The study aimed to identify coinfections of SARS-CoV-2 with other viruses in patients with moderate and severe COVID-19. 98 patients from Lima, San Martín, and Loreto were selected, from whom nasopharyngeal secretion, blood, and urine samples were taken and analyzed using serological and molecular tests to detect HTLV, HIV, hepatitis B, dengue, Chikungunya, Zika, and a panel of respiratory viruses (influenza A/B, rhinovirus, respiratory syncytial virus, metapneumovirus, and adenovirus). The results showed two cases of coinfection (2/98; 2%): one with SARS-CoV-2/rhinovirus and another with SARS-CoV-2/HTLV-2. Both patients presented with COVID-19-associated pneumonia but progressed favorably. It is concluded that the frequency of viral coinfection in patients from health facilities in the Peruvian coast and jungle with moderate and severe cases of COVID-19 was low. El estudio tuvo como objetivo identificar las coinfecciones de SARS-CoV-2 con otros virus en pacientes con COVID-19 moderada y grave. Se seleccionaron 98 pacientes de Lima, San Martín y Loreto, a quienes se tomaron muestras de secreción nasofaríngea, sangre y orina analizadas mediante pruebas serológicas y moleculares para detectar HTLV, VIH, hepatitis B, dengue, Chikungunya, Zika y un panel de virus respira-torios (influenza A/B, rinovirus, virus respiratorio sincitial, metaneumovirus y adenovirus). Los resultados mostraron dos casos de coinfección (2/98; 2%): uno con SARS-CoV-2/rinovirus y otro con SARS-CoV-2/HTLV-2. Ambos pacientes presentaron neumonía asociada a COVID-19, pero evolucionaron favorablemente. Se concluye que la frecuencia de coinfección viral en pacientes de establecimientos de salud de la costa y selva peruana con cuadros moderados y graves de COVID-19 fue baja.
To evaluate the association between family health and mental health among residents of a Peruvian community. Analytical cross-sectional study. Virgen del Carmen La Era community (Lurigancho-Chosica, Lima, Peru). A convenience sample of 321 adults. Family health was assessed using the SALUFAM scale (13 items) and mental health using DASS-21 (depression, anxiety, and stress). Categorical variables were summarized with frequencies and percentages, and age with median and interquartile range. Associations were estimated using generalized linear models with Poisson distribution and robust variance to obtain adjusted prevalence ratios (aPR) and 95% confidence intervals. The prevalence of impaired mental health was 37.4%; stress 42.1%; anxiety 38.0%; and depression 25.2%. Higher family vulnerability was associated with stress (aPR=1.39; 95%CI: 1.02-1.89), anxiety (aPR=1.41; 95%CI: 1.02-1.94), and impaired mental health (aPR=1.92; 95%CI: 1.32-2.79), but not depression (aPR=1.33; 95%CI: 0.86-2.05). Family vulnerability was associated with worse mental health outcomes, particularly stress and anxiety, supporting family-centered community interventions. Evaluar la asociación entre la salud familiar y la salud mental en pobladores de una comunidad peruana. Estudio analítico de corte transversal. Centro poblado Virgen del Carmen La Era (Lurigancho-Chosica, Lima, Perú). Se incluyeron 321 adultos mediante muestreo no probabilístico por conveniencia. La salud familiar se evaluó con la escala SALUFAM (13 ítems) y la salud mental con la DASS-21 (depresión, ansiedad y estrés). Las variables categóricas se describieron con frecuencias y porcentajes; la edad con mediana y rango intercuartílico. En el análisis bivariado se emplearon chi-cuadrado y U de Mann-Whitney. Se utilizaron modelos lineales generalizados de Poisson con varianza robusta para estimar razones de prevalencia ajustadas (RPa) e intervalos de confianza al 95%. La prevalencia de salud mental deteriorada fue del 37,4%; estrés 42,1%; ansiedad 38,0%, y depresión 25,2%. La mayor vulnerabilidad familiar se asoció con mayor prevalencia de estrés (RPa = 1,39; IC95%: 1,02-1,89), ansiedad (RPa = 1,41; IC95%: 1,02-1,94) y salud mental deteriorada (RPa = 1,92; IC95%: 1,32-2,79), pero no con depresión (RPa = 1,33; IC95%: 0,86-2,05). La vulnerabilidad familiar se asoció con mayor prevalencia de alteraciones de salud mental, principalmente estrés y ansiedad, lo que respalda intervenciones comunitarias centradas en la familia.
