Hospital In Peru Research Articles

Epidemiologic characteristics and clinical features of patients with monkeypox virus infection from a hospital in Peru between July and September 2022

ObjectivesMonkeypox (Mpox) recent outbreak has changed in terms of predominant transmission route and typical presentation. Describing current epidemiological and clinical characteristics is crucial to identifying cases and halting transmission. MethodsAn observational study was conducted at a Peruvian tertiary-level hospital and included all individuals with Mpox virus infection between July 01 and September 03, 2022. ResultsAmong 205 confirmed cases, 99% (202/205) were men, 94% (192/205) were men who have sex with men or bisexual, and 66% (136/205) were living with HIV. Regarding sexual behavior, 87% (179/205) had a sexual encounter 21 days before consultation, although only 8% (17/205) identified sexual contact with a Mpox confirmed case; 65% (133/205) had sexual intercourse with casual partners, 55% (112/205) reported a last sexual partner unknown, and 21.5% (44/205) continued having sexual intercourse with symptoms. Systemic symptoms were fever (162/205, 79%), malaise (123/205, 60%), headache (119/205, 58%), fatigue (105/205, 52%), and lymphadenopathy (111/205, 54%). The distribution of skin lesions was generalized (166/205, 81%), located in the anogenital area (160/205, 78%), polymorphic (174/205, 85%), and it was the first symptom identified in 46% (94/205) of cases. Overall, 10% (21/205) required hospitalization, of whom 85.7% (18/205) have HIV infection. Complications included bacterial superinfection (n = 18), proctitis (n = 6), balanitis (n = 4), and necrosis of skin lesions (n = 3). ConclusionIn 2022, Mpox mainly affects men who have sex with men and People living with HIV/AIDS. It presents with skin lesions localized to the anogenital area and can lead to severe complications requiring hospitalization.

Características epidemiológico-clínicas y resultados del manejo de plastrón apendicular en pacientes adultos de un hospital de referencia del Perú

Introduction: Appendicular plastron is considered a progressive form of acute appendicitis, with a national prevalence of 2-10%. Currently management is often controversial. It is that from this context, it seeks to promote studies that can elucidate the variables associated with the management of this condition. Objective: to determine the epidemiological-clinical characteristics associated with the results of the management of the appendiceal plastron in adult patients in a reference hospital in Peru. Methods: Non-experimental study, with a quantitative approach, observational, analytical and cross-sectional design, whose sample consisted of 100 patients with a diagnosis of appendicular plastron. The data collection sheet was applied as an instrument. Likewise, a Poisson regression model was used to respond to the objectives. Results: The multivariate analysis showed that alcohol consumption (p<0.05 RPa=1.12), nausea and vomiting (p<0.05, RPa=1.48), diarrhea (p<0.05; RPa=1.08), duration of symptoms before admission between 3 and 5 days (p<0.05; RPa=1.09), appendiceal mass (p<0.05, RPa=1.18) and bandemia (p<0.05, RPa=1.12) were significantly associated with unsuccessful management results of the appendiceal plastron. Conclusion: There are epidemiological and clinical characteristics associated with the results of the management of the appendicular plastron.

Invasive pneumococcal disease in patients from a pediatric hospital in Peru, 2017-2020.

Motivation for the study: there are few reports describing cases of invasive pneumococcal disease after the introduction of the 13-valent conjugate vaccine in Peru. Main findings: cases of invasive pneumococcal disease are still reported in children, more frequently in children under five years of age. The most frequent clinical form was bacteremia and there was greater antibiotic resistance to erythromycin, trimethoprim-sulfamethoxazole, and penicillin. Implications: our findings suggest the need to maintain epidemiological surveillance of invasive pneumococcal disease and to measure the impact of vaccination against pneumococcus in children. This study aimed to describe the clinical characteristics, serotypes, and antibiotic susceptibility in patients with invasive pneumococcal disease (IPD). The medical records of patients with IPD who were hospitalized at the Instituto Nacional de Salud del Niño-Breña (Lima, Peru) were reviewed. We evaluated 29 patients. The median age was 1.9 years (interquartile range: 1 to 4 years). Of the sample, 51.7% were women and the most frequent clinical form of IPD was bacteremia in 18 (62.1%) patients; 65.5% had a complete vaccination schedule, according to the Peruvian Ministry of Health. Germ isolation was performed from blood samples in 82.8% of patients. Antibiotic resistance to erythromycin (55.2%) was the most frequent, followed by resistance to trimethoprim-sulfamethoxazole (48.3%) and penicillin (24.1%). The isolated serotypes were 6C, 19A, 23A and 24F. One patient died of meningitis. In conclusion, IPD was more frequent in children aged one to five years and the most frequent clinical form was bacteremia. Five serotypes reported in previous studies were found to be resistant to penicillin and erythromycin.

