The impact of indoor pollution on asthma-related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma

Systematic review using GRADE of the impact of exposure to volatile organic compounds (VOCs), cleaning agents, mould/damp, pesticides on the risk of (i) new-onset asthma (incidence) and (ii) adverse asthma-related outcomes (impact). MEDLINE, EMBASE and Web of Science were searched for indoor pollutant exposure studies reporting on new-onset asthma and critical and important asthma-related outcomes. Ninety four studies were included: 11 for VOCs (7 for incidenceand 4 for impact), 25 for cleaning agents (7 for incidenceand 8 for impact), 48 for damp/mould (26 for incidence and 22 for impact) and 10 for pesticides (8 for incidence and 2 for impact). Exposure to damp/mould increases the risk of new-onset wheeze (moderate certainty evidence). Exposure to cleaning agents may be associated with a higher risk of new-onset asthma and with asthma severity (low level of certainty). Exposure to pesticides and VOCs may increase the risk of new-onset asthma (very low certainty evidence). The impact on asthma-related outcomes of all major indoor pollutants is uncertain. As the level of certainty is low or very low for most of the available evidence on the impact of indoor pollutants on asthma-related outcomes more rigorous research in the field is warranted.

The impact of outdoor pollution and extreme temperatures on asthma-related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma

Air pollution is one of the biggest environmental threats for asthma. Its impact is augmented by climate change. To inform the recommendations of the EAACI Guidelines on the environmental science for allergic diseases and asthma, a systematic review (SR) evaluated the impact on asthma-related outcomes of short-term exposure to outdoor air pollutants (PM2.5, PM10, NO2 , SO2 , O3 , and CO), heavy traffic, outdoor pesticides, and extreme temperatures. Additionally, the SR evaluated the impact of the efficacy of interventions reducing outdoor pollutants. The risk of bias was assessed using ROBINS-E tools and the certainty of the evidence by using GRADE. Short-term exposure to PM2.5, PM10, and NO2 probably increases the risk of asthma-related hospital admissions (HA) and emergency department (ED) visits (moderate certainty evidence). Exposure to heavy traffic may increase HA and deteriorate asthma control (low certainty evidence). Interventions reducing outdoor pollutants may reduce asthma exacerbations (low to very low certainty evidence). Exposure to fumigants may increase the risk of new-onset asthma in agricultural workers, while exposure to 1,3-dichloropropene may increase the risk of asthma-related ED visits (low certainty evidence). Heatwaves and cold spells may increase the risk of asthma-related ED visits and HA and asthma mortality (low certainty evidence).

Prediction models of COVID-19 fatality in nine Peruvian provinces: A secondary analysis of the national epidemiological surveillance system

There are initiatives to promote the creation of predictive COVID-19 fatality models to assist decision-makers. The study aimed to develop prediction models for COVID-19 fatality using population data recorded in the national epidemiological surveillance system of Peru. A retrospective cohort study was conducted (March to September of 2020). The study population consisted of confirmed COVID-19 cases reported in the surveillance system of nine provinces of Lima, Peru. A random sample of 80% of the study population was selected, and four prediction models were constructed using four different strategies to select variables: 1) previously analyzed variables in machine learning models; 2) based on the LASSO method; 3) based on significance; and 4) based on a post-hoc approach with variables consistently included in the three previous strategies. The internal validation was performed with the remaining 20% of the population. Four prediction models were successfully created and validate using data from 22,098 cases. All models performed adequately and similarly; however, we selected models derived from strategy 1 (AUC 0.89, CI95% 0.87-0.91) and strategy 4 (AUC 0.88, CI95% 0.86-0.90). The performance of both models was robust in validation and sensitivity analyses. This study offers insights into estimating COVID-19 fatality within the Peruvian population. Our findings contribute to the advancement of prediction models for COVID-19 fatality and may aid in identifying individuals at increased risk, enabling targeted interventions to mitigate the disease. Future studies should confirm the performance and validate the usefulness of the models described here under real-world conditions and settings.

Self-perceived competence in managing obstetric emergencies among recently graduated physicians from Lima, Peru

OBJECTIVE

This study aimed to examine the self-perception of competencies in obstetric emergencies among recently graduated physicians from universities in Lima, Peru; and to identify its associated factors.

