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Introduction. The severity and prevalence of cancer-related malnutrition vary among different cancer types. This study assessed malnutrition frequency in older adults (≥60 years) based on specific cancer types. Material and methods. An observational, retrospective, case-control study reviewed electronic reports, with (cases) and without cancer (control) patients. Malnutrition was defined using the Mini Nutritional Assessment Short Form (MNA-SF). Results. Malnutrition prevalence was 31.5% in cases and 13.2% in controls (p < 0.001), with an odds ratio (OR) of 3.0; 95% CI: 2.0-4.5; p < 0.001. The highest malnutrition risk was associated with pancreatic cancer (OR: 47.2), followed by head and neck (OR: 18.2), esophagus and stomach (OR: 15.9), lung (OR: 13.3), bile ducts (OR: 18.2), and colorectal (OR: 4.2) cancers (p < 0.001). Conclusions. The prevalence of malnutrition varies by cancer type, with pancreatic, head and neck, esophagus, stomach, and lung cancers showing the highest risk. [ABSTRACT FROM AUTHOR]

Introduction: Warfarin is an anticoagulant whose efficacy depends on reaching and maintaining an INR (International Normalized Ratio) within therapeutic ranges. Up to 60% of interindividual dose-response variability can be explained by pharmacogenes, in this regard there are no studies in Peru. We studied the effect of the CYP4F2 gene on the dose of warfarin in Peruvian patients. Material and Methods: A descriptive and ambispective observational study was carried out with patients seen in the Grau ESSALUD Hospital Hematology Service, Lima, Peru, selected by non-probabilistic convenience sampling. The inclusion criteria were patients anticoagulated for more than three months and with stable doses of warfarin (same dose for at least three outpatient visits and with an INR in therapeutic ranges of 2.5-3.5). Analysis of the CYP4F2 gene was performed by taking a DNA sample from peripheral blood. Results: 70 patients with a mean age of 69.6 + 13.4, male 38 (54.39%) and female 32 (45.7%) entered the study. The mean dose of warfarin was 31.6 + 15.2 mg/week. The genotypic frequency of the CYP4F2 gene, rs2108622 variant (C>T) was 55 (78%), 13 (19%) and 2 (3%) of CC, CT, TT, respectively. No deviation from the Hardy-Weinberg equilibrium was found in the variants studied (p=0.56). Mean warfarin doses/week of the CC, CT, TT genotypes were 30.34 + 11.98; 36.4 + 25.6 and 36.25 + 1.8 mg/week, respectively (p=0.397). Conclusion: In conclusion, it appears that CYP4F2 gene genotypes do not have a significant effect on warfarin dose. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to investigate the association between VKORC1 and CYP2C9 genes polymorphisms and the maintenance dose of warfarin in Peruvian patients. Methods: An observational study was conducted on outpatients from the Hospital Grau ESSALUD in Lima, Peru. The participants were selected using nonprobabilistic convenience sampling. Inclusion criteria required patients to have been on anticoagulation therapy for >3 months, maintain stable doses of warfarin (consistent dose for at least 3 outpatient visits), and maintain an international normalized ratio within the therapeutic range of 2.5–3.5. DNA samples were obtained from peripheral blood for gene analysis. Results: Seventy patients (mean age of 69.6 ± 13.4 years, 45.7% female) were included in the study. The average weekly warfarin dose was 31.6 ± 15.2 mg. The genotypic frequencies of VKORC1 were as follows: 7.1% (95% confidence interval, 2.4–15.9) for AA; 44.3% (32.4–56.7) for GA; and 48.6% (36.4–60.8) for GG. No deviation from the Hardy–Weinberg equilibrium was observed in the variants studied (P =.56). The mean weekly warfarin doses for AA, GA and GG genotypes were 16.5 ± 2.9, 26.5 ± 9.5 and 37.9 ± 17.1 mg, respectively (P <.001). The genotypic frequencies of CYP2C9 were as follows: 82.8% (72.0–90.8) for CC (*1/*1); 4.3% (1.0–12.0) for CT (*1/*2); and 12.9% (6.1–23.0) for TT (*2/*2). We did not find a significant association between the CYP2C9 gene polymorphism and the dose of warfarin. Conclusions: The AA genotype of the VKORC1 gene was associated with a lower maintenance dose of warfarin in Peruvian patients. [ABSTRACT FROM AUTHOR]

Background: With the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic posing a global health emergency, selfmedication with ivermectin has been observed in certain Latin American countries. This study aimed to characterize the clinical features of liver injury associated with ivermectin when used as self-medication for treating coronavirus disease 2019 (COVID-19). Materials and Methods: We reviewed the clinical records of patients diagnosed with severe COVID-19 at the Emergency Room of Rebagliati Hospital in Lima, Peru, in March 2021. The criteria of the Drug-Induced Liver Injury (DILI) Expert Working Group and the Council for International Organizations of Medical Sciences/Roussel Uclaf Causality Assessment Method (CIOMS/RUCAM) were utilized to establish the diagnosis of drug-induced liver injury and assess causality, respectively. Results: We report five cases of ivermectin-induced liver injury (IILI), comprising four men and one woman, with a mean age of 49.3±12.3 years. The mean daily dose, duration, and total dose of ivermectin were 32.9±21.8 mg/day, 2.6 ± 0.6 days, and 89.6±71.4 mg, respectively. On average, IILI occurred 11±3.8 days after the initiation of treatment, and none of the cases developed jaundice. The mean levels of alanine aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase were elevated 8±4.4, 1.7±0.9, and 10.9±5.0 times above the upper limit of normal, respectively. Two patients exhibited a hepatocellular pattern, two had a mixed pattern, and one displayed a cholestatic pattern. All cases were classified as mild and achieved recovery. Causality assessment categorized four cases as "possible" and one case as "highly probable.". Conclusion: The findings emphasize the need for further pharmacovigilance studies on IILI when used for COVID-19 treatment. [ABSTRACT FROM AUTHOR]