Identification of Probable sarcopenia based on SARC-F and SARC-CalF in older adults from a low-resource setting.

We aimed to investigate the frequency of probable sarcopenia and to compare the performance of SARC-F and SARC-CalF for detecting this condition in outpatient older adults from a low-resource setting. We conducted a retrospective, cross-sectional study in outpatient older adults aged ≥60 years attending a hospital in Peru, between August 2019 and February 2020. Probable sarcopenia was defined as low handgrip strength (<27 kg in men and <16 in women). We used SARC-F and SARC-CalF with their standard cut-off points (≥4 and ≥11, respectively). Low calf circumference was defined as ≤33 cm in women and ≤34 cm in men. We performed sensitivity and specificity analyses. We included 206 older adults, 102 (49.5%) aged ≥75 years old and 140 (67.9%) females. Probable sarcopenia was present in 36.40% of the participants. SARC-F ≥4 was observed in 29.61% and SARC-CalF ≥11 in 41.26% of the population. SARC-F≥4 showed 41.33% sensitivity and 77.10% specificity, whereas SARC-Calf ≥11 had 50.67% sensitivity and 64.12% specificity. We found that one out of three of the population had probable sarcopenia. SARC-Calf showed superior but still low sensitivity than SARC-F, while both had moderate specificity and thus may be useful for ruling out the disease in clinical practice.

Factors Associated with SARS-CoV-2 Positivity in Patients Treated at the Lambayeque Regional Hospital, Peru during a Pandemic Period

The aim of this study was to provide additional data on mortality from COVID-19 with particular attention to the factors associated with the positivity of patients admitted to the Lambayeque Hospital in Peru. A retrospective cohort analysis was carried out to determine the clinical-epidemiological factors associated with positivity for SARS-CoV-2 in patients treated at the Lambayeque Regional Hospital during the health emergency period in the context of the COVID-19 pandemic. It was observed that, as the demographic age group increased, the percentage of seropositivity increased, with 66.8% of elderly adults testing positive, compared to 37.4% of children (p &lt; 0.001). More seropositive men than women were evident (61.1% vs. 54.1%; p &lt; 0.001). The most frequent symptom of patients with suspected COVID-19 was cough (65.0%). However, the symptoms with the greatest frequency of seropositive patients were ageusia (78.6%) and fever (77.6%); cough was one of the symptoms with the lowest (63.9%) (p-value &lt; 0.001). The comorbidities with the most seropositive patients were obesity (80.7%) and diabetes mellitus (73.6%) (p-value &lt; 0.001), different from the top comorbidity of heart disease (12.7%) in suspected COVID-19 patients. In terms of disease signs, abnormal findings on MRI (98.11%) and dyspnea (28.7%) were the most common in suspected COVID-19 patients, similar to those in seropositive patients, which were dyspnea (81.4%) and abnormal tomography findings (75.3%) (p-value &lt; 0.001).

Type 2 Diabetes Mellitus and Demodex folliculorum Infestation: A Cross-Sectional Study in Peruvian Patients.

Background. Demodex folliculorum is a mite that causes human demodicosis, which is characterized by producing lesions on the face, and its infestation could be associated with factors that alter the immune response, including Type 2 Diabetes (T2D). This study aimed to evaluate the relationship between T2D and D. folliculorum infestation in patients attended at a hospital in Peru in 2021. Methods. A cross-sectional study enrolling patients who were classified according to the presence (n = 100) and absence (n = 100) of T2D was conducted. Information was obtained on age, sex, domestic animal husbandry, and symptoms and signs associated with demodicosis. Demodicosis was determined to be present when counts of D. folliculorum greater than five mites per cm2 were found in superficial facial skin biopsies. Results. A frequency of demodicosis in 76 and 35 patients with and without T2D, respectively, was observed. In the multivariate analysis adjusted for confounders age, sex, and domestic animal husbandry, T2D was found to be associated with D. folliculorum infestation (PR: 2.13; 95% CI95: 1.42–3.19). Conclusions. T2D was associated with D. folliculorum infestation. In this sense, it is important to strengthen surveillance to identify of D. folliculorum infestation in people with T2D.