The objective of this study was to determine the influence of lifestyle on Burnout Syndrome (BS) among Peruvian religious leaders. Data were collected from a total of 205 participants. The study had a quantitative, non-experimental, explanatory, and cross-sectional approach. The proposed model was evaluated through structural equation modeling (SEM). The results revealed that lifestyle has a highly significant correlation with BS, however, no significant correlation is observed between Lifestyle and the Reduced Personal Accomplishment dimension of BS; Lifestyle showed a significant negative influence on the BS of religious leaders, (β = - 0.80; p < .001), with the model explaining 64% of the variance in the dependent variable (R2 = 0.64). The findings of this study suggest that some lifestyle habits such as social support, physical activity, sleep, and personality can protect against and/or mitigate the negative effects of BS.
To examine the impact of different disease activity states (DAS) on outcomes in a longitudinal inception childhood-onset SLE cohort. Three DAS were included-remission: clinical SLE DAS (SLE Disease Activity Index (SLEDAI)=0, prednisone (≤5 mg/day) and/or immunosuppressants (IS) (maintenance dose)); lupus low DAS (LLDAS): SLEDAI ≤4 with 0 scores for major organ involvement, no increase in any SLEDAI component since the previous visit, on prednisone (≤7.5 mg/day) and/or IS (maintenance dose); and active disease otherwise. The association of these DAS with new damage (increase of at least 1 point in the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI)), severe new damage (an increase of ≥3 points in the SDI) and mortality (any cause) at any time during the follow-up was examined using Cox proportional hazards regression models. The majority of the 212 patients included had active disease at baseline (84%). There was no association between LLDAS and lower risk of new damage or severe new damage (HR 0.98, 95% CI 0.43 to 2.22, p=0.955 and HR 0.40, 95% CI 0.04 to 3.62, p=0.415, respectively). Remission was associated with lower risk of new damage (HR 0.36, 95% CI 0.15 to 0.91, p=0.030), but it had no impact on mortality (HR 0.45, 95% CI 0.06 to 3.66, p=0.454). Attaining LLDAS and remission was lower in our cohort than in other contemporary paediatric lupus cohorts. Remission but not LLDAS was associated with lower risk of new damage over 4.3 years of follow-up. None of these DAS were associated with mortality.
Fourteen species of monopisthocotyls were reported from the gills of Triportheus albus Cope (Characiformes: Triportheidae) collected from the Itaya River, Peru. Nine species belonged to Anacanthorus Mizelle & Price, 1965: seven previously described species: Anacanthorus acuminatus Kritsky, Boeger & Van Every, 1992, Anacanthorus alatus Kritsky, Boeger & Van Every, 1992, Anacanthorus bellus Kritsky, Boeger & Van Every, 1992, Anacanthorus euryphallus Kritsky, Boeger & Van Every, 1992, Anacanthorus quinqueramus Kritsky, Boeger & Van Every, 1992, Anacanthorus formosus Kritsky, Boeger & Van Every, 1992, and Anacanthorus ramulosus Kritsky, Boeger & Van Every, 1992, and two new species described herein. Three species belonged to Ancistrohaptor Agarwal & Kritsky, 1998: Ancistrohaptor falciferum Agarwal & Kritsky, 1998, Ancistrohaptor falcunculum Agarwal & Kritsky, 1998, and Ancistrohaptor forficata Diniz, de Sousa, Yamada & Yamada, 2025; and two to Jainus Mizelle, Kritsky & Crane, 1968: Jainus iquitensis Morey, Viana, Chota & Chero, 2025 and Jainus sardinae Morey, Viana, Chota & Chero, 2025. Anacanthorus itayensis n. sp. is characterized by a long sclerotized sigmoid male copulatory organ (MCO) with submedial cirral "feather" and by a four-branched accessory piece in which the second branch terminates in a fish-like fin, the others bifurcate into sub-branches with pointed tips. Anacanthorus ypsiloniformis n. sp. is characterized by an elongate, slightly conical MCO curving ventrally and terminating in a rounded, slightly tapered distal tip bearing a dense crown-like cluster with submedial small spines, and by a distinctively Y-shaped accessory piece with two divergent arms arising proximally: one broader and blunt-ended with a comb-like denticulate distal margin, the other narrower and more rounded distally. This study constitutes the first comprehensive record of monopisthocotyls from T. albus in Peru and documents one of the most species-rich dactylogyrid assemblages reported from a single host species of Triportheus Cope in the Neotropical region.
