RESUMO

Background: We sought to identify resistance patterns and key drivers of recent multidrug-resistant tuberculosis (MDR-TB) transmission in a TB-prevalent area in Peru. Methods: Cross-sectional study including MDR Mycobacterium tuberculosis complex (Mtbc) strains identified in Callao-Peru between April 2017 and February 2019. Mtbc DNA was extracted for whole genome sequencing which was used for phylogenetic inference, clustering, and resistance mutation analyses. Clusters indicative of recent transmission were defined based on a strain-to-strain distance of ≤5 (D5) single nucleotide polymorphisms (SNPs). Epidemiologic factors linked to MDR-TB clustering were analyzed using Poisson regression. Findings: 171 unique MDR-Mtbc strains were included; 22 (13%) had additional fluoroquinolone resistance and were classified as pre-XDR. Six strains (3.5%) harboured bedaquiline (BDQ) resistance mutations and were classified as MDR + BDQ. 158 (92%) Mtbc strains belonged to lineage 4 and 13 (8%) to lineage 2. Using a cluster threshold of ≤5 SNPs, 98 (57%) strains were grouped in one of the 17 D5 clusters indicative of recent transmission, ranging in size from 2 to the largest cluster formed by 53 4.3.3 strains (group_1). Lineage 4.3.3 strains showed the overall highest cluster rate (43%). In multivariate analyses, current or previous imprisonment was independently associated with being part of any MDR-TB transmission clusters (adjusted prevalence ratio [aPR], 1.45; 95% CI, 1.09-1.92). Interpretation: Pre-XDR-TB emerged in more than 10% of the MDR-TB strains investigated. Transmission of 4.3.3 Mtbc strains especially of the dominant group_1 clone is a major driver of the MDR-TB epidemic in Callao. Current or previous imprisonment was linked to recent MDR-TB transmissions, indicating an important role of prisons in driving the MDR-TB epidemic. Funding: This work was supported in part by the ERANet-LAC Network of the European Union, Latin America and the Caribbean Countries on Joint Innovation and Research Activities, and FONDECYT. Additional support was received from Leibniz Science Campus Evolutionary Medicine of the Lung, the Deutsche Forschungsgemeinschaft (German Research Foundation, under Germany's Excellence Strategy-EXC 2167 Precision Medicine in Inflammation), and the Research Training Group 2501 TransEvo.

RESUMO

Cardiac involvement in Adult-onset Still's Disease (AOSD) usually manifests as a pericardial disease, that has a benign course. The myocarditis is a rare complication with 7% of prevalence. The diagnosis of AOSD is based in the Yamaguchi or Fautrel criteria. The treatment with steroids and methotrexate is the first and second therapeutic lines, respectively, the combination is effective in 70% of cases. We report a case of AOSD with unusual presentation due to myocardial and pericardial commitment.

RESUMO

BACKGROUND: Among the most recent methods to diagnose liver fibrosis is 2D shear wave elastography (2D-SWE). However, the evidence in the Latin population is limited, and there is no consensus on the cutoff points for each stage of fibrosis. AIM: To evaluate the diagnostic performance of 2D-SWE for liver fibrosis in adults with obesity who underwent bariatric surgery (BS). METHODS: We conducted a cross-sectional study on patients with obesity who underwent BS between 2020 and 2021. Liver stiffness measurement was reported as the mean of valid measurements in kilopascals made with the 2D-SWE. The outcome was biopsy-proven liver fibrosis. ROC curves were constructed for significant fibrosis (F≥2) and advanced fibrosis (F≥3), with their respective area under the curve (AUC). To obtain the best cutoff point for each scenario, we used the Youden index. The 95% confidence intervals (95% CI) for each cutoff point were estimated by bootstrap with 1000 replications. RESULTS: We analyzed data from 227 patients. The mean age was 37.8 ± 11.1 years and 65.2% were women. Overall, the AUC for significant and advanced fibrosis was 0.54 (95% CI: 0.47-0.62) and 0.73 (95% CI: 0.60-0.87), respectively. For advanced fibrosis, higher AUCs were found among women (AUC: 0.82; 95% CI: 0.59-1.00) and among patients with morbid obesity (AUC: 0.78; 95% CI: 0.61-0.99). CONCLUSION: The 2D-SWE appears to be a valuable tool for screening advanced liver fibrosis in candidates for BS, mainly in the female population and in adults with morbid obesity.

