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Background. Malaria in humans is caused by apicomplexan parasites belonging to 5 species of the genus Plasmodium. Infections with Plasmodium ovale are widely distributed but rarely investigated, and the resulting burden of disease is not known. Dimorphism in defined genes has led to P. ovale parasites being divided into classic and variant types. We hypothesized that these dimorphs represent distinct parasite species. Methods. Multilocus sequence analysis of 6 genetic characters was carried out among 55 isolates from 12 African and 3 Asia-Pacific countries. Results. Each genetic character displayed complete dimorphism and segregated perfectly between the 2 types. Both types were identified in samples from Ghana, Nigeria, São Tomé, Sierra Leone, and Uganda and have been described previously in Myanmar. Splitting of the 2 lineages is estimated to have occurred between 1.0 and 3.5 million years ago in hominid hosts. Conclusions. We propose that P. ovale comprises 2 nonrecombining species that are sympatric in Africa and Asia. We speculate on possible scenarios that could have led to this speciation. Furthermore, the relatively high frequency of imported cases of symptomatic P. ovale infection in the United Kingdom suggests that the morbidity caused by ovale malaria has been underestimated.

Mpox has become a public health problem due to its rapid evolution and clinical variability. In Latin America, Peru ranks fifth in terms of the number of cases. The main objective of this study is to determine the epidemiological and clinical characteristics of Peruvian patients diagnosed with mpox, providing a detailed view of the situation of this affected population. A systematic review and meta-analysis of studies on mpox in Peru was carried out using ten databases and search tools (PubMed, Scopus, Web of Science, Embase, ScienceDirect, Google Scholar, Virtual Health Library, Scielo, Dimensions, and Epistemonikos) until August 22, 2024. The MeSH (Medical Subject Headings) terms used in the search were \"mpox\" and \"Peru\", combined with the logical operators AND and OR. Study quality was assessed using the Joanna Briggs Institute (JBI) assessment tool, and pooled estimates were generated using random-effects meta-analysis. Heterogeneity was assessed using the I² statistic. Statistical analysis was performed in R version 4.2.3, and the study was registered in PROSPERO (CRD42024582854). A total of 150 articles were evaluated, of which 9 studies were included: four retrospective observational studies, four case series, and one case report, covering a total of 3960 Peruvian patients with mpox. The quality of the studies was moderate. The combined results show that 97% (95% CI: 96-98%; 3804 participants; 4 studies; I2 = 24%, p = 0.27) of the patients were male, 63% (95% CI: 57-68%; 2366 participants; 4 studies; I2 = 66%, p = 0.03) had HIV (human immunodeficiency virus), and 91% (95% CI: 83-97%; 2019 participants; 4 studies; I2 = 90%, p < 0.01) of these were receiving antiretroviral therapy. In addition, 61% (95% CI: 46-75%; 2295 participants; 4 studies; I2 = 95%, p < 0.01) identified as homosexual, and 17% (95% CI: 09-26%; 702 participants; 4 studies; I2 = 91%, p < 0.01) had a history of syphilis. The most common clinical manifestations were skin lesions (88%; 95% CI: 79-94%; 3114 participants; 4 studies; I2 = 92%, p < 0.01), lymphadenopathy (83%; 95% CI: 25-100%; 3623 participants; 2 studies; I2 = 100%, p < 0.01), anogenital rash (72%; 95% CI: 65-79%; 2657 participants; 3 studies; I2 = 74%, p = 0.02), fever (67%; 95% CI: 59-76%; 2587 participants; 4 studies; I2 = 86%, p < 0.01), and headache (52%; 95% CI: 47-57%; 1962 participants; 3 studies; I2 = 60%, p = 0.08). This systematic review provides a detailed overview on the epidemiology and clinical characteristics of Peruvian patients with mpox, highlighting a high prevalence in men and a remarkable association with HIV coinfection. The data highlight the vulnerability of the affected population and the importance of a multidisciplinary medical approach, with emphasis on early diagnosis of the most common symptoms. The findings support the implementation of prevention strategies tailored to the most vulnerable populations, especially those with HIV coinfection, and the conduct of longitudinal studies to better understand the disease.