Lower respiratory tract infection is the leading cause of childhood death wordwide. Etiological agents showed seasonal, geographic, and pandemic-related variation. To determine the clinical manifestations of respiratory pathogens in children hospitalized due to lower respiratory tract infection before, during, and after the pandemic in a private hospital in Lima, Perú. This is a retrospective cohort study of patients under 13 years of age hospitalized with lower respiratory tract infection. Two multiplex polymerase chain reaction (PCR) tests, CLART Fast PneumoVir™ and PneumoCLART Bacteria®, were used to identify pathogens. We identified factors associated with prolonged hospitalization based on general characteristics and the presence of pathogens. A total of 612 patient records were analyzed. The average age was 2.89 years. Respiratory syncytial virus was identified in 33.66% (206/612) of cases, influenza A in 26.31% (161/612), and Haemophilus sp. in 19.28% (118/612). Before the COVID-19 pandemic, 48.9% of patients had a viral etiologic agent, and 87.78% (115/131) had one after the pandemic. During the pre-pandemic period, 17.34% (77/444) of patients had more than one microorganism, with frequent coinfections of respiratory syncytial virus with Haemophilus sp. (10.78%) (66/612) and respiratory syncytial virus with influenza A virus (8.82%) (54/612). Additionally, the identification of respiratory syncytial virus was associated with prolonged hospital stays of more than 6 days (p = 0.005). This study found that viral etiologic agents were predominant before and after the pandemic. Furthermore, coinfections between bacteria and viruses were frequent. The respiratory syncytial virus was the most common and was associated with coinfections and prolonged hospital stays. La infección de las vías respiratorias inferiores es la causa principal de muerte infantil en el mundo. Los agentes etiológicos mostraron variación estacional, geográfica y relacionada con la pandemia de la COVID-19. Determinar los factores asociados con los agentes patógenos y sus manifestaciones clínicas en niños con infección de las vías respiratorias inferiores, hospitalizados antes, durante y después de la pandemia en un hospital privado de Lima, Perú. Se llevó a cabo un estudio retrospectivo de cohorte de pacientes menores de 13 años hospitalizados por infecciones de las vías respiratorias inferiores. Se utilizaron dos pruebas de la reacción en cadena de la polimerasa (PCR) múltiple, CLART Fast PneumoVir™ y PneumoCLART Bacteria™ para identificar los agentes patógenos. Se determinaron los factores asociados con la hospitalización prolongada según los agentes patógenos que resultaron positivos y las manifestaciones clínicas generales. Se analizaron 612 registros de pacientes. La edad promedio fue de 2,89 años. Se identificó el virus sincitial respiratorio en el 33,66 % (206/612) de los casos, el de la influenza A en el 26,31 % (161/612) y Haemophilus spp. en el 19,28 % (118/612). Antes de la pandemia de COVID-19, el 48,87 % (217/444) de los pacientes tuvo un agente etiológico viral y, en la después de la pandemia, el 87,78 % (115/131). En la prepandemia, el 17,34 % (77/444) tuvo más de un microorganismo, siendo frecuentes las coinfecciones del virus sincitial respiratorio con Haemophilus spp. (10,78 %) (66/612) y del virus sincitial respiratorio con el virus de la influenza A (8,82 %) (54/612). Además, la identificación del virus sincitial respiratorio se asoció con una estancia hospitalaria de 6 o más días (p = 0,005). En este estudio, se encontró que los agentes etiológicos virales fueron predominantes antes y después de la pandemia. Las coinfecciones entre bacterias y virus fueron frecuentes. El virus sincitial respiratorio fue el más frecuente y se asoció con coinfecciones y estancia hospitalaria prolongada.
The "golden hour" concept remains debated in low- and middle-income countries with fragmented systems. This study evaluated the synergistic association of prehospital delay and injury severity on outcomes, specifically analyzing referral system inefficiencies. A retrospective study of 339 trauma patients was conducted in Guayaquil, Ecuador. Multivariable Poisson regression models with robust variance and restricted cubic splines were developed specifically for the n= 274 cohort (≤240 min) to identify independent predictors of complications and mortality, focusing on the time × New Injury Severity Score interaction. Urban distance analysis (n = 84) was performed to isolate geographic from systemic factors. Penetrating injuries predominated (80%, out of 273 penetrating cases, firearms n = 218). Prehospital delay independently predicted complications (P = 0.042), with a risk ratio of 1.55 (95% confidence interval: 1.01-2.38). A lethal synergistic interaction was identified between time and severity (P = 0.003); while delays were tolerated in moderate trauma, mortality escalated exponentially for critical patients (New Injury Severity Score 55) after the first hour. Kaplan-Meier analysis confirmed a survival disadvantage after the "golden hour" (P = 0.024). Crucially, for urban transfers, transport distance did not differ significantly between early and delayed groups (P = 0.226), indicating that systemic referral inefficiencies (door-in-door-out delays), rather than geography, drive prehospital exhaustion. Prehospital delay and injury severity exhibit a lethal synergistic interaction. The "golden hour" is frequently exhausted by referral chain inefficiencies regardless of physical proximity. Transitioning to a direct primary transport model ("scoop and run") is associated with mitigated physiological debt and potentially improves survival in critical penetrating trauma.
