Mood and Sleep Quality in Peruvian Medical Students During COVID-19 Pandemic.

INTRODUCTION: The prolongation and consequences of the COVID-19 pandemic have led to an uncertain and devastating panorama in many populations, and the evidence shows a high prevalence of mental health problems in medical students. The objective was to evaluate the association between mood disorders and sleep quality (SQ) in Peruvian medical students during the COVID-19 pandemic. METHODS: A cross-sectional study was conducted on 310 medical students from a private university in Peru. The SQ was measured using the Pittsburgh Sleep Quality Index (PSQI), while mood disorders were evaluated using the Depression Anxiety and Stress Scale-21 (DASS-21). All information was collected by online surveys and then analysed in the R programming language. RESULTS: The SQ results measured by PSQI were poor in 83.9% of the medical students. In the Poison regression analysis, the results of the bivariate analysis in men show that all mood disorders found the prevalence of poor SQ. However, in the multivariate analysis only stress (PRa=1.30; 95% CI, 1.08-1.57; P<0.01) and anxiety (PRa=1.34; 95% CI, 1.09-1.56; P <0.01) increased the prevalence of poor SQ. Women had a similar pattern in bivariate analysis, whereas in multivariate analysis, only severe stress (PRa=1.15; 95% CI, 1.01-1.29; P <0.05) increased the prevalence of poor SQ. CONCLUSIONS: This study allows us to observe the consequences that the COVID-19 pandemic is having on medical students in Peru. It also revealed a population group vulnerable to poor quality of sleep and bad mood, which in the future will impact on health. It is suggested to educate medical students about the importance of proper sleep hygiene and the consequences of poor sleep hygiene practices.

Longitudinal patterns of natural hazard exposures and anxiety and depression symptoms among young adults in four low- and middle-income countries.

We estimated the effect of community-level natural hazard exposure during prior developmental stages on later anxiety and depression symptoms among young adults and potential differences stratified by gender. We analyzed longitudinal data (2002-2020) on 5585 young adults between 19 and 26 years in Ethiopia, India, Peru, and Vietnam. A binary question identified community-level exposure, and psychometrically validated scales measured recent anxiety and depression symptoms. Young adults with three exposure histories ("time point 1," "time point 2," and "both time points") were contrasted with their unexposed peers. We applied a longitudinal targeted minimum loss-based estimator with an ensemble of machine learning algorithms for estimation. Young adults living in exposed communities did not exhibit substantially different anxiety or depression symptoms from their unexposed peers, except for young women in Ethiopia who exhibited less anxiety symptoms (average causal effect [ACE] estimate = - 8.86 [95% CI: - 17.04, - 0.68] anxiety score). In this study, singular and repeated natural hazard exposures generally were not associated with later anxiety and depression symptoms. Further examination is needed to understand how distal natural hazard exposures affect lifelong mental health, which aspects of natural hazards are most salient, how disaster relief may modify symptoms, and gendered, age-specific, and contextual differences.

Factors associated with the consumption of medicinal plants for the prevention of COVID-19 in peruvian population: a cross-sectional study. / Factores asociados con el consumo de plantas medicinales para la prevención de COVID-19 en población peruana: un estudio transversal.

OBJECTIVES.: Motivation for the study. No study conclusively recommends the use of medicinal plants to treat COVID-19 symptoms, and their indiscriminate use may present health risks. Main findings. Sixty percent of participants consumed medicinal plants to prevent COVID-19. This was particularly true for those living in the Peruvian highlands and individuals with family members diagnosed or deceased from COVID-19, who perceive a higher risk of infection and use medications or chlorine dioxide as preventive measures. Implications. Communication strategies emphasizing validated preventive practices and educating about the risks of consuming medicinal plants should be tailored to the predominant characteristics of the consumer. Determine the factors associated with the consumption of medicinal plants as a preventive measure against COVID-19 in the Peruvian population. MATERIALS AND METHODS.: A population over 18 years of age, living in Peru and without a history of COVID-19 disease, was evaluated. The factors associated with the consumption of medicinal plants were evaluated using a Poisson regression model with robust variances. RESULTS.: Of the 3231 participants included, 84.6% were young adults (18-29 years old), 62.7% were women, and 59.7% consumed a medicinal plant to prevent COVID-19 infection. The factors associated with the consumption of medicinal plants to prevent COVID-19 infection were residing in the Peruvian highlands, having had a family member diagnosed with COVID-19, having had a family member die from COVID-19, considering their family to be at increased risk of infection, having used medications or chlorine dioxide to prevent COVID-19, having medical information as the main source of information about COVID-19, thinking that medicinal plants are effective in preventing COVID-19 disease, or not being informed about their effectiveness. CONCLUSION.: Sixty percent of the participants reported having consumed a medicinal plant to prevent COVID-19. Authorities must apply communication strategies about the implications of consuming medicinal plants, prioritizing population groups with higher consumption patterns.

