ABSTRACT Objective To investigate the level of awareness of primary immunodeficiency diseases among physicians working at Instituto Nacional de Salud del Niño. Methods Cross-sectional study including pediatric residents and pediatricians working at the Instituto Nacional de Salud del Niño during the study period (2017-2019). Physicians working at the immunology unit and surgery departments were excluded. Three aspects of awareness of primary immunodeficiency diseases were investigated: education, general knowledge, and diagnostic suspicion and actions taken in the face of suspicion. Results This sample comprised 83 physicians with a median age of 33 years. Most physicians were women (71.1%) and half were pediatric residents. During their undergraduate studies, 43.1% had taken primary immunodeficiency disease courses, and 39.2% had attended conferences on this topic. During their residency training, 25.9% had taken primary immunodeficiency disease courses, and 60.3% had participated in conferences on this topic. Among pediatricians, 50% had taken primary immunodeficiency disease courses, and 53.1% had attended conferences on this topic. Only 39.8% of physicians reported being familiar with the list of 10 warning signs developed by the Jeffrey Modell Foundation. More than half of physicians considered the lack of access to laboratory tests the major challenge in making diagnosis of primary immunodeficiency diseases. Conclusion This study revealed limited awareness of primary immunodeficiency diseases among physicians working at Instituto Nacional de Salud del Niño. Although most physicians suspected primary immunodeficiency diseases in patients with a history of recurrent infections and frequent use of antibiotics, not all of them were familiar with the list of 10 warning signs proposed by the Jeffrey Modell Foundation, nor were they able to describe ancillary tests requested in suspected cases.

RESUMO Objetivo Investigar o nível de conscientização sobre imunodeficiências primárias entre os médicos do Instituto Nacional de Salud del Niño. Métodos Estudo transversal com todos os residentes de pediatria e pediatras que faziam parte do corpo clínico do Instituto Nacional de Salud del Niño quando o estudo foi realizado (2017-2019). Médicos atuantes na unidade de imunologia e nos setores de cirurgia foram excluídos. Foram estudados três aspectos da conscientização sobre imunodeficiências primárias: educação, conhecimento geral e suspeita diagnóstica e ações adotadas frente à suspeita. Resultados A amostra foi composta por 83 médicos com mediana de idade de 33 anos, em sua maioria mulheres (71,1%) e metade residentes em pediatria. Durante a graduação, 43,1% relataram participação em cursos sobre imunodeficiências primárias, e 39,2% participação em conferências relacionadas. Durante o programa de residência, 25,9% relataram participação em cursos sobre imunodeficiências primárias, e 60,3% participação em conferências relacionadas. Entre os pediatras, 50% relataram participação em cursos sobre imunodeficiências primárias e 53,1% participação em conferências relacionadas. Apenas 39,8% dos médicos declararam conhecer os 10 sinais de alerta propostos pela Fundação Jeffrey Modell. Mais da metade dos médicos considerou a falta de acesso a exames laboratoriais o principal desafio no diagnóstico das imunodeficiências primárias. Conclusão Este estudo revelou conscientização limitada sobre imunodeficiências primárias entre os médicos do corpo clínico do Instituto Nacional de Salud del Niño. Embora a maioria dos médicos tenha suspeitado de imunodeficiências primárias em pacientes com histórico de infecções recorrentes e uso frequente de antibióticos, nem todos conheciam os 10 sinais de alerta propostos pela Fundação Jeffrey Modell e nem todos foram capazes de descrever os exames complementares solicitados nos casos suspeitos.

Aim: To determine the associated factors with mortality of adult patients hospitalized with COVID-19. Methods: We conducted a prospective cohort study and included patients older than 18 years hospitalized with the diagnosis of SARS-CoV-2 infection. Those patients with a positive rapid serological test on admission, but no respiratory symptoms nor compatible images were excluded. We collected the data from clinical records. Results: A total of 813 adults were included, 544 (66.9%) with confirmed COVID-19. The mean age was 61.2 years (SD: 15.0) and 575 (70.5%) were male. The most frequent comorbidities were hypertension (34.1%) and obesity (25.9%). The most frequent symptoms on admission were dyspnea (82.2%) and cough (53.9%). A total of 114 (14.0%) patients who received mechanical ventilation, 38 (4.7%) were admitted to the Intensive Care Unit (ICU) and 377 (46.4%) died. The requirement for ventilatory support, greater lung involvement, comorbidities, and inflammatory markers were associated with mortality. It was found that for every 10 - year increase in age, the risk of dying increased by 32% (RR: 1.32 95% CI: 1.25 to 1.38). Those who required admission to the ICU and mechanical ventilation had 1.39 (95% CI: 1.13 to 1.69) and 1.97 (95% CI: 1.69 to 2.29) times the risk of dying compared to those who did not. Conclusion:  We found a high mortality rate in hospitalized patients associated with greater age, more elevated inflammatory markers, and more severe respiratory compromise.