Intravenous (IV) vitamin C has been proposed as an adjuvant therapy in sepsis/septic shock due to its biological plausibility and safety profile, but the proliferation of reviews has not resolved its clinical utility. To synthesize the evidence on IV vitamin C (monotherapy, HAT-hydrocortisone+vitamin C+thiamine-and vitamin C+thiamine) in adults with sepsis/septic shock, prioritizing 28-30-day mortality. Umbrella review of systematic reviews and meta-analyses (MEDLINE/PubMed, Embase, Scopus, and Web of Science, without language restriction). Quality was assessed with AMSTAR 2, overlap with CCA, and when available, TSA and component/network meta-analysis (CINeMA). Certainty of evidence was graded using GRADE with an anchor estimator per outcome and regimen. Thirty-one reviews were included (30 quantitative: 28 SR/MA and 2 component/network MA; 1 qualitative). Combinations (HAT and vitamin C+thiamine) did not reduce mortality; hemodynamic improvements (small decreases in ΔSOFA and vasopressor hours) were modest, did not translate into survival benefits, and were primarily attributable to the corticosteroid. Monotherapy showed a possible mortality benefit signal under specific conditions (initiation ≤24 h, intermediate dose 25-100 mg/kg/day, 3-4-day courses; more pronounced in sepsis than shock), but with low-to-moderate certainty due to heterogeneity, imprecision, publication bias, and very high overlap among reviews. Combination regimens (HAT and vitamin C plus thiamine) did not reduce mortality; hemodynamic improvements were modest, did not translate into survival benefits, and were primarily attributable to the corticosteroid component. For monotherapy, a possible mortality benefit signal was identified under specific conditions (initiation within 24 h, intermediate dose 25-100 mg/kg/day, 3-4-day courses, more pronounced in sepsis than shock), but overall certainty remains low-to-moderate due to heterogeneity, imprecision, publication bias, and very high overlap among reviews. These findings do not support routine use of IV vitamin C in any regimen; for monotherapy, the identified signal warrants rigorous multicenter trials in well-defined clinical scenarios before any recommendation can be made.
Diabetes is a major public health issue, especially in low-and middle- income countries (LMICs) where barriers to care are common. Despite insulin's critical role, access remains limited due to market concentration, weak policies, poor availability, and lack of trained staff. This study evaluated the implementation of an insulin use manual in Tumbes, Peru, focusing on healthcare workers training and systemic barriers. This was a two-phase descriptive mixed-methods study conducted in Tumbes, Peru. In the first phase (March-June 2023), a virtual course on insulin use followed by an on-site workshop was implemented for healthcare workers, with quantitative assessments of knowledge and satisfaction. In the second phase (October 2023), qualitative interviews were carried out with these healthcare workers as well as patients and caregivers to evaluate both the implementation process and the local health system using the Rapid Assessment Protocol for Insulin Access, Medical Research Council for Process Evaluation, and the World Health Organization (WHO)'s Six Building Blocks framework. Data were analyzed with descriptive statistics and thematic coding. The virtual course registered 193 participants, but only 44 completed all units, the median knowledge median scores rose from 15.3 to 19.1). In the on-site workshop, 28 participants attended. Median scores increased from 14 (IQR 10-16) at baseline to 15 (IQR 10-16) in the post-test. Feedback highlighted the course's flexibility and practical relevance, though participants suggested more hands-on components and patient education tools. Interviews revealed systemic barriers across WHO's Six Building Blocks framework, including limited training and confidence among healthcare workers in insulin management, shortages of insulin and related supplies at the primary care level, weak health information systems without proper tracking of insulin users; high out-of-pocket costs that undermine adherence, inadequate patient education, and insufficient leadership and supervision to ensure consistent diabetes care. This study shows that while targeted training can improve healthcare workers' knowledge on insulin use, systemic gaps continue to hinder quality diabetes care. Broader implementation of insulin protocols in LMICs requires not only training, but also a comprehensive reinforcement of the health system at all levels.