OBJETIVOS: Motivación para realizar el estudio. Ningún estudio recomienda de manera concluyente el uso de plantas medicinales para tratar los síntomas de la COVID-19, y su uso indiscriminado puede presentar riesgos para la salud. Principales hallazgos. El 60% de los participantes utilizó plantas medicinales para la prevención de la COVID-19. Especialmente aquellos de la sierra peruana y personas con familiares diagnosticados o fallecidos por COVID-19, que perciben mayores riesgos de contagio y utilizan medicamentos o dióxido de cloro como medidas preventivas. Implicancias. Las estrategias de comunicación esenciales para las prácticas preventivas validadas y la educación sobre los riesgos del consumo de plantas medicinales deben adaptarse a las características predominantes del consumidor. Determinar los factores asociados al consumo de plantas medicinales como prevención de la COVID-19 en la población peruana. MATERIALES Y MÉTODOS.: Se evaluó población mayor de 18 años, residentes en Perú y sin antecedentes de enfermedad por COVID-19. Los factores asociados al consumo de plantas medicinales se evaluaron mediante un modelo de regresión de Poisson con varianzas robustas. RESULTADOS.: De 3231 participantes incluidos, el 84,6% eran jóvenes (18-29 años), el 62,7% eran mujeres y el 59,7% consumía alguna planta medicinal para prevenir la COVID-19. Los factores asociados al consumo de plantas medicinales para prevenir el contagio de COVID-19 fueron residir en la sierra peruana, haber tenido un familiar diagnosticado con COVID-19, haber tenido un familiar fallecido por COVID-19, considerar que su familia se encuentra en mayor riesgo de infección, haber usado medicamentos o dióxido de cloro para prevenir la COVID-19, tener información médica como principal fuente de información sobre la COVID-19, pensar que las plantas medicinales son efectivas para prevenir la enfermedad COVID-19 o no estar informado sobre su eficacia. CONCLUSIÓN: . El 60% de los participantes reportó haber consumido alguna planta medicinal para prevenir la COVID-19. Es importante que las autoridades apliquen estrategias de comunicación sobre lo que implica el consumo de plantas medicinales, priorizando los grupos poblacionales que tienen mayores patrones de consumo.

The role of cattle in the transmission of cystic echinococcosis in a highly endemic area of the Peruvian Andes.

Cystic echinococcosis (CE) causes significant losses in Andean livestock production and affects Andean food security. However, more studies are needed to understand the epidemiology of the disease. In addition, the potential contribution of Andean cattle to the transmission of Echinococcus granulosus sensu lato needs to be known. This study aimed to determine the CE-prevalence and its association with risk factors, such as age and sex of the animals, the parasite load (number of cysts/organ) of condemned organs, and the viability and fertility of Echinococcus cysts from cattle in the Andes. The prevalence was examined in 348 cattle from an authorized slaughterhouse of Huancayo at 3300 m altitude. Cyst burden was determined by extracting all cysts from the total of the CE-infected organs. Cyst fertility and protoscolices viability were analysed from 90 randomly selected CE-infected organs. The CE prevalence was 35.6% (124/348; 95% CI: 30.6%-40.6%). There was no significant effect of age and sex on CE prevalence. CE was significantly more prevalent (p < 0.05) in lungs than livers, 34.8% (121/348; 95% CI: 29.8%-39.8%) vs 8.9% (31/348; 95% CI: 5.9%-11.9%). Most (75%) infected organs had one to five cysts. The mean cyst burden was significantly (p = 0.018) higher in the lungs than livers, 6.4 ± 4.9 vs 3.7 ± 2.9. Cyst fertility was 1.6% (10/608; 95% CI: 0.6%-2.6%). Despite the high CE prevalence, infected organs from Andean cattle play a minor role in CE transmission to dogs in the central Peruvian Andes.

Chest Radiograph Screening for Detecting Subclinical Tuberculosis in Asymptomatic Household Contacts, Peru.

The World Health Organization's end TB strategy promotes the use of symptom and chest radiograph screening for tuberculosis (TB) disease. However, asymptomatic early states of TB beyond latent TB infection and active disease can go unrecognized using current screening criteria. We conducted a longitudinal cohort study enrolling household contacts initially free of TB disease and followed them for the occurrence of incident TB over 1 year. Among 1,747 screened contacts, 27 (52%) of the 52 persons in whom TB subsequently developed during follow-up had a baseline abnormal radiograph. Of contacts without TB symptoms, persons with an abnormal radiograph were at higher risk for subsequent TB than persons with an unremarkable radiograph (adjusted hazard ratio 15.62 [95% CI 7.74-31.54]). In young adults, we found a strong linear relationship between radiograph severity and time to TB diagnosis. Our findings suggest chest radiograph screening can extend to detecting early TB states, thereby enabling timely intervention.

