en un establecimiento de salud de atención primaria, Lima, Perú / Risk factors for drug-sensitive tuberculosis therapy failure in a primary care health center in Lima, Peru

Identificar los factores asociados al abandono del tratamiento antituberculoso en un centro de salud de atención primaria del distrito de Chorrillos, Lima, Perú. Materiales y métodos: Estudio de casos y controles retrospectivo no pareado. Se definió como caso a los pacientes que abandonaron el tratamiento por un periodo de 30 días consecutivos o más y como controles a los pacientes que terminaron el tratamiento antituberculoso. Se evaluó el puntaje de riesgo de abandono que se realiza en el centro de salud (>22), así como variables demográficas. Se calculó el odds ratio (OR) e intervalos de confianza al 95% (IC95%) usando regresión logística. Resultados: Se incluyó 34 controles y 102 casos. En el análisis multivariado se encontró que quienes cursaron menos de seis años de educación (OR: 22,2; IC95%: 1,9-256,1) así como quienes tenían un puntaje > a 22 puntos en la prueba de riesgo de abandono (OR= 21,4; IC95%: 6,3-72,4) tenían mayor probabilidad de abandonar el tratamiento antituberculoso. Conclusión: El abandono del tratamiento antituberculoso está asociado con tener menos de seis años de educación y un score mayor a 22 puntos en la prueba de abandono de tratamiento antituberculoso...

Objective: To identify associated factors with failure of antituberculous therapy in a primary health center in Chorrillos, Lima, Peru. Material and methods: Retrospective case control study with a 1:3 case-control ratio. A case was defined as a patient who discontinued the treatment for a period of 30 consecutive days or more, and a control as a patient successfully completing antituberculous therapy. The score for risk of failure measured in the health center (>22) and demographic variables were assessed. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression. Results: Thirty-four cases and 102 controls were included. In the multivariate analysis, factors associated to a greater likelihood for a failure in antituberculous therapy were to have less than six years of education (OR: 22,2; 95% IC: 1,9-256,1) and to obtain a score greater or equal than 22 points in the test for risk of failure (OR= 21,4; 95% IC: 6,3-72,4). Conclusions: Failure of antituberculous therapy was associated with having less than six years of educationand a score greater than or equal to 22 points in the test for risk of failure...