Vector-borne pathogens continue to emerge, kill and harm humans with unrelenting regularity. Conventional strategies for controlling insect vectors grew out of the military; communication is hierarchical, responses unilateral, and regulation predetermined. We developed an alternative approach, modeled after the adaptive immune system, and compared the approaches through a cluster-randomized trial in the context of an ongoing urban Chagas disease vector control campaign in Arequipa, Peru. Clusters consisted of pre-defined geographic jurisdictions of health facilities, and averaged 2,271 households. Thirty clusters were assigned to the immune arm, and thirty to the conventional arm, balancing on antecedents related to the probability of vector infestation. Following delays, the trial initiated in October 2021. We report here early results from a pre-planned interim analysis scheduled for March 2023. In the immune arm 23 infested households were discovered and confirmed in 10 separate foci; in the conventional arm only 5 infested households were discovered and confirmed, and all were from the same focus. The immune approach was adaptive, and more effort was expended upon confirmation of an infestation (1085.2 person days in the immune arm vs 864.2 in the conventional; Rate ratio 23/1085.2:5/864.2 = 3.66 [1.49 - 10.60], p-value = 0.0038). Vector surveillance approaches modeled after the immune system are a potentially more effective alternative to conventional approaches, especially to control vector borne diseases in cities and other complex environments.
Tuberculosis (TB) remains a critical public health crisis in Peru, which bears the highest multidrug-resistant TB (MDR-TB) burden in the Americas. The objective of this study was to conduct a nationwide genetic surveillance of first- and second-line drug-resistant Mycobacterium tuberculosis isolates in Peru to characterize their structural and geographic distribution using a multilocus genotype approach. We analyzed 38,339 valid results from first- and second-line line probe assays (LPA 1L, GenoType MTBDRplus v2; and LPA 2L, GenoType MTBDRsl v2) routinely collected between 2019 and 2022 by the Peruvian National Institute of Health. First-line (G1) and second-line (G2) multilocus genotypes were generated by concatenating specific hybridization banding patterns across resistance-associated loci. Additionally, targeted next-generation sequencing was performed on a stratified proportional sample of 170 isolates exhibiting "inferred" resistance genotypes, defined by a missing wild-type signal without a corresponding mutant probe, to elucidate their underlying mutational profiles. Resistance genotypes were identified in 13.5% and 11.8% of LPA 1L and LPA 2L results, respectively. The genotypic landscape was highly concentrated: 13 dominant G1 genotypes and 19 dominant G2 genotypes accounted for over 85% of their respective resistant cohorts. Structurally, these dominant genotypes mainly carried globally successful, canonical mutations (e.g., katG S315T1, rpoB S450L). Geographically, dominant genotypes were heavily consolidated within the hyper-endemic central coastal axis (Lima, Callao, and Ica) and the Amazonian department of Ucayali, maintaining highly stable temporal frequencies. Conversely, heteroresistance and complex multi-mutational patterns were exclusively restricted to low-frequency rare and orphan genotypes. Targeted sequencing of inferred patterns successfully expanded the national catalog of resistance variants, identifying non-canonical determinants (e.g., inhA g-17t, gyrB T500N) and preventing false-positive resistance calls driven by synonymous mutations. This large-scale mapping demonstrates that Peru's drug-resistant TB epidemic is characterized by the widespread consolidation of a restricted number of canonical multilocus genotypes. Integrating targeted sequencing with routine molecular screening is essential to resolve unclassified hybridization patterns and optimize epidemiological management in high-burden settings.
The article analyzes the regulation of nicotine electronic cigarettes (EC) in Peru, with an emphasis on Law 32159 and its capacity to protect the health of adolescents in light of international evidence. Although they are often perceived as less harmful than combustible cigarettes, studies link their use to cardiovascular and respiratory risks, as well as a higher probability of transitioning to combustible tobacco use in adolescents. The evolution of the Peruvian regulatory framework for tobacco control is reviewed, and it is recognized that Law 32159 constitutes an advance by explicitly incorporating electronic nicotine delivery systems within a comprehensive regulatory approach. In this sense, the law addresses 100% smoke- and vape-free environments, the prohibition of advertising, promotion, and sponsorship, health warnings, marketing restrictions, multisectoral oversight, and incorporates Art. 5.3 of the Framework Convention on Tobacco Control regarding industry interference in control policies for the consumption of tobacco products, nicotine, and substitutes for both. However, gaps persist between the law and its implementation: insufficient definitions of flavorings, lower requirements for health warnings, and limited capacity to control indirect and digital advertising in a context of informal markets and online trade. The absence of fiscal measures weakens public policy. In conclusion, the impact of the law will depend on precise regulations, effective oversight, and complementary instruments such as price and tax policies. El artículo analiza la regulación de los cigarrillos electrónicos (CE) con nicotina en el Perú, con énfasis en la Ley 32159 y su capacidad para proteger la salud de los adolescentes a la luz de la evidencia internacional. Aunque suelen percibirse como menos dañinos que los cigarrillos combustibles, estudios vinculan su uso con riesgos cardiovasculares, respiratorios, además de mayor probabilidad de transición hacia el consumo de tabaco combustible en adolescentes. Se revisa la evolución del marco normativo peruano de control del tabaco y se reconoce que la Ley 32159 constituye un avance al incorporar explícitamente los sistemas electrónicos de administración de nicotina dentro de un enfoque regulatorio integral. En ese sentido, la norma aborda ambientes 100% libres de humo y vapeo, prohibición de publicidad, promoción y patrocinio, advertencias sanitarias, restricciones de comercialización, fiscalización multisectorial e incorpora el Art. 5.3 del Convenio Marco para el Control del Tabaco referida a la interferencia de la industria en las políticas de control del consumo de productos de tabaco, nicotina y sucedáneos de ambos. No obstante, persisten brechas entre la norma y su implementación: definiciones insuficientes sobre saborizantes, exigencias menores de advertencias sanitarias y limitada capacidad para controlar publicidad indirecta y digital, en un contexto de mercado informal y comercio en línea. La ausencia de medidas fiscales debilita la política pública. En conclusión, el impacto de la ley dependerá de un reglamento preciso, fiscalización efectiva e instrumentos complementarios como políticas de precio e impuestos.
