Background: We determined the frequency of genetic polymorphisms in three anti-TB drug metabolic proteins previously reported: N-acetyltransferase 2 (NAT2), cytochrome P450 2E1 (CYP2E1) and arylacetamide deacetylase (AADAC) within a Peruvian population in a cohort of TB patients. We included 395 participants completed their anti-tuberculosis treatment. Results: ~74% of the participants are carriers of slow metabolizer genotypes: NAT2*5, NAT2*6 and NAT2*7, which increase the sensitivity of INH at low doses and increase the risk of drug-induced liver injuries. ~ 64% are homozygous for the wild-type CYP2E1*1A allele, which could increase the risk of hepatotoxicity. However, 16% had a NAT2 fast metabolizer phenotype which could increase the risk of acquiring resistance to INH, thereby increasing the risk of multidrug-resistant (MDR) or treatment failure. The frequency of rs1803155 (AADAC*2 allele) was higher (99.9%) in Peruvians than in in European American, African American, Japanese, and Korean populations. Conclusions: This high prevalence of slow metabolizers for Isoniazid in the Peruvian population should be further studied and considered to help individualize drug regimens, especially in countries with a great genetic diversity like Peru. These data will help the Peruvian National Tuberculosis Control Program develop new strategies for therapies.

RESUMEN Objetivo: Analizar la Teleorientación como una estrategia costo efectivo para la atención de personas con Hipertensión Arterial (HTA) en el contexto Covid -19. Materiales y Métodos: Artículo de reflexión sobre el análisis crítico de la teleorientación de personas con hipertensión arterial en contexto COVID-19, que resalta aspectos del marco normativo, ventajas y beneficios para los usuarios y los servicios de salud.Resultados: La teleorientación representó una estrategia costo efectiva beneficiosa en países de Sudamérica ya que permitió brindar educación, seguimiento y atención de salud oportuna al paciente con HTA, disminuyó el costo farmacológico mensual de S/. 5.76, mejoraría la calidad de vida al identificar signos y síntomas de alerta de la HTA, disminuyó la demanda laboral y costos en hospitales para el personal de salud reduciendo tiempo de espera y riesgos de contagio con enfermedades concomitantes Conclusión: Resulta adecuado considerar a la teleorientación como una medida costo efectiva en el seguimiento, tratamiento, atención y educación de las personas con HTA, debido a que podría incrementar la esperanza de vida de estos pacientes, evitar la exposición innecesaria a otras enfermedades durante la asistencia a los establecimientos de salud, disminuir la carga laboral del profesional de salud y reduciría costos del sistema de atención en salud orientados a gastos farmacológicos y horarios prolongados de espera; asimismo, constituye uno de los primeros pasos hacia la transformación digital en salud, en la cual Sudamérica aún se encuentra en proceso de desarrollo.   Palabras Claves: Teleorientación; hipertensión arterial, COVID-19.

Resumo Objetivo: analisar a relação entre a preocupação e o medo da COVID-19 com o fatalismo no cotidiano de trabalho dos enfermeiros. Método: estudo transversal analítico, realizado com 449 enfermeiros. A coleta de dados foi realizada por meio de instrumentos validados no Peru. Na análise, foram utilizados o teste de Shapiro-Wilk e o coeficiente de correlação de Spearman, sendo estimados dois modelos de regressão múltipla, com seleção de variáveis por etapas. Resultados: os enfermeiros apresentaram nível moderado de fatalismo e baixo nível de medo e preocupação com a COVID-19. O primeiro modelo estatístico, que incluiu variáveis sociodemográficas, explica apenas 3% da variância de fatalismo. No entanto, um segundo modelo que inclui medo e percepção explica 33%. Conclusão: a preocupação, o medo e ter sido diagnosticado com COVID-19 foram fatores preditores de fatalismo. Sugere-se a implementação de intervenções psicoemocionais no cotidiano de trabalho, voltadas para profissionais de Enfermagem que apresentem altos níveis de medo ou preocupação, para reduzir o fatalismo e, assim, prevenir consequências fatais da pandemia e promover a saúde.

Objective: to analyze the relationship between the concern and fear of COVID-19 with fatalism in the daily work of nurses. Method: analytical cross-sectional study carried out with a total of 449 nurses. Data collection was performed using instruments validated in Peru. In the analysis, the Shapiro-Wilk test and the Spearman correlation coefficient were used, and two multiple regression models were estimated, with variable selection in stages. Results: nurses had a moderate level of fatalism and a low level of fear and concern about COVID-19. The first statistical model, which included sociodemographic variables, explains only 3% of the fatalism variance. However, a second model that includes fear and perception explains 33% of it. Conclusion: Worry, fear and having been diagnosed with COVID-19 were predictors of fatalism. It is suggested the implementation of psycho-emotional interventions in daily work - aimed at Nursing professionals who present high levels of fear or concern - to reduce fatalism and prevent fatal consequences of the pandemic and promote health.

Background In Peru, 32,970 people were diagnosed with tuberculosis (TB) in 2019. Although TB treatment is effective, 3.4%–13% is associated with significant adverse drug reactions (ADR), considering drug‐induced liver injury (DILI) as the most prevalent. Among the first‐line anti‐TB drugs, isoniazid (INH) is primarily responsible for the occurrence of DILI. INH is metabolized in the liver by the enzymes N‐acetyltransferase‐2 (NAT2) and Cytochrome P450 2E1 (CYP2E1). Based on the previous studies, we hypothesized that the interactions between slow CYP2E1 genotype and NAT2 slow acetylators will induce DILI in TB patients. Methods In this cross‐sectional study, all 377 participants completed their anti‐TB treatment, and we genotyped SNPs: rs1041983, rs1801280, rs1799929, rs1799930, rs1208, and rs1799931 for NAT2 and rs3813867 and rs2031920 for CYP2E1. Results We found that rapid, intermediate, and slow NAT2 acetylator were 15%, 38%, and 47%, respectively, in the general population. Intermediate NAT2 acetylator is the least prevalent among patients with adverse reactions ( p = 0.024). We did not confirm our hypothesis, however, we found that the combination of intermediate NAT2 acetylators and CYP2E1 c1/c1 genotype significantly protected (OR = 0.16; p = 0.049) against the development of DILI in our population. Conclusion We propose that the presence of NAT2 intermediate and CYP2E1 c1/c1 genotype could help in therapeutic drug monitoring, and optimize its therapeutic benefits while minimizing its risk for side effects or toxicity.