Accuracy of HemoCue301 portable hemoglobin analyzer for anemia screening in capillary blood from women of reproductive age in a deprived region of Northern Peru: An on-field study.

OBJECTIVE: We aim to assess the accuracy and effectiveness of the HemoCue 301, a point-of-care (POC) device for measuring hemoglobin levels, and detecting anemia among individuals living in Tumbes, a rural, underserved area in Northern Peru. METHODS: Baseline analysis of a clinical trial aimed at assessing the effect of multi-fortified bread (NCT05103709). Adult women with capillary blood HemoCue 301 readings below 12 g/dL were recruited in coastal city of Tumbes, Peru. A total of 306 women took part of the study, venous blood samples were taken and analyzed with an automated hematology analyzer. Serum samples were used to measure ferritin, serum iron and C reactive protein. RESULTS: Capillary blood measured by the Hemocue 301 has a bias of 0.36 ± 0.93 g/dL respect to the automated Hb. More than 50% of women with normal ferritin values were classified as anemics according to the HemoCue 301. Automated Hb cut-off of 10.8 g/dL [AUC 0.82 (0.77-0.88)] had a specificity of 0.817 and a sensitivity 0.711 while with the HemoCue 301 cut-off of 11.1 g/dL [AUC 0.71 (0.62-0.79)] had a specificity of 0.697 and a sensitivity 0.688. The performance of the automated Hb cut-off was significantly better than the HemoCue (p<0.001). CONCLUSION: Caution must be taken when using POC devices, especially with values around the threshold. Cut-off values found in our study could be used as surrogate means when no confirmatory tests are available. Clinical outcomes should be prioritized when diagnosing iron deficiency anemia in women of reproductive age to ensure proper diagnosis.

Anemia in pregnant women residing at different geographical altitudes in Arequipa, Peru / Anemia en gestantes residentes en diferentes altitudes geográficas de Arequipa, Perú

Purpose: To identify the frequency of anemia in pregnant women at different geographical altitudes in the Arequipa region of Peru. Methods: A quantitative, descriptive, and retrospective study was carried out. The study population consisted of 35,725 pregnant women living in the Arequipa Region at different altitudes. Data on age, gestational age, weight, height, province of residence, altitude, hemoglobin were collected. Results: Using World Health Organization altitude adjusted hemoglobin values, anemia prevalence in pregnant women between 2018-2019 was 13.7 percent in the Arequipa Region, while using unadjusted hemoglobin, the overall prevalence was 4.1 percent. When analyzed by altitudes, the frequency of anemia was 9.77 percent below 1 000 m 13.1 percent between 1 000-1 999 m, 13.1 percent between 2.000-2.999 m, 31.5 percent between 3.000-3.999 and 47.1 percent between 4.000-4.999. Nevertheless, when using unadjusted hemoglobin values rates were 6.67 percent for the 1.000-1.999 range, 2.39 percent for ranges between 2.000-2.999 m and 3.000-3.999 m, and 5.19 percent for altitudes above 4.000 m. Conclusions: There is a directly proportional correlation in the prevalence of anemia in pregnant women and higher altitude (p<0.01) as well as levels of anemia during the last trimester of pregnancy. Adjusting the hemoglobin values by altitude results in triple the prevalence of anemia. A throughout revision of the suitability of current guidelines to diagnose and prevent anemia at high altitude is recommended (AU)