METHODS

An analytical study was conducted, with the study population comprising newly graduated doctors who attended the "VI SERUMS National Convention" in 2017. We used Poisson regressions to assess the factors associated with the self-perception of competencies in obstetric emergencies, calculating prevalence ratios (PR) and their 95% confidence intervals (95% CI).

RESULTS

We analyzed a population of 463 newly graduated physicians (mean age: 25.9 years), of which 33.3% reported feeling competent in obstetric emergencies. In the adjusted analyses, we found that having a previous health career (PR: 1.77, 95% CI: 1.12-2.81), having completed the internship in EsSalud hospitals (PR: 1.48, 95% CI: 1.31-1.68), and completing a university externship (PR: 1.62, 95% CI: 1.34-1.96) were associated with a higher prevalence of self-perceived competence in obstetric emergencies.

CONCLUSION

Our findings suggest that certain academic factors, such as completing an externship and internship in specific hospital settings, may enhance the competencies or competence self-perception of recently graduated physicians in obstetric emergencies. Further studies are needed to confirm these results and identify other factors that may impact physicians' competencies in this field.

Latin America and the Caribbean Code Against cancer 1st edition: Environment, occupation, and cancer

Within the framework of the Latin America and Caribbean region (LAC) Code Against Cancer 1st edition, the current work presents recommendations to reduce exposure to environmental and occupational carcinogenic agents relevant for LAC. Using the methodology established by the International Agency for Research on Cancer (IARC) in the World Code Against Cancer Framework and experience from developing the European Code Against Cancer 4th edition, a working group of LAC cancer-prevention experts reviewed the list of Group I IARC carcinogenic agents, identified prevalent environmental and occupational exposures in the region, and proposed evidence-based cancer prevention recommendations suited to the epidemiological, socioeconomic, and cultural conditions of LAC countries. Two sets of recommendations were drafted: those targeting the general public and a second set for policymakers. Outdoor and indoor air pollution, ultra-violet radiation and occupational exposures to silica dust, asbestos, benzene, diesel, and welding fumes were identified as prevalent carcinogens in LAC and as agents that could be reduced or eliminated to prevent cancers. Recommendations for additional risk factors were not included due to insufficient data of their attributable burden in LAC (sunbeds, radon, aflatoxin), or lack of a clear preventive action to be taken by the individual (arsenic in drinking water, medical radiation), or lack of evidence of carcinogenicity effect (bisphenol A, phthalates, and pesticides). A broad consensus was reached on environmental and occupational carcinogenic exposures present throughout the LAC region and on individual-level and public policy-level recommendations to reduce or eliminate these exposures. Key educational content for the dissemination of these recommendations was also developed as part of LAC Code Against Cancer 1st Edition.

Association between self-reported evidence-based medicine competencies and prescribing of drugs without scientific evidence against mild COVID-19 among recently graduated physicians in Peru

Objective

To evaluate the association between self-rated evidence-based medicine (EBM) competencies and the prescription of drugs without scientific evidence against mild COVID-19 (present with any of the signs and symptoms of COVID-19 but who do not have shortness of breath, dyspnea, or abnormal chest imaging) among recently graduated physicians in Peru.

Methods

We conducted an analytical cross-sectional study where we evaluated a non-probability sample of recently graduated physicians during June and July 2021 (end of second wave of COVID-19 in Peru). Self-rated EBM competencies were assessed by four domains (formulation of a clinical question, search, analysis, and application) using a Likert scale with scores from zero to four ("Very inadequate" = 0, to "Very Adequate" = 4), it was considered as "Adequate" if the score was three or four. In addition, the variable "General competence on EBM" was rated as "Adequate" if in all domains evaluated it presented an adequate self-rating. For the outcome, drug prescription, we considered the use of ivermectin, azithromycin, other antibiotics, hydroxychloroquine, dexamethasone, and anticoagulants (drugs with no efficacy demonstrated for patients with mild COVID-19). To assess the association, we used Poisson regression models with robust variances and obtaining crude (cPR) and adjusted (aPR) prevalence ratios with their 95% confidence intervals (95%CI).

