Universidad Peruana Cayetano Heredia

Evidence-based program registries (EBPRs) are essential tools in prevention science, providing structured evaluations of intervention effectiveness to guide policymakers and practitioners. While established registries such as Blueprints for Healthy Youth Development and Xchange have been instrumental in cataloging evidence-based programs, Latin America has lacked a region-specific repository tailored to its unique prevention challenges. Evidencia Viva was developed to address this gap by systematically assessing and classifying substance use prevention programs implemented and evaluated in Latin America. The initiative draws from established EBPR models, employing rigorous inclusion criteria and a multidisciplinary expert review process to evaluate intervention efficacy. Programs are categorized into five tiers, ranging from beneficial to potentially harmful, ensuring that decision-makers have access to transparent and reliable information. The registry’s initial assessments include interventions from Brazil, Chile, Colombia, Guatemala, Mexico, Peru, and Uruguay, highlighting both effective and ineffective programs. Notably, programs like Unplugged and Keepin’ It REAL have demonstrated positive impacts, while others, such as PROERD (the Brazilian adaptation of DARE) and #Tamojunto, have shown limited or even negative effects. Despite its potential to strengthen evidence-based prevention in the region, Evidencia Viva faces challenges, including the limited number of rigorously evaluated programs, disparities in research capacity across Latin American countries, and the need for sustained funding to ensure long-term viability. Evidencia Viva contributes to the accessibility and dissemination of validated interventions, supporting informed policymaking and more effective substance use prevention strategies. However, ensuring its sustainability will require continued investment in research capacity, funding, and regional collaboration.

Background The Woven EndoBridge (WEB; Terumo) device has gained increasing recognition for treating ruptured intracranial aneurysms (RIAs) due to its ability to disrupt flow with a single implant, avoiding long-term dual antiplatelet therapy. Despite multiple studies, a comprehensive synthesis of recent evidence remains lacking. This study addresses this gap through a systematic review and meta-analysis evaluating the WEB device’s safety and efficacy in RIA management. Methods A systematic search of EMBASE, MEDLINE, Scopus, Cochrane, and the Web of Science identified studies on WEB treatment for RIAs up to January 2025. Key outcomes included implantation success, rebleeding, occlusion, retreatment, good functional outcomes (mRS 0–2) at 90 days, morbidity, mortality, and complications. A single-arm proportion analysis was conducted under a random-effects model. Results Twenty-five studies with 1,065 patients (1,077 aneurysms) were included. The implantation success rate was 98.04%, and rebleeding occurred in 0.33% of cases. Adequate and complete occlusion at 12 months were 83.77% and 59.42%, respectively. Good functional outcomes at 90 days were 87.27%, with a retreatment rate of 7.54%. Procedure-related mortality and morbidity were 0.39% and 1.39%. The overall complication rate was 12.82%, with thromboembolic and hemorrhagic events in 4.55% and 1.05% of cases, respectively. Conclusion Our findings indicate that the WEB device is a safe and effective treatment for RIAs, offering high rates of adequate occlusion, good functional outcomes, and low complication rates. This evidence reaffirms the WEB device’s safety and efficacy, supporting its wider adoption in clinical use.