Association between prehospital medication and fatal outcomes in a cohort of hospitalized patients due to coronavirus disease-2019 in a referral hospital in Peru

BackgroundTo explore the association between the use of prehospital medications and the development of fatal outcomes in patients who required hospitalization due to coronavirus disease-2019 (COVID-19). MethodsThis retrospective cohort study included adult patients who were hospitalized due to COVID-19. Demographic, clinical, and laboratory data, prehospital medication history, and fatal outcome development (use of high-flow oxygen therapy, intensive care unit [ICU] admission, or mortality) were extracted from the medical records of patients who were admitted due to COVID-19 to the Carlos Seguín Escobedo National Hospital of Arequipa, Peru during July to September 2021, the period after the second wave of COVID-19 cases in Peru. Survival was analyzed using the Cox proportional hazards model, and crude hazard ratios and adjusted hazard ratios (aHR) with their respective 95% confidence intervals (95% CI) were calculated. ResultsA total of 192 patients were evaluated, of whom 62% were males and 46.9% did not require oxygen support at admission. Additionally, 64.6% used nonsteroidal anti-inflammatory drugs, 35.4% used corticosteroids, 28.1% used macrolides or ceftriaxone, 24.5% used ivermectin, and 21.9% used warfarin before hospitalization. Of the patients, 30.2% developed a fatal outcome during follow-up. The multivariate analysis revealed that prehospital corticosteroid use was independently associated with the fatal outcome due to COVID-19 with an aHR = 5.29 (95%CI: 1.63–17.2). ConclusionPrehospital corticosteroid use was associated with a 5-fold increased risk of fatal outcome development.

A 47-Year-Old Man Presenting With Seizures and Prior Stroke.

A 47-year-old man presented to his local hospital in Peru after a generalized tonic-clonic seizure. His family reported a history of prior stroke of unclear etiology. This case report discusses the approach to a first seizure (including in tropical regions like Peru), the relationship between stroke and seizures, the approach to stroke in the young, and how to diagnose rare diseases in resource-limited settings.

An explanatory model of depressive symptoms from anxiety, post-traumatic stress, somatic symptoms, and symptom perception: the potential role of inflammatory markers in hospitalized COVID-19 patients

BackgroundThe context of the COVID-19 pandemic has harmed the mental health of the population, increasing the incidence of mental health problems such as depression, especially in those who have had COVID-19. Our study puts forward an explanatory model of depressive symptoms based on subjective psychological factors in those hospitalized for COVID-19 with and without biological markers (i.e., inflammatory markers). Therefore, we aim to evaluate the hypotheses proposed in the model to predict the presence of depressive symptoms.MethodWe conducted a cross-sectional study, using a simple random sampling. Data from 277 hospitalized patients with COVID-19 in Lima-Peru, were collected to assess mental health variables (i.e., depressive, anxiety, post-traumatic stress, and somatic symptoms), self-perception of COVID-19 related symptoms, and neutrophil/lymphocyte ratio (NLR) such as inflammatory marker. We performed a structural equation modeling analysis to evaluate a predictive model of depressive symptoms.ResultsThe results showed a prevalence of depressive symptoms (11.2%), anxiety symptoms (7.9%), somatic symptoms (2.2%), and symptoms of post-traumatic stress (6.1%) in the overall sample. No association was found between the prevalence of these mental health problems among individuals with and without severe inflammatory response. The mental health indicators with the highest prevalence were sleep problems (48%), low energy (47.7%), nervousness (48.77%), worry (47.7%), irritability (43.7%) and back pain (52%) in the overall sample. The model proposed to explain depressive symptoms was able to explain more than 83.7% of the variance and presented good goodness-of-fit indices. Also, a different performance between the proposed model was found between those with and without severe inflammatory response. This difference was mainly found in the relationship between anxiety and post-traumatic stress symptoms, and between the perception of COVID-19 related symptoms and somatic symptoms.ConclusionsResults demonstrated that our model of mental health variables may explain depressive symptoms in hospitalized patients of COVID-19 from a third-level hospital in Peru. In the model, perception of symptoms influences somatic symptoms, which impact both anxiety symptoms and symptoms of post-traumatic stress. Thus, anxiety symptoms could directly influence depressive symptoms or through symptoms of post-traumatic stress. Our findings could be useful to decision-makers for the prevention of depression, used to inform the creation of screening tools (i.e., perception of symptoms, somatic and anxiety symptoms) to identify vulnerable patients to depression.

