Alave Rosas, Jorge Luis

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Alave Rosas, Jorge Luis
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jorgealave@upeu.edu.pe
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    Percepciones e intención de los padres de vacunar a sus hijos bajo 12 años de edad contra la COVID-19: estudio transversal en Perú
    (2022-06-01)
    Jose Armando Gonzales Zamora
    ;
    David R. Soriano‐Moreno
    ;
    Anderson N. Soriano-Moreno  
    ;
    Linda Ponce-Rosas
    ;
    Abraham De-Los-Ríos-Pinto
    BACKGROUND: Despite the proven efficacy and safety of COVID-19 vaccines, pediatric vaccination coverage remains low in many countries. There are still doubts and fears in parents about vaccination in their children under 12 years of age. AIM: To evaluate the perceptions and intention of parents to vaccinate their children under 12 years of age. METHODS: Analytical cross-sectional study based on an online survey that evaluated the parents' perceptions regarding the risk of COVID-19 infection, the need for a vaccine, and the vaccine adverse events in their children under 12 years. We assessed the factors associated with the intention to vaccinate through crude (cPR) and adjusted prevalence rates (aPR), with confidence interval of 95% (CI 95%). RESULTS: 83.5% of respondents had the intention to vaccinate their children under 12 years of age. In the multivariate analysis, the factors associated with a decrease in the intention to vaccinate were to believe that the vaccine was not necessary (aPR 0.65; 95% CI 0.44 - 0.94), that it would not protect (aPR: 0.14; 95% CI 0.03 - 0.63), it would not be safe (aPR: 0.80; 95% CI 0.70 - 0.92) and it would cause long-term side effects (aPR: 0.92; 95% CI 0.85 - 1.00). On the other hand, living on the highlands or jungle was associated with an increase in the intention. CONCLUSION: In Peru, 16.5% of parents would not vaccinate their children under 12 years of age, because they perceived that the vaccine was not necessary and would not protect against COVID-19. In addition, they expressed concerns about the development of possible adverse events.
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    Percepciones e intención de los padres de vacunar a sus hijos menores de 12 años contra la COVID-19: Estudio transversal en Perú
    (2022-01-11)
    Jose Armando Gonzales Zamora
    ;
    David Soriano Moreno
    ;
    Anderson N. Soriano-Moreno  
    ;
    Linda Ponce-Rosas
    ;
    Abraham De-Los-Ríos-Pinto
    Objetivos: Evaluar las percepciones e intención de los padres de vacunar a sus hijos menores de 12 años en Perú.
 Metodología: Estudio transversal analítico a partir de una encuesta en línea (25 de noviembre al 6 de diciembre del 2021) para padres de niños menores de 12 años que recopiló la percepción sobre el riesgo de contagio por COVID-19 en sus hijos, sobre la necesidad de vacunación y sobre los eventos adversos relacionados con la vacuna. Evaluamos los factores asociados a la intención de vacunación mediante razones de prevalencia crudas (RPc) y ajustadas (RPa) con intervalos de confianza al 95% (IC 95%).
 Resultados: El 83.5% de los padres tenían la intención de vacunar a sus hijos menores de 12 años. En el análisis multivariado, los factores asociados a una disminución de la intención de vacunación fueron pensar que la vacuna no es necesaria (RPa: 0.65; IC 95% 0.44 – 0,94), que no protegería (RPa: 0.14; IC 95% 0.03 – 0.63), que no sería segura (RPa: 0.80; IC 95% 0.70 – 0.92) y que ocasionaría efectos negativos a largo plazo (RPa: 0.92; IC 95% 0.85 – 1.00). Por otro lado, residir en la Selva (RPa: 1.09; IC 95%: 1.03 – 1.15) o en la Sierra (RPa: 1.06; IC 95%: 1.00 – 1.11) se asoció a una mayor prevalencia de intención.
 Conclusiones: En Perú, un 16.5% de padres no vacunaría a sus hijos menores de 12 años, ya que perciben que la vacuna no es necesaria y no protegería contra la COVID-19, además de tener la preocupación de posibles eventos adversos.