Seroprevalence of Toxoplasma gondii, risk factors and knowledge about toxoplasmosis in undergraduate students from Lima, Peru.

Toxoplasma gondii is the causative agent of toxoplasmosis, a zoonotic disease of worldwide distribution. The aim of this study was to assess the seroprevalence of T. gondii in undergraduate students from Lima, Peru, and to identify the risk factors linked to the infection. For this, serum samples of 100 undergraduate students of the Faculty of Biological Sciences were tested for T. gondii antibodies with a commercially available ELISA. The seroprevalence of T. gondii in these subjects was 7 %. Only the age of students showed a statistical association with T. gondii seropositivity. The level of awareness regarding toxoplasmosis was also investigated. In the sample, 71 % of the students are aware of toxoplasmosis and 64 % that a parasite is the cause of the infection. Most know it is transmitted through undercooked meat (57 %), but are unaware of contaminated vegetables (40 %), organ transplants (17 %), blood transfusions (32 %), and soil contact (39 %). In the epidemiological context it will be valuable to verify toxoplasmosis awareness in other population groups and other regions in Peru.

Development and Pilot-Testing of an Optimized Conversational Agent or "Chatbot" for Peruvian Adolescents Living With HIV to Facilitate Mental Health Screening, Education, Self-Help, and Linkage to Care: Protocol for a Mixed Methods, Community-Engaged Study.

BACKGROUND: Adolescents living with HIV are disproportionally affected by depression, which worsens antiretroviral therapy adherence, increases viral load, and doubles the risk of mortality. Because most adolescents living with HIV live in low- and middle-income countries, few receive depression treatment due to a lack of mental health services and specialists in low-resource settings. Chatbot technology, used increasingly in health service delivery, is a promising approach for delivering low-intensity depression care to adolescents living with HIV in resource-constrained settings. OBJECTIVE: The goal of this study is to develop and pilot-test for the feasibility and acceptability of a prototype, optimized conversational agent (chatbot) to provide mental health education, self-help skills, and care linkage for adolescents living with HIV. METHODS: Chatbot development comprises 3 phases conducted over 2 years. In the first phase (year 1), formative research will be conducted to understand the views, opinions, and preferences of up to 48 youths aged 10-19 years (6 focus groups of up to 8 adolescents living with HIV per group), their caregivers (5 in-depth interviews), and HIV program personnel (5 in-depth interviews) regarding depression among adolescents living with HIV. We will also investigate the perceived acceptability of a mental health chatbot, including barriers and facilitators to accessing and using a chatbot for depression care by adolescents living with HIV. In the second phase (year 1), we will iteratively program a chatbot using the SmartBot360 software with successive versions (0.1, 0.2, and 0.3), meeting regularly with a Youth Advisory Board comprised of adolescents living with HIV who will guide and inform the chatbot development and content to arrive at a prototype version (version 1.0) for pilot-testing. In the third phase (year 2), we will pilot-test the prototype chatbot among 50 adolescents living with HIV naïve to its development. Participants will interact with the chatbot for up to 2 weeks, and data will be collected on the acceptability of the chatbot-delivered depression education and self-help strategies, depression knowledge changes, and intention to seek care linkage. RESULTS: The study was awarded in April 2022, received institutional review board approval in November 2022, received funding in December 2022, and commenced recruitment in March 2023. By the completion of study phases 1 and 2, we expect our chatbot to incorporate key needs and preferences gathered from focus groups and interviews to develop the chatbot. By the completion of study phase 3, we will have assessed the feasibility and acceptability of the prototype chatbot. Study phase 3 began in April 2024. Final results are expected by January 2025 and published thereafter. CONCLUSIONS: The study will produce a prototype mental health chatbot developed with and for adolescents living with HIV that will be ready for efficacy testing in a subsequent, larger study. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55559.

Associations between social network addiction, anxiety symptoms, and risk of metabolic syndrome in Peruvian adolescents-a cross-sectional study.