Introduction. The need for comprehensive geriatric assessment (CGA) in older adults with cancer is increasing, which makes it necessary to have a screening instrument to identify those who would benefit from this evaluation. This study aimed to investigate diagnostic performance of the Timed Up and Go test (TUG) for identifying vulnerable or frail older adults with cancer who might benefit from CGA. Material and methods. This observational and retrospective study took place at the geriatric center of Almenara Hospital in Lima, Peru We extracted CGA reports from electronic medical records of outpatients and inpatients aged 60 years and older with cancer, who were evaluated between November 2022 and July 2023. Patients were classified based on SIOG-2 (International Society of Geriatric Oncology) criteria as fit, vulnerable, or frail, based on scales including Activities of Daily Living (ADL), Instrumental ADL, Mini-Nutritional Assessment (MNA), Mini-Mental State Exam (MMSE), Geriatric Depression Scale, and Cumulative Illness Rating Scale-Geriatrics (CIRS-G). For the study, two groups were formed: fit patients and non-fit patients (vulnerable plus frail). We estimated sensitivity, specificity, and positive predictive values of the TUG test. The accuracy of the TUG test was analyzed using the area under the receiver operating characteristic curve (AUC). Results. Among the 283 included patients, 154 were men (54.4%) and 129 women (45.6%), and the mean age was 76.8 ± 15.8 years. The most common neoplasms were colorectal (19.4%), stomach (15.2%), prostate (9.9%), and bile duct cancers (8.1%). The percentage of fit and non-fit patients was 21.9% and 78.1%, respectively. When the TUG test was equal to or greater than 15.5 seconds, sensitivity, specificity, positive predictive value, and AUC were 68.5% (95% CI 61.9-74.5), 88.5% (77.8-95.3), 95.6% (91.1-98.2), and 84.8% (0.80-0.90), respectively. Conclusions. A TUG test result equal to or greater than 15.5 seconds demonstrated good screening properties for identifying older cancer patients who were vulnerable or frail and could benefit from CGA. [ABSTRACT FROM AUTHOR]

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Comprehensive geriatric assessment (CGA) is used to personalize cancer treatments in frail older adults. However, its utility to guide treatments in frail older patients with diffuse large B-cell lymphoma (DLBCL) is not well known. We performed a meta-analysis of evidence published in this area. Material and methods. We searched PubMed and Google Scholar for studies published between January 2000 and January 2023 that included patients aged ≥ 65 years with a diagnosis of DLBCL who underwent CGA before treatment (CGA-modulated studies) and who did not (non-CGA-modulated studies). We evaluated clinical outcomes in frail/unfit patients in terms of complete response (CR), incidence of grade ≥ 3 toxicity, and 2-year overall survival (OS) in both types of studies. Results. Fifteen studies [8 CGA-modulated (n = 733, median age 76, 54% male, 52% frail/unfit) and 7 non-CGA-modulated (n = 2447, median age 76, 52% male, 32% frail/unfit)] were included. In the CGA-modulated studies, the CR proportion of frail/unfit patients was 34% (95% CI 23–46%) vs. 28% (95% CI 19–38%) in the non-CGA-modulated studies (p = 0.436). Grade 3–4 hematological toxicity in frail/unfit patients was 26% (95% CI 5–55%) vs. 36% (95% CI 13–63%) (p = 0.583), respectively. Two-year OS of frail/unfit patients was 52% (95% CI 38–66%) vs. 27% (95% CI 19–36%) (p = 0.003), respectively. Conclusions. Although the proportion of frail/unfit patients was lower in non-CGA-modulated studies, CGA-modulated studies reported higher OS. CGA could be useful to guide the treatment plan in older patients with DLBCL. Randomized clinical trials with standardized CGA instruments are necessary to confirm these findings. [ABSTRACT FROM AUTHOR]