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    Knowledge and Perceptions about Diagnosis, Clinical Management, and Prevention of Dengue Fever among Physicians during the 2023 Outbreak: A Cross-Sectional Study in Peru
    (2024-08-27)
    Julieta M. Araoz-Salinas
    ;
    Brando Ortiz-Saavedra
    ;
    Anderson N. Soriano-Moreno  
    ;
    Martín E. Reategui-Garcia
    ;
    Carlos Quispe‐Vicuña
    The objective of this study was to evaluate the knowledge level and perception of dengue fever management among Peruvian physicians and to determine the factors associated with higher knowledge. We conducted an analytical cross-sectional study based on an online survey. To evaluate the factors associated with a high level of knowledge (≥70% of correct answers), we used crude (cPR) and adjusted (aPR) prevalence ratios by the Poisson regression model. Of 359 respondents (median age: 33 years; male: 56.5%), 78.8% achieved a high level of knowledge. Multivariable analysis showed an independent association with having read the Peruvian clinical practice guidelines for dengue management (aPR: 1.29; 95% CI: 1.12-1.49), having experience in treating patients (aPR: 1.32; 95% CI: 1.03-1.68), and having treated cases frequently (aPR: 1.22; 95% CI: 1.02-1.46). Residing in the eastern macroregion (aPR: 0.83; 95% CI: 0.71-0.97) was associated with a low level of knowledge. In conclusion, Peruvian physicians had a high level of knowledge about dengue fever. This was associated with having clinical experience in dengue management. However, given the low level of knowledge in the eastern macroregion, educational campaigns are necessary in this area.
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    1291. Acceptability and Perceptions towards an International Infectious Disease Videoconferencing Program among medical students and physicians-in-training in Miami.
    (2022-12-01)
    Anmary Fernandez
    ;
    Daniela De Lima
    ;
    Paola Lichtenberger
    ;
    Jorge Alave  
    ;
    Sebastián Solar
    Abstract Background Tele-education has emerged as an excellent alternative for traditional face-to-face education. It has allowed to connect first-world countries to developing countries for learning about low prevalent pathologies, such as tropical diseases, parasite infections, etc. Methods The Division of Infectious Diseases at University of Miami started an international videoconferencing program in 2018 in collaboration with 4 teaching sites (Miami, Peru, Chile, and Spain), in which 2 challenging cases were presented via Skype TM or Zoom TM. The cases were discussed by a partner institution member; all sites were invited to comment about the cases. After each conference, the medical students and physicians-in-training were asked to fill out a survey to evaluate their acceptance and perceptions towards this program. Results 54 participants completed the survey. 50% were residents or fellows, 18.5% were medical students, and 27.7% were visiting trainees. The overall acceptance was favorable, 64.9 % of participants reported that videoconferencing was as effective or more effective than face-to-face conferences, 96.3% wanted to continue participating in this program, and 87.04% would recommend it as an educational tool. Regarding the collaboration with international sites, 87% of participants felt they learned about diseases not commonly encountered in their countries, 85.2% considered that this program allowed them to learn about different treatment approaches, and 68.5% believed that it helped to learn about novel diagnostic tests. In terms of the content, 85.2% considered that the cases were interesting and 83.3 % believed that the cases were presented in an organized fashion. Regarding the software performance, 75.9 % believed that images were above average or outstanding, but only 48.1% felt the same about the audio. In terms of participation, 57.4% believed that interaction between the local audience and physicians from different sites was easily accomplished. Conclusion This videoconferencing program was widely accepted among trainees. The collaboration with international sites was perceived as one of the program assets. We believe that implementation of programs like this would be highly beneficial in Infectious Disease education. Disclosures Daniela De Lima, MD, Astra Zeneca: Stocks/Bonds|Pfizer: Stocks/Bonds.
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    Rhino-Orbital-Cerebral Mucormycosis in a Post-COVID-19 Patient from Peru
    (2022-03-15)
    Linda Ponce-Rosas
    ;
    Jose Armando Gonzales Zamora
    ;
    Nelson Diaz  
    ;
    Oliver Alarco-Cadillo
    ;
    Jorge Alave  
    Mucormycosis has been reported increasingly in patients affected by COVID-19, especially in India where the first cases were described. In Latin America, there is limited information about this association, mainly coming from Brazil, Mexico, and Peru. Herein, we report the case of a 66-year-old female that presented with rhino-orbital-cerebral mucormycosis, diabetic ketoacidosis, and COVID-19. The patient had the compromise of all the sinuses, orbital invasion, and intracranial extension. Isavuconazole was promptly initiated because amphotericin B was not available. She had a single open surgical debridement of necrotic tissues at the beginning of the diagnosis then multiple manual sessions to clear the residual or recurrent disease during approximately 5 months. Isavuconazole was effective and well-tolerated for 10 months without side effects. We highlight the importance of considering mucormycosis in post-COVID-19 patients with uncontrolled diabetes. The report emphasizes the favorable outcome of isavuconazole as an alternative therapy.
