Brenda Caira-Chuquineyra

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.

Introduction: Hypercalcemia secondary to vitamin D intoxication is a rare condition resulting from inadequate prescription. It is characterized by nonspecific symptomatology and can produce severe neurological, muscular, gastrointestinal, renal, and cardiovascular manifestations. Clinical case: We describe the case of an 86-year-old woman with a history of vitamin D supplementation for three months after hip arthroplasty. The initial presentation was gastrointestinal symptoms and sensorimotor disturbance. Hypercalcemia was found upon evaluation. After ruling out the main organic causes, vitamin D intoxication was suspected, which was confirmed after testing for 25-hydroxyvitamin D levels. Correction of hypercalcemia was performed, and the patient had a favorable clinical evolution. Conclusion: It is important to consider vitamin D intoxication as a differential diagnosis of hypercalcemia in geriatric patients and to ensure adequate monitoring of the prescription of vitamin supplements.

We aimed to conduct a scoping review to assess the profile of retracted health sciences articles authored by individuals affiliated with academic institutions in Latin America and the Caribbean (LAC). We systematically searched seven databases (PubMed, Scopus, Web of Science, Embase, Medline/Ovid, Scielo, and LILACS). We included articles published in peer‐reviewed journals between 2003 and 2022 that had at least one author with an institutional affiliation in LAC. Data were collected on the year of publication, study design, authors' countries of origin, number of authors, subject matter of the manuscript, scientific journals of publication, retraction characteristics, and reasons for retraction. We included 147 articles, the majority being observational studies (41.5%). The LAC countries with the highest number of retractions were Brazil (n = 69), Colombia (n = 16), and Mexico (n = 15). The areas of study with the highest number of retractions were infectology (n = 21) and basic sciences (n = 15). A retraction label was applied to 89.1% of the articles, 70.7% were retracted by journal editors, and 89.1% followed international retraction guidelines. The primary reasons for retraction included errors in procedures or data collection (n = 39), inconsistency in results or conclusions (n = 37), plagiarism (n = 21), and suspected scientific fraud (n = 19). In conclusion, most retractions of scientific publications in health sciences in LAC adhered to international guidelines and were linked to methodological issues in execution and scientific misconduct. Efforts should be directed toward ensuring the integrity of scientific research in the field of health.

Background: The objective of this study was to estimate the prevalence of adolescent pregnancy among sexually active adolescents, and identify the factors associated with this problem. Methods: A population-based analytical cross-sectional study was conducted using pooled data from the Demographic and Family Health Surveys of Peru, 2015-2019. A total sample of 8850 adolescent girls aged 12 to 19 years who reported a history of sexual intercourse were included. To identify factors related to adolescent pregnancy, the study employed adjusted prevalence ratios (aPR) with 95% confidence intervals (95% CI). The aPR were obtained from a multivariable logistic regression model. Results: The prevalence of adolescent pregnancy among sexually active adolescents in Peru was 30.9% (95%CI: 29.4–32.4%). In the multivariable analysis; being 17-19 years (aPR: 1.48; 95%CI :1.33–1.64), being married or cohabitant (aPR: 4.01; 95%CI: 3.48–4.61) and belonging to the Quechua ethnicity group (aPR: 1.16; 95%CI: 1.07–1.25), were associated with a higher prevalence. Conversely, the following factors were associated with a lower prevalence of pregnancy: being employed (aPR: 0.81; 95%CI: 0.76–0.86), being currently studying (aPR: 0.43; 95%CI: 0.38–0.49), belonging to the second (aPR: 0.91; 95%CI: 0.85–0.97), third (aPR: 0.81; 95%CI: 0.74–0.89), fourth (aPR: 0.79; 95%CI: 0.69–0.91) and fifth (aPR: 0.59; 95%CI: 0.47–0.75) wealth quintile, initiating sexual relations in middle adolescente (aPR: 0.76; 95%CI: 0.69–0.83) or late adolescence (aPR: 0.40; 95%CI: 0.35–0.46), perceiving a future pregnancy as a problem (aPR: 0.77; 95%CI: 0.72–0.83) and having knowledge of the moment in the cycle when pregnancy can occur (aPR: 0.84; 95%CI: 0.77–0.92) Conclusions: Approximately three out of ten adolescents who initiated a sexual life had at least one pregnancy. Age, marital status, employment, education, wealth, ethnicity, age at first intercourse, knowledge of when in the cycle she may become pregnant, and perception of future pregnancy were associated with adolescent pregnancy

Introducción. Los cursos en línea, masivos y abiertos, brindan la oportunidad de formar profesionales e investigadores en Latinoamérica sobre salud global.Objetivos. Determinar la oferta global de los cursos en línea, masivos y abiertos, sobre salud global y conocer las características de su contenido.Materiales y métodos. Se examinaron las plataformas especializadas en cursos en línea, masivos y abiertos, para recopilar aquellos sobre salud global. La búsqueda no tuvo restricción de tiempo y se realizó por última vez en noviembre de 2021. La estrategia de búsqueda solo incluyó el descriptor “global health”. Posteriormente, se obtuvieron las características del curso, su contenido y el dominio abordado de salud global. Estos datos fueron analizados descriptivamente, y se reportaron frecuencias absolutas y relativas. Resultados. La estrategia de búsqueda identificó 4.724 cursos en línea, masivos y abiertos. De ellos, solo 92 estaban relacionados con salud global. La mayoría de estos cursos (n=44; 47,8 %) se ofrecieron mediante la plataforma Coursera. Más de la mitad de los cursos (n=50; 54,4 %) fueron realizados por instituciones de Estados Unidos y en idioma inglés (n=90; 97,8 %). La mayor parte de los cursos se centró en la “globalización de la salud y la asistencia sanitaria” (n=24; 26,1 %), seguido de los dominios “fortalecimiento de capacidades” (n=16; 17,4 %), “carga global de enfermedad” y “determinantes sociales y ambientales de la salud” (n=15; 16,3 %).Conclusiones. Se encontró una importante oferta de cursos en línea, masivos y abiertos, sobre salud global. Estos cursos abordaron las competencias de la salud global que se requieren para los profesionales sanitarios.