Cerebrospinal fluid (CSF) kappa free light chain (KFLC) index has been described as a reliable marker of intrathecal IgG synthesis to diagnose multiple sclerosis (MS). Our aims were: (1) to compare the efficiency of KFLC through different interpretation approaches in diagnosing MS. (2) to evaluate the prognostic value of KFLC in radiologically and clinically isolated syndromes (RIS-CIS). We enrolled 133 MS patients and 240 with other neurological diseases (93 inflammatory including 18 RIS-CIS, 147 non-inflammatory). Albumin, lambda free light chain (LFLC) and KFLC were measured in the CSF and serum by nephelometry. We included two groups of markers: (a) corrected for blood-CSF barrier permeability: immunoglobulin G (IgG), KFLC and LFLC indexes. (b) CSF ratios (not including albumin and serum-correction): CSF KFLC/LFLC, CSF KFLC/IgG, CSF LFLC/IgG. KFLC were significantly higher in MS patients compared to those with other diseases (both inflammatory or not). KFLC index and CSF KFLC/IgG ratio showed high sensitivity (93% and 86.5%) and moderate specificity (85% and 88%) in diagnosing MS. RIS-CIS patients who converted to MS showed greater KFLC index and CSF KFLC/IgG. Despite OB are confirmed to be the gold-standard to detect intrathecal IgG synthesis, the KFLC confirmed their accuracy in MS diagnosis. A “kappa-oriented” response characterizes MS and has a prognostic impact in the RIS-CIS population.

Objectives To determine the association between internet addiction disorder (IAD) and anxiety and depressive symptomatology in high school students in two private schools in Chiclayo, Peru, during the COVID-19 pandemic. Materials and methods Analytical cross-sectional investigation of 505 adolescents from two private schools. The dependent variables were anxiety and depressive symptomatology, measured with the Beck Adapted Depression Questionnaire (BDI-IIA) and the Beck Anxiety Inventory (BAI), respectively. The main independent variable was IAD, measured with the Internet Addiction Test instrument(IATI). Prevalence ratios (PR) and 95% confidence intervals (95%CI) were estimated. Results The average age was 14.16 years and 54.9% were women. 22.2% and 3.2% presented mild and moderate IAD; respectively. 9.3% presented severe anxiety and 34.3% severe depressive symptomatology. In the simple regression, adolescents with mild, moderate and severe IAD presented 19% (PR = 1.19; 95%CI: 1.05–1.35), 25% (PR = 1.25; 95%CI: 1.02–1.53) and 53% (PR = 1.47; 95% CI: 1.47–1.60) higher prevalence of depressive symptomatology; however, this association was not maintained in the multiple model. Anxiety increased 196% in adolescents with severe IAD (PR = 2.96; 95%CI: 1.86–4.71). Conclusion  We found that 2, 1, and 3 out of 10 students presented IAD, depressive symptomatology, and anxiety, respectively. We did not find an association between IAD and depressive symptomatology, but we did find an association with anxiety. Among the factors associated with the development of depressive symptomatology were the male sex, the presence of eating disorders, subclinical insomnia, using devices for more than 2 h, and using the Internet for academic activities. About anxiety, the associated factors are the female sex, the presence of eating disorders, subclinical insomnia, and the use of the Internet as social interaction. We recommend implementing counseling programs in view of the imminent introduction of the Internet as a pillar in education.