Introduction: Diffuse large B-cell lymphoma (DLBCL) is a common neoplasm in older people; in this group, personalized therapies are important because while some patients are frailer, others are fitter. However, knowledge is lacking as to which frailty identification tools are most commonly used in older patients living with DLBCL. The aim of this systematic review was to address this knowledge gap. Material and methods: We searched the PubMed, EMBASE, and Cochrane databases and Google Scholar for studies published before December 2022. We included studies conducted with DLBCL patients aged 60 years or older, where a frailty classification (i.e. fit, unfit, or frail) had been reported in the context of prognostication and/or personalization of treatment. Results: Sixteen studies were included in our review, with a total of 8,705 DLBCL patients (mean age 76 years, 54% men). Overall, 42% were classified as 'frail', and 40% as 'fit'. The most frequent frailty identification method was the Comprehensive Geriatric Assessment (CGA) (simplified: 75%, full: 13%), followed by the physical phenotype (6%) and the cumulative deficits index (6%) tools. The most common CGA domains utilized in the classification of frailty were the evaluation of basic activities of daily living (86%), instrumental activities of daily living (63%), comorbidities (81%), and geriatric syndromes (19%). Conclusion: Two in five DLBCL patients aged 60 years or older were classified as frail, and an almost equal proportion as fit, most commonly post-application of simplified CGA. More studies are required to validate specific frailty identification instruments in this population. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to conduct a meta-analysis of the frequency of isoniazid-induced liver injury (INH-ILI) in patients receiving isoniazid (INH) preventative therapy (IPT). Background: The frequency of hepatotoxicity (drug-induced liver injury: DILI) of antituberculosis drugs has been studied, especially when INH, rifampin, and pyrazinamide are co-administered. However, little is known about the frequency of DILI in patients with latent tuberculosis infection (LTBI), where IPT is indicated. Methods: We searched PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews for studies reporting the frequency of INH-ILI in patients with IPT using one or more diagnostic indicators included in the criteria of the DILI Expert Working Group. Results: Thirty-five studies comprising a total of 22,193 participants were included. The overall average frequency of INH-ILI was 2.6% (95% CI, 1.7-3.7%). The mortality associated with INH-DILI was 0.02% (4/22193). Subgroup analysis revealed no significant differences in the frequency of INH-ILI in patients older or younger than 50 years, children, patients with HIV, candidates for liver, kidney, or lung transplant, or according to the type of study design. Conclusion: The frequency of INH-ILI in patients receiving IPT is low. Studies on INH-ILI are needed where the current DILI criteria are used. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to review in VigiBase the reports of serious hepatic disorders associated with the use of ivermectin for COVID-19 in adults. Background: In the face of the global health emergency caused by SARS-CoV-2, ivermectin, among other drugs, has been repurposed in some Latin American countries to treat COVID-19. Studies are needed on the safety of ivermectin for this new indication. VigiBase is the WHO pharmacovigilance database that registers all individual case safety reports (ICSRs) from more than 130 countries. Methods: We extracted the ICSRs of men or women aged ≥ 18 years and dated between 1 January 2020 and 7 March 2021 which included an association with the use of ivermectin. Results: Of 1393 ICSRs associated with ivermectin, 60 (4.3%) were registered as "serious." Ivermectin had been used for COVID-19 in 25 of those cases. Among the latter, 6 experienced hepatic disorders (hepatitis, hepatocellular injury, cholestasis, increased alanine aminotransferase and/or aspartate aminotransferase levels, abnormal liver function tests). Conclusion: The safety of the use of ivermectin should be studied more exhaustively, especially as regards the possibility of hepatic disorders developing when the drug is used for COVID-19. [ABSTRACT FROM AUTHOR]

Background: There is caurrently great interest in establishing the relationship between the severity of SARS-COV-2 infection in hypertensive patients who use angiotensin II antagonists (AIIRAs). Objective: To study the relationship between the previous use of angiotensin II antagonists (ARB) in hypertensive patients and mortality from COVID-19. Materials and methods: A retrospective observational study was carried out in a tertiary care hospital in Lima, Peru, in hypertensive patients hospitalized in March 2021 for severe COVID-19. Results: A total of 101 patients entered the study, with a mean age of 70.1 + 12.0 and 48% male. ARB users and non-users were 45 (45.6%) and 56 (54.4%), respectively. The Charlson Comorbidity Index was higher in the ARB group (3.6 + 1.56 vs 3.04 + 1.24) (p<0.05). Total and male vs women mortality, among those using ARBs or not, were 57.8% vs 62% (p = 0.633) and 36.36% vs 63.64% (p <0.05), respectively. Mean lactate dehydrogenase concentration was lower in those taking ARBs compared to non-users, 394.18 + 152.3 vs 503.5 + 252.7 (p<0.05); No significant difference was observed in the leukocyte count and serum levels of C-Reactive Protein, Ferritin, D-dimer and fibrinogen. Conclusion: Among hospitalized COVID-19 patients with hypertension, prior use of ARBSs was not associated with mortality risk. [ABSTRACT FROM AUTHOR]

This study aimed to determine the relationship between ABO blood groups and mortality in patients hospitalized for severe SARS-CoV-2 infection. An observational and retrospective research was conducted in a tertiary care hospital in Lima, Peru. A total of 203 patients with a mean age of 62.58 ± 16.45 years were included in the research, out of whom 71.92 % were males. The frequency of O, A and B blood groups were 75.37 %, 17.24 % and 7.39 %, respectively. An association with mortality from severe COVID-19 infection was found with non-A blood groups (O group or B group), with a PR (prevalence ratio) of 2.25 and 95% CI (confidence interval) of 1.07 -- 4.71. When adjusting the main variables, the association with PR remained in 2.78 and 95% CI in 1.06 -- 7.24. In conclusion, patients hospitalized for severe SARS-CoV-2 infection with O and B blood groups seem to be associated with higher mortality rates than those with A blood group. [ABSTRACT FROM AUTHOR]

We are very close to completing two years since the start of the COVID-19 pandemic. Even though vaccines have been developed and applied to more than 4 billion people in the world, SARS-CoV-2 continues to be a challenge for humanity. Therefore, it is important to study modifiable risk factors that may increase the severity of COVID-19, and one of the most discussed has been vitamin D. Currently, there is some evidence of association between low serum 25-hydroxyvitamin D [25(OH)D3] and increased mortality and severity due to SARS-CoV-2 infection. Before the pandemic, experimental evidence in animal and human studies had reported that an acute inflammatory process can cause a secondary decrease in 25(OH)D3. COVID-19 can be associated with a severe inflammatory process with an elevation of inflammatory markers; in this light, the reported association between low 25(OH)D3 and COVID-19 severity and/or mortality may be an epiphenomenon of the inflammatory process induced by SARS-CoV-2 and be an example of reverse causality. [ABSTRACT FROM AUTHOR]