Objetivo: Identificar la frecuencia de anemia en gestantes de diferentes altitudes geográficas en la región Arequipa, Perú. Métodos: Se realizó un estudio cuantitativo, descriptivo y retrospectivo. La población de estudio estuvo constituida por 35 725 gestantes residentes en la Región Arequipa a diferentes altitudes. Se recogieron datos de edad, edad gestacional, peso, talla, provincia de residencia, altitud, hemoglobina. Resultados: Utilizando los valores de hemoglobina ajustados por altitud de la Organización Mundial de la Salud, la prevalencia de anemia en gestantes entre 2018-2019 fue de 13,7 por ciento en la Región Arequipa, mientras que utilizando la hemoglobina no ajustada, la prevalencia global fue de 4,1 por ciento. Al analizar por altitudes, la frecuencia de anemia fue de 9,77 por ciento por debajo de 1 000 m 13,1 por ciento entre 1 000-1 999 m, 13,1 por ciento entre 2 000-2 999 m, 31,5 por ciento entre 3 000-3 999 y 47,1 por ciento entre 4 000-4 999. Sin embargo, cuando se utilizaron valores de hemoglobina no ajustados, las tasas fueron del 6,67 por ciento para el intervalo de 1 000-1 999, del 2,39 por ciento para los intervalos entre 2 000-2 999 m y 3 000-3 999 m, y del 5,19 por ciento para altitudes superiores a 4 000 m. Conclusiones: Existe una correlación directamente proporcional en la prevalencia de anemia en embarazadas y mayor altitud (p<0,01), así como niveles de anemia durante el último trimestre del embarazo. Ajustando los valores de hemoglobina por la altitud se triplica la prevalencia de anemia. Se recomienda una revisión en profundidad de la idoneidad de las directrices actuales para diagnosticar y prevenir la anemia a gran altitud(AU)

The road to patient-centred care in Peru: The difficulties and opportunities to achieve participatory health care.

Patient-centred care (PCC) is a pillar of quality health services, where decision-making power is shared between the clinician and the patient. Although, this approach could be adopted with easiness in high income settings or in countries with unified health systems, in settings such as Peru, where universal access and other structural problems remain a challenge, the practice of PCC is not a priority. In Peru, research on PCC has been conducted for almost two decades, but this has not generated a need for development in academia, decision makers, health personnel or patients. Here, we give an overview of the road that PCC research has taken in Peru and the challenges that remain to translate it into clinical practice.

Perceptions of self-medication of the population, during the covid-19 pandemic in Peru / Percepciones de automedicación de la población durante la pandemia covid-19 en Perú

Background: Describe characteristics of self-medication of the population, in the context of the COVID 19 pandemic. Material and Methods: We carried out a cross-sectional survey with students in a major public Peruvian university. We measured perception of self-medication of the population, as well as characteristics, consequences, and associated factors. Results: A total of 274 students of Pharmacy and biochemistry filled in the questionnaire, 80.3% of which reported to know someone that self-medicated during the COVID-19 pandemic. 98.9 % of surveyed participants considered that the current pandemic increased self-medication practices in the population and that it occurred more frequently when people have symptoms associated with COVID-19 (65.4%). The medicines most frequently used were ivermectin (79.2%), azithromycin (71.2%) and hydroxychloroquine (38.7%). Conclusion: According to the surveyed participants, self-medication has increased in the general population during the COVID-19 pandemic. Strategies to prevent these practices are needed, as they could delay adequate medical care.

Introducción: Describir las características de la automedicación de la población, en el contexto de la pandemia de COVID 19. Material y Metodos: Realizamos una encuesta transversal con estudiantes de una importante universidad pública peruana. Se midió la percepción de la automedicación de la población, así como características, consecuencias y factores asociados. Resultados: Completaron el cuestionario un total de 274 estudiantes de Farmacia y Bioquímica, de los cuales el 80,3% refirió conocer a alguien que se automedicó durante la pandemia de COVID-19. El 98,9% de los encuestados consideró que la pandemia actual aumentó las prácticas de automedicación en la población y que se presentó con mayor frecuencia cuando las personas presentan síntomas asociados al COVID-19 (65,4%). Los medicamentos más utilizados fueron ivermectina (79,2%), azitromicina (71,2%) e hidroxicloroquina (38,7%). Conclusión: Según los participantes encuestados, la automedicación ha aumentado en la población general durante la pandemia de COVID-19. Se necesitan estrategias para prevenir estas prácticas, ya que podrían retrasar la atención médica adecuada.

Workplace Violence Against Physicians Treating COVID-19 Patients in Peru: A Cross-Sectional Study.