IntroductionInformatics applied to health sciences has brought cutting -edge solutions to healthcare problems. However, the number of health professionals trained in "Health Informatics" is low. Virtual education, such as massive online open courses, provide the opportu-nity for training in this field.ObjectiveTo estimate the global offer of massive online open biomedical informatics courses and characterize their content.MethodsA search for massive online open courses was conducted throughout December 2021 on 25 platforms offering these courses. The search strategy included the terms "health informatics" and "biomedical informatics". The application areas of biomedical informat-ics, platform, institution, duration, time required per week, language, and subtitles available for each course were evaluated. Data were analyzed descriptively, reporting absolute and relative frequencies.ResultsOur search strategy identified 1333 massive online open courses. Of these, only 79 were related to health informatics. Most of these courses (n = 44; 55.7%) were offered through Coursera. More than half (n = 55; 69.6%) were conducted by U.S. institutions in english (n = 76; 96.2%). Most courses focused on areas of translational bioinformatics (n = 27; 34.2%), followed by public health informatics (n = 23; 29.1%), and clinical research informatics (n = 13, 16.5%).ConclusionsWe found a significant supply of massive online open courses on health informatics. These courses favor the training of more pro-fessionals worldwide, mostly addressing competencies to apply informatics in clinical practice, public health, and health research.

Introduction: Monkeypox has become a public health emergency given the rapid spread of the disease worldwide. Due to the high incidence of this disease in Peru and the poor knowledge about monkeypox among healthcare workers in non-endemic countries, it is crucial to determine the knowledge status of Peruvian physicians. Methodology: We conducted an analytical cross-sectional study based on an online survey from August to September 2022. Physicians who had a medical license and lived and practiced Medicine in Peru were included. To evaluate the factors associated with a higher level of knowledge, we used crude (cPR) and adjusted (aPR) prevalence ratios with 95% confidence intervals (95% CI) using Poisson regression. Results We included 463 physicians. The mean age was 36.6 (SD: 10.3) years, and most were male (58.1%). Regarding knowledge, the median knowledge score was 14 [IQR: 13 to 15] out of 17 points. In terms of knowledge gaps, only 60.7% of the participants knew that there was an FDA-approved vaccine for monkeypox, 49.0% of participants knew about monkeypox proctitis and 33.3% acknowledged that it could be transmitted by the bite of an infected rodent. We found that taking care of patients with monkeypox (aPR: 1.39; 95% CI: 1.13 to 1.72) was associated with a higher knowledge (> p50) while living in the jungle (aPR: 0.61; 95% CI: 0.41 to 0.91) was associated with lower knowledge (< p50). Conclusions Our study showed a high level of knowledge about monkeypox among Peruvian physicians. However, educational campaigns may be necessary, especially for physicians from the jungle and those who do not have clinical experience in monkeypox.

Introducción: Toda investigación científica, incluyendo las tesis, requiere ser publicada en una revista científicas para que sea considerada como un aporte a la comunidad académica. Objetivos: Identificar las barreras y limitaciones para la publicación en revistas científicas indizadas de las tesis de pregrado de médicos recién egresados de universidades peruanas y determinar los factores asociados con la intención de publicarlas. Material y métodos: Estudio transversal realizado en 167 médicos que se graduaron en 2021 de siete universidades peruanas y respondieron un cuestionario en línea compuesto por tres secciones (datos generales, barreras percibidas para la publicación de la tesis e intención para publicarla en una revista científica). Se calcularon razones de prevalencia crudas y ajustadas (RPa) mediante modelos de regresión de Poisson para identificar los factores asociados a la intención de publicación. Resultados: La tasa de respuesta del cuestionario fue de 39.6% (167 /422 médicos egresados en 2021). La mediana de edad fue 25 (P25-75= 24-27) años y el 55.09% de los participantes fueron mujeres. El 42.52% tenía intención de publicar su tesis de pregrado (28.74% reportó tener la intención, 11.38% estaba en proceso de publicarla y 2.40% ya la había publicado). Las barreras para la publicación de las tesis más comúnmente informadas fueron la falta de conocimientos sobre cómo realizar un envío a una revista científica (71.85%) y la falta de acceso a asesores con experiencia en investigación científica (68.26%). En el modelo de regresión de Poisson ajustado se observó que a mayor edad hubo una menor intención de publicación (RPa: 0.62; IC 95%: 0.51-0.75). Conclusión: La tasa de publicación de la tesis fue baja y menos de la mitad de los médicos tenían intención de publicarla. Las barreras para la publicación más comúnmente reportadas fueron la falta de conocimientos sobre cómo realizar un envío a una revista científica y la falta de acceso a asesores con experiencia en investigación. Tener mayor edad se asoció con una menor intención de publicar la tesis.