Coronary disease (CD) is the main cause of mortality worldwide. Data about trends and geographical variation in CD mortality is available in some American countries. This information varies among ...countries since CD risk factors frequencies vary. To describe the trend and geographical variation of coronary disease (CD) mortality in Peru, 2005-2017. Analysis of secondary data of the Peruvian Ministry of Health's registry of deaths. We analyzed CD mortality. We described the absolute and relative frequency of deaths and age-standardized mortality rate (ASMR) by natural regions, departments, age, sex, and year. We also described the change of ASMR between two periods (2005-2010 vs. 2011-2017). There were 64,721 CD deaths between 2005 and 2017 (4.12% among all deaths). The absolute frequency of CD deaths was 5,665 and 6,565 in 2005 and 2017, respectively. CD mortality was more frequent in men and older adults. The ASMR varied among natural regions, being higher in the Coast (19.61 per 100,000 inhabitants). The change between the two periods revealed that almost all departments reduced their ASMRs, except for Callao, Lambayeque, and Madre de Dios. CD mortality has increased in Peru. Mortality was higher in men and older adults, and it varied among departments. More political efforts are needed to reduce these trends.
Objective
To evaluate the association between social determinants of health and trends in the prevalence of hypertension among patients of the Peruvian Ministry of Health 2007–2016.
Methods
We ...conducted an ecological study with secondary data sources using health care and death records obtained from the Peruvian Ministry of Health, data from the Peruvian National Household Survey and data from the Regional Information System for Decision Making. We determined the standardised prevalence of hypertension at national and region level, conducted a geospatial exploratory analysis at region level, and applied generalised linear mixed models to evaluate the association between social determinants of health and the prevalence of HT, according to the domains suggested by Healthy People 2020.
Results
The prevalence of hypertensive patients of the Peruvian Ministry of Health increased from 966.8/100 000 in 2007 to 1619.1/100 000 in 2016. The prevalence of hypertension rose by 17.7/100 000 per 1% increase of insurance coverage and by 2.2/100 000 per 1% increase in the number of hospitals. In contrast, it decreased by 12.3/100 000 per 1% increase of the poverty rate, by 9.8/100 000 per 1% increase of the proportion of people with native language, by 3.6/100 000 per 1% increase of GDP per capita and by 3/100 000 per 1% increase in the number of local health centres.
Conclusions
The growing trend of HT prevalence in Peru is directly associated with insurance coverage and number of hospitals, and inversely associated with poverty rate, proportion of people with native language, GDP per capita and number of local health centres.
Objectif
Evaluer l'association entre les déterminants sociaux de la santé et les tendances de la prévalence de l'hypertension chez les patients du Ministère de la Santé du Pérou 2007–2016.
Méthodes
Nous avons mené une étude écologique avec des sources de données secondaires utilisant des données de santé et de décès obtenues du ministère péruvien de la santé, des données de l’enquête nationale sur les ménages péruviens et du système d’information régional pour la prise de décision. Nous avons déterminé la prévalence standardisée de l'hypertension (HT) aux niveaux national et régional, mené une analyse exploratoire géospatiale au niveau régional et appliqué des modèles mixtes linéaires généralisés pour évaluer l'association entre les déterminants sociaux de la santé et la prévalence de l'HT, selon les domaines suggérés par Healthy People 2020.
Résultats
La prévalence des patients HT du Ministère de la Santé du Pérou est passée de 966,8/100.000 en 2007 à 1.619,1/100.000 en 2016. La prévalence de l’HT a augmenté de 17,7/100.000 pour 1% d'augmentation de la couverture d'assurance et de 2,2/100.000 pour 1% d'augmentation du nombre d'hôpitaux. En revanche, elle a diminué de 12,3/100.000 pour 1% d'augmentation du taux de pauvreté, de 9,8/100.000 pour 1% d'augmentation de la proportion de personnes de la langue locale, de 3,6/1000.000 pour 1% d'augmentation du PIB par habitant et de 3/100.000 pour 1% d’augmentation du nombre de centres de santé locaux.