Assuntos

RESUMO

Floating communities exist throughout the world. Many live on water with a high pathogen load due to difficulties associated with sewage management. In Claverito, an informal floating community in Iquitos, Peru, we conducted a controlled experiment to test the ability of water hyacinth (Eichhornia crassipes) to remove Escherichia coli from water. When river E. coli concentrations were at or below ∼1,500 CFU 100 mL-1, water hyacinth reduced shallow concentrations (8 cm depth) down to levels deemed safe by U.S. EPA for recreational use. Above this threshold, plants were able to reduce E. coli levels within shallow water, but not down to "safe" levels. At deeper depths (>25 cm), there was evidence that plants increased E. coli concentrations. Water hyacinth removed E. coli from shallow water by providing a surface (i.e., submerged roots) onto which E. coli sorbed and by protecting organisms that can potentially consume E. coli. Unfortunately, because of root association, the total E. coli load within the water column was greater with water hyacinth present. The use of water hyacinth to keep surface water around floating communities low in E. coli could be beneficial as this is the water layer with which people most likely interact. Aquatic vegetation naturally proliferates in and around Claverito. While this study was based on curating aquatic plants in order to achieve a water-quality outcome, it nonetheless supports concrete actions for Claverito residents under non-curated conditions, which are outlined at the end of the manuscript.

RESUMO

AIMS: Increasing evidence supports a relationship between poor oral health and growth in children. Our objective was to assess the association between the presence of dental caries and anthropometric measurements of children residing in Claverito, a floating slum community in the Peruvian Amazon. METHODS: For this cross-sectional study, presence of caries was assessed using dmft/DMFT (decayed, missing, filled teeth) scores and the SiC Index (mean dmft/DMFT of one-third of the study group with the highest caries score). Anthropometric categories for age-sex-specific z-scores for height and weight were calculated based on WHO standardized procedures and definitions. The association between SiC (measured by dmft/DMFT) and anthropometric measures was estimated using unadjusted and adjusted multivariable linear regression models. Critical value was established at 5%. RESULTS: Our study population consisted of 67 children between the ages of 1 and 18 years old. Mean age was 9.5 years old (SD: 4.5), and the majority were female (52.2%). Almost all had dental caries (97.0%) and the mean dmft/DMFT score was 7.2 (SD: 4.7). The SiC Index of this population was 9.0. After adjusting for confounding variables, participants who had permanent dentition with the highest dmft/DMFT levels had statistically significant decreased height-for-age z-scores (HAZ) (p=0.04). CONCLUSIONS: We found an inverse linear association between SiC Index and height-for-age z-scores (HAZ) among children living in poverty in a floating Amazonian community in Peru. Children from under-resourced communities, like floating slums, are at high risk for oral disease possibly negatively impacting their growth and development.

Assuntos

RESUMO

Abstract Aims: Increasing evidence supports a relationship between poor oral health and growth in children. Our objective was to assess the association between the presence of dental caries and anthropometric measurements of children residing in Claverito, a floating slum community in the Peruvian Amazon. Methods: For this cross-sectional study, presence of caries was assessed using dmft/DMFT (decayed, missing, filled teeth) scores and the SiC Index (mean dmft/DMFT of one-third of the study group with the highest caries score). Anthropometric categories for age-sex-specific z-scores for height and weight were calculated based on WHO standardized procedures and definitions. The association between SiC (measured by dmft/DMFT) and anthropometric measures was estimated using unadjusted and adjusted multivariable linear regression models. Critical value was established at 5%. Results: Our study population consisted of 67 children between the ages of 1 and 18 years old. Mean age was 9.5 years old (SD: 4.5), and the majority were female (52.2%). Almost all had dental caries (97.0%) and the mean dmft/DMFT score was 7.2 (SD: 4.7). The SiC Index of this population was 9.0. After adjusting for confounding variables, participants who had permanent dentition with the highest dmft/DMFT levels had statistically significant decreased height-for-age z-scores (HAZ) (p=0.04). Conclusions: We found an inverse linear association between SiC Index and height-for-age z-scores (HAZ) among children living in poverty in a floating Amazonian community in Peru. Children from under-resourced communities, like floating slums, are at high risk for oral disease possibly negatively impacting their growth and development.