Background: The link between physical and mental health and screen time in adolescents has been the subject of scientific scrutiny in recent years. However, there are few studies that have evaluated the association between social network addiction (SNA) and metabolic risk in this population. Objective: This study determined the association between SNA and anxiety symptoms with the risk of metabolic syndrome (MetS) in adolescents. Methods: A cross-sectional study was conducted in Peruvian adolescents aged 12 to 18 years, who completed a Social Network Addiction Questionnaire and the Generalized Anxiety Disorder 2-item scale (GAD-2), between September and November 2022. A total of 903 participants were included in the study using a non-probability convenience sample. Sociodemographic and anthropometric data were also collected. Binary logistic regression was used to explore the association between SNA and anxiety symptoms with MetS in a cross-sectional analysis. Results: Males were more likely to have MetS than females (OR = 1.133, p = 0.028). Participants who were 16 years of age or older and those with excess body weight were 2.166, p = 0.013 and 19.414, p < 0.001 times more likely to have MetS, respectively. Additionally, SNA (OR = 1.517, p = 0.016) and the presence of anxiety symptoms (OR = 2.596, p < 0.001) were associated with MetS. Conclusion: Our findings suggest associations between SNA, anxiety symptoms, and MetS among youth. However, more studies are needed to better understand this association and to deepen the possible clinical and public health implications.

Prevalence of hypertension and diabetes mellitus in Peruvian patients with chronic kidney disease: a systematic review and meta-analysis.

BACKGROUND: Chronic Kidney Disease (CKD) represents a major challenge for public health, with hypertension and diabetes being the main causes of its occurrence. Therefore, this study aims to determine the prevalence of hypertension (HTN) and diabetes mellitus (DM) in Peruvian patients with CKD. METHODS: A systematic search for studies about CKD in Peru was carried out in PubMed, Scopus, Embase, Web of Science, ScienceDirect, Google Scholar, Virtual Health Library (VHL), and Scielo from 2011 to December 2023. The protocol of this research was registered in the international registry of systematic reviews, the Prospective International Registry of Systematic Reviews (PROSPERO), with registration number CRD42023425118. Study selection, quality assessment, and data extraction were performed independently by two authors. Study quality was assessed using the Joanna Briggs Institute Statistical Meta-Analysis Assessment and Review Instrument. A random-effects model with inverse variance weighting was used to estimate the combined prevalence of HTN and DM in Peruvian patients with CKD. To analyze data heterogeneity, the I2 statistical test was used. Statistical analysis was performed with R version 4.2.3. RESULTS: A total of 1425 studies were retrieved, of which 23 were included in the final meta-analysis. A total of 43,321 patients with CKD were evaluated, of whom 52.22% were male and 47.78% were female. The combined prevalence of HTN in Peruvian patients with CKD was 38% (95% CI: 30-46%; 41,131 participants; 21 studies, I2 = 99%, p = 0), while the combined prevalence of DM in Peruvian patients with CKD was 33% (95% CI: 26-40%; 43,321 participants; 23 studies, I2 = 99%, p = 0). CONCLUSION: Approximately one-third of Peruvian patients with CKD have HTN and DM. These findings highlight the importance of implementing prevention and control measures for these chronic noncommunicable diseases in the Peruvian population, such as promoting healthy lifestyles, encouraging early detection and proper management of hypertension and diabetes, and improving access to medical care and health services.

Identifying priority double-duty actions to tackle the double burden of malnutrition in infants and young children in Peru: Assessment and prioritisation of government actions by national experts.

Multiple forms of malnutrition coexist in infants and young children (IYC) in Peru. The World Health Organization has proposed double-duty actions (DDAs) to simultaneously address undernutrition and overweight/obesity. We assessed current implementation of- and priority for- government-level actions to tackle multiple forms of malnutrition in IYC in Peru. Mapping of current policy activity was undertaken against 47 indicators of good practice for five DDAs (exclusive breastfeeding, complementary feeding, food marketing, maternal nutrition, preschool nutrition; assessed by 27 indicators) and for the enabling policy environment, i.e., 'infrastructure support' (health in all policies, platforms for interactions, financing, monitoring, governance, leadership; assessed by 20 indicators). Interviews with 16 national experts explored views on the level of and barriers to implementation of DDAs and infrastructure support, as well as their prioritisation based on likely impact and feasibility. The level of implementation of actions was categorised into two groups (agenda setting/formulation vs. implementation/evaluation). Mean scores were generated for prioritisation of DDAs and infrastructure support. Deductive qualitative analysis was undertaken to identify barriers that influence policy implementation. Only 5/27 DDA indicators were reported as fully implemented by all national experts (international code that regulates the marketing of breastmilk substitutes, iron supplementation for IYC, micronutrient powders in IYC, iron/folic acid supplementation in pregnant women, paid maternity leave). Only 1/20 infrastructure support indicator (access to nutrition information) was rated as fully implemented by all experts. Barriers to implementing DDAs and infrastructure support included: legal feasibility or lack of regulations, inadequate monitoring/evaluation to ensure enforcement, commercial influences on policymakers, insufficient resources, shifting public health priorities with the COVID-19 pandemic and political instability. The experts prioritised 12 indicators across all five DDAs and eight infrastructure support indicators. Experts highlighted the need to improve implementation of all DDAs and identified ways to strengthen the enabling policy environment.

