Universidad Peruana Cayetano Heredia

Background Dengue has emerged as an unprecedented epidemic in Peru, and it is anticipated that this issue will escalate further owing to climate change. This study aimed to determine the risk factors associated with death from dengue in patients treated at Hospital II in Pucallpa, Peru. Methodology This retrospective cohort study collected information from the medical records of patients with a diagnosis of dengue treated at Hospital II Pucallpa-Peru between January 2019 and March 2023. The primary outcome was death, and the secondary outcome was death, development of severe dengue, or Intensive Care Unit (ICU) admission. Cox regression models were used to determine risk factors. Findings The clinical records of 152 patients were evaluated, with a median age of 27.5 years (interquartile range, 11–45). Among all patients, 29 (19.1%) developed severe dengue, 31 (20.4%) were admitted to the ICU, and 13 (8.6%) died during follow-up. In the survival analysis, bilirubin >1.2 mg/dL was associated with a higher risk of death aHR: 11.38 (95% CI: 1.2 106.8). Additionally, factors associated with poor prognosis included having 1 to 3 comorbidities aRR: 1.92 (1.2 to 3.2), AST ≥251 U/L aRR: 6.79 (2.2 to 21.4), history of previous dengue aRR: 1.84 (1.0 to 3.3), and fibrinogen ≥400 mg/dL aRR: 2.23 (1.2 to 4.1). Significance Elevated bilirubin was associated with death from dengue, whereas an increase in comorbidities and a history of previous dengue were related to a poor prognosis of the disease. Early identification of severe dengue would be more feasible with improved access to laboratory testing, particularly in tropical areas with a high dengue incidence.

Purpose: In Peru, breast cancer (BC) stands as the most predominant malignancy neoplasm among women. Trastuzumab has marked a significant milestone in the management of this disease. It has been shown to improve prognosis in human epidermal growth factor receptor 2 (HER2)–expressing female patients, but its repercussions and efficacy are yet to be analyzed in a context with limited resources. Methods: The study population is made of woman patients aged 18 years and older diagnosed with HER2-positive BC at Instituto Nacional de Enfermedades Neoplásicas (INEN, Lima, Peru) during 2019–2021 and treated with at least one dose of subcutaneous trastuzumab. We reviewed medical records to register treatment characteristics, adverse events (AEs), disease progression, and survival status. We considered a median follow-up time of 36 and 45 months for progression and survival status. Results: The majority of patients were over 50 years old (54.29%). Tumor size averaged 19.7±16.1 mm. Lymph nodes were present in 44.78% of patients. Most patients received adjuvant chemotherapy (63.8%) as first-line treatment. Descriptive analyses of treatment outcomes revealed a 30% toxicity rate, primarily attributed to arthralgia (47.62%), followed by diarrhea, fatigue, and injection site reactions, with relatively lower discontinuation rates compared to larger scale studies. Differences in demographic, clinical, and treatment characteristics were not statistically significant concerning the emergence of AEs (p>0.05). Progression appeared in nine patients, and the overall survival (OS) rate stood at 98.6% and 92.8%, respectively, during a median follow-up of 36 and 45 months. Conclusion: The research suggests that subcutaneous trastuzumab is comparable in effectiveness and safety to the intravenous administration. Regional-specific studies may provide valuable insights into demographic factors influencing treatment outcomes in Peru or other countries. Furthermore, it could represent a more accessible alternative, potentially enhancing patient adherence and optimizing healthcare resource logistics.

SARS-CoV-2, responsible for COVID-19, has led to over 500 million infections and more than 6 million deaths globally. There have been limited effective treatments available. The study aims to find a drug that can prevent the virus from entering host cells by targeting specific sites on the virus’s spike protein. We examined 13,397 compounds from the Malaria Box library against two specific sites on the spike protein: the receptor-binding domain (RBD) and a predicted cryptic pocket. Using virtual screening, molecular docking, molecular dynamics, and MMPBSA techniques, they evaluated the stability of two compounds. TCMDC-124223 showed high stability and binding energy in the RBD, while TCMDC-133766 had better binding energy in the cryptic pocket. The study also identified that the interacting residues are conserved, which is crucial for addressing various virus variants. The findings provide insights into the potential of small molecules as drugs against the spike protein.