Depression is a public health concern, nearing 1.5 million cases and accounting for 9.7% of years lost due to disability. Several factors, including altitude, contribute to its development. Altitude has become a topic for recent research, but its association with depressive symptoms has not been fully clarified. Therefore, this study aimed to determine the association between altitude and depressive symptoms in the Peruvian population. A retrospective, cross-sectional study of the 2019 Demographic and Family Health Survey (ENDES in Spanish) was conducted. The dependent variable, depressive symptoms, was measured using the Patient Health Questionnaire (PHQ-9) and the independent variable, altitude, was categorized into: <1500 meters above sea level (masl), 1500-2499 masl and ≥2500 masl. To evaluate the association between altitude and depressive symptoms, we used Poisson regression model, constructing crude and multiple models. Of those living at 1500 to 2499 masl and ≥2500 masl, 7.23% and 7.12% had depressive symptoms, respectively. After adjusting for confounding variables, high altitude was found to be associated with depressive symptoms (prevalence ratio adjusted (aPR): 1.38, 95% confidence interval: 1.04-1.84; aPR 1.41, 95% CI: 1.20-1.66). A statistically significant association was found between high altitude and depressive symptoms. This may be attributable to hypobaric hypoxia that occurs at high altitudes and its effects on brain function. This study's findings should be considered to identify the population at risk and expand the coverage of preventive and therapeutic measures in high-altitude areas of Peru with poor access to health services.

The Oropouche virus (OROV), discovered in 1955, has evolved from being a pathogen limited to the Amazon basin to becoming a growing threat to public health in Latin America. Because its symptoms are similar to those of dengue and zika, diagnosis is complicated. In this context, the objective of this study is to determine the prevalence of epidemiological and clinical characteristics in Peruvian patients diagnosed with Oropouche. A systematic review and meta-analysis were performed in accordance with PRISMA guidelines. An exhaustive literature search was conducted up to April 10, 2025, across ten databases using MeSH terms like \"Oropouche\" and \"Peru,\" combined with Boolean operators. Only observational studies conducted in Peru that reported confirmed OROV infections through reverse transcription polymerase chain reaction (RT-PCR) or enzyme-linked immunosorbent assay (ELISA), and that described clinical or epidemiological characteristics, were included. The methodological quality of these studies was evaluated using the JBI-MAStARI tool. To estimate the pooled prevalence and 95% confidence intervals, random-effects models were applied in R (version 4.2.3). Heterogeneity was assessed using the I² statistic, and publication bias was evaluated through funnel plots and Egger's test, when applicable. Six observational studies published between 2010 and 2020 were included, involving 396 Peruvian patients diagnosed with OROV by RT-PCR or ELISA. The studies were conducted in Piura, Loreto, Huánuco, Madre de Dios, and San Martín. Most patients were between 20 and 30 years old; 44.9% were male. All studies were of moderate quality. Due to the limited number of studies, publication bias was not assessed. The most common symptoms were fever, headache, myalgia, arthralgia, and retro-ocular pain. The findings of this study reveal a significant occurrence of diverse symptoms in Peruvian patients infected with OROV. Due to the clinical resemblance to other arboviruses, it is essential to establish more precise diagnostic methods to prevent misdiagnosis and underreporting. The existing evidence remains limited, highlighting the importance of enhancing epidemiological monitoring, improving diagnostic tools, and creating public health strategies specifically targeted at endemic regions to reduce the effects of this emerging infection.