Mental health impacts of nurses caring for patients with COVID-19 in Peru: Fear of contagion, generalized anxiety, and physical-cognitive fatigue.

The health crisis caused by COVID-19 has resulted in the physical and emotional deterioration of health personnel, especially nurses, whose emotional state is affected by the high risk of contagion, the high demands of health services, and the exhausting working hours. The objective of this research was to determine the relationship between fear, anxiety, and fatigue of nurses caring for patients with COVID-19 in a second level public hospital in Peru. This study presents a quantitative approach and correlational level, cross-sectional, and non-experimental design. The sample consisted of 145 nurses who attended patients with COVID-19 in health care areas. The results show a significant relationship between fear of contagion and physical-cognitive fatigue (p < 0.001; r = 317) and a significant relationship between generalized anxiety and physical-cognitive fatigue (p < 0.001; r = 480). It is concluded that in this context, both fear of contagion and generalized anxiety are related to physical-cognitive fatigue.

Brechas de acceso al tratamiento oncológico en un hospital de salud de referencia del Sur de Lima en el año 2019

Introduction: Cancer, a chronic disease that has a high incidence with 14.1 million people and more than 8.1 million deaths, generating a large access gap according to the user's perception. Objectives: To determine the gaps in access to cancer treatment in a Hospital in Peru in 2019, due to predisposing, enabling and necessary factors. Method: observational, descriptive, cross-sectional study with 185 patients diagnosed with cancer who were treated at the oncology department of the Hospital María Auxiliadora between March and December 2019, applying a random survey. Results: The predisposing factors for the gap in access to cancer care were: primary education or none (p= 0.000), female gender (p=0.043), being afraid of a cancer diagnosis (p=0.000), being afraid of interventions (p=0.043) and being over 65 years old (p=0.000), having feelings of helplessness (p=0.000). Within the enabling factors as a gap: not having a job (p=0.011), payment for exams in a private way (p=0.035), stop working (p=0.039), payment for medicines in a private way (p= 0.000), resort to the loan (p= 0.009), health expenditure between 501-1000 soles in health (p=0.048). Of the necessary factors: having moderate to severe anemia (p=0.002) or having required more than one treatment in combination (p=0.003). Conclusions: there is a gap for cancer care such as those concerning the predisposing factor (fear of cancer diagnosis and treatment); enabling (infrastructure and equipment, payment for medicines) and necessary factor (severe anemia).

Translated article] Use of Ottawa ankle rules in a referral hospital in Peru

ObjectiveThe aim of the study was to evaluate the validity and safety of Ottawa's ankle rules (OAR) in the urgency department of referral hospital in Peru. Materials and methodsAn observational-transversal study was conducted for a duration of 5 months (April–June 2016). Target population were all patients older than 18 years with a foot and ankle injury who came to the urgency department. A convenience non-randomised sampling was used. The OAR test was applied and X-rays of the foot and/or ankle were performed in all patients who met the inclusion and exclusion criteria. The data obtained was analysed using the SPSS 20.0 software. Sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio positive and negative were calculated from statistical analysis. ResultsA total of 428 patients were evaluated. The OAR test's sensitivity was 97.2%, specificity was 30.3%, positive predictive value was 22.0%, negative predictive value was 98.2%, likelihood ratio positive and negative were 1.39 and 0.09, respectively. With the application of the OAR test, a reduction of 31.2% of the total X-rays was evidenced, which could generate a saving of US $1165. ConclusionsIn conclusion, OAR's validity and safety in our environment are comparable to international data, with a reduction in the unnecessary use of radiographs. Multicentric studies involving a larger sample and longer study time are necessary to protocolize OAR in emergency units.