Introduction In 2016, WHO estimated there were roughly 374 million new infections among adults of the following four curable sexually transmitted infections (STIs): chlamydia (caused by Chlamydia trachomatis (CT)), gonorrhoea ( Neisseria gonorrhoeae (NG)), syphilis ( Treponema pallidum ) and trichomoniasis ( Trichomonas vaginalis (TV)). Accurate point-of-care tests (POCTs) for screening of genital and extragenital CT, NG and TV infections are of great value and have been developed during recent decade. Several tests are commercially available and have shown encouraging performance compared with ‘gold-standard’ reference tests in laboratory-based studies. However, there is limited data on their clinical performance, including at the POC. Key populations, such as men who have sex with men (MSM), are at higher risk of these STIs at genital and extragenital sites and these STIs are often asymptomatic, especially in extragenital sites and in women. We will conduct a clinical-based evaluation to assess the performance characteristics and acceptability to end-users of molecular-based diagnostic technology for POC/near patient use of the Xpert CT/NG (Cepheid, Sunnyvale, California, USA) test for screening of genital, anorectal and pharyngeal CT and NG infections in MSM and the Xpert CT/NG and Xpert TV (Cepheid, Sunnyvale, California, USA) for screening of genital CT, NG and TV among women at risk for these STIs compared with gold-standard reference nucleic acid amplification tests. This master protocol outlines the overall research approach that will be used in seven countries. Method and analyses Consecutive MSM and women at risk presenting at the clinical sites in high, and low- and middle-income countries will be enrolled. The POCTs to be evaluated are Xpert CT/NG and Xpert TV. All procedures will be carried out by trained healthcare staff and tests performed in strict accordance with the manufacturer’s instructions. The sensitivity, specificity, positive and negative predictive values for each POCT will be calculated. The study is ongoing with recruitment expected to be completed in all countries by mid-2022 to late-2022. Ethics and dissemination Prior to enrolment, this core protocol was independently peer-reviewed and approved by the research project review panel (RP2) of the WHO Department of Sexual and Reproductive Health and Research and by the WHO Ethics Review Committee (ERC). The core protocol has been slightly adapted accordingly to individual countries and adaptations approved by both RP2 and ERC, as well as all relevant institutional review boards at each participating site. Results will be disseminated through peer-reviewed journals and presented at relevant national/international conferences.

HIV stigma is a social determinant of health that can influence multiple health outcomes, including adherence to antiretroviral therapy (ART), engagement in HIV care, and viral suppression levels in people with HIV (PWH). In Peru, where the HIV epidemic is concentrated in men who have sex with men (MSM) and transgender women (TGW), stigma may play an important role in healthcare engagement. To understand the relationship between stigma and two outcome variables, ART adherence and engagement in HIV care in 400 MSM and TGW, we assessed factors from the Behavioral Model for Vulnerable Populations at two HIV clinics that tailor services for sexual and gender minorities. While some predisposing, need, and enabling resource factors were associated with optimal (≥ 90%) ART adherence or engagement in HIV care, none of the stigma subscales were correlated, suggesting that when LGBTQ-affirming care is provided to MSM/TGW, stigma may not influence HIV-related outcomes.

In patients with systemic lupus erythematosus (SLE), remission and low disease activity (LDA) have been shown to be protective of damage accrual, mortality, and flares; they have also been shown to be associated with a better health-related quality of life. ¹ However, the large majority of published studies include patients with long-standing disease.

Background Waist reduction by ultrasound-guided monocortical fracture (RibXcar), usually performed on floating ribs, may show limitations when performed on false ribs (9 and 10) because of the stress force exerted on the anterior fixation point (cartilage union to sternum). Hence, we introduced a procedure for conversion from false to floating ribs to improve the final result of the treatment of false ribs through a rib treatment scheme. Methods Forty-nine female patients undergoing rib surgery were recruited. Waist measurements and angular variations were compared between two groups of patients, the first (26 patients) consisting of patients who underwent RibXcar with conversion surgery (ribs 9 and 10) and the second (23 patients) consisting of patients who underwent RibXcar without conversion surgery (ribs 9 and 10). Results The waist measurements taken after 6 months showed a mean decrease of 8.70 cm in the group where only RibXcar was performed, whereas a statistically significant mean reduction of 17.04 cm was observed in the group where RibXcar was performed with rib conversion surgery. Conclusions The false-to-floating-rib conversion technique combined with RibXcar demonstrated more reduction in waist circumference and a more efficient rib angulation compared with RibXcar alone.

