Roberto Shimabuku

Objective: To determine the incidence of central venous catheter-associated bloodstream infections (CVCABSIs) in the Pediatric Intensive Care Unit (PICU) of the Instituto Nacional de Salud del Niño (INSN) in Lima, Peru, from 2009 to 2019. Materials and methods: Retrospective longitudinal analytical study that evaluated patients under 18 years of age with CVC. BSI incidence rates per 1000 catheter-days were calculated. Results: CVC were inserted in 2269 patients. Forty-seven patients had BSIs. The average BSI incidence density was 2.14 per 1000 catheter days. The maximum peak was in 2010 at 5.49 per 1000 catheter days. Conclusions: Decreasing CVCABSIs per year were observed. It is necessary to keep the implementation of simple low-cost measures based on centralized evidence and supervised multidisciplinary work.

Se conoce poco sobre la visita al Perú en abril de 1920, hace 100 años, del Dr. Hideyo Noguchi y su contribución al estudio de la Enfermedad de Carrión o bartonelosis humana. Tal vez por ser una enfermedad casi exclusiva del Perú, aunque se han reportado casos en menor número en Ecuador y Colombia, sin tener repercusión internacional. Aun cuando su visita fue muy comentada por los diarios de la época, el tiempo han difuminado las actividades de la visita, cuyo objetivo era combatir un brote epidémico de fiebre amarilla en Paita. Permaneció tres semanas en Piura y una cuarta semana en Lima. Es en Lima que se enteró de la Enfermedad de Carrión y la controversia de que era una o eran dos enfermedades distintas (fiebre de La Oroya y verruga peruana). Un lustro después realizó numerosas investigaciones experimentales en New York contribuyendo a resolver la controversia.

The double burden of malnutrition is the coexistence of two different conditions, mainly reflected as excess or deficit in weight. Anemia is a specific nutritional deficit not always included in the double burden assessment. We reviewed overweight and/or obesity (OW/OB) and anemia studies from Latin-American Children over the last ten years up to 2019. Two authors evaluated the MEDLINE, SCOPUS, and LILACS databases. A scale of ten questions was used to assess the risk of bias in prevalence studies. Fourteen studies were selected. The population studies’ size ranged from 147 to 20,342 children with different socio-economic backgrounds, such as urban, peri-urban and rural settings, socio-economic status, schooling, population (ethnic minorities and indigenous), and environmental differences (sea level or high altitude). The prevalence of OW/OB ranged from 4.9% to 42%. The prevalence of anemia was from 3.4% to 67%. The double burden, including OW/OB and anemia, ranged from 0.7% to 67%. A higher prevalence of excess weight and anemia was found in rural and high altitude above sea level environments, extreme poverty, low education level, and indigenous communities. These heterogeneous data, before the 2020 (COVID-19 pandemic), reflect the vast inequities between countries and within each country. Food insecurity linked to poverty and the induced change in eating habits and lifestyles threaten optimal child nutrition in ongoing and future scenarios. The existence of OW/OB and anemia and their simultaneous coexistence in the community, home, and individual levels, indicates that interventions should be comprehensive to face the double burden of malnutrition.

The reported number of new cases underestimates the real spread of COVID-19 pandemic because of non-tested asymptomatic people and limited global access to reliable diagnostic tests. In this context, COVID-19 mortality with confirmed diagnosis becomes an attractive source of information to be included in the analysis of perspectives and proposals. Objective data are required to calculate the capacity of resources provided by health systems. New strategies are needed to stabilize or minimize the mortality surge. However, we will not afford this goal until more alternatives were available. We still need an effective treatment, an affordable vaccine, or a collective achievement of sufficient immunity (reaching up to 70% of the whole population). At any time, the arriving waves of the pandemic are testing the capacity of governments. The health services struggle to keep the plateau in a steady-state below 100 deaths per million inhabitants. Therefore, it is necessary to increase the alternatives and supplies based on the current and near-future expected demands imposed by the number of deaths by COVID-19. Estimating COVID-19 mortality in various scenarios with the gradual release of social constraints will help predict the magnitude of those arriving waves.

Introduction: Neonatal resuscitation demands equipment for respiratory support not always available in rural areas. Innovative devices are required, and rapid prototyping allows to generate them using three-dimensional (3D) designs and printers. Objective: To evaluate the non-clinical performance and the acceptability by health personnel of a neonatal respiratory device produced by rapid prototyping. Methods: Observational study, descriptive, of proof of concept developed in two steps. Step 1: Manufacture of the device with rapid prototyping in three-dimensional (3D) scanners and printers. Step 2: Demonstration of the invention during training programs in neonatal resuscitation for health personnel in three regions of Peru (Tarapoto, Huánuco and Ayacucho). In both steps, we evaluated the performance of the device connected to a gas flow analyser. A survey was administered to the health workers of Tarapoto and Ayacucho to know their acceptability. Results: The developed prototype is T-shaped with two side bellows that, when pressed with one hand, project air through the centre towards a facial adapter. The use of the prototype in the laboratory generated an average air flow of 4.8 Lt /min (SD ± 1.7) and an average pressure of 5.9 cmH2O (SD ± 1.4). This device was considered to be “very simple to use” in an acceptability survey involving 39 nurses and 11 doctors in remote areas of the capital of Peru. Conclusions: The evaluated prototype is acceptable by the staff and has a performance capable of generating spontaneous breathing at birth.

Mr. Editor, Quechua is the original language with the most users in Peru, with around 4 million speakers according to the 2007 census. It coexists with the Spanish language in many regions of the sierra, where it is the predominant language, and It is used daily by patients or users of health services. In the Faculty of Medicine of the National University of San Antonio Abad of Cusco, which began operating in 1980, Quechua is a compulsory course.87.1% of the graduates of the first eight promotions considered it important or very important to know that language1. Also, various publications in our environment, give an account of the importance of knowing native languages overcoming prejudices 2,3,4.

Background: Three-dimensional (3D) scanners have made it possible to measure and display body surface and shape with high precision. These are fast measurements with minimum discomfort, which is especially useful when children are involved. The objective was to assess the reliability and validity of a 3D-scanner for measuring unconventional torso parameters in children and adolescents. Methods: This is a sub-sample of the SAYCARE study, an observational multicentre research effort being conducted in six South American countries, aimed at developing methods to collect data on cardiovascular health biomarkers, lifestyles, and environmental, social and family risk factors. Images were captured using a portable scanner (iSense, Cubify, USA) attached to a Tablet 128Gb with OSX (Ipad-Air Apple, USA). Images were reshaped to exclude head, hair, arms and legs; area and volume were measured using 3D design software ((Rhinoceros for OSX, v5.02, USA). Results: The sub-sample for our study comprised 54 girls and 46 boys, aged 6 to 17 years old, from two private schools in Lima, Peru. Out of 100 participants, 82 were scanned twice. There was strong reliability (rho_c> 0.80) between first and second measurements of area and volume in boys of every age group. In girls, the reliability coefficient was moderate (rho_c> 0.70) only for area comparison in adolescents older than 10 years of age. The mean torso area was 0.55 m2 (SD 0.08) in girls and 0.63 m2 (SD 0.13) in boys. The overall mean torso volume was 24.4 l (SD 5.33) in girls and 31.47 l (SD 10.14) in boys. Area under ROC curve oscillates between 0.5707 and 0.6383 when volume/area ratio was compared to the selected “gold standard” (waist to height ratio > 0.5). Conclusion: Use of portable and low cost 3D-scanners provides a reliable but inaccurate alternative for area and volume torso measurements in children and adolescents.