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To describe the clinical characteristics of drug-induced liver injury (DILI) in multidrug-resistant tuberculosis (MDR-TB) patients. Materials and methods: A retrospective study conducted in hospitalized patients with MDR-TB and DILI. The criteria of the DILI Expert Working Group were used for the diagnosis of DILI, and the RUCAM (Roussel Uclaf Causality Assessment Method) for the causality analysis. The specific association between DILI and antitubercular drugs was established by drug rechallenge or discontinuation and recovery. Results: Seven cases of MDR-TB and DILI are described in this research. The mean age (standard deviation) was 39.10 (3.30) years. Mean DILI occurred 30.40 (27.70) days after starting the treatment. Three (43.00 %) patients presented jaundice. Regarding the type of injury, four (57.00 %) had hepatocellular injury and three (43.00 %) cholestatic injury. Four patients showed mild DILI and three moderate DILI. All the patients had taken pyrazinamide (pyrazinamide alone: four patients; pyrazinamide and ethionamide: one patient; pyrazinamide, rifampin and isoniazid: one patient; pyrazinamide and rifampicin: one patient). The mean hospital stay was 48.10 (48.70) days. The mean serum alkaline phosphatase (AP), alanine aminotransferase (ALT) and gamma-glutamyl-transpeptidase (GGT) were 2.40 (1.10), 7.90 (7.10) and 5.60 (3.70) times the upper limit of normal (ULN), respectively. The mean total bilirubin was 2.30 (2.00), with a range of 0.50 to 6.40 mg/dl. As part of the discharge plan, quinolones were given to seven patients (levofloxacin: six patients; ofloxacin: one patient) and amoxicillin/clavulanic acid was added to one patient. Conclusions: MDR-TB patients may develop DILI after the first month of treatment. Hepatocellular injury was the most common type of liver injury, and pyrazinamide was the most frequently used antimycobacterial. [ABSTRACT FROM AUTHOR]

INTRODUCTION: There is experimental and clinical evidence that the serum concentration of 25-hydroxyvitamin D [25(OH)D)] may decrease in acute systemic inflammatory responses; in this context, low values may not necessarily indicate a pre-existing deficiency. This may also apply to low 25(OH)D levels found in the context of the systemic inflammatory response caused by SARS-CoV-2 infection. To conduct a systematic review of the relationship between serum 25(OH)D and the concentrations of C-reactive protein (CRP), interleukin 6 (IL-6) and tumour necrosis factor a (TNF-a) in acutely hospitalized patients with SARS-CoV-2 infection. MATERIAL AND METHODS: We searched PubMed, EMBASE, Google Scholar and the Cochrane Database of Systematic Reviews for studies published between January 2020 and February 2021. In each study, the authors compared levels of inflammatory markers between patients reported as having low levels of 25(OH) D and those above the study cut-off. RESULTS: 18 studies were included (n = 3482, mean age 63.5 ± 9.3 years, 56.9% men). The cut-off for the definition of low 25(OH)D varied across studies. In all studies, mean values for inflammatory markers were higher in the low 25(OH)D groups. These differences were statistically significant (p < 0.05) in 6/15 studies with CRP, 4/8 with IL-6 and 0/1 with TNF-α. CONCLUSIONS: Markers of acute systemic inflammatory response were elevated in patients with SARSCoV-2 infection and low concentrations of 25(OH)D. Therefore, the vitamin D status in those patients should be interpreted with caution, and studies should be designed to assess whether hypovitaminosis D could be an epiphenomenon. [ABSTRACT FROM AUTHOR]

Background: Hypertension and type 2 diabetes increase the risk of severe SARS-CoV-2 infection. On the other hand, homozygous ACE deletion polymorphism (DD) has been associated with these two diseases and risk of acute respiratory distress syndrome. The aim of the study was to conduct a meta-analysis of the association between ACE gene I/D polymorphism (DD, II and DI) and severity of SARS-CoV-2 infection in hospitalized patients. Material and methods: We searched PubMed, EMBASE and Google Scholar for studies published between January 2020 and April 2021. We included case-control studies evaluating the association between ACE I/D and severity of SARS-CoV-2 infection in hospitalized patients, were there was sufficient genotype or allele frequency data to calculate IRR (incidence rate ratio) and 95% confidence intervals (CIs). Results: Five studies were included (mean age 58.5 years and 61% men), combining to a total of 786 patients. Four studies were conducted in Caucasians. Overall, patients who had homozygous co-dominance genotype DD were at 47% higher risk of severe COVID-19 compared with II or ID (IRR: 1.47; 95% CI: 1.15-1.89; p = 0.002). Conclusions: The ACE DD genotype may confer a greater risk of severe COVID-19 in hospitalized patients. Further studies including more diverse ethnic groups are necessary to fully establish this association. [ABSTRACT FROM AUTHOR]