To analyze the psychometric properties of the abbreviated version of HLS-EU-Q47 in the Peruvian population. Cross-sectional analytical design. Two capital cities in the northern region of Peru. 1196 male and female residents aged 18-59. The translation and back-translation processes into the local language of the instrument under study were carried out. It was subsequently tested with a focus group, after which the final version was finalized. Both exploratory and confirmatory construct validation of an abbreviated version of the HLS-EU-Q47 were conducted. The abbreviated version showed adequate internal consistency (McDonald's Omega) and a well-defined three-factor structure. Exploratory factor analysis yielded 12 items grouped into functional literacy, critical literacy, and health promotion/action, explaining 68% of the total variance, with strong factor loadings (0.58-0.95) and adequate communalities (0.58-0.82). Confirmatory factor analysis supported the three-factor correlated model showing adequate goodness-of-fit indices and confirming the structural validity of the instrument (Comparative Fit Index, CFI=0.970; Tucker-Lewis Index, TLI=0.961; Standardized Root Mean Square Residual, SRMR=0.056); although Root Mean Square Error of Approximation, RMSEA was elevated (0.096), consistent with parsimonious models. Additionally, factorial invariance across sex and age groups was confirmed (ΔCFI≤0.001; ΔRMSEA≤0.006), supporting the stability and comparability of the instrument. The short version of 12 items of the HLS-EU is a valid and reliable tool for the Peruvian population and is theoretically more powerful for integrating the functional and critical levels of health literacy.
Endovascular embolization has historically complemented microsurgery or stereotactic radiosurgery for brain arteriovenous malformations (bAVMs), but advances in imaging, devices, and technique have enabled its use as a stand-alone curative therapy in selected patients. Data from resource-limited settings remain limited. We report a 10-year single-center experience with stand-alone curative embolization in a middle-income country and identify factors associated with angiographic cure. We performed a retrospective cohort study of adults with bAVMs treated with curative-intent embolization at a tertiary center in Lima, Peru (2014-2024). Treatment strategy (transarterial, transvenous, or combined) was individualized. Baseline clinical, angiographic, and procedural variables were collected. The primary outcome was complete angiographic obliteration. Secondary outcomes included intraprocedural complications, postprocedural intracranial hemorrhage (ICH), and mortality. Logistic regression analyses identified predictors of outcomes. Among 184 patients (median age 37 years, 55 % women), 64.7 % presented with rupture. Complete obliteration was achieved in 67.4 % overall, improving from 44.4 % in 2014-81.4 % in 2024. Smaller nidus size and fewer arterial feeders were strongly associated with cure, whereas larger size and greater feeder number independently predicted treatment failure. Intraprocedural complications occurred in 8.7 %, particularly in higher Spetzler-Martin grades. Postprocedural ICH occurred in 15.8 % and was associated with increasing feeder number. Mortality was 3.5 %. Stand-alone curative embolization is feasible and effective in carefully selected bAVMs, especially those with favorable angioarchitectural features. Prospective comparative studies are needed to define its optimal role in bAVM management.