Quality of life and its associated factors in chronic kidney disease patients undergoing hemodialysis from a Peruvian city: A cross-sectional study.

OBJECTIVE: To assess quality of life and explore its associated factors in a group of patients with chronic kidney disease (CKD) undergoing hemodialysis in Peru. METHODOLOGY: We conducted a cross-sectional analysis of patients with CKD treated at two medical centers in Tacna, Peru; between July and September 2023. We conducted a survey via telephone interviews with eligible patients using the Short Form 36 (SF 36) to assess their quality of life. RESULTS: Of 257 patients with CKD undergoing hemodialysis, we successfully interviewed 207 (59.9% males, median age: 62 years, median time on hemodialysis: 3.5 years). In the context of the SF-36 assessment, the dimensions with the lowest scores were physical role (mean: 13.9), emotional role (32.2), and physical function (32.4). Regarding the SF-36 summary scores, the average scores were 42.2 in the mental health domain and 32.0 in the physical health domain. In the adjusted model, the physical health domain score was higher in males (ß = 2.7) and those with economic self-sufficiency (ß = 3.0) and lower in older adults (ß = -2.5). The score in the mental health domain was higher in those with a higher level of education (ß = 4.1), in those with economic self-sufficiency (ß = 3.8), and in those receiving care at one of the centers included (ß: 4.2). CONCLUSION: Quality of life was affected, particularly in the realms of physical and emotional well-being. Furthermore, both the physical and mental health domains tend to show lower scores among women, older individuals, those lacking economic self-sufficiency, individuals with lower educational levels, and those with comorbidities.

Original article: novelty of Canadian manufacture nasopharyngeal swabs for collection of samples being tested for SARS-CoV-2 in a pandemic setting.

Objectives: The COVID-19 pandemic caused a global shortage of nasopharyngeal (NP) swabs, required for RT-PCR testing. Canadian manufacturers were contacted to share NP swab innovations. The primary objective was to determine whether novel NP test swabs were comparable to commercially available swabs regarding user characteristics, ability to collect a specimen, and diagnostic performance using RT-PCR testing. Methods: Participants were randomized by swab (test/control) and nostril (left/right). A calculated positive percent agreement ≥90% was considered successful. Mean Ct values of viral genes and housekeeping gene (RNase P) were considered similar if a Ct difference ≤ 2 between control and test group was obtained. There also was a qualitative assessment of swabs usability. Results: 647 participants were enrolled from Huaycan Hospital in Lima, Peru, distributed over 8 NP swabs brands. Seven brands agreed to share their results. There were no statistically significant differences between the test swabs of these 7 brands and control swabs. Conclusion: All the seven brands are comparable to the commercially available flocked swabs used for SARS-CoV-2 regarding test results agreement, ability to collect a specimen, and user characteristics.

Evaluation of naturally acquired immune responses against novel pre-erythrocytic Plasmodium vivax proteins in a low endemic malaria population located in the Peruvian Amazon Basin.

BACKGROUND: Plasmodium vivax represents the most geographically widespread human malaria parasite affecting civilian and military populations in endemic areas. Targeting the pre-erythrocytic (PE) stage of the parasite life cycle is especially appealing for developing P. vivax vaccines as it would prevent disease and transmission. Here, naturally acquired immunity to a panel of P. vivax PE antigens was explored, which may facilitate vaccine development and lead to a better understanding of naturally acquired PE immunity. METHODS: Twelve P. vivax PE antigens orthologous to a panel of P. falciparum antigens previously identified as highly immunogenic in protected subjects after immunization with radiation attenuated sporozoites (RAS) were used for evaluation of humoral and cellular immunity by ELISA and IFN-γ ELISpot. Samples from P. vivax infected individuals (n = 76) from a low endemic malaria region in the Peruvian Amazon Basin were used. RESULTS: In those clinical samples, all PE antigens evaluated showed positive IgG antibody reactivity with a variable prevalence of 58-99% in recently P. vivax diagnosed patients. The magnitude of the IgG antibody response against PE antigens was lower compared with blood stage antigens MSP1 and DBP-II, although antibody levels persisted better for PE antigens (average decrease of 6% for PE antigens and 43% for MSP1, p < 0.05). Higher IgG antibodies was associated with one or more previous malaria episodes only for blood stage antigens (p < 0.001). High IgG responders across PE and blood stage antigens showed significantly lower parasitaemia compared to low IgG responders (median 1,921 vs 4,663 par/µl, p < 0.05). In a subgroup of volunteers (n = 17),positive IFN-γ T cell response by ELISPOT was observed in 35% vs 9-35% against blood stage MSP1 and PE antigens, respectively, but no correlation with IgG responses. CONCLUSIONS: These results demonstrate clear humoral and T cell responses against P. vivax PE antigens in individuals naturally infected with P. vivax. These data identify novel attractive PE antigens suitable for use in the potential development and selection of new malaria vaccine candidates which can be used as a part of malaria prevention strategies in civilian and military populations living in P. vivax endemic areas.