Results

Of a total of 239 physicians included 70.7% prescribed at least one drug without scientific evidence. A total of 51.1% reported adequate ratings in all evaluated domains of EBM. Self-rating the "Clinical Question Formulation" competency as adequate was associated with a lower frequency of prescribing medications for mild COVID-19 (aPR: 0.93; 95% CI: 0.91-0.95). While self-rating as adequate the competency of "Identify possible implications of investigations" was associated with an increase in the prescription of such drugs (aPR: 1.14; 95% CI: 1.09-1.20). Additionally, self-rating all domains as adequate were associated with less prescription (aPR: 0.93; 95% CI: 0.90-0.96).

Conclusion

Seven out of ten recently graduated physicians prescribed some type of medication without scientific evidence to treat patients with mild COVID-19. Having adequate self-perceived EBM competencies was associated with a lower frequency of prescribing medications without scientific evidence to manage patients with mild COVID-19.

An appraisal of the methodology and quality of evidence of systematic reviews on the efficacy of prone positional ventilation in adult patients with acute respiratory distress syndrome: an umbrella review

The objective of the study was to evaluate all available systematic reviews on the use of prone positional ventilation in adult patients with acute respiratory distress syndrome (ARDS). An umbrella review on the efficacy of prone positional ventilation in adult patients ventilation in adult patients with acute respiratory distress syndrome was conducted. We performed a systematic search in the database of Medline (Pubmed), Scopus, Cochrane Library, Web of Science, and Epistemonikos. The ROBIS tools and GRADE methodology were used to assess the risk of bias and certainty of evidence. We estimated the necessary number of patients to be treated to have benefit. For the synthesis of the result, we selected the review with the lowest risk of bias. Sixteen systematic reviews including 64 randomized clinical trials and evaluating the effect of prone positional ventilation, with or without other ventilation strategies were included. Aoyama 2019 observed prone positioning, without complementary ventilation strategies, leading to a reduction in the 28-day mortality only when compared to high-frequency oscillatory ventilation (RR 0.61; 95% CI 0.39-0.95) and lung-protective ventilation in the supine position (RR 0.69; 95% CI 0.48-0.98), with an ARR of 9.32% and 14.94%, an NNTB of 5.89 and 8.04, and a low and moderate certainty of evidence, respectively. Most reviews had severe methodological flaws that led to results with very low certainty of evidence. The review with the lowest risk of bias presented results in favor of prone positional ventilation compared with high-frequency oscillatory ventilation and lung-protective ventilation. There is a need to update the available reviews to obtain more accurate results.

Factors Associated With Drug Consumption Without Scientific Evidence in Patients With Mild COVID-19 in Peru

OBJECTIVE

This study aimed to evaluate the factors associated with the consumption of drugs without scientific evidence in patients with mild COVID-19 infection in Peru.

METHODS

An analytical cross-sectional study was carried out including 372 adult patients with a history of mild COVID-19 disease. Factors associated with drug consumption were evaluated by Poisson regressions with robust variance adjustment using the bootstrapping resampling method.

RESULTS

Seventy-two percent consumed some medication without scientific evidence, with antibiotics (71%) and ivermectin for human use (68%) being the most commonly used. Factors associated with the consumption of drugs to treat mild COVID-19 infection were thinking that the drugs are not effective (adjusted prevalence ratio, 0.55; 95% confidence interval, 0.41-0.74) and not being informed about the efficacy of the drugs (adjusted prevalence ratio, 0.48; 95% confidence interval, 0.36-0.65).

CONCLUSIONS

Education of the population seems to be the main factor that increases the consumption of drugs without scientific evidence in the Peruvian population to treat mild COVID-19.

Binary endocardial appearance for Fabry disease diagnosis: a systematic review and meta-analysis

Objective

This study aimed to determine the performance of the endocardial binary appearance (binary sign [BS]) on echocardiography for Fabry-Anderson disease (FD) diagnosis.

Methods

A diagnostic systematic review was performed, which included studies with >20 patients selected, with enough reported data to compute the 2 × 2 tables, and with a BS evaluation against a genetic test. Evidence was searched up to October 4, 2020, in the following databases: PubMed, Scopus, EMBASE, and Web of Science. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 tool and certain evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results

Four studies were included in the systematic review. All studies were cross-sectional that included 524 patients that compared the BS vs. the alpha-galactosidase-A and/or genetic test, alpha-galactosidase-A and globotriaosylceramide isoform, and genetic test alone. The BS was found to have a sensitivity of 41% (confidence interval [CI] 95% = 17–71) and specificity of 91% (CI 95% = 60–99) and area under the curve of 0.71 (CI 95% = 0.64–0.78) for diagnostic of FD, with a certain of evidence low.