Qualitative research offers valuable insights into complex social and behavioral processes in the health sciences; however, its contribution depends on the quality and transparency of reporting. This scoping review aimed to describe the methodological characteristics and reporting quality of qualitative studies published by Peruvian authors between 2022 and 2025. Following Prisma-scr guidelines, a systematic search was conducted in SCOPUS, and reporting quality was assessed using the Standards for Reporting Qualitative Research (SRQR) tool. A total of 147 qualitative studies were included. Most were published in English (49.0%), had a median of five authors; 71.4% had a first author affiliated with a Peruvian institution, and 58.5% involved exclusively Peruvian authors. Studies were mainly conducted in Lima (50.3%). Ethics committee approval was not reported in 24.5% of studies, and 40.8% did not provide an ethics approval code. Adherence to SRQR items was highest for abstracts (95.9%), study purpose (95.2%), and presentation of findings (93.9%), whereas reporting of title elements (31.3%), qualitative approach (49.0%), and researcher reflexivity (37.4%) was limited. Publication in Spanish and Peruvian first authorship were associated with lower SRQR scores, whereas a higher number of authors and international collaboration were associated with higher scores. Overall, qualitative studies published by Peruvian authors showed variable reporting quality, with important methodological and ethical aspects frequently under reported, highlighting the need to strengthen reporting practices, particularly for core qualitative components.
Over 1 million people have chronic pulmonary aspergillosis (CPA) secondary to pulmonary tuberculosis. Additionally, Aspergillus fumigatus (Af) has been reported as one of the most common pathogens associated with mycobacteria in patients with cystic fibrosis. Mycobacterial virulence factors, like lipoarabinomannan, have been shown to interfere with host's intracellular pathways required for an effective immune response, however, the immunological basis for mycobacterial-fungal coinfection is still unknown. We therefore investigated the effect of lipoarabinomannan on macrophage responses against Af. Bone marrow-derived macrophages (BMDMs) were stimulated with non-mannose-capped lipoarabinomannan (LAM) from Mycobacterium smegmatis or mannose-capped lipoarabinomannan (ManLAM) from Mycobacterium tuberculosis for 2 hours and then infected with swollen Af conidia. Cell death was assessed by lactate dehydrogenase release. Cytokine release was measured in supernatant using Enzyme Linked Immuno-Sorbent Assay (ELISA). Colony forming units counting and time-lapse fluorescence microscopy was performed for studying conidia killing by macrophages. BMDMs stimulated with LAM showed increased cell death and inflammatory cytokine release in a dose-dependent manner, characterised by a significant increase of IL-1β release. Time-lapse fluorescence microscopy and CFUs revealed that both LAM and ManLAM significantly decrease the capacity of macrophages to kill Af conidia within the first 6 hours of infection. The mycobacterial virulence factor, lipoarabinomannan, disrupts macrophage capacity to efficiently clear Af at early stages of infection in-vitro.
While the protective role of neighborhood social cohesion against mental disorders is well-documented in high-income countries, evidence from resource-constrained settings remains scarce. This study evaluated the cross-sectional and longitudinal associations between neighborhood social cohesion and depressive symptoms in a Peruvian cohort. Data from the CRONICAS Cohort Study were analyzed. The primary outcomes were the prevalence and incidence of depressive symptoms, assessed via the Center for Epidemiologic Studies Depression Scale (CES-D). Neighborhood social cohesion, conceptualized through trust, reciprocity, and solidarity, was measured using a 4-item scale and categorized into tertiles. Single variable and multivariable-adjusted Poisson regression models were used to estimate incidence rate ratios (IRR) and 95% confidence intervals (95% CI). Among 3533 participants (mean age 55.8 ± 12.7 years; 51.5% female), baseline prevalence of depressive symptoms was 18.6% (95%CI: 17.3%-19.9%). Middle and high levels of social cohesion were associated with a 27% (95% CI: 13%-38%) and 47% (95% CI: 19%-66%) lower prevalence of symptoms at baseline. We identified 221 incident cases (4.0 cases per 100 person-years, 95% CI: 3.5-4.6). High social cohesion was associated with an adjusted 46% (95% CI: 9%-68%) reduction in the risk of developing depressive symptoms over 30 months. Higher neighborhood social cohesion was significantly associated with a reduced prevalence and a lower incidence of developing depressive symptoms. These findings suggest that interventions aimed at fostering community trust and social capital may represent a viable strategy for mental health prevention in resource-constrained environments.