Health in Persons Deprived of Their Liberty in South America: A Painful Reflection of Our Public Health.

Objectives: To describe sociodemographic characteristics and health-related data in persons deprived of liberty (PDL) from South America in the last five years. Methods: Documentary descriptive study. Results: There are 1.5 million PDL in Latin America and the Caribbean; the average overcrowding is 64%; 58% do not sleep in beds, 20% do not have access to clean water and 29% do not receive medical care. In Peru, during 2021, there were 87,245 PDL and 69 penal institutions. The national average overcrowding is 120%, the second-highest in South America. In South America, the prevalence of tuberculosis is 2.0% SD = 0.64 and the median of illegal substances prevalence is 34.6 (IQR = 7.5-41.4). In Peru, the prevalence of tuberculosis has decreased since 2016 (4.3%), 2018(3.5%), and 2021(2.5%). Among the health problems by country, there were more data on substance use: 8/10, and tuberculosis, 7/10 countries. Cardiovascular diseases had the least available data. Regarding COVID-19, during the first wave in Peru, 54% of the total PPL were infected, and by the end of the wave, 446 PDL and 46 members of the prison staff had died. In Colombia, between April and October 2020, there were 16,804 cases (80 in ICU) and 136 deaths. In Brazil, up to March 2021, 340 people had died, and there were over 67,000 infections. Conclusions: Overcrowding is an unresolved problem; tuberculosis and substance use are the most frequent issues. Data are limited in quality, homogeneity and availability. Greater effort is needed from health authorities to improve health management and information systematization. Source: MesH.

Proportion of cancer cases and deaths attributable to potentially modifiable risk factors in Peru.

BACKGROUND: Limited evidence exists on the population attributable fraction (PAF) of cancer cases and deaths in Latin America. In Peru several studies have been published regarding the PAF of various risk factors and their associated diseases. The objective of this study was to estimate the fraction of cancer cases and deaths attributable to potentially modifiable risk factors in Peru in 2018, before the COVID-19 pandemic in the population of 15 years old and older. METHODS: An ecological study was conducted using the prevalence of exposure of the Peruvian population to modifiable risk factors for cancer, the relative risk associated with each factor, and the number of cancer cases and deaths in 2018 as inputs. We used the Parkin formula with a Montecarlo statistical simulation model to calculate the PAF and confidence intervals. The number of new cancer cases and deaths attributed to each risk factor was determined by multiplying the number of cases and deaths in each gender by the PAF of each risk factor. FINDINGS: In Peru, 38.5% of new cases (34.5% in men and 42% in women) and 43.4% of cancer-related deaths (43.4% in men and 43.4% in women) were attributable to modifiable risk factors. The number of cancers attributable was 25,308 (10,439 in men and 14,869 in women) and the number of deaths attributable to cancer was 14,839 (6,953 in men and 7,886 in women). The predominant modifiable risk factors contributing to the highest number of cases and deaths were HPV infection (4,563 cases, 2,409 deaths), current tobacco use (3,348 cases, 2,180 deaths), and helicobacter pylori infection (2,677 cases, 1,873 deaths). Among the risk factors, oncogenic infections constituted the group with the highest PAF (16.6% for cases, 19.2% for deaths) followed by other unhealthy lifestyle factors (14.2% for cases, 16.7% for deaths), tobacco (7.2% for cases, 7.2% for deaths) and ultraviolet radiation (0.5% for cases, 0.3% for deaths). CONCLUSIONS: Prior to the COVID-19 pandemic, 38.5% of cancer cases and 43.4% of cancer-related deaths in Peru were linked to modifiable risk factors in the population of 15 years old and older. Most preventable cancer cases and deaths were related to oncogenic infections, primarily caused by HPV and helicobacter pylori, followed by tobacco and obesity.

[Registry of Members of the Association of Patients with Hereditary Angioedema of Perú]. / Registro de miembros de la Asociación de Pacientes con Angioedema Hereditario de Perú.