Conclusion

The BS has a good performance in confirming the diagnosis of FD, but not for screening. However, the evidence had low certainty, thus future studies could modify these results.

Funding Acknowledgement

Type of funding sources: None.

Vitamin E supplementation improves testosterone, glucose- and lipid-related metabolism in women with polycystic ovary syndrome: a meta-analysis of randomized clinical trials

AIM

This systematic review and meta-analysis assessed the effect of vitamin E supplementation on testosterone, glucose, lipid profile, pregnancy rate, hirsutism, and body mass index (BMI) in women with polycystic ovary syndrome (PCOS).

METHODS

A multi-database search was performed from inception to January 2022 for randomized controlled trials (RCTs) reporting the effects of vitamin E supplementation with or without another nutritional supplement on women with PCOS. A random-effects model was used to obtain mean differences (MDs) and its 95% confidence intervals (95%CI). Evidence certainty was assessed with GRADE methodology.

RESULTS

We meta-analyzed eight RCTs reporting vitamin E supplementation alone or combined with other individual substances like omega-3, vitamin D3, or magnesium oxide in adult women ≤40 years old with PCOS. Vitamin E supplementation reduced fasting glucose (MD: -1.92 mg/dL, 95%CI: -3.80 to -0.05), fasting insulin (MD: -2.24 µIU/mL, 95%CI: -3.34 to -1.14), HOMA-IR (MD: -0.42, 95%CI: -0.65 to -0.19), total cholesterol (MD: -18.12 mg/dL, 95%CI: -34.37 to -1.86), LDL-cholesterol (MD: -15.92 mg/dL, 95%CI: -29.93 to -1.90), triglycerides (MD: -20.95 mg/dL, 95%CI: -37.31 to -4.58), total testosterone (MD: -0.42 ng/mL, 95%CI: -0.55 to -0.29), and increased sex hormone-binding globulin (MD: 7.44 nmol/L, 95%CI: 2.68 to 12.20). However, it had no impact on female sex hormones, HDL-cholesterol, BMI, and hirsutism. Two RCTs assessed pregnancy and implantation rates with inconsistent results. The certainty of the evidence was very low to moderate.

CONCLUSION

Vitamin E supplementation improves glucose, lipid, and androgenic-related biomarkers in women with PCOS.

Factors associated with the intention to participate in COVID-19 vaccine clinical trials: A cross-sectional study in Peru

OBJECTIVE

To evaluate the factors associated with the intention to participate in COVID-19 vaccine clinical trials in the Peruvian population.

METHODS

Cross-sectional study and secondary analysis of a database that involved Peruvian population during September 2020. The Poisson regression model was used to estimate the associated factors.

RESULTS

Data from 3231 individuals were analyzed, 44.1% of whom intended to participate in COVID-19 vaccine clinical trials. Factors associated with the outcome were being male (RPa: 1.25; 95% CI: 1.15-1.35), being from the highlands region (RPa: 1.18; 95% CI: 1.09-1.28) or jungle (RPa: 1.30; 95% CI: 1.15-1.47), having a relative that is a healthcare professional (PRa: 1.16; 95% CI: 1.06-1.28), using a medical source of information (PRa: 1.28; 95% CI: 1.17-1.41), and trusting in the possible effectiveness of vaccines (PRa: 1.40; 95% CI: 1.29-1.51). The main reason for not participating in the trial was the possibility of developing side effects (69.80%).

CONCLUSION

There is an urgent need to generate a perception of safety in COVID-19 vaccine clinical trials, to increase the population's intention to participate in these studies, and to provide evidence-based information about the vaccine.

Factors associated with prevention practices against COVID-19 in the Peruvian population: Disparities between rural and urban areas

Objective

To determine the factors associated with prevention practices against COVID-19 in the Peruvian population according to rural vs. urban locations.

Methods

Analytical cross-sectional study, secondary analysis based on a previously collected database. A sample of individuals over 18 years of age, residing in Peru and with no history of COVID-19was evaluated. Factors associated with prevention practices were evaluated using Poisson regressions with variance adjustment by region cluster and stratified by rurality.