Background Caused by the parasite Trypanosoma cruzi, Chagas disease affects an estimated 7 million people globally. Diagnosis of Chagas disease in infants is urgently needed, as early detection allows for more effective treatment and reduced mortality. However, current diagnostics are inappropriate for effective detection in infants due to differences in the mechanism of disease in infants and the infant immune system, as well as lack of diagnostic sensitivity and loss to follow up. Studying peripheral biomarkers in urine can leverage physiological concentration in the bladder to increase yield of proteins secreted by pathogen, infected cells, or antigen processed by immune cells residing in different body sites. Principal findings We analyzed the urine of a cohort of infants who were congenitally infected with Chagas disease, using a method including affinity enrichment, mass spectrometry, and bioinformatics analysis to characterize the T. cruzi secreted peptidome. We identified 198 peptides specific for T. cruzi and analyzed them in light of their potential for diagnostic utility. Our protocol revealed that peptides of the hyper-mutating mucin-associated surface protein and trans-sialidase protein families could be identified in patient urine and can serve as diagnostic markers of disease. We developed antibodies against conserved regions of each protein and validated that these antibodies could be used to differentiate the urine of Chagas disease patients (N = 16 cases) from healthy controls (N = 19). By utilizing affinity enrichment sample preprocessing and anti-trans-sialidase and anti-MASP antibodies in tandem, we differentiated cases from controls with 87.5% sensitivity and 94.7% specificity. Conclusions/Significance Our work suggests that it is possible to detect Trypanosoma cruzi infection directly from a noninvasively collected fluid such as urine. A direct test in urine with this success rate would be well suited for rapid diagnosis in low-resource areas. Further studies to validate this approach are warranted.

Objective To estimate the social cost of nasal sequelae in patients with cleft lip and palate (CL/P) treated in a Peruvian university dental clinic. Methods This is a cross-sectional study. The sample consisted of thirty patients over 18 years of age with nasal sequelae due to CL/P. This study conducted a partial economic analysis from a social perspective, by using the following questionnaires: ENAHO-Peru to assess sociodemographic variables, the Instituto de Salud del Niño - San Borja care guidelines and its tariff schedule to estimate health care costs, the Rhinoplasty Outcome Evaluation (ROE) scale to assess quality of life about the nasal sequela, and the “willingness to pay” (WTP) technique to calculate the monetary cost of the sequela from the patients’ perspective. Costs in soles, where the exchange rate was: 1 USD = S/3.878. Results A total of 30 CL/P patients, who agreed to participate, were evaluated. Most of the patients were male (70.0%), aged 18–39 years (73.0%), single (93.4%), students (73.4%), and had secondary education (50.0%). Additionally, most were attended with Seguro Integral de Salud (46.7%), most had no daily income (50.0%), and the average quality of life score was 8.1. The highest direct cost reported was dental treatment (S/5756.89 ± S/359.22) and hospitalization (S/5013.60 ± S/880.15), statistically significant (p<0.05). The highest indirect cost was reported for absenteeism with a mean of 5288.6 ± 1280.23 (p<0.05). Regarding direct, indirect, and intangible costs in the treatment of nasal sequelae due to CL/P, the lowest median (S/6000.00) was found in intangible costs, with significant differences (p<0.05). Conclusion About half of the social cost (12,000 Peruvian soles = 3094 US dollars) was assumed by the patients, a prohibitive cost considering that most of them come from low socio-economic backgrounds.

Non-small cell lung cancer (NSCLC) accounts for 85% of lung cancer cases globally and most patients receive their diagnosis at advanced or metastatic disease stages. The use of tyrosine kinase inhibitors (TKIs) such as erlotinib (first-generation) and osimertinib (third-generation) to treat NSCLC is possible because of activating mutations in the epidermal growth factor receptor (EGFR). Although osimertinib has shown better results in recent trials, direct and updated comparisons with erlotinib, especially in combination regimens, are still limited. Background/Objectives: This study aimed to compare the efficacy and safety of osimertinib versus erlotinib, both as monotherapies and in combination, in treatment-naïve patients with advanced or metastatic EGFR-mutated NSCLC. Methods: A systematic review and network meta-analysis were conducted following PRISMA-NMA guidelines and registered in PROSPERO (CRD42025649761). PubMed, EMBASE, and Scopus were searched up to February 2025 for randomized controlled trials (RCTs) that compared erlotinib- or osimertinib-based regimens in previously untreated EGFR-mutated advanced NSCLC. Outcomes included overall survival (OS), progression-free survival (PFS), and grade ≥ 3 adverse events. A frequentist random-effects model was used, and treatments were ranked using p-scores. Results: Eleven RCTs (2341 patients) were included. Osimertinib, alone or with chemotherapy, resulted in significantly longer OS compared to erlotinib-based regimens (HR for OS vs. erlotinib: 1.59, 95% CI 1.09–2.31). All osimertinib and erlotinib regimens outperformed chemotherapy for PFS, but no statistically significant differences were observed between osimertinib and erlotinib. Severe adverse events were comparable, though osimertinib ranked highest for safety. The combination of osimertinib with chemotherapy achieved the highest p-scores for both OS and PFS. Conclusions: Osimertinib is associated with superior overall survival and comparable safety versus erlotinib-based strategies in first-line treatment of advanced EGFR-mutated NSCLC. These findings reinforce osimertinib as the preferred first-line option in this setting.