Conclusions
La tendance croissante de la prévalence de l'HT au Pérou est directement liée à la couverture d'assurance et au nombre d'hôpitaux et inversement associée au taux de pauvreté, à la proportion de personnes de la langue locale, au PIB par habitant et au nombre de centres de santé locaux.
Background: Congenital pulmonary malformations (CPMs) are rare in children. This study aimed to describe the clinical, imaging characteristics, and treatment of patients with this pathology. Methods: ...We conducted a descriptive and retrospective study with data from patients with CPMs diagnosed at Instituto Nacional de Salud del Niño-Breña (Lima-Peru), from January 2010 to December 2020. We described CPM clinical and imaging characteristics, type and treatment. Results: The sample was formed of 70 patients. The median age was 29 months (range 15 days-14 years) and the male/female ratio was 1.4. The chest tomography found parenchymal involvement in 50 (71.4%) cases and mixed involvement (parenchymal and vascular) in 18 (25.7%) cases. Congenital malformation of the pulmonary airway was present in 39 (55.7%) cases, followed by bronchogenic cyst in 10 (14.3%), intralobar pulmonary sequestration in 9 (12.9%), and extralobar pulmonary sequestration in 7 (10%). Lobectomy was performed in 61 (87.1%) cases, cystectomy in 5 (7.1%), segmentectomy in 2 (2.9%), and embolization in 2 (2.9%). The most frequent post-operative complication was pneumonia, found in 9 (12.9%) cases. The median hospital stay was 26 days. No patient died during hospitalization. Conclusions: In our institution, the most frequent CPM was congenital malformation of the pulmonary airway, and lobectomy was the most frequently performed surgical procedure. CPMs represent a diverse group of disorders of lung development with varied imaging patterns and clinical manifestations.
Background: Untreated human immunodeficiency virus (HIV)-immunosuppressed pediatric patients show high morbidity and mortality from opportunistic infections. Limited cases of hyperferritinemic sepsis ...have been described in patients with toxoplasmosis. Case report: We describe the case of a 13-year-old female patient with a history of untreated HIV who presented with hyperferritinemic sepsis secondary to Toxoplasma gondii infection and Pneumocystis jirovecci pneumonia. She received ventilatory support, inotropic drugs, treatment for opportunistic germs, and high-dose corticosteroids, but with unfavorable evolution. Conclusions: The global approach to sepsis with elevated ferritin guides to using of therapies aimed at neutralizing the severe inflammatory response. A timely diagnosis would allow prompt treatment and minimize complications.
Background: Pleural empyema secondary to a ruptured amoebic liver abscess is a rare complication in the pediatric population. Case report: We report the case of a 13-year-old male with right flank ...abdominal pain, productive cough with foul-smelling sputum, fever, and respiratory distress. Physical examination revealed breathlessness, decreased vesicular murmur in the right hemithorax, abdominal distension, hepatomegaly, and lower limb edema. Laboratory tests revealed mild anemia, leukocytosis without eosinophilia, elevated alkaline phosphatase, hypoalbuminemia, and positive immunoglobulin G antibodies against Entamoeba histolytica in pleural fluid. He required a chest tube and treatment with metronidazole. After 2 months of follow-up, the abscesses disappeared, and the empyema decreased. Conclusions: Massive pleural empyema secondary to a ruptured liver abscess is a rare complication. The epidemiological link associated with the symptoms and serological tests can help in the diagnosis.
Abstract Introduction: Hypertension (HTN) is a public health problem. The prevalence and mortality rates are significantly higher in middle and low-income countries, such as Peru. This study aimed to ...determine the trend of mortality attributable to HTN for the 2005-2016 period in Peru. Methods: We conducted a secondary analysis based on death certificates provided by the Ministry of Health. We applied linear regression models to test the HTN mortality rate trend. Results: The age-standardized HTN mortality per 100,000 inhabitants decreased from 14.43 for the 2005 to 2010 period to 11.12 for the 2011 to 2016 period. The coast was the natural region with the highest decrease in mortality rate. Moreover, Tumbes, Callao, and Lambayeque were regions with the highest decline in mortality rate. Conclusion: The age-standardized mortality attributable to HTN decreased in Peru, with variations in both natural and political regions of the country.