Background. It has been postulated that metformin could have anti-SARS-CoV-2 action. This raises the hypothesis that people who take metformin may have lower SARS-CoV-2 severity and/or mortality. Objectives. To conduct a meta-analysis of the association between the use of Metformin and risk of severity and mortality in SARS-CoV-2 infection. Methods. We searched PubMed, EMBASE, Google scholar, the Cochrane Database of Systematic Reviews and preprint servers (medRxiv and Research Square) for studies published between December 2019 and January 2021. Data was extracted on study location, year of publication, design, number of participants, sex, age at baseline, body mass index, and exposure and outcome definition. Effect statistics were pooled using random effects models with 95% confidence intervals (CI). The quality of included studies was assessed with the Newcastle-Ottawa Scale (NOS). Results. Thirty-two observational studies were included, combining to a total sample of 44306 participants. The mean NOS score of included studies was 7.9. Results suggested that metformin use was associated with a reduced risk of SARS-CoV-2 mortality (OR = 0.56, 95% CI: 0.46-0.68, P < 0.001; 22 studies) but not with disease severity (OR = 0.85, 95% CI: 0.71-1.02, P = 0.077; 15 studies). In the subgroup analysis, metformin reduces the risk of mortality (OR = 0.69, 95% CI: 0.55-0.88; P = 0.002) and severity (OR = 0.83, 95% CI: 0.70-0.97, P = 0.023) in patients aged 70 and above. Conclusions. The use of metformin was associated to lower risk of mortality from SARS-CoV-2 infection. This association does not imply causation and further research is required to clarify potential mechanisms. [ABSTRACT FROM AUTHOR]

Background: Epidemiological studies have shown an association between the ACE gene I/D polymorphism with arterial hypertension, specifically the DD genotype, in different populations. The objective of this study is to evaluate the association between ACE polymorphisms (Insertion, Deletion or I/D) and essential hypertension in a population of Lima, Peru. Material and methods: This is a study of cases (essential arterial hypertension) and controls, with determination of the ACE I/D genotype. Results: Cases (65) and controls (39) had a mean age (standard deviation) of 74.3 (7.9) and 72.6 (6.5) (p = 0.24). In cases, the genotype frequencies DD, ID, and II were 6 (9.2%), 28 (43.1%) and 31 (47.7%), respectively. In controls, the genotype frequencies DD, ID, and II were 6 (15.4%), 14 (35.9%) and 19 (48.7%). The Hardy-Weinberg equilibrium analysis in cases and controls was p = 0.93 and p = 0.23, respectively. No significant associations between genotype DD vs. ID + II (OR = 0.56, 95% CI: 0.17-1.87, p = 0.34) or II vs. DD + ID (OR = 0.95, 95% CI: 0.43-2.12, p = 0.92) and essential hypertension were found. Conclusions: The ACE I/D polymorphism was not associated with hypertension in our sample. [ABSTRACT FROM AUTHOR]

Background: The mechanism of entry of SARS-CoV-2 into the human host cell is through the ACE2 receptor. During the pandemic, a hypothesis has been proposed that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) could be risk factors for the development of severe SARS-CoV-2 infection. The objective of the study was to conduct a meta-analysis of the association between ACEI or ARB use and SARSCoV- 2 infection severity or mortality. Material and methods: We searched PubMed, EMBASE, Google scholar and the Cochrane Database of Systematic Reviews for observational studies published between December 2019 and August 4, 2020. Studies were included if they contained data on ACEI or ARB use and SARS-CoV-2 infection severity or mortality. Effect statistics were pooled using random-effects models. The quality of included studies was assessed with the Newcastle-Ottawa Scale (NOS). Data on study design, study location, year of publication, number of participants, sex, age at baseline, outcome definition, exposure definition, effect estimates and 95% CIs were extracted. Results: Twenty-six studies (21 cohort studies and 5 case-control studies) were identified for inclusion, combining to a total sample of 361467 participants. Mean age was 61.48 (SD 8.26) years and 51.63% were men. The mean NOS score of included studies was 7.85 (range: 7-9). Results suggested that ACEI or ARB use did not increase the risk of severe disease or mortality from SARS-CoV-2 infection (OR = 0.88, 95% CI: 0.75-1.02, p > 0.05). Conclusions: At present, the evidence available does not support the hypothesis of increased SARS-CoV-2 risk with ACEI or ARB drugs. [ABSTRACT FROM AUTHOR]

Background: Some studies have suggested that the insertion(I)/deletion(D) polymorphism of the Angiotensin-Converting Enzyme (ACE) gene may be associated with human longevity, especially in centenarians. However, this association is still controversial. Besides, there have been no studies in Peruvians. Aim: To describe the age distribution of the ACE polymorphism in a convenience sample of Peruvian older people. Subjects and methods: This was a cross-sectional study in 104 Geriatric Day Hospital patients in Lima, Perú. The ACE polymorphism was determined in all patients. For the purpose of association with age, the sample was divided into four categories: young (< 65), youngest-old (65–74), middle-old (75–84) and oldest-old (85 or more). Results: The distribution of genotype frequencies was consistent with a population in Hardy-Weinberg equilibrium (p = 0.62). The number (%) of D/D, I/D and I/I genotypes in the young was 2 (14.3%), 3 (21.4%) and 9 (64.3%), respectively; in youngest-old: 4 (11.4%), 15 (42.9%) and 16 (45.7%); in middle-old: 6 (12.2%), 20 (40.8%) and 23 (46.9%); and in oldest-old: 0 (0.0%), 4 (66.7%) and 2 (33.3%). A chi-square analysis showed no significant differences in genotype distribution between age groups (p = 0.647). Conclusion: No significant age differences were found in the distribution of the ACE polymorphism in this sample. Further studies with greater statistical power are recommended. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the nutritional status as a predictor of mortality in elderly people with gastric cancer. Materials and methods: An observational, prospective and analytical study which included 47 patients over 60 years of age with a diagnosis of gastric cancer, referred to the geriatric department of the Hospital Nacional Guillermo Almenara from March 2014 to October 2015. The Body Mass Index (BMI) and the Mini Nutritional Assessment Short-Form (MNA-SF) were used to evaluate the patients. Results: Forty-seven (47) patients with a diagnosis of gastric cancer were included: 33 (70.2 %) were males, and the mean age was 75.52 (SD +/- 6.88) years for males and 77 (SD + / - 7.66) years for women. When performing the survival analysis, it was found that the nutritional assessment using the MNA-SF obtained statistical significance (p <0.05). Conclusions: In conclusion, A poor nutritional status is a prognostic factor of gastric cancer mortality in elderly people. [ABSTRACT FROM AUTHOR]