Objetivos. Determinar los factores asociados a mortalidad de los pacientes adultos hospitalizados con COVID-19 en un hospital de referencia de la seguridad social. Materiales y métodos. Se realizó un estudio de cohorte prospectivo. Se incluyó a pacientes mayores de 18 años hospitalizados con el diagnostico de infección por SARS-CoV-2 y se excluyó a quienes ingresaron asintomáticos respiratorios, con prueba rápida serológica positiva al ingreso y sin imágenes compatibles. Los datos se recolectaron a partir de la historia clínica. Resultados. Se incluyó un total de 813 adultos, 544 (66.9%) tuvieron COVID-19 confirmado. La media de la edad fue de 61.2 años (DE: 15.0) y 575 (70.5%) fueron de sexo masculino. Las comorbilidades más frecuentes fueron hipertensión arterial (34.1%) y obesidad (25.9%). Los síntomas más frecuentes al ingreso fueron disnea (82.2%) y tos (53.9%). Un total de 114 (14.0%) pacientes recibieron ventilación mecánica, 38 (4.7%) ingresaron a UCI y 377 (46.4%) fallecieron. El requerimiento de soporte ventilatorio, el mayor compromiso pulmonar, las comorbilidades y los marcadores inflamatorios se asociaron a la mortalidad. Se halló que por cada 10 años que aumenta la edad, el riesgo de morir se incrementa en 32% (RR: 1.32 IC95%: 1.25 a 1.38). Aquellos que requirieron ingreso a UCI y ventilación mecánica tuvieron 1.39 (IC95%: 1.13 a 1.69) y 1.97 (IC95%: 1.69 a 2.29) veces el riesgo de morir, respectivamente. Conclusión. La mortalidad encontrada en nuestro estudio fue alta y estuvo asociada a la edad,  marcadores inflamatorios y compromiso respiratorio. 

Introduction: According to the millennium development goals, our country must reduce maternal mortality rate in 75%, and the Strategic National Action Plan for Reduction of Maternal and Perinatal Mortality considers reducing the possibilities of complications during pregnancy, labor and puerperium by recognizing the danger signs during pregnancy. Objectives: To determine the level of knowledge and practices on danger signs in pregnant women. Design: Descriptive study. Setting: Hospital Nacional Docente Madre-Niño San Bartolome, Lima, Peru. Patients: Pregnant women in hospitalization and outpatient consultation during June 2013. Interventions: A survey was administered to evaluate knowledge and practices on danger signs during pregnancy. Chisquare test bivariate analysis was used; odds ratio assessed association strength. Main outcome measures: With/without knowledge and practices. Results: Knowledge: 93% of patients considered danger signs as an indicator of risk for both mother and fetus; 100% knew that they should immediately go to a health care center if they showed any of the danger signs. Practices: Patients attended the health care center when they presented seizures (100%), small abdominal growth according to gestational age (100%), dysuria (86.1%), vaginal bleeding (84.4%) and fever (84.2%). Conclusions: The majority of patients considered danger signs as a risk and in case of presenting any of these, they knew they should attend a health care center immediately and they would do it. Further studies are recommended to determine why even when knowing danger signs some women do not go to a health center in time.

Introducción: De acuerdo a los objetivos del milenio, nuestro país debe reducir la mortalidad materna en 75%. El Plan estratégico nacional para la reducción de la mortalidad materna y perinatal considera reducir las posibilidades de complicaciones durante el embarazo, parto y puerperio. Esto es posible mediante la identificación de los signos de alarma. Objetivos: Determinar el nivel de conocimientos y prácticas sobre signos de alarma en gestantes. Diseño: Estudio descriptivo transversal. Lugar: Hospital Nacional Docente Madre-Niño San Bartolomé, Lima, Perú. Pacientes: Gestantes en hospitalización y consulta externa, durante junio del 2013. Intervenciones: Encuesta sobre conocimientos y prácticas de los signos de alarma durante la gestación. Se realizó análisis bivariado utilizando la prueba de chi cuadrado; la fuerza de asociación se calculó con odds ratio. Principales medidas de resultados: Con/ sin conocimientos y prácticas Resultados: Conocimientos: 93% de las gestantes consideró los signos de alarma como indicadores de peligro para la madre y el feto; el 100% sabía que debe acudir a un centro de salud de inmediato. Prácticas: Los signos por los cuales la mayor proporción de gestantes acudió a emergencia fueron convulsiones (100%), no crecimiento de barriga conforme a la gestación (100%), ardor al orinar (86,1%), sangrado vaginal (84,4%) y fiebre (84,2%). Conclusiones: La mayoría de pacientes consideró a los signos de alarma como peligro; de presentarse algunos de estos signos, todas conocían que deben acudir a un centro de salud inmediatamente y siempre acudirían. Se requiere estudios cualitativos para determinar las causas por las cuales, a pesar del conocimiento, algunas gestantes no acuden a tiempo.