During the COVID-19 pandemic, smartphone use among students increased, even before going to sleep, which resulted in an increased risk of dependence, addiction, and sleep problems such as insomnia and daytime somnolence. The objective of this study was to determine the association between different levels of problematic smartphone use (dependence and addiction) and insomnia among medical students. In this study, \"dependence\" refers to subclinical, yet compulsive, smartphone use, while \"addiction\" denotes a more severe behavioral disruption involving loss of control and functional impairment. This was a secondary cross-sectional study of a cohort of medical students from Piura (Peru) during the COVID-19 pandemic in 2020. The study included 370 participants. Insomnia was assessed using the Insomnia Severity Index, and the extent of smartphone use was determined using the Smartphone Dependence and Addiction Scale. A chi-squared test was used for the bivariate analysis, and prevalence ratios (PR) were estimated using Poisson regression with crude and adjusted models and 95% confidence intervals (CI). Insomnia was reported by 67.8% of participants. Smartphone dependence was identified in 67.8% of students, and 10.8% met the criteria for addiction. The prevalence of insomnia was notably higher among students aged ≥26 years (80.0%) and among those with symptoms of depression (79.3%) and anxiety (81.9%). After adjusting for potential confounders, students classified as dependent were 1.43 times more likely to report insomnia (aPR: 1.43; 95% CI: 1.10-1.86), while those classified as addicted showed an even higher association (aPR: 1.66; 95% CI: 1.26-2.17), compared to nondependent users. Both smartphone dependence and addiction were significantly associated with a higher prevalence of insomnia among medical students. These findings highlight the need for preventive strategies targeting problematic smartphone use to promote better sleep health in academic settings.

Background Cerebrospinal fluid (CSF) kappa-free light chains (KFLC) are becoming a diagnostic biomarker for multiple sclerosis (MS). Objectives We aimed to compare the diagnostic performance of intrathecal synthesis biomarkers to that of oligoclonal bands (OB) in diagnosing MS, radiological and clinical isolated syndromes (RIS-CIS) on a large cohort of patients collected over 10 years. Methods We collected 1124 patients (58% females) in 10 years who underwent CSF analysis for intrathecal synthesis in the diagnostic work-up, and they were classified according to their diagnosis as 417 MS, 287 with other neurological inflammatory disorders (including 76 RIS-CIS), and 420 non-inflammatory diseases (excluding lymphoproliferative and infective diagnosis). Results MS patients significantly differ from all other groups (including if considering the RIS-CIS cohort) for CSF KFLC, KFLC intrathecal fraction (IF), Kappa index, and OB. Evaluating the diagnostic performance, the Kappa index cut-off was 6.4 for diagnosing MS and 5.7 for predicting OB. A diagnostic algorithm could avoid IEF if the Kappa index is higher than 20. Conclusions The KFLC index confirmed its accuracy for MS diagnosis in this large Italian cohort, adding information also in the RIS-CIS population.

Background Existing literature has not stablished the factors associated with sleep quality, which requires further research in the context of the mental health of future medical professionals. This study aimed to determine the prevalence and factors related to sleep quality in Latin American medical students during the COVID-19 pandemic. Methods Cross-sectional multicenter analytic study of secondary data analysis in Latin American medical students. The sampling was non-probabilistic snowball sampling. Sleep quality (Pittsburgh questionnaire) and its association with psychosocial-academic variables, depressive symptoms (PHQ-9 questionnaire), anxious symptoms (GAD-7 questionnaire), resilience (abbreviated CD-RISC questionnaire), eating disorder (EAT-26 questionnaire), physical activity (IPAQ questionnaire-short version), tobacco and alcohol consumption (ASSIST questionnaire) and burnout syndrome (Maslash questionnaire) were assessed. Prevalence ratios and 95% confidence intervals were estimated. Results Of 2019 medical students, the prevalence of poor sleep quality was 62.2% (95%CI: 60.00%-64.28%). In the multiple regression model, factors that were positively associated with poorer sleep quality were female sex (PR: 1.13), moderate risk of smoking (PR: 1.08), the presence of moderate to severe depressive symptoms (PR: 2.19 and PR: 2.14, respectively), as well as moderate and severe anxiety symptoms (PR: 1.21 and PR: 1.22, respectively). On the other hand, factors that were negatively associated with poorer sleep quality were having received training on COVID-19 (PR: 0.95), having a history of COVID-19 (PR: 0.80), and having a high level of resilience (PR: 0.86). Conclusion It was found that 62.2% of students had poor sleep quality. Factors such as female sex, moderate risk of smoking, and depressive and anxious symptoms were associated with poor sleep quality, while COVID-19 training, history of the disease, and a high level of resilience were linked to better quality. These findings are key for public health, as poor sleep quality affects physical and mental health and academic performance, underscoring the importance of intervening on these factors to improve student well-being.