Aim CKD-EPIcr (Chronic Kidney Disease Epidemiology Collaboration creatinine) and BIS1 (Berlin Initiative Study) are two serum creatinine-based formulae for the estimation of glomerular filtration rate (GFR). However, their comparative accuracy in older people has not been well established. Our aim was to conduct a systematic comparative study of the accuracy of estimation of GFR in older people with these two formulae. Methods We conducted a systematic search in Pubmed, EMBASE and Central databases on the validity of the CKD-EPIcr and BIS1 formulae in people aged 60 or more years. The search ranged from 2009 and 2012 for CKD-EPIcr and BIS1, respectively, until May 2017. The validity criterion for comparing the formulae was to have a P30 accuracy level equal to or greater than 80%. Results Of 1295 identified studies, 16 met our inclusion criteria. Out of 16 studies reporting the accuracy of the CKD-EPIcr formula, only 5 (31.3%) had P30 scores ≥80% (mean P30 was 77.1 ± 7.711 range 55.5–91.7), and out of 9 studies on accuracy using the BIS1 formula, 6 (66.7%) were ≥80% (mean P30 was 83.88 ± 9.37, range 67.0–95.8). Conclusion Our results suggest that for the estimation of the GFR in older people, BIS1 formula may be more accurate than CKD-EPIcr. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate the Peruvian adaptation of the money test (Eurotest) for identifying cognitive impairment among >60-year-old adults. Materials and methods. This is a phase I study of diagnostic test, with a convenience sampling and calculation of the test's sensitivity and specificity, based on a pretest prevalence of 50%. The criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) and Global Deterioration Scale (GDS) were used for the operational definition of patients with cognitive impairment. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal cut-off value. Results. The study evaluated 42 cases and 42 controls; there was no significant difference between age (77.88 ± 6.01 years vs. 6.49 76.14 ± years) and years of education (13.69 ± 3.70 years vs. 8.17 ± 4.71 years). The Peruvian version of the Eurotest has a sensitivity of 90.5% and specificity of 83.3% with cut-off value of 24. Conclusions. The Peruvian adapted version of the Eurotest, called prueba de la moneda peruana could be useful in screening for cognitive impairment among older adults. [ABSTRACT FROM AUTHOR]

Context: In the last decades, patients with chronic terminal diseases have had more frequent visits to emergency services. Aims: This study aims to determine the proportion of terminal illness in patients readmitted to emergency room, to evaluate the use of this service and rate of death. Settings and Design: A cross-sectional study in a tertiary hospital with 120 stretchers which annually reports 160 thousand attentions and 22 thousand admissions. Subjects and Methods: Included 18-year-old patients or older who were readmitted to emergency room. Patient and/or caregiver were interviewed; medical record was reviewed and made 1-year follow-up. Terminal cancer was determined by histologically confirmation in Stage IV and nononcologic terminal disease by total functional dependence (Katz index) or severe cognitive impairment (Pfeiffer questionnaire) in addition of advanced organ failure. Statistical Analysis Used: Fisher's exact and U of Mann--Whitney tests for two independent samples. Results: Ninety-two (26%) of 349 were readmissions; 29 (36.7%) of 79 evaluated patients were identifying with terminal disease. Eleven (38%) of them had cancer (genitourinary in 64%). Nononcologic terminal disease was identified in 18 cases (62%) (Neurodegenerative involvement in 50%). More frequent symptoms were dyspnea 41%, mental confusion 24%, and pain 21%. Terminal patients had 6.2 (standard deviation 8.2) emergency visits at last year, being admitted 48,6% of these visits. Six-month mortality rate was 73 and 61% in oncologic and nononcolgic patients, respectively (P < 0.05). Conclusions: End-stage disease is frequent in readmitted patients to emergency, more of nononcologic kind. These patients use frequently emergency service, with high mortality (more elevated in oncologic). [ABSTRACT FROM AUTHOR]

Objective: To investigate the use and accessibility to drugs in patients covered by the National Social Security Argentina (SNSSA). Material and Methods: We studied the accessibility to drugs that were consumed the last 15 days before hospitalizaron, in 500 patients in 5 hospitals in the area of Buenos Aires. Results: Of the 500 patients surveyed, 292 patients had medical prescription 15 days before being hospitalized, 171 (58.6%) patients had no access to medicines. The mean age was 47.4 + 18.8 and range of 0.1 to 89 years; 173 (34.6%) were male and 327 (65.4%) female. The distribution of coverage of patients studied was predominantly belonging to the Public System with 280 (56.0 %), Social Work 175 (35.0 %) and Prepay 45 (9.0%). The reasons for non- accessibility were mainly: the errors in processes ranging from issuing prescriptions, improper filling of forms to non-availability of medicines in pharmacies. Conclusions: The lack of access to medicines for patients covered by SNSSA is a common phenomenon. [ABSTRACT FROM AUTHOR]