Identification of Co-Infections by Viral and Bacterial Pathogens in Covid-19 Hospitalized Patients in Peru: Molecular Diagnosis and Clinical Characteristics

PurposeThe impact of respiratory coinfections in COVID-19 is still not well understood. This study sought to identify the respiratory pathogens causing coinfections in patients with moderate/severe SARS-CoV-2 pneumonia from a hospital in Peru. Also, to describe the clinical characteristics and outcomes of coinfected and non-coinfected patients.Methods & MaterialsA descriptive study was conducted on hospitalized patients with a confirmed diagnosis of moderate/severe pneumonia due to SARS-CoV-2 infection. The selection criteria included patients older than 18 years of age who were admitted to the Guillermo Almenara Irigoyen Hospital in Lima, Peru during the period July-November 2020. Pregnant women were excluded from the study. A nasopharyngeal swab sample was obtained from the patients included in the study. Diagnosis of SARS-CoV-2 infection was performed by reverse-transcriptase polymerase chain reaction (RT-PCR). The detection of the following respiratory viruses was performed by RT-PCR: Influenza A and B, Respiratory syncitial virus (RSV) A and B; and Adenovirus. The detection of atypical bacteria, Mycoplasma pneumoniae and Chlamydia pneumoniae was carried out using conventional polymerase chain reaction.ResultsA total of 295 patients with confirmed SARS-CoV-2 infection were enrolled during the study period. A coinfection with one or more respiratory pathogen was detected in 154 (52.20%) patients at hospital admission. The most common coinfections were Mycoplasma pneumoniae (28.12%), Chlamydia pneumoniae (8.81%) and with both bacteria (11.53%); followed by Adenovirus (1.70%), Mycoplasma pneumoniae/Adenovirus (0.71%), Chlamydia pneumoniae/Adenovirus (0.71%), RSV-B/Chlamydia pneumoniae (0.32%), Mycoplasma pneumoniae/Chlamydia pneumoniae/Adenovirus (0.32%). Sepsis was more frequent among coinfected patients than non coinfected (33.12% vs 20.57%, p = 0.018). Expectoration was less frequent in coinfected individuals compared to non coinfected (5.84% vs 12.77%, p = 0.045). We could highlight that the majority of patients were administered an antibiotic (69.50%). The correlation between the empirical use of macrolides in patients with Mycoplasma pneumoniae and Chlamydia pneumoniae was observed in 41% of the cases.ConclusionMycoplasma pneumoniae and Chlamydia pneumoniae were the main microorganisms associated with SARS-CoV-2 coinfection at hospital admission. The presence of multiple coinfections was described in some patients. Antibiotics should be carefully prescribed, as high rates of antibiotic use was found, particularly with macrolides.

Image-Guided Radiation Therapy for Squamous Cell Cancer of the Head and Neck in a Specialized Peruvian Public Hospital.

Squamous cell cancer of the head and neck (SCCHN) often requires adjuvant radiotherapy. Radiotherapy for SCCHN is a challenge because the head and neck contain several critical organs that should receive minimal doses of radiation. These organs include the eyes, parotid glands, brainstem, spinal cord, mandible, and thyroid gland. Approaches like image-guided radiotherapy (IGRT) combined with volumetric modulated arc therapy hold the promise to focus radiation to the planning target volume and spare nearby structures while observing potential changes to patient anatomy during treatment to determine whether replanning is required. IGRT, however, requires the frequent imaging of patients to update the treatment plan. In this retrospective study, we present our findings of SCCHN patients treated in a public hospital in Peru. The patients reflected overall demographic trends associated with SCCHN. Each patient was imaged using computed tomography once before radiotherapy and once by cone-beam computed tomography (CBCT) during treatment, for a total of two images. Tumor displacement, planning target volume, gross tumor volume, and neck diameter were compared between the two images. Among the measurements, only a small statistically significant increase in gross tumor volume was observed between the images. However, a minority of patients did experience changes to anatomy, which highlights the need for continued research into criteria to determine which patients are likely to benefit from treatment replanning due to intra-treatment anatomical changes. Alternatively, a lack of frequent CBCT imaging before each session, due to high patient flows and limited staff resources, made it difficult to observe transient changes and trends in each patient. We conclude that the treatment and outcome improvements associated with IGRT are likely associated with frequent imaging during radiotherapy and properly selecting which patients will benefit most from this resource-intensive technique.