Background/Objectives: Syphilis, a chronic sexually transmitted disease caused by the spirochete Treponema pallidum subspecies pallidum (T. pallidum), is still endemic in low- and middle-income countries and has been resurgent for decades in many high-income nations despite being treatable. Improving our understanding of syphilis pathogenesis, immunology, and T. pallidum biology could result in novel measures to curtail syphilis spread, including new therapeutics, a preventive vaccine, and, most importantly, improved diagnostics. Methods: Using overlapping synthetic peptides spanning the length of the T. pallidum Tp0435 mature lipoprotein, an abundant antigen known to induce an immunodominant humoral response during both natural and experimental infection, we evaluated which Tp0435 linear epitopes are most significantly recognized by antibodies from an infected host. Specifically, we used sera from 63 patients with syphilis at different stages, sera from non-syphilis patients (n = 40), and sera longitudinally collected from 10 rabbits infected with either the Nichols or SS14 isolates of T. pallidum, which represent the model strains for the two known circulating clades of this pathogen, to further evaluate the use of this animal model for syphilis studies. Recognized amino acid sequences were then mapped to the experimentally determined Tp0435 structure. Results: Reactive epitopes in both serum groups mapped predominantly to the α-helix preceding Tp0435 soluble β-barrel and the loops of the barrel. Conclusions: In the current effort to improve current syphilis diagnostics, the peptides corresponding to these immunodominant epitopes could help develop epitope-based assays such as peptide-based ELISAs and lateral flow point-of-care tests to improve the performance of treponemal tests and expedite diagnosis in low-income settings, where the infection is still a significant concern for public health and access to facilities with laboratories equipped to perform complex procedures might be challenging.

Background Chronic subdural hematomas (cSDHs) are potentially life-threatening neurological conditions with an increasing incidence worldwide. However, comparative data on the different cSDH managements remain limited. Herein, we aimed to conduct a network meta-analysis comparing standalone embolization (EMB), surgery, EMB plus surgery (EMBSurgery), and observation, to provide further clarity. Method We systematically searched PubMed, Embase, Web of Science, and Cochrane Library for studies comparing at least two cSDH approaches between EMB, surgery, EMBSurgery, and observation. Primary endpoints included the need for reintervention, length of hospital stay, procedure-related complications, and mortality. Random-effects model was used to calculate mean difference (MD) and odds ratio (OR) under a 95% confidence interval (CI). Cost-effective analysis and subanalyses for the randomized studies were conducted. Results A total of 19 studies involving 23,996 patients were included. A significant reduction in reintervention was observed with EMBSurgery (OR 0.21, CI 0.04–0.79), while EMB showed a non-significant reduction (OR 0.41, CI 0.12–1.32), compared to surgery. EMBSurgery neither significantly increased hospital stay (MD 4.80, CI −0.435–11.4) nor yielded higher complications (OR 1.11, CI 0.49–2.36) compared to surgery. Indeed, lower mortality was observed in both groups (EMB: OR 0.61, CI 0.03–5.08; EMBSurgery: OR 0.41, CI 0.03–3.05) and procedural costs were not significantly higher for EMB and EMBSurgery compared to surgery (EMB: MD 32,000, CI –13,500–70,300; EMBSurgery: MD 16,200, CI –40,100–72,600). Subanalyses revealed significantly lower reintervention rates in the EMBSurgery group versus the surgery group (OR 0.34, CI 0.16–0.74; I2 0%). Conclusion EMB combined with surgery seems to reduce reinterventions in cSDH compared to surgery alone with non significant complications that need further analysis through randomized trials with longer follow-ups.