Background Lithium (Li) remains the treatment of choice for bipolar disorders (BP). Its mood-stabilizing effects help reduce the long-term burden of mania, depression and suicide risk in patients with BP. It also has been shown to have beneficial effects on disease-associated conditions, including sleep and cardiovascular disorders. However, the individual responses to Li treatment vary within and between diagnostic subtypes of BP (e.g. BP-I and BP-II) according to the clinical presentation. Moreover, long-term Li treatment has been linked to adverse side-effects that are a cause of concern and non-adherence, including the risk of developing chronic medical conditions such as thyroid and renal disease. In recent years, studies by the Consortium on Lithium Genetics (ConLiGen) have uncovered a number of genetic factors that contribute to the variability in Li treatment response in patients with BP. Here, we leveraged the ConLiGen cohort (N = 2064) to investigate the genetic basis of Li effects in BP. For this, we studied how Li response and linked genes associate with the psychiatric symptoms and polygenic load for medical comorbidities, placing particular emphasis on identifying differences between BP-I and BP-II. Results We found that clinical response to Li treatment, measured with the Alda scale, was associated with a diminished burden of mania, depression, substance and alcohol abuse, psychosis and suicidal ideation in patients with BP-I and, in patients with BP-II, of depression only. Our genetic analyses showed that a stronger clinical response to Li was modestly related to lower polygenic load for diabetes and hypertension in BP-I but not BP-II. Moreover, our results suggested that a number of genes that have been previously linked to Li response variability in BP differentially relate to the psychiatric symptomatology, particularly to the numbers of manic and depressive episodes, and to the polygenic load for comorbid conditions, including diabetes, hypertension and hypothyroidism. Conclusions Taken together, our findings suggest that the effects of Li on symptomatology and comorbidity in BP are partially modulated by common genetic factors, with differential effects between BP-I and BP-II.

Whole Genome Sequencing (WGS) is a promising tool in the global fight against tuberculosis (TB). The aim of this study was to evaluate the use of WGS in routine conditions for detection of drug resistance markers and transmission clusters in a multidrug-resistant TB hot-spot area in Peru. For this, 140 drug-resistant Mycobacterium tuberculosis strains from Lima and Callao were prospectively selected and processed through routine (GenoType MTBDRsl and BACTEC MGIT) and WGS workflows, simultaneously. Resistance was determined in accordance with the World Health Organization mutation catalogue. Agreements between WGS and BACTEC results were calculated for rifampicin, isoniazid, pyrazinamide, moxifloxacin, levofloxacin, amikacin and capreomycin. Transmission clusters were determined using different cut-off values of Single Nucleotide Polymorphism differences. 100% (140/140) of strains had valid WGS results for 13 anti-TB drugs. However, the availability of final, definitive phenotypic BACTEC MGIT results varied by drug with 10–17% of invalid results for the seven compared drugs. The median time to obtain results of WGS for the complete set of drugs was 11.5 days, compared to 28.6–52.6 days for the routine workflow. Overall categorical agreement by WGS and BACTEC MGIT for the compared drugs was 96.5%. Kappa index was good (0.65≤k≤1.00), except for moxifloxacin, but the sensitivity and specificity values were high for all cases. 97.9% (137/140) of strains were characterized with only one sublineage (134 belonging to “lineage 4” and 3 to “lineage 2”), and 2.1% (3/140) were mixed strains presenting two different sublineages. Clustering rates of 3.6% (5/140), 17.9% (25/140) and 22.1% (31/140) were obtained for 5, 10 and 12 SNP cut-off values, respectively. In conclusion, routine WGS has a high diagnostic accuracy to detect resistance against key current anti-TB drugs, allowing results to be obtained through a single analysis and helping to cut quickly the chain of transmission of drug-resistant TB in Peru.

