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BACKGROUND: Mine tailings are metallic wastes which are deposited in the environment due to mining activity. Long-term exposure to these metals is harmful to human health. OBJECTIVE: To determine if chronic exposure to mine tailings constitutes a risk factor for the development of dermatological diseases in the district of San Mateo de Huanchor (Lima, Peru). METHODS: An observational case-control study was carried out in the communities of Mayoc, Daza and Tamboraque (exposed to mine tailings, case group) located in the district of San Mateo de Huanchor, and also in the communities of Choccna and Caruya (not exposed to mine tailings, control group) located in the same district. Out of 230 adults, 121 were exposed and 109 were not exposed to mine tailings and out of 135 children, 71 were exposed and 64 were not exposed to mine tailings. RESULTS: In the adult group, 71% of the exposed cases had some noninfectious dermatological disease while in the nonexposed group the frequency was 34% [P < 0.001; odds ratio (OR) 5.40; 95% confidence interval (CI) 3.02-9.68]. A statistically significant difference between groups was found for arsenical dermatitis, nonpruritic papulovesicular eruption, atopic dermatitis, contact dermatitis, seborrhoeic dermatitis and xerosis. In the paediatric population, 71 exposed and 64 nonexposed children were evaluated. Sixty-nine per cent of the exposed group had some noninfectious dermatological disease vs. 30% in the nonexposed group (P < 0.001; OR 6.00; 95% CI 2.71-13.31). A statistically significant difference between groups was found for xerosis and atopic dermatitis. CONCLUSION: Chronic exposure to mine tailings represents a risk factor for development of noninfectious dermatological diseases in both adults and children.

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Conocer la etiología del síndrome febril agudo en pacientes que acudieron a tres establecimientos de saludde la provincia de Jaén entre mayo de 2004 y abril de 2005. Materiales y métodos: Estudio descriptivo prospectivo realizado en tres establecimientos de salud: Hospital General de Jaén, Hospital de Apoyo Bellavista y Centro de Salud Morro Solar. Se incluyeron pacientes entre 5 y 65 años con fiebre de menos de ocho días de evolución y sin foco infeccioso aparente. Inicialmente se les realizó gota gruesa para malaria y frotis sanguíneo para Bartonelosis; de los casos negativos se obtuvo una segunda muestra de sangre para la búsqueda de ELISA IgM y microaglutinación para el diagnóstico de leptospirosis, ELISA IgM para dengue, Mayaro, Oropuche y encefalitis equina venezolana, e inmunofluorescenciaindirecta para Rickettsiosis. Resultados: De 1039 febriles incluidos, se determinó la etiología en 680(65,4 por ciento) casos, malaria por P. falciparum 312 (30,0 por ciento), leptospirosis 115 (11,1 por ciento), dengue 105 (10,1 por ciento), malaria por P.vivax 76 (7,3 por ciento), leptospirosis más dengue 30 (2,9 por ciento), Rickettsiosis 15 (1,4 por ciento), Bartonelosis 17 (1,6 por ciento), leptospirosis másRickettsiosis 7 (0,7 por ciento), y leptospirosis, dengue más Rickettsiosis 3 (0,3 por ciento). Los serovares de Leptospira más frecuentesfueron varilla (35,7 por ciento) y bratislava (32,5 por ciento). Conclusión: La malaria es la principal causa de síndrome febril agudo en Jaén, se destaca la presencia de la leptospirosis como segunda causa, por delante del dengue; es necesario considerar dentro del diagnóstico diferencial Rickettsiosis y Bartonelosis.