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    Medication Possession Ratio Predicts Antiretroviral Regimens Persistence in Peru
    (2013-10-01)
    Jorge Salinas
    ;
    Jorge Alave  
    ;
    Andrew O. Westfall
    ;
    Jorge Paz
    ;
    Fiorella Moran
    OBJECTIVES: In developing nations, the use of operational parameters (OPs) in the prediction of clinical care represents a missed opportunity to enhance the care process. We modeled the impact of multiple measurements of antiretroviral treatment (ART) adherence on antiretroviral treatment outcomes in Peru. DESIGN AND METHODS: Retrospective cohort study including ART naïve, non-pregnant, adults initiating therapy at Hospital Nacional Cayetano Heredia, Lima-Peru (2006-2010). Three OPs were defined: 1) Medication possession ratio (MPR): days with antiretrovirals dispensed/days on first-line therapy; 2) Laboratory monitory constancy (LMC): proportion of 6 months intervals with ≥1 viral load or CD4 reported; 3) Clinic visit constancy (CVC): proportion of 6 months intervals with ≥1 clinic visit. Three multi-variable Cox proportional hazard (PH) models (one per OP) were fit for (1) time of first-line ART persistence and (2) time to second-line virologic failure. All models were adjusted for socio-demographic, clinical and laboratory variables. RESULTS: 856 patients were included in first-line persistence analyses, median age was 35.6 years [29.4-42.9] and most were male (624; 73%). In multivariable PH models, MPR (per 10% increase HR=0.66; 95%CI=0.61-0.71) and LMC (per 10% increase 0.83; 0.71-0.96) were associated with prolonged time on first-line therapies. Among 79 individuals included in time to second-line virologic failure analyses, MPR was the only OP independently associated with prolonged time to second-line virologic failure (per 10% increase 0.88; 0.77-0.99). CONCLUSIONS: The capture and utilization of program level parameters such as MPR can provide valuable insight into patient-level treatment outcomes.
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    Lemierre-like syndrome after soft tissue infection due to methicillin-resistant Staphylococcus aureus: A case report and literature review
    (2024-02-16)
    Xossé Carreras
    ;
    Andrea S. Salcedo
    ;
    Linda Ponce-Rosas
    ;
    Jose Armando Gonzales Zamora
    ;
    Nelson Diaz  
    RATIONALE: Lemierre-like syndrome (LLS) is characterized by bacteremia, septic thrombophlebitis of the internal jugular vein, and metastatic abscesses. In contrast to classic Lemierre syndrome, sources of infection are not related to oropharyngeal infections, as are frequent soft tissue infections. In recent years, Staphylococcus aureus has been identified as an emergent pathogen that causes this syndrome. The mortality rate of LLS caused by this pathogen is approximately 16%. Timely diagnosis, antibiotic treatment, and infection control are the cornerstones to treat LLS. Anticoagulant therapy as adjuvant treatment remains controversial. PATIENT CONCERNS: A 31-year-old woman from California, United States (US), was admitted to the emergency room with a history of 2 days of fever and severe throbbing pain in the left cervical region. Thorax and neck CT tomography revealed confluent cavities suggestive of septic embolism in the lungs and a filiform thrombus in the lumen of the left internal jugular vein, with moderate swelling of the soft and muscular tissues. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the blood culture. DIAGNOSIS: The thrombus in the internal jugular vein associated with cellulitis in the neck and multiple cavitary lesions in the lungs support the diagnosis of LLS caused by MRSA with septic embolization. INTERVENTIONS: During treatment, the patient received vancomycin IV for 25 days and returned to the US with linezolid orally. In addition, assisted video-thoracoscopy and bilateral mini-thoracotomy with pleural decortication were performed for infectious source control, where 1700cc of purulent pleural fluid was drained. OUTCOMES: The patient was discharged with optimal evolution. LESSONS: LLS should be suspected in patients with skin and soft tissue infections who develop thrombosis or metastatic infections. MRSA infections should be considered in patients from areas where this pathogen is prevalent.