Background Lupus nephritis (LN) is one of the most common, serious manifestations of systemic lupus erythematosus (SLE) and is associated with significant morbidity and mortality. Objectives To evaluate health-related quality of life (HRQoL) in patients with active LN at baseline and 12 months after treatment in relationship to the patients’ renal response. Methods GLADEL 2.0 is an observational prevalent and incident cohort initiated in 2019. Forty-four centers from 10 Latin-American countries enrolled patients ≥18 years of age who fulfilled the 1982/1997 American College of Rheumatology (ACR) and/or the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for Systemic lupus erythematosus (SLE). These patients were from four different groups according to the presence or not of LN. For this analysis, patients in Group II (prevalent inactive LN), III (prevalent active LN) and IV (incident LN, onset < 3 months) and follow-up data at 12 months were included. Demographic, clinical manifestations, treatments, disease activity (SLEDAI-2k) and damage SLICC/ACR Damage Index (SDI) were examined.At baseline, HRQoL was assessed with the LupusQoL and compared by the presence of active or inactive LN. At 12 months, the LupusQoL was applied to the active LN patients as a function of their renal response. Partial and complete responses were defined according to EULAR/KDIGO: Complete clinical response (CCR): UPCR < 0.5 g/g; Partial Clinical Response Criteria (PRC): ≥50% reduction in UPCR and No Response (NR): <50% reduction in proteinuria. A descriptive analysis was performed. Results Of the 1081 patients included in the cohort, 651 patients with LN were evaluated (423 with active and 228 with inactive disease). The active LN patients were predominantly women [569 (87.4%)], younger at cohort entry, of lower socioeconomic status, exhibited higher levels of unemployment, and had a higher SLEDAI than patients with inactive LN. As to the baseline LupusQoL, it was found to be worse in patients with active LN in all domains (Table 1). At 12 months, however, no differences were found between those patients who achieved complete/partial renal response versus those who did not (Table 2). Conclusion At baseline, active LN patients showed a worse QoL compared to those with inactive LN. However, at 12 months no differences were found between patients who achieve or did not achieve a renal response. Future analyses with a larger number of follow-up patients would be necessary to provide conclusive data. • Download figure • Open in new tab • Download powerpoint • Download figure • Open in new tab • Download powerpoint REFERENCES NIL Acknowledgements Medical writing support was provided by Panita Maturavongsadit, PhD, of Lumanity Communications Inc., and was funded by Janssen Global Services, LLC. Disclosure of Interests Romina Nieto: None declared, Rosana Quintana: None declared, Diana Carolina Fernández Ávila: None declared, Rosa Serrano: None declared, Guillermina Harvey: None declared, Lucia Hernández: None declared, Karen Roberts: None declared, Erika S. Palacios Santillan: None declared, Nidia Meras: None declared, Cintia Otaduy: None declared, Elisa Novatti: None declared, Valeria Arturi: None declared, Boris Kisluk: None declared, Luciana González Lucero: None declared, Eduardo Kerzberg: None declared, Nicolás Pérez: None declared, Cecilia Pisoni: None declared, Paola Pirruccio: None declared, María Elena Crespo Espindola: None declared, Ana Carolina de Oliveira e Silva Montandon GSK, AstraZeneca, Andrese Aline Gasparin: None declared, Angela Duarte: None declared, Laissa Alvino: None declared, Eloisa Bonfa: None declared, Emily Figueiredo Neves Yuki: None declared, Lucas Victoria de Oliveira Martins: None declared, Iris Guerra Herrera: None declared, Milena Mimica Davet: None declared, Lizeth De La Hoz Rueda: None declared, Andrés Cadena Bonfanti: None declared, Roberth Rivera: None declared, Paola Coral Alvarado: None declared, John Fredy Jaramillo: None declared, José Martínez: None declared, Mario Moreno Alvarez: None declared, Reyna Elizabeth Sánchez Briones: None declared, Mario Pérez Cristóbal: None declared, Eduardo Martin Nares: None declared, Yaneli Juárez-Vicuña: None declared, Yelitza González Bello: None declared, Jose Octavio González Enriquez: None declared, Leonardo René Aguilar Rivera: None declared, Margarita Duarte: None declared, Patricia Langjarth: None declared, Wilkerson Pérez Medina: None declared, Armando Calvo Quiroz: None declared, Teresandris Polanco Mora: None declared, Carina Pizzarossa: None declared, Gonzalo Silveira: None declared, Cristina Reátegui-Sokolova: None declared, Graciela S. Alarcón: None declared, Urbano Sbarigia Johnson & Johnson, Johnson & Johnson Innovative Medicine, Federico Zazzetti Johnson & Johnson, Johnson & Johnson Innovative Medicine, Ashley Orillion Johnson & Johnson, Johnson & Johnson Innovative Medicine, Guillermo Pons-Estel AstraZeneca, Boehringer Ingelheim, GSK, Janssen, Novartis, Pfizer, RemeGen, Sanofi and Werfen Diagnostics, AstraZeneca, Boehringer Ingelheim, GSK, Janssen, Novartis, Pfizer, RemeGen, Sanofi and Werfen Diagnostics, AstraZeneca, Boehringer Ingelheim, GSK, Janssen, Novartis, Pfizer, RemeGen, Sanofi and Werfen Diagnostics, Bernardo Pons-Estel AstraZeneca, GSK, Janssen.

