Daniel Fernandez-Guzman

Our objective was to evaluate the frequency and characteristics of acute respiratory infections (ARI) with confirmed viral etiology in children treated at a Peruvian referral hospital before and during the COVID-19 pandemic between 2019 and 2022. We conducted a descriptive study based on the detection records of adenovirus, influenza A and B (IA and IB), parainfluenza 1-3 (PIV), metapneumovirus (hMPV), and respiratory syncytial virus (RSV). Of 1740 episodes (1220 patients), 14.4% tested positive: 196 (78.0%) RSV, 23 (9.2%) IA, 14 (5.6%) PIV-3, and 13 (5.2%) hMPV. In children under five years of age, RSV predominated, while in children over five years of age, it was IA. The frequency of ARI was lower with increasing age, during the pandemic (2020- 2021), and the spring and summer seasons. The higher frequency of respiratory viruses in 2022 highlights the need to maintain and strengthen surveillance and preparedness against these outbreaks.

To evaluate the clinical features, radiological findings, and mortality in patients with e-cigarette or vaping product use-associated lung injury (EVALI).

Electronic cigarette (e-cigarette) use is increasing globally, yet comprehensive prevalence data for Latin America and the Caribbean (LAC) remain limited. We conducted a meta-analysis to estimate the prevalence of e-cigarette use in the LAC region. A comprehensive search was performed in PubMed/Medline, Scopus, Web-of-Science, Embase, SciELO and Virtual-Health-Library, from inception to January 2025. We included observational studies reporting the prevalence of e-cigarette use in the general population of LAC. Pooled prevalence estimates and corresponding 95% confidence intervals (95%CI) were calculated using random-effects meta-analysis models. A total of 82 studies were included, comprising 46 primary studies and 36 reports from international tobacco-related surveys. Lifetime e-cigarette use was highest among adolescents, with a pooled prevalence of 12.5% (95%CI: 9.1%-17.0%; I²=99.5%), compared with 6.4% (95%CI: 2.8%-14.1%; I²=97.5%) in adults. Current e-cigarette use was also most prevalent among adolescents (6.7%; 95%CI: 5.5%-8.3%; I²=99.2%), compared with adults (1.5%; 95%CI: 0.8%-2.9%; I²=98.9%). Adolescent current use varied geographically, ranging from 1.4% (El Salvador) and 2.5% (Mexico) to 14.5% (Jamaica) and 17.2% (Trinidad and Tobago). Meta-regression analysis showed a significant increasing temporal trend in e-cigarette use, with prevalence rising by 0.10% per year (95%CI: 0.01-2.0; p = 0.047), independent of age group. Despite heterogeneity across countries, the prevalence of e-cigarette use in LAC is high, particularly among adolescents, and has increased significantly over time. These findings indicate that e-cigarette use represents a growing public health concern in the region, calling for strengthened regulation, targeted youth prevention, and continuous surveillance.

Background: Metabolic syndrome (MetS) is a common condition marked by abdominal obesity, insulin resistance, hypertension, and hyperlipidemia. It has significant health and economic impacts, highlighting the need for early predictive markers. Objective: To compare the prognostic performance of various obesity indices in the 1-year incidence of MetS among adult employees of a private educational institution. Design: Cohort study. Methods: A prospective cohort study was conducted using data from adults employed at a private educational institution in Lima, Peru. Participants were enrolled in 2019 and followed for 1 year to monitor anthropometric and biochemical parameters. The outcome was the development of MetS at the end of follow-up, defined according to the criteria of the Latin American Diabetes Association. Receiver operating characteristic curves were plotted, and the area under the curve (AUC) with 95% confidence intervals (CI) was calculated to assess the predictive utility of each index for MetS after 1 year. Results: Of the 792 adults initially enrolled, 475 were included in the final analysis after exclusions and loss to follow-up. Their average age was 38.4 years, and 54.3% were women. The overall incidence of MetS was 7.4%, with 12% for males and 4% for females. The highest AUC values for predicting MetS were observed for the body mass index (AUC: 0.88; 95% CI: 0.84–0.92), waist-to-height ratio (WHtR; AUC: 0.89; 95% CI: 0.85–0.92), abdominal volume index (AVI; AUC: 0.89; 95% CI: 0.86–0.92), and body roundness index (BRI; AUC: 0.89; 95% CI: 0.85–0.92). In sex-stratified analyses, results were consistent for males. Among females, the body adiposity index also showed good discrimination (AUC: 0.91; 95% CI: 0.83–1.00). The wide 95% CI reflects the small number of incident MetS cases among women ( n = 10) and should be interpreted with caution. Conclusion: In conclusion, the incidence of MetS after 1 year of follow-up was 7.4%, with a higher rate among males. The WHtR, BRI, and AVI were the most useful anthropometric indices for predicting MetS.