Clinical Performance of The call Score for the Prediction of Admission to ICU and Death in Hospitalized Patients with Covid-19 Pneumonia in a Reference Hospital in Peru

Objective: Determine the CALL SCORE's diagnostic accuracy for the prediction of ICU admission and death in patients hospitalized for COVID-19 pneumonia in a reference hospital in Peru. Methods: We performed an analytical cross-sectional observational study. We included patients with COVID-19 pneumonia treated at the "Dos de Mayo" National Hospital. Patients over 18 years old with a diagnosis confirmed by rapid or molecular testing were included. Those with an incomplete, illegible, or missing medical history and/or bacterial or fungal pneumonia were excluded. Data were extracted from medical records. The primary outcomes were mortality and admission to the ICU. The Call Score was calculated for each patient (4 to 13 points) and classified into three risk groups. Summary measures were presented for qualitative and quantitative variables. The area under the model curve and the operational characteristics (sensitivity, specificity) were calculated for the best cut-off point. Results: The Call Score reported an area under the curve of 0.59 (IC95%: 0.3 to 0.07), p = 0.43 for predicting death. However, for a cut-off point of 5.5, a sensitivity of 87% and a specificity of 65% were obtained. The area under the curve for ICU admission was 0.67 (95%CI: 0.3 to 0.07), p = 0.43; the 5.5 cut-off point showed a sensitivity of 82% and a specificity of 51%. Conclusions: The Call Score shows a low performance for predicting mortality and admission to the ICU in Peruvian patients. Keyword: (MESH) Mortality; Intensive Care Units; Clinical Decision Rules

Clinical inflammatory biomarkers associated with the tumor stage of gastric cancer: retrospective analysis of a Hospital in Peru during the years 2018–2020

Introduction: Gastric cancer is a disease with a high rate of morbidity and mortality in the world. Objective: To determine which clinical inflammatory biomarkers are associated with the tumor stage of gastric cancer of the oncology service of the Hospital María Auxiliadora in Lima, Peru, during the years 2018-2020. Methodology: Observational, analytical, cross-sectional and retrospective study. There was a sample of 110 patients. The PR values ​​were obtained from the absolute frequencies of the variables: serum albumin, Platelet-Lymphocyte Ratio (PLR) and Neutrophil-Lymphocyte Ratio (NLR). Results: The average age was 63,727±13.85. 55.45% were female. The most frequent histopathological type was intestinal adenocarcinoma with 62.73%. In the bivariate analysis, an association was found between INL (PR:6.88 CI95% 2.36-20 p&lt;0.001), IPL (PR:2.55 CI95% 1.68-3.86 p&lt;0.001) and serum albumin (PR:3.16 CI95% 1.91-5.24 p&lt;0.001) in the advanced clinical stage. The multivariate analysis found a relationship between INL and clinical stage (PR:4.11 CI95% 1.25-13.49 p=0.020) Conclusion: INL is an independent predictive factor in relation to the clinical stage of gastric cancer in this study.

Professional performance in the administration of medicines in pediatrics: a study cross-sectional observational.

to evaluate Patient Safety actions carried out by nurses in the Administration of Medicines in Pediatrics. observational, cross-sectional, quantitative study carried out in 2018, with 25 nurses from a Hospital in Peru. 183 observations were made; the instrument Safety of the patient was used in the administration of medicines in Pediatrics Spanish version. The performance of the professionals was evaluated by the Positivity Index. of 22 itens observed, five were adequate, five were safe, two were classified as borderline and ten as endurable among those who stand out; Bring to bed only medications prescribed for a single child and maintains an adequate record of prepared medications that will be stored. weaknesses were observed in the medication administration process, since only 10 itens were classified as safe or adequate, reinforcing the need for permanent education activities by the institution for nursing training.