Background Lupus nephritis (LN) is one of the most common, serious manifestations of systemic lupus erythematosus (SLE) and is associated with significant morbidity and mortality. Data on treatment response among Latin American patients with LN remain limited. Objectives To describe the rate of treatment response at 12 months in a cohort of SLE patients with active LN. Methods GLADEL 2.0 is an observational prevalent and incident cohort. Forty-four centers from 10 Latin-American countries enrolled patients ≥18 years old who fulfilled the 1982/1997 American College of Rheumatology (ACR) and/or 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria. Patients were categorized into 4 subsets according to the presence of LN. For this analysis, patients in Group III (prevalent and active LN) and IV (incident LN, onset <3 months with renal biopsy) and sufficient follow-up data at 12 months were included. Baseline demographics, clinical manifestations, disease activity (SLEDAI-2k) and SLICC/ACR Damage Index (SDI) and LN treatments were examined. Partial and complete response according to EULAR/KDIGO were examined at 12 months: Complete Response Criteria (CRC): proteinuria <0.5 g/g measured as the urine protein to creatinine ratio (UPCR) from a 24-h urine collection; Partial Response Criteria (PRC): ≥50% reduction in UPCR from a 24-h urine collection and No Response (NR): <50% reduction in proteinuria. Results One-thousand eighty-one patients were enrolled in GLADEL 2.0 with 364 patients included in this analysis: 195 (53.5%) in group III and 169 (46.4%) in group IV. At the 12-month follow-up, 13/364 (3.5%) patients had died, 14/364 (3.8%) had been lost to follow-up and 28/364 (7.6%) had incomplete data; therefore, the calculation of renal response was carried out in the remaining 309 patients. Table 1 describes the characteristics of patients with LN. Table 2 shows that patients who achieved renal response (complete or partial) had a shorter disease duration, greater use of pulse corticosteroids and IV cyclophosphamide, a lower chronicity index and all belonged to the LN incident group. When comparing complete vs partial response, patients who achieved complete response had lower baseline proteinuria and creatinine values, belonged to histological Class III and had lower SLEDAI. Conclusion Renal response was achieved in 64% of patients having their first episode of LN, with lower chronicity rates in the biopsy and a lower SLEDAI. Pulsed corticosteroids and IV cyclophosphamide continue to be the options chosen by treating physicians. More data in the follow-up will allow us to evaluate the persistence of this response over time and what factors may influence it. • Download figure • Open in new tab • Download powerpoint • Download figure • Open in new tab • Download powerpoint REFERENCES NIL Acknowledgements Medical writing support was provided by Panita Maturavongsadit, PhD, of Lumanity Communications Inc., and was funded by Janssen Global Services, LLC. Disclosure of Interests Rosana Quintana: None declared, Romina Nieto: None declared, Diana Carolina Fernández Ávila: None declared, Rosa Serrano: None declared, Guillermina Harvey: None declared, Lucia Hernández: None declared, Karen Roberts: None declared, Marina Scolnik Speaker fees/advisory: GSK, Astrazeneca, Janssen, Roche, Pfizer, Grants: GSK, Astrazeneca, Janssen, Roche, Pfizer, Carmen Funes Soaje: None declared, Paula Alba: None declared, Verónica Saurit: None declared, Mercedes Argentina García: None declared, Guillermo Berbotto: None declared, Verónica Bellomio: None declared, Wilfredo Patiño Grageda: None declared, Graciela Gómez: None declared, Cecilia Pisoni: None declared, Ana Malvar: None declared, Vicente Juarez: None declared, Nílzio A. da Silva: None declared, Odirlei André Monticielo: None declared, Henrique Ataide Mariz: None declared, Francinne Machado Ribeiro: None declared, Eduardo F. Borba: None declared, Luciana Parente Speaker GSK, astrazeneca, Edgard Torres: None declared, Oscar Neira: None declared, Loreto Massardo: None declared, Gustavo Aroca Martínez: None declared, Carlos A. Cañas Davila: None declared, Gerardo Quintana López: None declared, Carlos Enrique Toro-Gutierrez: None declared, Mario Moreno Alvarez: None declared, Andres Zúñiga: None declared, Miguel A. Saavedra Salinas: None declared, Margarita Portela Hernandez: None declared, Hilda Fragoso Loyo: None declared, Luis Silveira: None declared, Ignacio García De La Torre: None declared, Carlos Abud Mendoza: None declared, Marcos Fonseca Hernández: None declared, Jorge Antonio Esquivel-Valerio: None declared, Isabel Acosta Colmán: None declared, Jhonatan Losanto: None declared, Claudia Mora Trujillo: None declared, Katiuska Zuñiga Corrales: None declared, Roberto Muñoz Louis: None declared, Martin Rebella: None declared, Álvaro Danza: None declared, Manuel F. Ugarte-Gil Speaker: GSK and Aztra-Zeneca, Advisory boards: Aztra-Zeneca and Ferrer, Grant support: Janssen, Graciela S. Alarcón: None declared, Urbano Sbarigia Johnson & Johnson, Johnson & Johnson, Federico Zazzetti Johnson & Johnson, Johnson & Johnson, Ashley Orillion Johnson & Johnson, Johnson & Johnson, Guillermo Pons-Estel Speaker and/or advisor: AstraZeneca, GSK, Janssen, Bernardo Pons-Estel Speaker and/or advisor and/or steering committee for the following companies: AstraZeneca, Boehringer Ingelheim, GSK, Janssen, Novartis, Pfizer, RemeGen, Sanofi and Werfen Diagnostics, Grants, consulting fees: AstraZeneca, Boehringer Ingelheim, GSK, Janssen, Novartis, Pfizer, RemeGen, Sanofi and Werfen Diagnostics.