Resumo Introdução: A hipertensão arterial (HA) é um problema de saúde pública. As taxas de prevalência e mortalidade são significativamente mais altas em países de média e baixa renda, como o Peru. O objetivo do estudo foi determinar a tendência de mortalidade atribuível à HA para o período de 2005-2016 no Peru. Métodos: Realizamos uma análise secundária com base em atestados de óbito fornecidos pelo Ministério da Saúde. Aplicamos modelos de regressão linear para testar a tendência da taxa de mortalidade por HA. Resultados: A mortalidade por HA padronizada para idade por 100.000 habitantes diminuiu de 14,43 no período de 2005 a 2010 para 11,12 no período de 2011 a 2016. O litoral foi a região natural com maior queda na taxa de mortalidade. Além disso, Tumbes, Callao e Lambayeque foram as regiões com maior declínio na taxa de mortalidade. Conclusão: A mortalidade padronizada para idade atribuível à HA diminuiu no Peru, com variações tanto em regiões naturais como políticas do país.
Introduction: There are limited epidemiological reports of Kawasaki disease (KD) in Latin America. Objetive: To describe the characteristics, seasonality, and trend of hospitalizations for KD in ...children. Methods: Descriptive study of secondary analysis was performed with data on hospitalizations due to KD from healthcare institutions from Peru, 2015-2019. Results: Two hundred ninety-seven hospitalizations were registered. 59.9% were male. 82.2% were under five years old, and 16.2% were under one year old. The departments with more hospitalizations were Lima (202 cases), Lambayeque (21 cases), and Piura (17 cases). The seasons of the year with more hospitalizations were winter and spring. The incidence of KD increased from 0.52 to 2.28 cases per 100,000 children under five years old between 2015 and 2019. Conclusions: There was an increase in hospitalizations due to KD, this was more frequent in children under five years of age and males, and it occurred in all seasons.
Introducción: Existen limitados reportes epidemiológicos de la enfermedad de Kawasaki (EK) en Latinoamérica. Objetivo: Describir las características, estacionalidad y tendencia de las hospitalizaciones por EK en niños. Métodos: Se realizó un estudio descriptivo de análisis secundario con datos de hospitalizaciones por EK de instituciones de salud de Perú en el periodo 2015-2019. Resultados: 297 hospitalizaciones fueron registradas. El 59,9% fueron varones. El 82,2% fue menor de cinco años y el 16,2% menor de un año. Los departamentos con más hospitalizaciones fueron Lima, Lambayeque y Piura con 202, 21 y 17 casos. Las estaciones con mayor registro fueron invierno y primavera. La incidencia de EK se incrementó de 0,52 a 2,28 casos/100 000 niños menores de cinco años entre el 2015 al 2019. Conclusiones: Hubo un incremento de las hospitalizaciones por EK, este fue más frecuente en niños menores de cinco años, varones y se presentó en todas las estaciones.
ABSTRACT Introduction: Acute kidney injury (AKI) is a common disorder that causes high healthcare costs. There are limited epidemiological studies of this disorder in low- and middle-income ...countries. The aim of this study was to describe trends in the age-standardized incidence and mortality rates of AKI in Peru. Methods: We conducted an ecological study based on a secondary data sources of the basic cause of death from healthcare and death records obtained from establishments of the Ministry of Health of Peru for the period 2005-2016. The age-standardized incidence and mortality rates of AKI were described by region and trend effects were estimated by linear regression models. Results: During the period 2005-2016, 26,633 cases of AKI were reported nationwide. The age-standardized incidence rate of AKI per 100,000 people increased by 15.2%, from 10.5 (period 2005-2010) to 12.1 (period 2011-2016). During the period 2005-2016, 6,812 deaths due to AKI were reported, which represented 0.49% of all deaths reported for that period in Peru. The age-standardized mortality rate of AKI per 100,000 people decreased by 11.1%, from 2.7 (period 2005-2010) to 2.4 (period 2011-2016). The greatest incidence and mortality rates were observed in the age group older than 60 years. Conclusions: During the study period, incidence of AKI increased and mortality decreased, with heterogeneous variations among regions.