Results

Of 3231 participants included, 2741 (84.8%) were from urban areas and 490 (15.2%) from rural areas. The frequency of good prevention practices against COVID-19 was 27.8% in our total sample. In urban areas the frequency of good prevention practices was 28.8% and in rural areas it was 22.5%. Factors associated with prevention practices against COVID-19 in both urban and rural areas were male sex (urban: aPR 0.64, 95%CI 0.55–0.75; rural: aPR 0.66, 95%CI 0.54–0.80) and self-considering adequately carrying out prevention practices (urban: aPR 2.48, 95%CI 2.13–2.89; rural: aPR 2.70, 95%CI 2.27–3.19).

Conclusion

The frequency of good prevention practices against COVID-19 was less than 30% in both urban and rural areas. There are differences in the factors associated with good preventive practice against COVID-19. Only sex and considering that preventive measures were adequately carried out were associated with good prevention practices in both areas. In view of this, prevention measures should be promoted taking into account cultural principles and considering geographical location in the face of present and future outbreaks or pandemics.

Systematic review of warfarin-induced skin necrosis case reports and secondary analysis of factors associated with mortality

OBJECTIVE

Warfarin-induced skin necrosis (WSN) is a rare (0.0.1%-0.1%) and severe adverse reaction. The clinical characteristics of this reaction and its mortality rate have not been explored in a large population. Therefore, we present the case of a Peruvian patient who developed WSN and perform a systematic review of case reports of WSN.

METHODS

A systematic search was performed using the Pubmed/Medline, Scopus, Web of Science and Embase databases. Patient clinical data were collected and extracted from every case report. Furthermore, we analysed the factors associated with mortality because of WSN using the Poisson regression model with robust variations, obtaining risk ratios (RR) and their respective confidence intervals (95% CI).

RESULTS

We identified 90 case reports that included a total of 111 patients with WSN (mean age 52.5 years), 20.72% of whom died of complications because of WSN. Being male (RR: 2.87; 95% CI 1.21-6.83) and having three or more affected regions (RR: 6.81; 95% CI 2.62-17.74) were associated with an increased risk of death caused by WSN.

CONCLUSION

This systematic review identified 90 case reports of WSN with three or more affected body regions. Male sex was associated with an increased risk of death. Further studies are needed to analyse and confirm these results.

Factors associated with the consumption of chlorine dioxide to prevent and treat COVID-19 in the Peruvian population: a cross-sectional study

BACKGROUND

Chlorine dioxide has been promoted as an alternative for the prevention and treatment of COVID-19, especially in Peru, despite the lack of evidence to support its efficacy. This study aimed to evaluate the factors associated with chlorine dioxide consumption in the Peruvian population.

METHODS

Analytical cross-sectional study. An adult Peruvian population was evaluated where chlorine dioxide consumption was divided into two groups according to the purpose of use: as prevention (individuals without COVID-19 history) and as treatment (individuals with COVID-19 history). The associated factors in each group were evaluated using Poisson regressions with the bootstrapping resampling method.

RESULTS

Of 3610 participants included, 3213 reported no history of COVID-19, and 397 had been infected. The prevalence of chlorine dioxide consumption to prevent or treat COVID-19 was 8 and 16%, respectively. Factors either positively or negatively associated with chlorine dioxide consumption for prevention were male sex (aPR: 1.36; 95% CI: 1.09-1.71), being an adult or older adult (aPR: 0.54; 95% CI: 0.35-0.82), having a health sciences student within the family unit (aPR: 1.38; 95% CI: 1.02-1.87), using medical information as the main source of information of COVID-19 (aPR: 0.57; 95% CI: 0.40-0.80), having comorbidities for COVID-19 (aPR: 1.36; 95% CI: 1.01-1.82), considering COVID-19 dangerous and deadly (aPR: 0.57; 95% CI: 0.45-0.74), using medications (aPR: 1.59; 95% CI: 1.25-2.06) and plants to prevent COVID-19 (aPR: 1.69; 95% CI: 1.21-2.36), considering chlorine dioxide ineffective (aPR: 0.18; 95% CI: 0.18-0.24), and being uninformed of its efficacy (aPR: 0.21; 95% CI: 0.16-0.28). In addition, factors associated with chlorine dioxide consumption for treatment were considering COVID-19 dangerous and deadly (aPR: 0.56; 95% CI: 0.33-0.96), considering chlorine dioxide ineffective (aPR: 0.22; 95% CI: 0.12-0.42), and being uninformed of its efficacy (aPR: 0.15; 95% CI: 0.07-0.32).