OBJECTIVE: To report the registry of the HAE Peruvian patient's association. METHODS: We used the questionnaire of the Latin American HAE committee. Consent was requested from the patient's association to report the data. RESULTS: We report data of 63 patients, 51 Female, 12 Male, range age between 6 to 74 years. Nine under 18 years old, 5/9 between 6 to 13 years. Forty-five HAE C1-INH type I, 12 HAE-FXII, 5 HAE UNK, 1 AAE. Symptoms onset average age in 56/62 HAE patients was 16.8. In a group of 50/62 adult HAE patients, the average diagnostic delay approximately was 19.3 years. Laboratory tests: we can perform C4 complement C1-inhibitor antigenic and functional tests. Treatments: The patients have access to tranexamic acid (TA) and attenuated androgens. We do not have registered specific long-term prophylaxis treatments. We used moderate/high doses of TA, in most patients up to 6 gr i.v./in 24 hours, we start with the treatment immediately the HAE acute crisis is beginning, it helps to the HAE attacks are less symptomatic, resolves in a few days and decrease the frequency. CONCLUSIONS: We present 63 members of the Association of Patients with Hereditary Angioedema of Perú. We have improved blood tests for HAE diagnosis. Moderate and high doses of Tranexamic Acid are used for prophylaxis and acute crisis respectively, with acceptable response. No deaths have been reported due to HAE crisis in the patient's association.

OBJETIVO: Reportar el registro de pacientes de la Asociación de Pacientes con Angioedema Hereditario de Perú, AEH. MÉTODOS: Se utilizó el cuestionario del Comité de AEH, de la Sociedad Latinoamericana de Alergia, Asma e Inmunología (SLAAI). Se solicitó el consentimiento a la Asociación de Pacientes para reportar los datos. RESULTADOS: Se reportan datos de 63 pacientes, 51 mujeres y 12 hombres, en un rango de edad entre 6 y 74 años. Nueve menores de 18 años, 5/9, entre 6 y 13 años. 45 con AEH-C1-INH tipo I, 12 AEH-FXII, 5 AEH-D, 1 AEA. La edad promedio de inicio de síntomas en 56/62 pacientes fue de 16,8. En 50/62 pacientes adultos con AEH, el promedio de tiempo de espera en el diagnóstico fue de 19,3 años. Laboratorio: Se puede desarrollar C4 complemento, C1-Inhibidor antigénico y funcional. Tratamientos: Se cuenta con acceso al ácido tranexámico (AT) y andrógenos atenuados. No se cuenta con tratamientos específicos para profilaxis de largo plazo. Se utilizaron dosis moderadas/altas de (AT), hasta 6 g por I V/ en 24 horas, inmediatamente, al inicio de las crisis de AEH, ayuda a que los ataques no sean tan intensos y tengan menor duración y frecuencia. CONCLUSIONES: Se presentan 63 miembros de la Asociación de Pacientes con Angioedema Hereditario de Perú. Se han mejorado los exámenes sanguíneos para el diagnóstico del AEH. Se utilizaron dosis moderadas/altas de ácido tranexámico con aceptable respuesta en los pacientes. No se han presentado decesos por crisis de AEH en los miembros de la Asociación.

[Identification and sensitization to environmental fungal spores in Lima City, Peru]. / Identificación y sensibilización a hongos ambientales en Lima, Perú.

OBJECTIVE: To identify and registry the most important fungal spores trapped in our aerobiology station, as well as to report the prevalence of skin sensitization to these allergens. METHODS: The pollen counts were made according to standardized technique with a Burkard seven days spore trap, following the American Academy of Allergy, Asthma and Immunology (AAAAI) through National Allergy Bureau (NAB) recommendations. The trap was installed on the roof of Clinica SANNA, El GOLF, San Isidro, which is 20 m high, 12°5'54"S 77°3'6"W in the west-south of the Lima urban area. The sampling period was performed from September 2020 to October 2021. Skin prick tests were carried out according to the recommendations of the Spanish Society of Allergology and Clinical Immunology (SEAIC) in 200 patients (18 to 60 years old) with symptoms of rhinoconjunctivitis and/or asthma, who were evaluated in the Allergology Service of Clinica SANNA el Golf. Allergenic extracts were applied, dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis), cat and dog danders, cockroach (Periplaneta americana), grass 6 mix, weed mix, molds (Cladosporium herbarum, Alternaria alternata, Aspergillus fumigatus, Penicillium notatum, Nigrospora spp.), INMUNOTEK-Spain provided the extracts. We also tested other fungal allergens such as Fusarium spp, Stemphylium spp, Curvularia spp, a mixture of Helmintosporum/Dreschlera spp. from the DIATER-Argentina laboratory. RESULTS: We identified spores of Alternaria alternata, Cladosporium spp., Nigrospora spp., Stemphylium spp., Fusarium spp., Curvularia spp., Dreschlera/Helmintosporum spp. The patients showed sensitization to Cladosporium herbarum (14%), Fusarium spp. (13,5%), Nigrospora spp. (8%), Alternaria Alternata (7%), Stemphylium (6%), Dreschlera/Helmintosporium spp. (5,5%), Curvularia spp. (3%), Aspergillus fumigatus (2,5%). CONCLUSIONS: The inhabitants of the south-western area of the urban city of Lima are exposed to different fungal spores with allergenic potential, with a higher concentration being identified during the summer/autumn months. Cutaneous sensitization is demonstrated in variable percentages to the fungal spores identified in this aerobiological sampling. The results of this study should be expanded and compared with data in the forthcoming years, identify seasonal and annual fluctuations and extend the traps to other locations in Lima.