Elderly people are particularly vulnerable to adverse drug reactions (ADR) due to polypathology and polypharmacy and the changes in pharmacokinetics and pharmacodynamics of medications induced by aging. It is very important to evaluate the safety aspects and appropriate use of medications in this population. For this purpose, a checklist is proposed consisting of a list of medications (including herbal medicine), detecting and treating geriatric syndromes induced by medications, overprescription, unprescription and underprescription; measuring and treating drug adhesion, measuring parameters for geriatric posology, preventing adverse reactions due to inadequate drug recalls, evaluating aging people's capacity to take their medications and using the minimum datasheet regarding the medication prescribed to the patient. This checklist is developed based on validated instruments. It is a proposal which application in the outpatient and inpatient context is possible and feasible. [ABSTRACT FROM AUTHOR]

Research about accessibility to medicines through household surveys is very important in order to verify the reality and effectiveness of interventions done to increase the access of the population to the medications. Unfortunately, such studies, on top of being very few, have methodological problems, which mostly result from a lack of uniformity in the operational definitions of access and the differentiation with the dimensions of accessibility. The aim of this paper is to propose setting a difference between both terms. We propose an operational definition of access to medications as the process of verification of the purchase of a drug by a patient, independently from many factors that can affect this process. The term "usability of drugs" is introduced, defining it operationally as aimed at measuring the dimensions of the accessibility to the medications: physical availability, affordability, geographical accessibility, acceptability (or satisfaction). [ABSTRACT FROM AUTHOR]

Objectives. To diagnose drug-related problems (DRPs) in patients over 64 years of age at the time of hospitalization. Materials and methods. The detection of overprescription and misprescription of medications was done using the Index of Appropriate Drug Use, and for underprescription the Indication of Adequate Drug Use in Vulnerable Elderly Adults and the test of the Evaluation of the Underuse of Drugs were used. The evaluation of drug adherence and adverse drug reactions was completed using the Morisky-Green Questionnaire and the Karch and Lasgna Algorithm, respectively. Results. The study was conducted in 100 inpatients in a geriatric service in a multi-specialty hospital in Lima, Peru; the median age was 76.26 ± 6.91 and 55% were males. After evaluating 555 drugs with the Index of Appropriate Drug Use, 254 of them (45.8%) qualified for at least one or more of the criteria studied for inadequate prescription, corresponding to 89 of the studied patients. We found the underuse (21%) of Warfarin or aspirin by eligible patients with auricular fibrillation, and no use (59%) of beta blockers by patients with a history of acute myocardial infarction. The non-adherence and frequency of adverse reactions that motivated hospitalization were 63% and 24%, respectively. Conclusions. The diagnosis of DRPs in elderly adults at the time of hospitalization using valid instruments is extremely useful and should be part of the integral geriatric evaluation of the elderly. [ABSTRACT FROM AUTHOR]

• Amid the SARS-CoV-2 pandemic, controversy has arisen regarding the cardiotoxicity of hydroxychloroquine (HCQ) • LQT during HCQ treatment in SARS-CoV-2 patients and HCQ discontinuation due to this cause were 6.7% and 3.7%, respectively • Frequency of Torsades de Pointes, ventricular arrhythmias and arrhythmogenic death was 0.06%, 1.7% and 0.69%, respectively • HCQ-associated cardiotoxicity in SARS-CoV-2 patients is uncommon but requires ECG monitoring • Monitoring is particularly needed in patients >60 years and/or taking other QT-prolonging drugs Introduction Hydroxychloroquine (HCQ) has been proposed as a SARS-CoV-2 treatment but the frequency of long QT (LQT) during use is unknown. Objective To conduct a meta-analysis of the frequency of LQT in patients with SARS-CoV-2 infection treated with HCQ. Data Sources PubMed, EMBASE, Google Scholar, the Cochrane Database of Systematic Reviews and preprint servers (medRxiv, Research Square) were searched for studies published between December 2019 and June 30, 2020. Methods Effect statistics were pooled using random effects. The quality of observational studies and randomized controlled trials was appraised with STROBE and the Cochrane Risk of Bias Assessment tools, respectively. Outcomes Critical LQT was defined as: (1) maximum QT corrected (QTc)≥500 ms (if QRS<120 ms) or QTc≥550 ms (if QRS≥120 ms), and (2) QTc increase ≥60 ms. Results In the 28 studies included (n=9124), the frequency of LQT during HCQ treatment was 6.7% (95% confidence interval [CI]: 3.7-10.2). In 20 studies (n=7825), patients were also taking other QT-prolonging drugs. The frequency of LQT in the other 8 studies (n=1299) was 1.7% (95% CI: 0.3-3.9). Twenty studies (n=6869) reported HCQ discontinuation due to LQT, with a frequency of 3.7% (95% CI: 1.5-6.6). The frequency of ventricular arrhythmias during HCQ treatment was 1.68% (127/7539) and that of arrhythmogenic death was 0.69% (39/5648). Torsades de Pointes occurred in 0.06% (3/5066). Patients aged >60 years were at highest risk of HCQ-associated LQT (P <0.001). Conclusions HCQ-associated cardiotoxicity in SARS-CoV-2 patients is uncommon but requires ECG monitoring, particularly in those aged >60 years and/or taking other QT-prolonging drugs. [ABSTRACT FROM AUTHOR]