Objective: To know the etiology of acute febrile syndrome in patients presenting to three healthcare facilities in Jaen province,between May 2004 and April 2005. Materials and methods: A prospective and descriptive study was performed in three healthcare facilities:Jaen General Hospital,Bellavista Support Hospital and Morro Solar Health Center.Patients between 5 and 65 years were included.They had fever for less than eight days and with no apparent infectious etiology. Initially patients were screened with a thick smear blood test for malaria and a thin smear for Bartonellosis.Patients reported as negative for these test underwent a second blood test which included the following assays:IgM ELISA and microagglutination for leptospirosis,IgM ELISA for dengue fever,Mayaro,Oropuche and Venezuelan equine encephalitis, and indirect immunofluorescence for Rickettsiosis. Results: Of 1039 febrile patients included,a diagnosis was made in 80 65,4%)ases:P.alciparum malaria n 12 30,0%),eptospirosis in 15 11,1%),engue ever in 05 10,1%), P.vivax malaria in 76 (7,3%),leptospirosis and dengue fever in 30 (2,9%),rickettsiosis in 15 (1,4%),and leptospirosis plus dengue plus Rickettsiosis in 3 (0,3%).Most frequent Leptospira serovars were varilla (35,7%)and bratislava (32,5%). Conclusion: Malaria is the main cause of acute febrile syndrome in Jaen.It is also noteworthy the presence of leptospirosis in second place,above dengue fever;it is necessary to include this condition,as well as Bartonellosis and Rickettsiosis in the differential diagnosis.

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Objetivos: Investigar un brote de síndrome febril en el distrito de Punchao mediante una evaluación clínica, laboratorial y entomológica para conocer los factores asociados a la aparición de dicho brote. Materiales y métodos: Debido al reporte de tres pacientes con cuadro clínico febril asociado a cefalea, mialgias y postración en la semana epidemiológica N° 41 del año 2000, procedentes del distrito de Punchao, Humalíes, Huánuco y ante la información de presentación inusual de pacientes febriles en la última semana de dicho lugar, se decidió investigar la naturaleza y caracter1sticas del brote. Se definió como caso a todo paciente con cuadro febril agudo y uno de estos síntomas: cefalea, mialgias o postración; procediendose a la búsqueda activa de éstos y la evaluación de presencia de anticuerpos para rickettsias en suero mediante inmunofluorescencia indirecta (IFI). Se capturaron roedores y se colectaron ectoparásitos en las viviendas (roedores, animales domésticos y humanos), a fin de identificar la presencia de Rickettsias en ellos mediante IFI, aislamiento o PCR. Resultados: No se logró el aislamiento del agente causal. Se evidenció circulación de las Rickettsia sp. (serología positiva) tanto en humanos (en casos y en no casos) como en roedores. Se evidenció mayor presencia de malos hábitos de aseo y condiciones inadecuadas de saneamiento básico en los casos (respecto a los no casos) y una disminución de los casos luego del inicio de las medidas de control. Conclusiones: Laas evidencias encontradas permitieron identificar un brote de tifus en Punchao, no pudiendose determinar la especie involucrada debido a que no se aisló el agente causal

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Objetivos:Determinar la distribución geográfica de los serotipos del virus dengue en el Perú en el año 2001 e identificar las manifestaciones clínicas asociadas a dichos serotipos a partir de las muestras que ingresaron al Instituto Nacional de Salud (INS) de Lima, Perú. Materiales y métodos: En este estudio transversal analítico se incluyó 236 pacientes cuyas muestras sanguíneas resultaron confirmatorias de dengue por el método del aislamiento viral, realizado en el laboratorio de arbovirus y rickettsias durante el año 2001. Los datos clínicos de estos pacientes fueron extraídos de las fichas epidemiológicas enviadas por los establecimientos de salud en el ámbito nacional notificantes al INS. Resultados: Los cuatro serotipos del dengue estuvieron circulando en el Perú en el año 2001 (DEN-3 y DEN-4 recientemente identificados). La mayoría de los pacientes (76,7 por ciento) refirieron no haber tenido anteriormente dengue. Los pacientes con infección por el serotipo DEN-2 presentaron mayores síntomas y signos que aquellos infectados con DEN-1 y DEN-3; siendo este último serotipo el que produjo menor sintomatología en los pacientes. Conclusiones: Los cuatro serotipos del dengue están circulando en el país. El serotipo DEN-2 sería responsable de cuadros clínicos con mayor sintomatología o severidad