CONCLUSIONS

The prevalence of chlorine dioxide consumption to treat COVID-19 was higher than prevent. It is important to apply information strategies, prioritizing population groups with certain characteristics that are associated with a higher consumption pattern.

[Clinical practice guidelines for the diagnosis and management chronic infection of hepatitis viral C of the Peruvian Health Social Security (EsSalud)]

INTRODUCTION

This article summarizes the clinical practice guidelines (CPG) for the diagnosis and treatment of chronic infection of hepatitis viral C of the Peruvian Health Social Security (EsSalud).

OBJECTIVE

To provide clinical recommendations based on evidence for the diagnosis and treatment of chronic infection of hepatitis viral C in EsSalud.

METHODS

A guideline development group (GDG) was established, including medical specialists and methodologists. The GDG formulated 4 clinical questions to be answered in this CPG. Systematic searches of systematic reviews and primary studies (when pertinent) were conducted in PubMed, and Central (Cochrane) during 2019. The evidence was selected to answer each of the clinical questions. The accuracy of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice and the treatment flowchart. Finally, the CPG was approved with Resolution No. 151-IETSIESSALUD-2019.

RESULTS

The present CPG addressed 4 clinical questions of four topics: screening, diagnosis, staging and treatment. Based on these questions, 13 recommendations (8 strong recommendations and 5 weak recommendations), 27 points of good clinical practice, and 1 flowchart were formulated.

CONCLUSION

This paper summarizes the methodology and evidencebased conclusions from the CPG for for the diagnosis and treatment of chronic infection of hepatitis viral C of the EsSalud.

Perceived discrimination as a barrier for the adequate treatment of chronic diseases in Venezuelan migrants from Peru

OBJECTIVE

To determine the association between perceived discrimination and receiving adequate treatment for chronic diseases in Venezuelan migrants.

METHODOLOGY

A cross-sectional study was performed. This is a secondary analysis of the ENPOVE national survey from Peru. The association between the perceived discrimination and receiving adequate treatment for chronic diseases was evaluated using a Poisson regression model, considering the adjusted effect of the multistage sampling.

RESULTS

A total of 865 migrants were evaluated (age: 36.6 ± 0.7 years and 58.2% women). Of these, 54.8% perceived discrimination, and 89.2% did not receive adequate treatment for chronic diseases. Perceived discrimination was significantly associated with a lower prevalence of receiving adequate treatment for chronic diseases (PRa = 0.49; 95%CI 0.25 - 0.97).

CONCLUSION

This study evidenced that perceived discrimination decreases the prevalence of receiving adequate treatment for chronic diseases by approximately 50% compared with those who did not perceive discrimination.

Association between daily working hours and depressive symptoms in resident physicians in Peru

INTRODUCTION

Resident physicians who work more hours a day are prone to suffer mental health problems such as depression, a subject that has been little studied. In this regard, the aim of this study was to determine the prevalence of depressive symptoms and to evaluate the association between the number of daily working hours and depressive symptoms in Peruvian residents.

METHODS

Analytical cross-sectional study that used the database of the National Survey for Resident Physicians-2016, a voluntary survey issued virtually by the National Council of Medical Residency of Peru to physicians who were undertaking their residency in Peru. The presence of depressive symptoms was considered as having obtained a score ≥3 with the Patient Health Questionnaire-2 scale. The number of hours worked each day was collected through a direct question. To assess the association of interest, prevalence ratios (PR) and their 95% confidence intervals (95% CI) were calculated using crude and adjusted Poisson regressions with robust variance.

RESULTS

The responses of 953 residents (41.3% women, mean age: 32.5 years) were evaluated, 14.6% of which presented depressive symptoms. In the adjusted analysis, it was found that the prevalence of depressive symptoms increased for each additional hour worked (PR=1.11; 95% CI, 1.04-1.17).

CONCLUSIONS

One in seven residents had depressive symptoms. For every extra daily working hour, the frequency of depressive symptoms increased by 11%.

Self-perception of competences in clinical practice among recently graduated physicians from Lima, Peru

Objective

To describe the self-perception of basic competencies in clinical practice and evaluate their associated factors, among recently graduated physicians from Lima, Peru.