Background Lupus nephritis (LN) is one of the most common, serious manifestations of systemic lupus erythematosus (SLE) and is associated with significant morbidity and mortality. Objectives To evaluate work productivity (WP) and activity impairment (AI) in patients with active LN at cohort entry and 12 months after treatment initiation according to their renal response. Methods GLADEL 2.0 is an observational prevalent and incident cohort. Forty-four centers from Latin-American countries enrolled patients ≥18 years of age who fulfilled the 1982/1997 American College of Rheumatology (ACR) and/or the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE. Patients from different subsets of LN were enrolled. For this analysis, patients in Group II (prevalent inactive LN), III (prevalent active LN) and IV (incident LN) and 12-month follow-up data were included. Demographic, clinical manifestations, disease activity (SLEDAI- 2k) and damage SLICC/ACR Damage Index (SDI) were examined. At baseline, WPAI scores stratified by the presence of active or inactive LN were compared. At 12 months, absenteeism, presenteeism, global work impairment in employed patients and AI in patients with active LN were compared according to their renal response. Renal responses were defined according to EULAR/KDIGO: Complete clinical response: UPCR < 0.5 g/g; Partial clinical response: ≥50% reduction in UPCR, No Response: <50% reduction in proteinuria. Descriptive analyses were performed. Results Of the 1081 patients included in the cohort, 651 with history of LN were evaluated (423 with active LN and 228 with inactive LN). Of the active LN patients, 369 (87.4%) were women, were younger at cohort entry, of a lower socioeconomic status, had a higher unemployment rate and a higher SLEDAI than patients with inactive LN. Of the LN patients, 257 (39.5%) were employed (salaried work) at cohort entry and were included in this analysis. Patients with active LN showed higher rates of impairment in the WPAI score with greater impact and lower WP in all domains than in patients with inactive LN (Table 1). At 12 months, there was no evidence of a positive impact on WP as measured by the WPAI in patients who achieved renal response (Table 2). Conclusion Patients with active LN presented a greater impairment on WP compared to patients with inactive LN. There was no evidence of a positive impact on WP in patients who achieved a complete or partial renal response after 12 months of treatment. Future analyses with a larger number of patients being followed up would be necessary to provide more definitive data. • Download figure • Open in new tab • Download powerpoint • Download figure • Open in new tab • Download powerpoint REFERENCES NIL Acknowledgements Medical writing support was provided by Panita Maturavongsadit, PhD, of Lumanity Communications Inc., and was funded by Janssen Global Services, LLC. Disclosure of Interests Guillermo Pons-Estel AstraZeneca, Boehringer Ingelheim, GSK, Janssen, Novartis, Pfizer, RemeGen, Sanofi and Werfen Diagnostics, AstraZeneca, Boehringer Ingelheim, GSK, Janssen, Novartis, Pfizer, RemeGen, Sanofi and Werfen Diagnostics, AstraZeneca, Boehringer Ingelheim, GSK, Janssen, Novartis, Pfizer, RemeGen, Sanofi and Werfen Diagnostics, Romina Nieto: None declared, Rosana Quintana: None declared, Diana Carolina Fernández Ávila: None declared, Rosa Serrano: None declared, Guillermina Harvey: None declared, Lucia Hernández: None declared, Karen Roberts: None declared, Luis Catoggio: None declared, Gislea Subils: None declared, Carla Gobbi: None declared, Florencia Bordon: None declared, Pablo David Ibañez Peña: None declared, Leonel Ariel Berbotto: None declared, María Constanza Bertolaccini: None declared, Diego O. Rinesi: None declared, Maria de los Ángeles Gargiulo: None declared, Cecilia Pisoni: None declared, Joaquín Martínez Serventi: None declared, Emilio Buschiazzo: None declared, Vitalina Barbosa: None declared, Odirlei André Monticielo: None declared, Carolina Albanez de A. Da C. Andrade: None declared, Francinne Machado Ribeiro: None declared, Eloisa Bonfa: None declared, Eduardo F. Borba: None declared, Emília I. Sato: None declared, Alexis Peralta Bondi: None declared, Silvana Donoso: None declared, Gustavo Aroca Martínez: None declared, Hellen Medina: None declared, Alex Echeverri: None declared, Sebastian Molina-Rios: None declared, Manuela Rubio Rivera: None declared, Rafael Lopez Martinez: None declared, Mario Moreno Alvarez: None declared, Olga L. Vera Lastra: None declared, Mario Pérez Cristóbal: None declared, Carlos Núñez Álvarez: None declared, Luis M. Amezcua-Guerra: None declared, Ignacio García-Valladares: None declared, Carlos Abud Mendoza: None declared, Dionicio A. Galarza-Delgado: None declared, Marcos Vázquez: None declared, Astrid Paats: None declared, Jorge N. Cieza Calderón: None declared, Ana Mabel Quiros Alva: None declared, Roberto Muñoz Louis: None declared, Carina Pizzarossa: None declared, Adriana Carlomango: None declared, Rocío V. Gamboa-Cardenas: None declared, Graciela S. Alarcón: None declared, Urbano Sbarigia Johnson & Johnson, Johnson & Johnson, Federico Zazzetti Johnson & Johnson, Johnson & Johnson, Ashley Orillion Johnson & Johnson, Johnson & Johnson, Bernardo Pons-Estel AstraZeneca, GSK, and Janssen.