BACKGROUND: The COVID-19 pandemic is an unprecedented challenge to health systems that has revealed shortcomings and increased unmet demands. Such situations might exacerbate workplace violence (WPV) against physicians, as has been reported in several parts of the world. METHODS: To identify the frequency and characteristics of WPV suffered by physicians attending COVID-19 patients in Peru, a descriptive, cross-sectional study was conducted with an online survey of 200 physicians. RESULTS: Of the survey respondents, 84.5% had suffered some type of WPV; 97.6% of these suffered nonphysical violence. Suffering more than one incident of violence was reported by 75.7% of respondents. The primary aggressor was a patient's family member or caregiver. Violence occurred most frequently in critical areas inside the health service facility, such as COVID-19 triage, tents, and hospital units, although it also occurred during teleconsultations. Multiple shortcomings of the health services were perceived as the main trigger of violence. Being a female physician (odds ratio [OR] = 2.48, 95% confidence interval [CI] = 1.06-5.83) and working in a COVID-19 ICU (OR = 5.84, 95% CI = 1.60-21.28) were the main factors associated with WPV. CONCLUSION: Violence against physicians attending COVID-19 patients in Peru is common. The perceived factors that contribute most to violence are linked to deficiencies in health services.

Is the prevalence of anemia in children living at high altitudes real? An observational study in Peru.

Anemia diagnosis in populations residing at high altitude (HA) involves an adjustment of hemoglobin (Hb) values owing to the increase in its concentration with altitude. The suitability of the adjustment has been questioned since Hb concentrations depend on how adapted a population is to HA. In Peru, anemia in preschool children (PSC) is a matter of severe public concern for its high rates; in the city of Puno (∼3800 MASL), for example, 67.7% of children under 3 years are diagnosed with anemia. Here, we conducted an observational study in PSC living at different altitudes in Puno to assess Hb, iron status, and the suitability of altitude-adjusted Hb values in defining iron deficiency anemia. After adjusting Hb, 65.66% of the population had anemia, while only 4.8% of PSC had anemia when using unadjusted Hb. Receiver-operating characteristic curves using total body iron (TBI) as a marker of iron status are presented. In the 36- to 59-month age group, unadjusted Hb performed better than altitude-adjusted Hb. In the 6- to 35-month age group, anemia (adjusted or unadjusted) was not associated with TBI. We conclude that Hb adjustment by altitude is not appropriate. Anemia at an early age is not entirely attributable to iron deficiency.

Increased Outdoor PM2.5 Concentration Is Associated with Moderate/Severe Anemia in Children Aged 6-59 Months in Lima, Peru.

Anemia affects 1.62 billion people worldwide. Although iron deficiency is the main cause of anemia, several other factors may explain its high prevalence. In this study, we sought to analyze the association between outdoor particulate matter PM2.5 levels with anemia prevalence in children aged 6-59 months residing in Lima, Peru (n = 139,368), one of the cities with the worst air pollution in Latin America. The study period was from 2012 to 2016. Anemia was defined according to the World Health Organization (Hb < 11 g/dL). PM2.5 values were estimated by a mathematical model that combined data observed from monitors, with satellite and meteorological data. PM2.5 was analyzed by quintiles. Multiple linear and logistic regressions were used to estimate the associations between hemoglobin concentration (beta) and anemia (odds ratio) with PM2.5, after adjusting by covariates. Prevalence of anemia was 39.6% (95% confidence interval (CI): 39.3-39.9). Mild anemia was observed in 30.8% of children and moderate/severe in 8.84% of children. Anemic children compared with nonanemic children are mainly males, have low body weight, higher rate of stunting, and live in an environment with high PM2.5 concentration. A slight decrease in hemoglobin (4Q B: -0.03, 95% CI: -0.05 to -0.02; 5Q B: -0.04, 95% CI: -0.06 to -0.01) and an increase in the probability of moderate/severe anemia (4Q OR: 1.18, 95% CI: 1.10-1.27; 5Q OR: 1.18, 95% CI: 1.08-1.29) were observed with increased exposure to PM2.5. We conclude that outdoor PM2.5 levels were significantly associated with decreased hemoglobin values and an increase in prevalence of moderate/severe anemia in children under 5 years old.