Methods

Cross-sectional study. We evaluated the self-perception of the competencies in recently graduated physicians of four dimensions of the Tuning Project. Each item had six possible responses on a Likert scale: "non-existent" (1 point), "insufficient" (2 points), "sufficient" (3 points), "good" (4 points), "very good" (5 points) and "excellent" (6 points). To evaluate associated factors of the average scores for each dimension, we used linear regressions with the bootstrap method.

Results

We analyzed data from 425 (54.9% were between 22 and 25 years old), which represent 31.1% of all physicians who graduated in 2016 from all medical schools located in Lima. The average self-perception score of the assessed dimensions was, in descending order: 4.49 for carrying out a patient consultation with a patient; 4.13 for carrying out practical procedures; 4.12 for providing immediate care of medical emergencies; and 4.04. for applying the principles, skills, and knowledge of evidence-based medicine (EBM). Regarding the factors associated with the average score per dimension, physicians from one university had higher average scores in all dimensions, and having done an externship and done an internship at social security hospitals was associated with a higer score with self-perception in two dimensions.

Conclusion

Self-perception of competence was greater for the patient consultation dimension, and lower for the EBM. Only physicians from one university had higher average scores in all dimensions.

Atypical lymphangioma and hyperkeratosis in a patient with morbid obesity

Lymphangioma is a rare and understudied pathology that is usually detected in the first decade of life, and its appearance in adults is rare. This report details a 51-year-old man with morbid obesity who presented, for the last eight months, multiple asymmetric tumor lesions with extension to the scrotal region. The diagnosis of circumscribed lymphangioma with associated infection was confirmed. This case report demonstrates an unusual presentation of the characteristics of the lymphangioma that are seldom described in the literature.

Guía de práctica clínica para el tratamiento quirúrgico de pacientes con urolitiasis en el Seguro Social del Perú (EsSalud)

Introducción. El presente artículo resume la guía de práctica clínica (GPC) para el tratamiento quirúrgico de pacientes con urolitiasis en el Seguro Social del Perú (EsSalud). Objetivo. Proveer recomendaciones clínicas basadas en evidencias para la para el tratamiento quirúrgico de los pacientes con urolitiasis en EsSalud. Método. Se conformó un grupo elaborador de la guía (GEG) constituido por médicos urólogos y metodólogos, los cuales formularon las preguntas clínicas que fueron respondidas dentro de la presente GPC. Para cada una de estas preguntas se realizó búsquedas de revisiones sistemáticas y de estudios primarios (cuando se consideró pertinente) en PubMed durante el 2018. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas, posteriormente se evaluó la certeza de la evidencia usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Se programaron reuniones de trabajo periódicas en las cuales el GEG revisó la evidencia y formuló recomendaciones, puntos de buenas prácticas clínicas y flujogramas usando la metodología GRADE. La GPC fue aprobada con Resolución N° 66–IETSI-ESSALUD-2018. Resultados. Se abordó 6 preguntas clínicas sobre el tema de tratamiento quirúrgico en urolitiasis. En base a dichas preguntas se formularon 5 recomendaciones (2 recomendaciones fuertes y 3 recomendaciones condicionales), 21 puntos de buena práctica clínica, y 3 flujogramas de manejo. Conclusión. El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el tratamiento quirúrgico de pacientes con urolitiasis en EsSalud.

Factors associated with homophobia in medical students from eleven Peruvian universities

BACKGROUND

The consequences of homophobia can affect the integrity, mental and physical health of homosexual individuals in society. There are few studies in Peru that have evaluated homophobia in the medical student population.

OBJECTIVE

To establish the social, educational and cultural factors associated with homophobia among Peruvian medical students.

METHODS

A cross-sectional analytical study was conducted in 12 medicine schools in Peru. Homophobia was defined according to a validated test, which was associated with other variables. Statistical associations were identified.

RESULTS

The lowest percentages of homophobic students (15-20%) were found in the four universities in Lima, while universities in the interior of the country had the highest percentages (22-62%). Performing a multivariate analysis, we found that the frequency of homophobia was lower for the following variables: the female gender (PRa=0.74; 95% CI, 0.61-0.92; p=0.005), studying at a university in Lima (PRa=0.57; 95% CI, 0.43-0.75; p<0.001), professing the Catholic religion (PRa=0.53; 95% CI, 0.37-0.76; p<0.001), knowing a homosexual (PRa=0.73; 95% CI, 0.60-0.90; p=0.003) and having treated a homosexual patient (PRa=0.76; 95% CI, 0.59-0.98; p=0.036). In contrast, the frequency of homophobia increased in male chauvinists (PRa=1.37; 95% CI, 1.09-1.72; p=0.007), adjusted by four variables.