Although the mothership transport (MS) model (direct transport to a thrombectomy-capable center) has been associated with improved functional outcomes compared with the drip-and-ship (DS) model (initial transport to a local center for thrombolysis followed by transfer) in acute ischemic stroke, the influence of stroke system integration on these outcomes remains unclear. To compare clinical outcomes between DS and MS models and assess the impact of system integration. This systematic review and meta-analysis involved a search of PubMed, Embase, and Cochrane (from inception up to March 2026) for studies comparing DS and MS in acute ischemic stroke. Inclusion required reporting of 90-day functional outcomes. Outcomes included the modified Rankin Scale (mRS), recanalization, hemorrhage, and mortality. Data were pooled using random-effects models, with analyses stratified by stroke system integration level. Thirty-seven studies encompassing 21,644 patients (mean age 70.1 (DS) and 70.7 (MS)) were included. MS was associated with significantly shorter symptom onset-to-recanalization times (251.0 ± 111.0 vs. 347.0 ± 128.0 minutes). MS patients had higher rates of functional independence (mRS, 0-2; OR, 0.78; 95% CI: 0.70-0.86) and lower rates of poor outcomes (mRS, 3-6; OR, 1.30; 95% CI: 1.17-1.45). No significant differences were found for successful recanalization, rates of symptomatic intracranial hemorrhage, or mortality. Stratified analyses showed no significant interaction between transport model outcomes and the level of system integration. The MS model provides shorter treatment times and superior functional outcomes compared to DS, regardless of stroke system integration level. Rates of recanalization, hemorrhage, and mortality were similar between models.
Breast cancer (BC) is the most common malignant neoplasm in women worldwide and in Peru. Beyond hormonal and genetic factors, cytokines play a key role in tumor aggressiveness and therapeutic resistance. However, evidence on circulating cytokine profiles in Latin American populations is limited. We aimed to characterize the plasma cytokine profile in Peruvian women with BC and evaluate its association with molecular subtypes and treatment response. A prospective cohort study was conducted. We included 88 BC patients with clinical stage II-III, who were diagnosed at three different cancer centers in Peru: Instituto Nacional de Enfermedades Neoplásicas (INEN, Lima-Peru), Instituto Regional de Enfermedades Neoplásicas del Norte (IREN-NORTE, Trujillo-Peru), and Instituto Regional de Enfermedades Neoplásicas del Sur (IREN-SUR, Arequipa-Peru). Plasma samples were obtained prior to any treatment being administered and underwent analysis using the Bio-Plex Pro™ Human Cytokine 48-Plex Screening Panel kit. Poisson regression models were used to evaluate the association between cytokine levels and complete pathological response (pCR) and clinical response. Cytokine concentration differences in MIP-1β, IL-9, GRO-α, and TNF-β were observed between BC molecular subtypes. Furthermore, lower levels of circulating FGF BASIC appear necessary to increase the relative risk of achieving pCR (RR = 0.9779; 95% CI 0.9573-0.9989; p=0.0392). Decreased levels of FGF BASIC, PDGF BB, SDF-1, IL-12 P40, and IL-8 were also found to be related to an increased chance of clinical responses to treatments. Multivariable analyses indicated that only FGF-BASIC, PDGF-BB, and IL-12 P40 remained independently associated with clinical response. Our study identified plasma cytokines linked to BC subtypes and treatment response in a Peruvian cohort. FGF-BASIC consistently demonstrated a significant association with both pCR and clinical response.
There is limited evidence regarding the association between weather and Plasmodium vivax (Pv), particulary in Latin America where Pv is the predominant malaria species and key challenge for countries to achieve malaria elimination. We analyzed the association between weather and Pv malaria incidence from 2017 to 2024 in 136 communities in the Peruvian Amazon. Monthly community-level incidence was calculated using Pv case data from Notiweb, the national epidemiological surveillance system, and population census data. Predictors included weekly minimum and maximum temperature and total weekly precipitation and were calculated using hourly weather from the climate dataset ERA5. Non-linear distributed lag models were fit using a lookback period of 2-16 weeks. Temperature models were adjusted for total precipitation; precipitation models were adjusted for maximum temperature. Sub-group analyses were conducted by community type (adjacent to river versus highway) and El Niño Southern Oscillation (ENSO) period. Minimum temperature at the 90th percentile (23.7°C) was associated with 10% (95% CI 5-14%) higher malaria incidence compared to the 5th percentile (20.5°C) at a 7-week lag. Maximum temperature at the 90th percentile (33.7°C) was associated with 10% (95% CI 8-13%) higher malaria incidence compared to the 5th percentile (29.6°C) at a 9-week lag. Total weekly precipitation at the 90th percentile (1000 mm) was associated with 29% (95% CI 24-33%) higher malaria incidence compared to weeks with the 5th percentile (57 mm) at an 11-week lag. Incidence was higher and associations were stronger in communities adjacent to rivers versus highways. Malaria incidence was lower during El Niño periods, and there was evidence of interaction on the multiplicative scale for the association between incidence, all weather predictors, and ENSO period. Pv malaria incidence was positively associated with higher temperatures and precipitation in an elimination setting in Peru, particularly in riverine communities during non-El Niño years, with longer lag periods than previously reported for such associations. These findings can inform malaria elimination interventions to combat the long-lasting effects of weather on Pv transmission.