OBJETIVO: Identificar y registrar las esporas de hongos más importantes captadas en nuestra estación de aerobiología, además reportar la prevalencia de sensibilización cutánea a estos alérgenos. MÉTODOS: La identificación y los conteos de esporas de hongos se realizaron según la técnica estandarizada con un equipo colector Burkard Spore Trap For Seven Days, siguiendo las recomendaciones de la National Allergy Bureau (NAB), de la American Academy Allergy Asthma and Immunology (AAAAI). El equipo se instaló a 20 m de altura desde el nivel del suelo, en la azotea de la Clínica SANNA El Golf, distrito de San Isidro, (12°5'54"S 77°3'6"O), en la zona sur-oeste del área urbana de Lima. El periodo de captación se llevó a cabo entre septiembre de 2020 y octubre de 2021. Se realizaron estudios de pruebas cutáneas (skin prick-test), según recomendaciones de la Sociedad Española de Alergología e Inmunología Clínica (SEAIC), en 200 pacientes (entre 18 y 60 años), con sintomatología de rinoconjuntivitis y/o asma. Fueron evaluados en el servicio de Alergología de la Clínica SANNA El Golf. Se aplicaron extractos alergénicos de ácaros del polvo (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis), epitelios de gato y perro, Periplaneta americana, mezclas de seis gramíneas, mezclas de malezas, hongos ambientales (Cladosporium herbarum, Alternaria alternata, Aspergillus fumigatus, Penicillium notatum, Nigrospora spp.), extractos del laboratorio INMUNOTEK-España. Además, testeamos otros alérgenos fúngicos de Fusarium spp, Stemphylium spp, Curvularia spp, una mezcla de Helmintosporum/Dreschlera spp. del laboratorio DIATER-Argentina. RESULTADOS: Identificamos esporas de Alternaria alternata, Cladosporium spp., Nigrospora spp., Stemphylium spp., Fusarium spp., Curvularia spp., Dreschlera/Helmintosporum spp. Los pacientes mostraron sensibilización a Cladosporium herbarum (14%), Fusarium spp. (13,5%), Nigrospora spp. (8%), Alternaria Alternata (7%), Stemphylium (6%), Dreschlera/Helmintosporium spp. (5,5%), Curvularia spp. (3%) y Aspergillus fumigatus (2,5%). CONCLUSIONES: Los habitantes de la zona sur-oeste de la ciudad urbana de Lima están expuestos a distintas esporas de hongos con potencial alergénico, identificándose mayor concentración durante los meses de verano y otoño. Se demuestra sensibilización cutánea en porcentajes variables a las esporas fúngicas identificadas en este muestreo aerobiológico. Los resultados de este estudio deberían ampliarse y ser comparados con data en los años siguientes, identificar fluctuaciones estacionales y anuales y extender los captadores a otras locaciones en Lima.

Association between cardiovascular risk and maternal perception of BMI in Peruvian schoolchildren.

Introduction: In the modern era, the maternal perception of children's nutritional status has emerged as a critical area of study, given its potential influence on nutritional interventions and long-term child health. The relationship between this perception and children's Body Mass Index (BMI) by age is particularly intriguing, as it may reveal discrepancies between perception and reality. Objective: The aim of this study was to evaluate Peruvian mothers' perception of their children's Body Mass Index (BMI) in relation to age and to determine how this perception associates with the children's cardiovascular risk. The study also analyzed sociodemographic factors that might influence this perception. Methods: The study included 130 mothers of schoolchildren aged 5 to 11 from a school in Lima. Mothers' perceptions of their children's weight were assessed using pictograms, and sociodemographic characteristics were collected through a questionnaire. Weight and height measurements were taken to calculate BMI, and waist circumference was measured to classify cardiovascular risk. Results: A total of 57.4% of the schoolchildren presented with excess malnutrition, and 51.5% of the mothers incorrectly classified the actual BMI/Age of their children (kappa 0.11; p ≤ 0.05). Additionally, it was found that the schoolchild's age is associated with the mother's failure to accurately perceive her child's weight (OR 1.59). Lastly, there was a significant association between maternal perception and cardiovascular risk (p ≤ 0.05). Conclusion: There is a significant discrepancy between maternal perception and the actual nutritional status of children, which can increase cardiovascular risk. It is necessary to implement intervention and education strategies targeted at parents to enhance the recognition and management of childhood overweight and obesity.