BACKGROUND AND OBJECTIVES Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain management in adults undergoing craniotomy for brain surgery, with several randomized clinical trials supporting their efficacy. However, concerns remain about their safety, particularly regarding the risk of postoperative bleeding because of cyclooxygenase inhibition. This study aimed to evaluate whether NSAIDs increase the risk of hemorrhagic complications after craniotomy for brain surgery when compared with non-NSAID approaches or placebo. METHODS A systematic search was conducted in PubMed, Scopus, Web of Science, and Cochrane databases to identify studies comparing NSAIDs with non-NSAID drugs for postoperative analgesia after craniotomy for brain surgery. End points were (1) all bleeding complications and (2) bleeding complications requiring surgical intervention. Subanalyses focused on randomized controlled trials (RCTs) and patients undergoing tumor resection. Risk ratios (RR) and risk difference (RD) with 95% CI were pooled using a random-effects model, and heterogeneity was assessed with the I ² statistic. RESULTS Seven studies (5 RCTs), including 2251 patients (1119 males; median ages ranging from 11 to 55 years), of whom 583 (25.9%) received NSAIDs, met the inclusion criteria. Surgical indications included tumor resection, aneurysm clipping, and microsurgery for brain arteriovenous malformations. No significant differences were observed between NSAID and non-NSAID groups for overall bleeding complications (RR: 1.05; 95% CI: 0.58, 1.93; I ² = 0%; RD: 0.31%; 95% CI: −1.46%, 0.84%) or bleeding complications requiring surgical intervention (RR: 1.27; 95% CI: 0.51, 3.16; I ² = 0%; RD: 0.03%; 95% CI: −0.90%, 0.97%). Similar results were found in the RCT-only and tumor resection subanalyses. CONCLUSION Our findings suggest that NSAIDs are a safe option for postoperative analgesia in patients undergoing craniotomy for brain surgery, because they do not significantly increase the risk of bleeding complications, including those requiring surgical intervention, compared with non-NSAID analgesics.

Objectives: To determine the activity of cefiderocol against 101 Peruvian Pseudomonas aeruginosa isolates. Methods: Carbapenem– and/or third- and fourth-generation cephalosporin–resistant P. aeruginosa clinical iso-lates were isolated in nine Peruvian health centres. Antibiotic susceptibility was established by automated meth-ods and/or disc diffusion (10 antimicrobial agents), colistin agar test (colistin) and microdilution (cefiderocol).The presence of blaPER, blaCTX-M, blaGES, blaKPC, blaIMI, blaIMP, blaNDM, blaOXA-23, blaOXA-24, blaOXA-48, blaOXA-58,blaVIM and oprD was established by PCR; blaCTX-M and oprD were sequenced. The levels of antimicrobial resistanceranged from 20.8% (colistin) to 97.0% (meropenem). Results: The MIC of cefiderocol ranged from ≤ 0.06 to 8 mg/L (one isolate). Cefiderocol resistance rates were 1.0%(according to the FDA and EUCAST) and 0% according to CLSI, whereas 14.9% and 1.0% of isolates were classifiedas cefiderocol-intermediate according to FDA and CLSI, respectively. CTX-M-131 and GES, and IMP and VIM werethe most frequent ESBLs and carbapenemases, respectively. The presence of oprD mutations was tested in 47 car-bapenem-resistant isolates, 23 with oprD-inactivating mutations as the sole underlying mechanism. Although nospecific association was found between the presence of ESBLs and carbapenemases with cefiderocol resistance,carbapenemase-producing isolates tended to present slightly higher cefiderocol MIC values. The cefiderocol-resist-ant isolate did not present ESBLs or carbapenemases, showing only an oprD-inactivating mutation. Conclusions: Cefiderocol showed excellent activity against P. aeruginosa, irrespective of the presence of ESBLsand/or carbapenemases. The high number of isolates bordering cefiderocol-resistant levels suggests theneed for cautious use and continuous surveillance of this antibiotic.