Effects of the "Free of COVID-19" educational program on teenagers’ preventive social skills

Objective: To determine the effects of the “Free of COVID-19” educational program on the preventive social skills ofteenagers treated at a provincial hospital in Peru. Materials and methods: An explanatory, pre-experimental, longitudinal and prospective research with a pretest andposttest intact group design. The population consisted of 40 male and female teenagers aged between 13 and 19, whowere treated at the Tayabamba provincial hospital. The inclusion criteria were a) teenagers aged between 13 and 19, b)teenagers with complete medical records and c) teenagers treated at the Tayabamba provincial hospital. The variables(before and after the program) were the preventive social skills and their dimensions: assertiveness, communication,self-esteem and decision-making. The “Free of COVID-19” educational program was implemented with a pretest and a posttest. A questionnaire made up of four dimensions and 27 questions was administered for assessing the preventivesocial skills. A non-parametric analysis of longitudinal data was used for a sample of subjects who were evaluated twiceduring the course of the study. Results: Before the implementation of the “Free of COVID-19” educational program, the teenagers’ preventive social skillswere, in general terms, fair (55.00 %) and, after the program, good (80.00 %). Their assertiveness was fair (45.00 %) beforethe program and improved to good (75.00 %) after the program. Their communication was fair (70.00 %) before the programand good (85.00 %) afterwards. Their decision-making was good (50.00 %) before the program and also good (90.00 %) afterthe implementation of the program. Conclusions: The preventive social skills of teenagers treated at the Tayabamba provincial hospital, as well as theirassertiveness, communication, self-esteem and decision-making, significantly improved with the implementation of the“Free of COVID-19” educational program.

Managing Post-Stroke Care During the COVID-19 Pandemic at a Tertiary Care Level Hospital in Peru

ObjectivesTo understand the hospital-to-outpatient care transition and how the discharge process of stroke patients is managed; and to identify potential opportunities to improve these processes, while contrasting pre- and during COVID-19 experiences in Peru. MethodsA qualitative study was conducted between February and March 2021 consisting of in-depth interviews of patients with stroke, their caregivers and healthcare personnel regarding stroke care at a national tertiary referral center for stroke care in Lima, Peru. We explored the following phases of the patients’ journeys: pre-hospitalization, emergency room, hospitalization, discharge process and post-discharge. For each phase, we explored experiences, feelings and expectations using thematic analysis. ResultsWe conducted a total of 11 interviews with patients or caregivers and 7 with health care personnel and found disruption in the continuity of care for patients with stroke. Mainly, caregivers and patients referred to problems related to communication with healthcare personnel and an absence of training to provide post-discharge care at home. Potential solutions included increasing human resources and caregiver participation in care, implementation of electronic healthcare records, improving the referral system and reinforcing telemedicine services. ConclusionThe continuity of care of patients with stroke was negatively affected during the COVID-19 pandemic. In LMICs, the impact was likely greater due to the already weak and fragmented healthcare systems. The COVID-19 pandemic presents an opportunity to improve post-stroke care services, and address patients’ experiences and feelings by developing solutions in a participatory manner.

Association between olfactory dysfunction and COVID-19 severity: A prospective study in a highly complex hospital in Peru.

Olfactory dysfunction has been included among the early symptoms of coronavirus disease (COVID-19). Evidence suggests that a relationship exists between the duration of olfaction disorders and the probability of developing severe COVID-19. Given the scope of the COVID-19 pandemic, this study aimed to determine the frequency of smell alteration and its association with the severity of COVID-19 in a referral hospital in Peru, which is one of the most affected countries in the Latin American region. This study was an observational, prospective cohort study that included patients with COVID-19 who were treated at the Hospital Nacional Edgardo Rebagliati Martins from August to November 2020. To assess the association, the chi-square test of independence or Fisher's exact test was performed. The outcome variable was COVID-19 severity, and the exposure variable was olfactory dysfunction. The first data collection was in the emergency department and the follow-up was via telephone. A total of 179 patients were included. The mean age was 61.6 ± 15.5years, and 129 patients (72.1%) were male. Olfactory dysfunction was observed in 43 patients (24%). An inverse association was found between age and olfactory dysfunction (P = .002). No significant association was found between COVID-19 severity level and olfactory alteration (P = .056). However, a direct association was found between COVID-19 severity and age (P = .003), cough (P < .001), and respiratory distress (P = .003). This study did not find any association between the severity of COVID-19 and olfactory dysfunction. It showed a low incidence rate of smell alteration compared with studies from other regions. Moreover, smell alteration was associated with younger age.