Background:Systemic sclerosis (SSc) is characterized by progressive fibrosis and microvascular dysfunction that involves multiple organ systems, including kidneys. Kidney involvement, beyond the scleroderma renal crisis (SRC), is often asymptomatic and underdiagnosed, associated with subclinical renal vasculopathy characterized by abnormalities in renal microcirculation and mild changes of glomerular filtration rate (GFR). Kidney involvement is rare in isolated Sjögren’s syndrome (SS) and reported between 5% and 14% in european patients and approximately 30% in asian patients.Objectives:The aim of the study was to assess renal involvement in SSc and SS and follow its progression over a three-year period.Methods:Patients with SSc (2013 EULAR criteria) and isolated SS (2016 ACR/EULAR criteria) were consecutively enrolled. Demographic and clinical characteristics at baseline (T0) were gathered including sex, age, body mass index (BMI), history of essential hypertension and diabetes, serum creatinine, and estimated GFR calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Exclusion criteria were presence of SRC, atherosclerosis renal artery stenosis and other secondary causes of hypertension, glomerulonephritis, urinary tract obstruction, urinary infections, heart failure, pulmonary arterial hypertension, malignancies. All patients were followed for three years (T1) with renal function assessment. Group comparisons were made using the Student’s t-test or Mann-Whitney test for continuous variables and the chi-square test or Fisher’s exact test for categorical variables. A significance level of p<0.05 was considered.Results:A total of 248 patients were enrolled, 127 SSc and 121 SS patients. Their features at baseline (T0) are summarized in Table 1. Table 2 summarizes the comparative analysis of renal function between SSc and SS patients at baseline and after 3 years. SS patients had similar median serum creatinine both at T0 and at T1 [0.78 mg/dl (IQR 0.68;0.84) vs 0.78 mg/dl (IQR 0.7;0.84), p>0.05], but a higher eGFR at T0 than at T1 [87.9 ml/min (IQR 72.6;102.3) vs 86.4 ml/min (IQR 72.7;96.7), p<0.05], with a variation of −2.1 ml/min (IQR −11.4;1.1). SSc patients had a statistically significant lower median serum creatinine at T0 than at T1 [0.7 mg/dl (IQR 0.6;0.8) vs 0.8 mg/dl (IQR 0.7;0.9), p<0.001], with a variation of 0.1 mg/dl (IQR 0;0.2), and a statistically significant higher median eGFR at T0 than at T1 [97 ml/min (IQR 85;108.5) vs 91 ml/min (IQR 73;103), p<0.001], with a variation of −3 ml/min (IQR −18;−1). In both SSc and SS eGFR median variation was statistically significant higher in patients affected by systemic arterial hypertension compared to those without [−12.2 ml/min (IQR −16.32;5.42) vs −1.8 ml/min (IQR −3;0.4), p<0.01 for SS patients and −18 ml/min (IQR −26; −12) vs −2 ml/min (IQR −7;2.25), p<0.001 for SSc].SSc patients had a significantly higher variation compared to SS patients both for median serum creatinine [0.1 mg/dl (IQR 0;0.2) vs 0 mg/dl (IQR −0.1;0.1), p<0.05] and median eGFR [−3 ml/min (IQR −18;−1) vs −2.1 ml/min (IQR −11.4;1.1), p<0.05].Conclusion:In both SSc and SS patients, renal involvement exhibited a subclinical pattern (eGFR > 60 ml/min). This preliminary study also highlights slight differences in renal involvement and its progression between the two groups considered. In SSc patients, creatinine levels at T0 are, on average, lower than in pSS patients possibly linked to their reduced muscle mass. Over time, SSc patients tend to show a tendency toward eGFR reduction, for the continuous microvascular damage leading to chronic hypoxic-ischemic injury.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.