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    1975. Trends in the parents’ intention to vaccinate their children against COVID-19: A comparative study in Peru
    (2022-12-01)
    Jose Armando Gonzales Zamora
    ;
    David R. Soriano‐Moreno
    ;
    Linda Ponce-Rosas
    ;
    Mariano G Alarcón Parra
    ;
    Noelia Morocho-Alburqueque
    Abstract Background Although COVID-19 vaccination has shown to be clearly beneficial in children and adolescents to reduce hospitalization and potentially transmission, there is still a lot of hesitation among parents due to concerns about vaccine safety and efficacy, especially in children under 12 years of age. Methods We conducted a comparative study in Peru to evaluate the trends in parents’ intention to vaccinate their children under 12 years of age against COVID-19, for which an online survey was administered. The survey was distributed through social networks (Facebook, Twitter, etc.), and was applied during two periods: 11/25/2021 to 12/06/2022 (Period 1) and 01/16/2022 to 01/24/2022 (Period 2). We also assessed the factors associated with the intention to vaccinate in each period through crude (cPR) and adjusted prevalence rates (aPR). Results During period 1, there were 673 participants (69.7% women). In period 2, we had 1139 respondents (77.7% women). Regarding intention to vaccinate, 83.5% of parents intended to vaccinate their children under 12 years of age during period 1. This percentage was almost the same during period 2 (83.3%). During period 1, the factors associated with a decrease in this intention were to believe that the vaccine was not necessary (aPR 0.65; 95% CI 0.44 – 0.94, p=0.022), that it would not protect (aPR: 0.14; 95% CI 0.03 – 0.63, p=0.011), that it would not be safe (aPR: 0.80; 95% CI 0.70 – 0.92, p=0.001), that it could cause long-term side effects (aPR: 0.92; 95% CI 0.85 – 1.00, p=0.037), and to think it should not be mandatory (aPR: 0.89; 95% CI 0.80-0.99, p=0.038). During period 2, besides the factors identified in period 1, not knowing about COVID-19 infection risk in children (aPR: 0.92; 95% CI 0.85-1.00, p=0.042) was also associated with a decrease in the intention. Living on the highlands or jungle was associated with an increase in the intention in both periods. Conclusion A high rate of intention to vaccinate children under 12 years of age was noted among parents in Peru, which was maintained until the end of January of 2022, right before COVID-19 vaccination started for this age group. There was a perception in some parents that the vaccine might not be necessary or safe, leading to a lower intention to vaccinate their children. Disclosures All Authors: No reported disclosures.
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    Original Article Exploring the Link Between Hepatitis A and B Vaccination and Social Support in the US Population: Insights from the NHANES 2005-2006 Cohort
    (2025-09-22)
    Daniel Bancovsky
    ;
    Manjushree Shastry
    ;
    Martina Caccamo
    ;
    Omar E. Vásquez-Pérez
    ;
    Merce Avellanet
    Background: High social support is easily assessed and associated with a healthier lifestyle, including vaccination adherence. Similarly, immunization is a widely available public health statistic associated with healthier behaviors. However, the link between the hepatitis immunization status and social support needs to be explored. Methods: We assessed the association between levels of social support and hepatitis immunization status using the National Health and Nutrition Examination Survey (NHANES), a cross-sectional multidisciplinary database publicly available for researchers. With 2005–2006 data, 2997 participants were included. Statistical analyses were conducted using STATA18.5v software, including the odds ratio of both univariable logistic regression and multivariable logistic regression. After adjusting for clinically relevant confounders, two distinct models were designed: 1) full immunization, and 2) incomplete immunization. Results: Multivariable analysis revealed significantly greater odds of high social support for participants fully or partially immunized against both hepatitis A and B: 3.15 (95% CI 1.03–9.66,p=0.04) and 3.35 (95% CI 1.15–9.75,p=0.03), respectively. Conclusion: Our findings show an association between vaccination and social support in both adjusted models. Individuals not vaccinated at all may behave differently from those willing to be, at least partially, immunized. It seems that a similar behavior that may lead to vaccination may also lead to increased social support. Therefore, our study suggests that hepatitis vaccination could perhaps be a surrogate marker for public-health-related outcomes.
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    Factors associated with the intention to participate in COVID-19 vaccine clinical trials: A cross-sectional study in Peru
    (2022-04-07)
    Abraham De-Los-Ríos-Pinto  
    ;
    Daniel Fernandez‐Guzman
    ;
    David R. Soriano‐Moreno
    ;
    Lucero Sangster-Carrasco
    ;
    Noelia Morocho-Alburqueque
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