Background Intraoperative and postoperative hypotension are associated with myocardial injury/infarction, stroke, acute kidney injury, and death. Because of its prolonged duration, postoperative hypotension contributes more to the risk of organ injury compared with intraoperative hypotension. A prediction model for clinically important postoperative hypotension after noncardiac surgery is needed to guide clinicians. Methods We performed a secondary analysis of the Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study. Patients aged ≥45 yr who had inpatient noncardiac surgery across 28 centres in 14 countries were included. In 14 of the centres selected at random (derivation cohort), we evaluated 49 variables using logistic regression to develop a model to predict postoperative clinically important hypotension, defined as a systolic blood pressure ≤90 mm Hg, that resulted in clinical intervention. The postoperative period was defined from the Post-Anesthesia Care Unit to hospital discharge. We then evaluated its calibration and discrimination in the other 14 centres (validation cohort). Results Among 40 004 patients in VISION, 20 442 (51.1%) were included in the derivation cohort, and 19 562 (48.9%) patients were included in the validation cohort. The incidence of clinically important postoperative hypotension in the entire cohort was 12.4% (4959 patients). A 41-variable model predicted the risk of clinically important postoperative hypotension (bias-corrected C-statistic: 0.73, C-statistic in validation cohort: 0.72). A simplified prediction model also predicted clinically important hypotension (bias-corrected C-statistic: 0.68) based on four information items. Conclusions Postoperative clinically important hypotension may be estimated before surgery using our primary model and a simple four-element model. Clinical trial registration NCT00512109.

During the COVID-19 pandemic (2020-2023), governments around the world implemented an unprecedented array of non-pharmaceutical interventions (NPIs) to control the spread of SARS-CoV-2. From early 2021, these were accompanied by major population-wide COVID-19 vaccination programmes-often using novel mRNA/ DNA technology, although some countries used traditional vaccines. Both the NPIs and the vaccine programmes were apparently justified by highly concerning model projections of how the pandemic could progress in their absence. Efforts to reduce the spread of misinformation during the pandemic meant that differing scientific opinions on each of these aspects inevitably received unequal weighting. In this perspective review, based on an international multidisciplinary collaboration, we identify major problems with many aspects of these COVID-19 policies as they were implemented. We show how this resulted in adverse impacts for public health, society, and scientific progress. Therefore, we propose seven recommendations to reduce such adverse consequences in the future. HOW TO CITE: Quinn GA, Connolly R, ÓhAiseadha C, Hynds P, Bagus P, Brown RB, Cáceres CF, Craig C, Connolly M, Domingo JL, Fenton N, Frijters P, Hatfill S, Heymans R, Joffe AR, Jones R, Lauc G, Lawrie T, Malone RW, Mordue A, Mushet G, O’Connor A, Orient J, Peña-Ramos JA, Risch HA, Rose J, Sánchez-Bayón A, Savaris RF, Schippers MC, Simandan D, Sikora K, Soon W, Shir-Raz Y, Spandidos DA, Spira B, Tsatsakis AM and Walach H (2025) What Lessons can Be Learned From the Management of the COVID-19 Pandemic?. Int. J. Public Health 70:1607727. doi: https://doi.org/10.3389/ijph.2025.1607727