RESUMO Introdução: A lesão renal aguda (LRA) é um distúrbio comum que causa altos custos para a saúde. Existem estudos epidemiológicos limitados sobre esse distúrbio em países de baixa e média renda. O objetivo deste estudo foi descrever as tendências nas taxas de incidência e mortalidade padronizadas por idade da LRA no Peru. Métodos: Realizamos um estudo ecológico com base em fontes de dados secundárias da causa básica de morte de registros de saúde e óbito obtidos de estabelecimentos do Ministério da Saúde do Peru no período de 2005 a 2016. A incidência padronizada por idade e as taxas de mortalidade por LRA foram descritas por região, e os efeitos de tendência foram estimados por modelos de regressão linear. Resultados: No período de 2005 a 2016, 26.633 casos de LRA foram relatados em todo o país. A taxa de incidência padronizada de LRA por idade por 100.000 pessoas aumentou 15,2%, de 10,5 (período de 2005 a 2010) para 12,1 (período de 2011 a 2016). Durante o período de 2005 a 2016, foram relatadas 6.812 mortes por LRA, o que representou 0,49% de todas as mortes relatadas para esse período no Peru. A taxa de mortalidade por LRA padronizada por idade por 100.000 pessoas diminuiu 11,1%, de 2,7 (período de 2005 a 2010) para 2,4 (período de 2011 a 2016). As maiores taxas de incidência e mortalidade foram observadas na faixa etária acima de 60 anos. Conclusões: Durante o período do estudo, a incidência de LRA aumentou e a mortalidade diminuiu, com variações heterogêneas na epidemiologia entre as regiões.
Chronic kidney disease (CKD) is a growing public health problem and an important cause of morbidity and mortality. Disparities in CKD may be related to social determinants and health inequalities in ...low- and middle-income countries. This study determined how social determinants of health influence trends in the prevalence and mortality of CKD in Peru.
This was an ecological study based on a secondary analysis of health care and death records obtained from the Ministry of Health of Peru for the period 2010-2016. The standardized prevalence and mortality rates of CKD were descriptively reported using geospatial exploratory analysis. We also determined the association with social determinants of health according to the domains suggested by Healthy People 2020.
In the studied period, CKD prevalence increased by 300% and was associated with the health insurance coverage rate (β=5.9 95% CI 0.82 to 10.92), proportion of people with a secondary education level (β=11.4 95% CI 1.94 to 20.93), mean age (β=-10.7 95% CI -19.33 to -2.12), monetary poverty rate (β=-2.2 95% CI -3.88 to -0.60) and gross domestic product per capita (β=-63.2 95% CI -117.81 to -8.52). The standardized mortality decreased by 10% and was associated with mean age (β=-0.6 95% CI -1.22 to -0.06) and the proportion of people with a primary education level (β=-0.5 95% CI -0.9 to -0.05).
During the period 2010-2016, the prevalence of CKD increased and the mortality associated with CKD decreased. The observed changes were associated with some social determinants of health, such as increased health coverage and education. The health system of Peru must be prepared to take on the challenge.
Pulmonary embolism (PE) is a complication reported in the adult population with coronavirus disease 2019 (COVID-19); however, its documentation in the pediatric population is limiteda.
We report the ...case of a 15-year-old male with obesity and Down syndrome who was admitted for severe COVID-19 pneumonia. On day 7 of admission, he presented with chest pain, hemoptysis, respiratory distress, and marked elevation of D-dimer. Pulmonary CT angiography found an extensive thrombus in the right lower lobar artery. He received treatment with enoxaparin and rivaroxaban and had a favorable clinical outcome. In the tomographic control 1 month after treatment, thrombus was not evidenced and was successfully resolved.
There are few reports of PE in children with COVID-19. Prompt diagnosis and early anticoagulant treatment are important to avoid life-threatening complications.
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