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The objective of this study was to identify risk factors related to the driver, the vehicle and the environment, that are associated with motor vehicles accidents on highways. A case and control design was used where the case was: the driver of a motor vehicle who was involved in an accident while traveling on the Mexico-Cuernavaca highway; and the control was: the driver or a motor vehicle who, traveling on the highway, completed the trip without being involved in a traffic accident. Risk factors associated with the occurrence of a traffic accident (P > 0.05) were: age under 25 years, frequent travel, traveling to work, alcohol consumption, driving during the daylight, on a week-day, under adverse weather conditions and in the Mexico Cuernavaca direction of road. Risks adjusted by logistic regression were: age under 25 years odds ratio (OR) 3.01, confidence interval (CI) (95%) 1.46-6.18; work as a travel reason OR 1.74, CI 1.06 2.86; alcohol intake OR 4.70, Cl 1.62 13.6; driving under adverse weather conditions OR 5.70, CI 3.66-8.85; traveling on a week-day OR 1.84, CI 1.14-2.94; during daylight hours OR 4.23, CI 2.36-7.58 and in the Mexico Cuernavaca direction of road OR 2.69, CI 1.67 4.32. The identification of factors associated with the risk of being involved in a highway traffic accident allows us to propose primary prevention measures for this important public health problem.

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OBJECTIVE: To evaluate the effect of interventions at a highway, in the occurrence and severity of injuries by traffic accidents. METHOD: It was made a comparative analysis of two cross-sectional studies in 1994 and 1996. RESULTS: In 1994 the rate was 7.96 accidents/ 100,000 vehicles and in 1996 8.49 / 100,000 vehicles. The increase was not significant (p>0.05). The rate of injured drivers in 1994 was of 2.10 / 100,000 vehicles and of 1.35 / 100,000 vehicles in 1996, which was a significant decrease (p<0.000). The self-report of use of seat belt (63.46% versus 76.6%), the small vehicles involved in accidents (7.9% versus 37.7%), nocturnal schedule (23.7% versus 31.8%) and in Mexico-Cuernavaca direction (45% versus 66.7%), were more frequent in 1996 (p<0.05). The risk of injury, using a logistic regression model, between drivers exposed to the interventions (1996) and those that were not exposed (1994) adjusted by: age, speed, use of seat belt, alcohol intake and external cause, showed a protective effect of the interventions at the highway (OR 0.42 CI95% 0.27-0.66). CONCLUSION: There is an evident need of multisectorial approaches in the study and evaluation of the interventions in the field of the traffic accidents. The present research is a clear example of the repercussions over health of interventions developed by the transportation sector at the highway.

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Traffic accidents are a well-known public health problem worldwide. In Mexico research into risk factors for motor involving vehicles accidents and their consequences has recently been taken into account. The relevant literature does not normally describe the methodological aspects involved in the collection of primary data, since most studies have used secondary data the good quality and validity of which are assumed. The paper presented seeks to discuss and share with researchers in this field, some of the methodological aspects to be considered in the attempt to recreate the scene of the accident and obtain information approximating to reality. The measurements in situ of, such traffic accident variables as injury, use of seat belt, speed and alcohol intake are discussed.

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Portal vein thrombosis has been considered idiopathic in 50% of cases reported in adults. Protein C deficiency is a recently described disorder characterized by a predisposition to develop thromboembolic disease. We report the findings in two patients with portal hypertension and bleeding varices due to portal vein thrombosis in whom a deficiency of protein C was present. Both cases were very similar, with a history of recurrent episodes of systemic thromboembolic disease, mesenteric venous thrombosis that required intestinal resection and upper gastrointestinal bleeding from gastroesophageal varices. Portal hypertension as well as portal vein thrombosis were demonstrated. The hematologic work-up revealed a deficiency of protein C. Both patients were subjected to the Sugiura procedure, and anticoagulation was instituted thereafter. At the time of surgery, a liver biopsy was performed, which was reported as "normal." Two years and 3 months, respectively, after surgery both patients are in good condition. We conclude that protein C deficiency should be investigated in all cases of portal vein thrombosis, especially in those with a history of thromboembolic disease elsewhere.

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