Background: Depression is a major public health concern, and understanding its symptom structure can improve assessment and treatment. Network analysis offers a novel approach to examine the relationships between depressive symptoms and identify core symptoms. Aim: this study aimed to evaluate the structure and dynamics of the depressive symptom network in the Peruvian population using network analysis methodologies and to assess its evolution across different years. Methods: This study utilized data from 119,909 Peruvian adults collected between 2019 and 2022. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Network analysis was employed to examine symptom interconnections and their evolution over time. Results: The depressive symptom network showed high stability across the 4 years, with “feeling down, depressed, or hopeless” (PHQ-9 item 2) consistently emerging as the most central and interconnected symptom. Conclusion: The stability of the depression network and the centrality of specific symptoms suggest potential targets for interventions aimed at improving the assessment and treatment of depression in Peruvian adults.

Objective: To evaluate the effects of incobotulinumtoxinA (incoBoNT‐A) in children and adolescents with spastic cerebral palsy (CP). Literature survey: CP is a leading cause of childhood disability, with spasticity present in >90% of cases. BoNT‐A is widely used to manage spasticity, improving function and quality of life. IncoBoNT‐A, a highly purified BoNT‐A formulation, offers reduced immunogenicity and greater stability across storage conditions. Although previous reviews have evaluated BoNT‐A in CP, none have focused specifically on incoBoNT‐A. Methodology: For this systematic review, we searched databases and trial registries through February 2025 for randomized controlled trials (RCTs) comparing incoBoNT‐A with placebo, other BoNT‐A formulations, or different doses in patients ≤18 years with spastic CP. Meta‐analyses used random‐ or fixed‐effects models; evidence certainty was rated with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Synthesis: We included four RCTs. IncoBoNT‐A showed very uncertain effects compared to onabotulinumtoxinA (onaBoNT‐A) on spasticity, gait, and adverse events. Higher doses of incoBoNT‐A (≥6 units/kg) showed minimal improvement in spasticity (mean difference: −0.19, 95% confidence interval [CI]: −0.36 to −0.01; moderate certainty) compared to lower doses (≤4 units/kg), with no meaningful differences in motor function, global impression of change, or adverse events. Certainty ranged from moderate to very low. Conclusions: The available evidence is insufficient to determine whether incoBoNT‐A offers any advantages or disadvantages compared to onaBoNT‐A in children with spastic CP, given the very low certainty of the data. Similarly, using a higher dose of incoBoNT‐A is unlikely to yield a meaningful clinical benefit compared to a lower dose. Further high‐quality trials are needed to reduce uncertainty and guide clinical decision‐making.

Introduction: Fever of unknown origin (FUO) in people living with HIV presents a significant diagnostic challenge due to its broad range of potential aetiologies. Objective: The aims of this study were to evaluate the prevalence of different aetiologies causing FUO in people living with HIV through a systematic review and meta‐analysis. Additionally, we assessed the prevalence of FUO and its associated mortality. Methods: We searched PubMed/Medline, Scopus, Web of Science, Embase and the Virtual Health Library, up to September 2024. We included observational studies that evaluated the aetiology, prevalence and mortality of FUO in people living with HIV. We performed meta‐analyses using a random‐effects model to estimate the pooled effects for each outcome. Risk of bias was performed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Studies Reporting Prevalence Data. Results: A total of 1678 studies were screened, of which 23 studies comprising 1592 people living with HIV were included. The pooled prevalence of FUO was 9.7% (95% confidence interval [CI]: 4.7%–16.3%; I ² = 99%). FUO prevalence varied across continents, with higher rates in Asia (21.8%) and South America (17.1%) than in Europe (8.9%) and North America (8.5%). The pooled mortality rate was 15.2% (95% CI: 5.6%–28.2%; I ² = 92%), with long‐term follow‐up studies reporting higher mortality (≥24 months: 63.0%). Bacterial infections were the leading cause of FUO (49.2% [95% CI: 40.8%–57.6%]; I ² = 92%), followed by fungal infections (11.8%), non‐haematologic cancers (2.1%) and rheumatologic diseases (1.5%). Tuberculosis was the most prevalent aetiology (27.6%), followed by nontuberculous mycobacteria (13.4%), leishmaniasis (10.1%) and pneumocystis pneumonia (6.6%). Other common causes included non‐Hodgkin's lymphoma (6.3%), histoplasmosis (4.7%), cytomegalovirus (4.6%) and cryptococcosis (4.1%). Conclusion: Infections remain the predominant cause of FUO in people living with HIV, with significant heterogeneity among studies. The findings underscore the need for region‐specific diagnostic approaches and early intervention to reduce mortality in this population.