Background Frailty, measured with the SLICC-FI, has been reported as a predictor of damage in several cohorts. Objectives To evaluate the SLICC-FI as a predictor of hospitalization in systemic lupus erythematosus (SLE) patients. Methods Patients from a single-center prevalent cohort were included. The SLICC-FI was measured at baseline. Hospitalizations were reported during the first two years after the baseline visit as their number as well as their duration. Univariable and multivariable negative binomial regressions were performed to determine the association between the baseline SLICC-FI (per 0.05 increase) and hospitalizations during follow-up (number and length), adjusted for sex, age at diagnosis, socioeconomic status, educational level, disease duration, SLE Disease Activity Index 2000 (SLEDAI-2K), SLICC damage index (SDI), prednisone daily dose, antimalarial and immunosuppressive drug use at baseline. Results Of the 302 patients included 280 (92.7%) were female, with mean (SD) age at diagnosis of 34.6 (7.2) years. At baseline, the mean (SD) disease duration was 7.2 (6.4) years, and the mean (SD) SLICC-FI was 0.21 (0.05). The mean number of hospitalizations per patient was 0.5 (1.6) and the mean number of days hospitalized during the two-year period per patient was 5.3 (16.8) days; 58 (17.9%) of the patients were hospitalized at least once during the follow-up. The SLICC-FI predicted a higher probability of hospitalizations as well as with a higher number of hospitalizations; these data are depicted in Table 1.View this table: • View inline • View popup Table 1. Impact of the SLICC-FI on the number and length of hospitalizations. Univariable and multivariable analyses Conclusion The SLICC-FI predicts hospitalizations in SLE patients, independently of other well-known risk factors of hospitalizations. Further studies are needed to determine strategies to improve frailty in SLE patients. REFERENCES NIL Acknowledgements NIL Disclosure of Interests Manuel F. Ugarte-Gil GSK, AztraZeneca, AztraZeneca, Ferrer, Janssen, Rocío V. Gamboa-Cardenas: None declared, Victor Pimentel-Quiroz: None declared, Cristina Reátegui-Sokolova: None declared, Claudia Elera-Fitzcarrald: None declared, Cesar Pastor Asurza: None declared, Zoila Rodriguez Bellido: None declared, Risto Perich Campos: None declared, Graciela S. Alarcón: None declared.

Aim To describe the perceptions and experiences of key stakeholders to understand the use of telehealth in community mental health centers (CMHCs) during the COVID-19 pandemic in Lima and Callao, Peru. Methods A qualitative study was carried out in four CMHCs in Lima and Callao, Peru. Forty-nine individual semi-structured interviews were conducted between September 2021 and March 2022, considering CMHCs' users and their relatives, health and administrative workers, directors, as well as local and national policymakers. Data was analyzed using thematic analysis. Results Regarding the transition from in-person care to telehealth, CMHCs' directors and workers identified some of the regulations issued by the Government during the pandemic, such as the continuity of care through telehealth, especially for pregnant women and for people with comorbidities related to COVID-19. Regarding benefits, workers and users indicated that it allowed better communication, such as constant follow-ups. Directors and workers recognized that Google Drive facilitated access to user information, since they did not have an electronic medical record. Additionally, workers said they used social media to share educational information on mental health, and explained that some new users began their treatment this way. Regarding difficulties, participants reported a lack of devices and poor internet connection in CMHCs. Users mentioned that scheduling an appointment was difficult because the phone lines were usually saturated, and they could not find available appointments. Conclusion Although the pandemic forced an immediate and disruptive change towards telehealth, CMHCs were able to adapt most of their services. This study reports the adaptations made by CMHCs to move from in-person to remote care, identifying the benefits and challenges faced, information that can be used for the nationwide implementation of telehealth in CMHCs. We recommend ensuring technological equipment and internet connection and adapt the telehealth system to make it responsive to the routine practices of CMHCs.