Association Between Plasma N-Acylethanolamides and High Hemoglobin Concentration in Southern Peruvian Highlanders.

Alarcón-Yaquetto, Dulce E., Lidia Caballero, and Gustavo F. Gonzales. Association between plasma N-acylethanolamides and high hemoglobin concentration in Southern Peruvian highlanders. High Alt Med Biol 18:322-329, 2017.-High-altitude (HA) hypoxia is a stressful condition endured by organisms through different mechanisms. Failing to adapt to chronic HA exposure leads to a disease called chronic mountain sickness (CMS) characterized by excessive erythrocytosis (hemoglobin [Hb] ≥19 g/dL for women and ≥21 g/dL for men). Genes encoding for peroxisome proliferator-activated receptor (PPAR) subunits α and γ have been proposed as candidate genes for HA adaptation. N-acylethanolamides (NAEs) are endogenous fatty acid substances that bind to PPAR-α and -γ. NAEs are also able to modulate the endocannabinoid system, a signaling pathway activated in physiological stressful conditions. In the frame of a metabolomic study, we measured plasma levels of four NAEs: palmitoylethanolamide (PEA), oleoylethanolamide (OEA), stearoyl ethanolamide (SEA), and linoleoyl ethanolamide (LEA) in natives from Puno (3830 m), a city located in the Peruvian Southern Andes, and Lima (150 m). All NAEs were significantly higher in the HA population (p < 0.001, q < 0.001). Subjects with higher NAE values were those with higher Hb concentration and lower pulse oxygen saturation. However, there was no association between NAEs and CMS score. Our results suggest that PEA and OEA could be involved in physiological regulation following long-term HA exposure.

Acceptability, Safety, and Efficacy of Oral Administration of Extracts of Black or Red Maca (Lepidium meyenii) in Adult Human Subjects: A Randomized, Double-Blind, Placebo-Controlled Study.

The plant maca, grown at 4000 m altitude in the Peruvian Central Andes, contains hypocotyls that have been used as food and in traditional medicine for centuries. The aim of this research was to provide results on some health effects of oral administration of spray-dried extracts of black or red maca (Lepidium meyenii) in adult human subjects living at low (LA) and high altitude (HA). A total of 175 participants were given 3 g of either placebo, black, or red maca extract daily for 12 weeks. Primary outcomes were changes in sexual desire, mood, energy, health-related quality of life score (HRQL), and chronic mountain sickness (CMS) score, or in glycaemia, blood pressure, and hemoglobin levels. Secondary outcomes were acceptability and safety, assessed using the Likert test and side effect self-recording, respectively, and the effect of altitude. At low altitude, 32, 30, and 32 participants started the study receiving placebo, red maca, or black maca, respectively. At high altitudes, 33, 35, and 31 participants started the study receiving placebo, red maca, and black maca, respectively. Consumption of spray-dried extracts of red and black maca resulted in improvement in mood, energy, and health status, and reduced CMS score. Fatty acids and macamides were higher in spray-dried extracts of black maca than in red maca. GABA predominated in spray-dried extracts of red maca. Effects on mood, energy, and CMS score were better with red maca. Black maca and, in smaller proportions, red maca reduced hemoglobin levels only in highlanders with abnormally high hemoglobin levels; neither variety of maca reduced hemoglobin levels in lowlanders. Black maca reduced blood glucose levels. Both varieties produced similar responses in mood, and HRQL score. Maca extracts consumed at LA or HA had good acceptability and did not show serious adverse effects. In conclusion, maca extract consumption relative to the placebo improved quality of life parameters. Differences in the level of improvement between red and black maca are probably due to differences in the composition of these two plant varieties. Both maca extracts were well tolerated and safe.