Objective. To determine the frequency and prognostic value of anemia in cancer patients receiving care at the National Institute of Neoplastic Diseases (Instituto Nacional de Enfermedades Neoplásicas - INEN) between January and April of 2010. Materials and Methods. Anemia was considered for men with hemoglobin levels at <13 g/dL; and for women, at <12 g/dL. Associations between qualitative features were assessed with a Chi-square test. Kaplan-Meier estimator was used for the analysis of the survival curves, and differences between the curves were performed with the log-rank test. Results. 772 patients were included; 584 (75.7%) had solid tumors and 188 (24.3%) had hematologic malignancies. Anemia was diagnosed in 359 patients (46.5%); hematologic malignancies in 127 patients (67.6%); and solid neoplasms in 235 (40.2%). Hematologic malignancies with the highest frequency of anemia were chronic myeloid leukemia, acute leukemias, and multiple myeloma (100%, 92.5% and 60%, respectively); and were cancer of gastrointestinal, gynecological, and urological origin were in the group of solid neoplasms (62%, 52.1% and 45%, respectively). Two hundred and four (204) patients (26.4%) were transfused. In 762 patients, a significant difference in overall survival was found between groups with and without anemia, estimated at 5 years in 62% and 47% respectively (p <0.001). In the solid tumor subgroup (p = 0.002), and the hematological malignancies subgroup (p = 0.007), such association was also found. Conclusions. Anemia is common in cancer patients, and its presence determines an independent prognostic factor in overall survival. [ABSTRACT FROM AUTHOR]

Background: Anti-hypertensive medications may reduce the incidence of cognitive disorders. This may be due to reasons beyond their pure hypotensive effect. This study aimed to systematically review the association between the use of Angiotensin-Receptor Blockers (ARBs) and the incidence of Alzheimer's disease (AD)., Methods: We systematically searched studies reporting the association between ARB use and the incidence of AD., Results: Ten studies (1 RCT, 2 case-control and 7 cohort studies) met the inclusion criteria. When all observational studies (9) were analyzed, ARB use was associated with a reduced risk of incident AD (HR 0.72, 95% CI: 0.58-0.88, p<0.001). In the only RCT, decrease in the incidence of AD was also significant (HR= 0.31, 95% CI: 0.14-0.68)., Conclusion: ARB use may reduce the risk of incident AD. This association does not imply causation and further research is required to clarify potential mechanisms., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objective.: To determine the frequency and prognostic value of anemia in cancer patients receiving care at the National Institute of Neoplastic Diseases (Instituto Nacional de Enfermedades Neoplásicas - INEN) between January and April of 2010., Materials and Methods.: Anemia was considered for men with hemoglobin levels at <13 g/dL; and for women, at <12 g/dL. Associations between qualitative features were assessed with a Chi-square test. Kaplan-Meier estimator was used for the analysis of the survival curves, and differences between the curves were performed with the log-rank test., Results.: 772 patients were included; 584 (75.7%) had solid tumors and 188 (24.3%) had hematologic malignancies. Anemia was diagnosed in 359 patients (46.5%); hematologic malignancies in 127 patients (67.6%); and solid neoplasms in 235 (40.2%). Hematologic malignancies with the highest frequency of anemia were chronic myeloid leukemia, acute leukemias, and multiple myeloma (100%, 92.5% and 60%, respectively); and were cancer of gastrointestinal, gynecological, and urological origin were in the group of solid neoplasms (62%, 52.1% and 45%, respectively). Two hundred and four (204) patients (26.4%) were transfused. In 762 patients, a significant difference in overall survival was found between groups with and without anemia, estimated at 5 years in 62% and 47% respectively (p <0.001). In the solid tumor subgroup (p = 0.002), and the hematological malignancies subgroup (p = 0.007), such association was also found., Conclusions.: Anemia is common in cancer patients, and its presence determines an independent prognostic factor in overall survival.

Objectives To evaluate the Peruvian adaptation of the money test (Eurotest) for identifying cognitive impairment among >60-year-old adults. Materials and methods This is a phase I study of diagnostic test, with a convenience sampling and calculation of the test´s sensitivity and specificity, based on a pretest prevalence of 50%. The criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) and Global Deterioration Scale (GDS) were used for the operational definition of patients with cognitive impairment. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal cut-off value. Results The study evaluated 42 cases and 42 controls; there was no significant difference between age (77.88 ± 6.01 years vs. 6.49 76.14 ± years) and years of education (13.69 ± 3.70 years vs. 8.17 ± 4.71 years). The Peruvian version of the Eurotest has a sensitivity of 90.5% and specificity of 83.3% with cut-off value of 24. Conclusions The Peruvian adapted version of the Eurotest, called prueba de la moneda peruana could be useful in screening for cognitive impairment among older adults.

Beta 2 agonist bronchodilators (β2A) are very important part in the pharmacotherapy of bronchial asthma, a disease that progresses in the world in an epidemic way. The β2A are prescribed to millions of people around the world, therefore the safety aspects is of public interest. Short-Acting β2 Agonists (SABAs), such as albuterol inhaler, according to current evidence, confirming its safety when used as a quick-relief or rescue medication. The long-acting β2 agonists (LABAs) The long-acting bronchodilators β2A (Long acting β2 Agonists or LABAs) are used associated with inhaled corticosteroids as controller drugs for asthma exacerbationsaccess, for safety reasons LABAs are not recommended for use as monotherapy.

Elderly people are particularly vulnerable to adverse drug reactions (ADR) due to polypathology and polypharmacy and the changes in pharmacokinetics and pharmacodynamics of medications induced by aging. It is very important to evaluate the safety aspects and appropriate use of medications in this population. For this purpose, a checklist is proposed consisting of a list of medications (including herbal medicine), detecting and treating geriatric syndromes induced by medications, overprescription, unprescription and underprescription; measuring and treating drug adhesion, measuring parameters for geriatric posology, preventing adverse reactions due to inadequate drug recalls, evaluating aging people's capacity to take their medications and using the minimum datasheet regarding the medication prescribed to the patient. This checklist is developed based on validated instruments. It is a proposal which application in the outpatient and inpatient context is possible and feasible.