Background The “Virtual Semester for Medical Research Aachen” (vSEMERA) is an international, interdisciplinary, virtual education program developed for health profession students. The first edition (2021) was hosted by the Medical Faculty of RWTH Aachen University (Germany) in cooperation with Centro Universitário Christus (Brazil) and Universidad Peruana Cayetano Heredia (Peru). The primary aim of the 12-weeks program was to provide students with skills in health science research and prepare them for scientific career paths. Methods vSEMERA was built on a virtual learning platform, the “vSEMERA-Campus”, designed to foster students’ learning process and social interactions. Maximum flexibility was offered through synchronous and asynchronous teaching, enabling participants to join via any device from any part of the Globe alongside their regular studies. For the program’s first edition (September - November 2021), health profession students from Germany, Brazil, Peru, Spain, and Italy filled all 30 available spots. Satisfaction, quality of the program and courses offered, as well as perceived learning outcomes, were examined using questionnaires throughout and at the end of the program. Results The program received a rating of 4.38 out of 5 stars. While it met most expectations (4.29 out of 5), participants were unable to attend as many courses as intended (2.81 out of 5), mainly due to scheduling conflicts with the home university schedule (46%), internships (23%), and general timing issues (31%). Participants acknowledged considerable improvements in their scientific skills, English language skills, confidence in scientific project management, research career progression, and enthusiasm for a scientific career. Conclusions vSEMERA represents a promising example of an online international learning and exchange program using pedagogical and technological elements of virtual collaboration and teaching. In addition to advancing future vSEMERA editions, our results may offer insights for similar projects that address the targeted integration of scientific research education into an international, digital learning environment.

e15549 Background: Early-onset colorectal cancer (EO-CRC) is defined as colorectal cancer diagnosed before age 50 and its incidence has been increasing during the last decade. Average-onset colorectal cancer (AO-CRC) has presented a steady decline in incidence and related mortality over the past 20 years. There is controversy surrounding the disparities in outcomes and overall survival (OS) in EO-CRC vs. AO-CRC. Our study compared the OS and cause-specific survival (CSS) between metastatic EO-CRC (mEO-CRC) and metastatic AO-CRC (mAO-CRC) and identified associated factors. Methods: Data on patient characteristics, tumor characteristics, incidence and mortality were obtained from the SEER database from 2010 to 2020. We identified 23,278 individuals aged > 18 with confirmed diagnosis of all histologic subtypes of metastatic CRC (M1 on TNM stage) using ICD-O-3 site code C180, C182-9, C209 and histology codes: 8000, 8010, 8012, 8013, 8020-2, 8031-33, 8041, 8045, 8070-2, 8083, 8123-4, 8140, 8144-45, 8201, 8210-11, 8213, 8220-1, 8240, 8243-46, 8249, 8253, 8255, 8260-3, 8261-3, 8265, 8310, 8323, 8480-1, 8490, 8507, 8510, 8550, 8560, 8570, 8574, 8936, 8980. OS distributions and CCS were conducted using the Kaplan-Meier method and log-rank test was used to assess differences between mEO-CRC and mAO-CRC. Cox regression model used to assess associations between variables. Results: mEO-CRC constituted 17.79% of the cases, while 82.21% were mAO-CRC. Most patients with mEO-CRC were between 45-49 years old (47.66%), males (52.16%), white (72.57%), with histology of adenocarcinoma (87.30%). Left colon tumors were most prevalent in both groups (40.26%), but higher among mEO-CRC than in mAO-CRC (49.63% vs 38.23%, p < 0.001). mEO-CRC were more likely to receive chemotherapy (87.23% vs. 66.66%, p < 0.001) and radiotherapy (14.92% vs. 9.51%, p < 0.001), while surgery was similar in both groups (87.71% vs. 88.52%, p = 0.140). Patients with mEO-CRC had a higher OS (HR: 1.53, CI 95% 1.47-1.59, p < 0.001), as well as a higher CSS (HR: 1.33, 95% CI: 1.27-1.39, p < 0.001) when compared to mAO-CRC. mEO-CRC also had a significantly better median overall survival (30 months vs. 18 months p < 0.001). Factors associated with worse OS include mAO-CRC (p < 0.001), mucinous adenocarcinoma (p < 0.001), male sex (p 0.003) and no surgical intervention (p < 0.001). Conclusions: Patients with mEO-CRC had better OS and CSS when compared to patients with mAO-CRC and were more likely to receive cancer-directed therapy which could be explained by the mEO-CRC cohort having a higher performance status, less comorbidities, and better tolerance to cancer-related therapy. Factors associated with worse OS and CSS are mAO-CRC, mucinous adenocarcinoma, male sex and lack of surgical intervention. Furthermore, it is crucial to continue studying potential candidates who would benefit from early CRC screening.