Purpose: The Pressure Cooker Technique (PCT) is an endovascular technique for brain arteriovenous malformations (bAVMs) that can minimize reflux and inadvertent embolization compared with conventional techniques, leading to a safer and more controlled embolization. This systematic review and meta-analysis aimed to assess the feasibility, safety, and efficacy of PCT for bAVMs. Methods: We searched PubMed, Embase, and Web of Science databases. Eligible studies included ≥ 4 patients employing PCT for bAVMs and reporting on clinical and angiographic outcomes. We used single-proportion analysis with 95% confidence intervals under a random-effects model to pool the data. Transvenous (TVE) and transarterial (TAE) approaches were analyzed separately. Results: Eight observational studies involving 168 patients, 106 treated by TVE and 62 by TAE, were included. The immediate complete obliteration rate was 97% (94%-100%) with TVE and 70% (38%-100%) with TAE. Procedure failure rate was 3% (0%-6%) and 0% (0%-3%) for TVE and TAE, respectively. Intracranial hemorrhagic complications were the most prevalent, with a 13% rate (3%-23%) in TVE. A good clinical outcome rate (Modified Rankin Scale ≤ 2) was 93% (82%-100%) in the TVE. Recurrence was 0% (0%-10%) in the TVE. The surgical retreatment rate was 11% (3%-19%) and 49% (36%-62%) in TVE and TAE, respectively. Conclusion: This systematic review and meta-analysis found that PCT is highly feasible, safe, and effective in treating bAVMs. Given the current evidence, PCT may be considered a valuable option for the treatment of high-grade bAVMs.

Objective To describe the differences in lipid profiles and other factors associated with fitness-for work assessments in workers in Peru according to job sector. Methodology This was an analytical cross-sectional study with secondary data analysis in an Occupational Health Clinic. The quantitative measures of the lipid profile (total cholesterol, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, very-low-density lipoprotein [VLDL] cholesterol and triglycerides) were analyzed descriptively and analytically compared between job sectors and other variables. Results Among 63940 medical registries, differences in all 5 indicators were significant in workers in the construction sector (HDL cholesterol p = 0.002, all other indicators p < 0.001), and workers in the other sectors had 3–4 significant indicators. Among the adjustment variables, there were differences between groups divided according to sex, age and type of preoccupational examination. Conclusion Lipid profile indicators were found to vary among workers according to job sector, sex and age.

Objective The Systemic Lupus International Collaborating Clinics Frailty Index (SLICC‐FI) as a predictor of quality of life (QoL) in patients with systemic lupus erythematosus (SLE) has not been evaluated longitudinally. We estimated the association of SLICC‐FI scores with future QoL in our prevalent Latin American Mestizo cohort. Methods Patients from a single‐center SLE cohort were included. Health‐related QoL was ascertained with the LupusQoL tool, and frailty was ascertained with the SLICC‐FI. Generalized estimating equations were performed, using each domain of the LupusQoL as an outcome in the subsequent visit, and the SLICC‐FI (as a continuous variable) in the previous visit. Alternative analyses were also conducted including the SLICC‐FI as a categorical variable. In both approaches, the multivariable models were adjusted for possible confounders (age at diagnosis, sex, socioeconomic status, ethnicity, Systemic Lupus Erythematosus Disease Activity Index 2000, SLICC/American College of Rheumatology damage index [SDI], disease duration at baseline, prednisone daily dose, antimalarial and immunosuppressive drug treatment, and the same domain of the LupusQoL in the previous visit). Results A total of 428 patients and 2,645 visits were included in this study, and they were observed for 4.71 ± 3.52 years. At baseline, the mean ± SD of disease duration, SDI scores, and SLICC‐FI scores were 7.2 ± 6.6 years, 1.0 ± 1.3, and 0.17 ± 0.05, respectively. In the main analysis, after adjusting for possible confounders, higher SLICC‐FI scores predicted a higher LupusQoL score in the domains of pain, planning, emotional health, and fatigue. In the alternative analyses, after adjustment, the frail and least fit categories were predictive of higher LupusQoL scores in the domain of fatigue, and frailty (SLICC‐FI score of >0.21) predicted worse body image compared with least fit (SLICC‐FI score 0.03–0.10). Conclusion Higher SLICC‐FI scores predicted worse health‐related QoL as measured by higher LupusQoL scores from patients from the Almenara lupus cohort. Our findings reinforce the prognostic value of this tool in patients with SLE. image