Objective: To evaluate the benefits and harms of Dupilumab in children and adolescents with moderate to severe asthma. Methods: We conducted a systematic search in Medline, Embase, Cochrane Controlled Register of Trials, and Clinical Trials Registries up to August 18, 2024. Whenever possible, we performed meta‐analyses of the studies. The certainty of the evidence for each outcome was assessed using the GRADE methodology. Results: Seven publications from two multicenter RCTs were included. These studies included 408 children (6−11 years old) and 134 adolescents (12−17 years old). Both studies were funded by the pharmaceutical company that manufactures Dupilumab. The evidence suggests that Dupilumab probably leads to a substantial reduction in the annual rate of severe exacerbations (incidence rate ratio [IRR]: 0.46, 95% CI: 0.31−0.67; moderate certainty), particularly in children with a Th2 phenotype. Dupilumab probably improves quality of life to a clinically meaningful extent (RR: 1.18, 95% CI: 1.01−1.29; moderate certainty). However, it probably does not lead to a substantial improvement in asthma control (mean difference: −0.43, 95% CI: −0.56 to −0.30; two studies; moderate certainty; minimal‐important‐difference: 0.5). The frequency of serious adverse events may be similar between Dupilumab and placebo (4.8% vs. 4.5%; RR: 1.05, 95% CI: 0.41–2.68; low certainty). Finally, at 52 weeks, Dupilumab lead to an important increase in the Z ‐score pre‐BD FEV1/FVC (RR: 1.45, 95% CI: 1.22–1.63; high certainty). Conclusion: In children and adolescents with uncontrolled moderate to severe asthma, particularly those with a Th2 inflammatory phenotype, the use of Dupilumab probably reduced the annual rate of severe exacerbations, increases both the percentage of children with good quality of life and pulmonary function parameters, with probably minimal serious adverse events.

Introducción: El presente artículo resume la guía de práctica clínica (GPC) para el manejo de pacientes con carcinoma hepatocelular (CHC) en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el manejo de pacientes con CHC en EsSalud. Materiales y métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos, el cual formuló preguntas clínicas. Se realizaron búsquedas sistemáticas de revisiones sistemáticas y –cuando fue considerado pertinente– estudios primarios en PubMed durante el 2024. Se seleccionó la evidencia para responder cada una de las preguntas clínicas formuladas. Se evaluó la certeza de la evidencia usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y los flujogramas. Finalmente, la GPC fue aprobada con Resolución N° 53-IETSI-ESSALUD-2024. Resultados: La GPC abordó 8 preguntas clínicas de manejo de pacientes con CHC. En base a dichas preguntas se formularon 9 recomendaciones (8 condicionales, 1 basada en un Dictamen Preliminar de Evaluación de Tecnología Sanitaria), 12 puntos de buena práctica clínica, y 1 flujograma. Conclusión: Se emitieron recomendaciones basadas en evidencia para el manejo de pacientes con CHC.

Background: Despite the growth of physical medicine and rehabilitation (PM&R) in recent years, the same cannot be said for its workforce conditions. Although various issues regarding the reality of the physiatry workforce have been reported, no studies were found that have evaluated it in Peru. Objective: To assess characteristics, proficiency profile, and specialty perceptions of Peruvian physiatrists. Design: Cross‐sectional survey, designed and validated by the Peruvian Society of PM&R. Setting: Online anonymous and voluntary questionnaire. Participants: One hundred five Peruvian physiatrists. Interventions: During August 2023, after approval from the ethics committee, a Google Forms questionnaire was shared with the participants via WhatsApp, providing information about study details. Responses were monitored through direct communication with each participant. Main Outcome Measures: Twenty‐four questions covering sociodemographic data, training‐related characteristics, work‐related characteristics, proficiency perceptions, and specialty perceptions. Results: Most surveyed physiatrists were females (80%) and completed residency between 2017 and 2022 (46.7%). Only 2.8% had pursued a subspecialty fellowship; 41.9% were involved in teaching and easily found employment after residency. Most worked in the public sector (82.9%) and had a permanent employment status under the 728 regime (33.3%). Most reported having much proficiency (Level 3) in all competency domains. Mastery in ultrasound (US) (10.2%) and electrodiagnostic medicine (EDX) (4.1%) was reported mainly by those completing residency between 2017 and 2022. Only 2.9% reported ability to conduct scientific research. Overall satisfaction with the specialty was high (75.2%). Conclusions: The survey found that most of surveyed Peruvian physiatrists worked in the public sector, had permanent employment status, considered themselves highly proficient in all evaluated domains, reported low mastery in US and EDX, and were very satisfied with the specialty. Given the lack of literature, these findings provide valuable insights for policymakers and educators, highlighting key areas for improving conditions for the physiatry workforce.