CONCLUSIONS

Homophobia was less common in women, in those who study in the capital, those who profess Catholicism and those who know/have treated a homosexual. In contrast, male chauvinists were more homophobic.

Male Chauvinism Among Peruvian Medical Students: Related Socio-Educational Factors in 12 Peruvian Universities

INTRODUCTION

Male chauvinism is rooted in certain populations, but it has not been measured among those who will be responsible for healthcare.

OBJECTIVE

To determine the factors associated with male chauvinism among the medical students of 12 Peruvian universities.

METHODS

Cross-sectional multicentre analytical study, with previously collected data, which used validated tests to measure male chauvinism and strong religious beliefs. In addition, other social and educational factors were analysed and the data was crossed. Descriptive and analytical statistics were obtained.

RESULTS

In the multivariate analysis, we found an association between male chauvinism and religious non-believers (RP=1.88; 95% CI, 1.47-2.40), as well as being female (RP=0.35; 95% CI, 0.27-0.46). Of the 12 universities evaluated, the least chauvinistic university was in Lima. Using this university as a comparison category, the statistically more chauvinistic universities were a private university in Chiclayo (α=3.63; p<0.001), followed by a university in Huancayo (α=3.20; p=0.001), Huancayo national university (α=2.79; p<0.001) and the public university of Ica (α=2.32; p=0.006); the crossed data were adjusted for age.

CONCLUSIONS

It was found that male chauvinism is greater among non-religious believers, men and in some universities, with a predominance of universities in the central highlands of Peru or that had migrants from the mountains. This is important, since it gives us an overview about this trait in those who will be responsible for the future healthcare of Peruvians.

[Gait speed and the appearance of neurocognitive disorders in older adults: Results of a Peruvian cohort]

INTRODUCTION

The prevention and management of neurocognitive disorders (NCD) among older adults can be improved by early identification of risk factors such as walking speed. The objective of the study is to assess the association between gait speed and NCD onset in a population of Peruvian older adults.

MATERIAL AND METHODS

Cohort conducted in older adults who attended the geriatrics service of Naval Medical Center (Callao, Peru). During the baseline assessment, participants' gait speed was recorded. Subsequently, participants were followed-up annually for 5 years, with a mean of 21 months. NCD onset was defined as the occurrence of a score ≤24 points on the Mini Mental State Examination (screening test) during follow-up. The hazard ratios (HR) and their 95% confidence intervals (95% CI) were calculated using Cox regression.

RESULTS

The study included 657 participants, with a mean age of 73.4±9.2 (SD) years, of whom 47.0% were male, 47.8% had a gait speed <0.8 m/s, and 20.1% developed NCD during the follow up. It was found that older adults who had gait speed <0.8 m/s at baseline were more likely to develop NCD than those who had a gait speed ≥0.8 m/s (adjusted HR=1.41, 95% CI=1.34-1.47).

CONCLUSION

A longitudinal association was found between decreased gait speed and NCD onset, suggesting that gait speed could be useful to identify patients at risk of NCD onset.

Features of mobile provider education applications for prehospital trauma life support

Many educational tools are used for prehospital trauma life support (PHTLS) training, including mobile apps. This study describes the currently available mobile apps for PHTLS training. Systematic searches in the Apple Store, Google Play Store, and BlackBerry World were conducted in December 2015. Two researchers performed all searches independently and collected their findings in different databases, which were later compared. Finally, a descriptive analysis was carried out. A total of 41 mobile apps that fulfilled the inclusion criteria were found. Among these, 97.5% (n = 40) were in English, 58.5% (n = 24) were updated in 2015, and 51.2% (n = 21) were not free. Of the 20 free apps, 85% (n = 17) did not require an internet connection for any function, 70% (n = 14) had no videos or animation, 10% (n = 2) had any game, and 70% (n = 14) had no institutional certification. In conclusion, it was found that PHTLS apps usually lack interactive content and institutional certification, which should be taken into consideration by users and researchers.