Resumo Objetivos: Há cada vez mais evidências apoiando uma relação entre a saúde bucal precária e o crescimento das crianças. Nosso objetivo foi avaliar a associação entre a presença de cárie dentária e medidas antropométricas de crianças residentes em Claverito, uma comunidade flutuante de favelas na Amazônia peruana. Métodos: Para este estudo transversal, a presença de cárie foi avaliada utilizando os escores dmft/DMFT (dentes cariados, ausentes, preenchidos) e o Índice SiC (média dmft/DMFT de um terço do grupo de estudo com a maior pontuação de cárie). As categorias antropométricas para pontuações z específicas de idade e sexo para altura e peso foram calculadas com base nos procedimentos e definições padronizados da OMS. A associação entre SiC (medido por dmft/DMFT) e medidas antropométricas foi estimada usando modelos de regressão linear multivariável não ajustados e ajustados. O valor crítico foi estabelecido em 5%. Resultados: A população do estudo consistia de 67 crianças entre 1 e 18 anos de idade. A idade média era de 9,5 anos (DP: 4,5), e a maioria era do sexo feminino (52,2%). Quase todas tinham cárie dentária (97,0%) e a média da pontuação dmft/DMFT foi de 7,2 (DP: 4,7). O índice SiC desta população era de 9,0. Após ajuste para variáveis confusas, os participantes que tinham dentição permanente com os níveis mais altos de dmft/DMFT tinham diminuído estatisticamente a pontuação z de altura por idade (HAZ) (p=0,04). Conclusões: Encontramos uma associação linear inversa entre o Índice SiC e as pontuações z de altura por idade (HAZ) entre crianças que vivem na pobreza em uma comunidade amazônica flutuante no Peru. Crianças de comunidades com poucos recursos, como favelas flutuantes, correm alto risco de contrair doenças orais, possivelmente impactando negativamente seu crescimento e desenvolvimento.

RESUMO

INTRODUCCIÓN: En la mayoría de los servicios de emergencia del Perú no se cuenta con un cirujano vascular, teniendo que resolver los problemas vasculares el cirujano general. Es necesario que los cirujanos generales estén entrenados en el manejo vascular, sobre todo de aquellas condiciones que pueden comprometer la vida. OBJETIVO: Compartir los resultados del primer curso de cirugía vascular para el cirujano no vascular y el nivel de satisfacción de los alumnos participantes. MÉTODO: El curso de entrenamiento utilizó cinco modelos de simulación distribuidos en cinco sesiones prácticas. Al final del curso se evaluó a los alumnos usando la escala OSATS (Objetive Structured Assesment of Technical Skills) y se midió el tiempo de anastomosis arterial; adicionalmente se evaluó el nivel de satisfacción del curso. RESULTADOS: Participaron 12 alumnos, de los cuales ocho cumplieron los criterios de inclusión. La edad media fue de 39.9 años. La calificación OSATS fue de 19 (± 2.1). El tiempo de anastomosis fue de 17.6 (± 7.9) minutos. El nivel de satisfacción global de curso fue de 31.05; no hubo diferencias significativas entre la satisfacción de las diferentes sesiones prácticas (p = 0.85). El alfa de Cronbach de la encuesta fue de 0,96 (excelente). CONCLUSIONES: El curso intensivo de entrenamiento vascular combina diferentes escenarios quirúrgicos basados en la simulación. El nivel de satisfacción del curso y la fiabilidad de la encuesta para «percepción de las prácticas de simulación¼ fueron excelentes. INTRODUCTION: In most emergency services in Peru there is no vascular surgeon, the general surgeon having to solve the vascular problems. General surgeons need to be trained in vascular management, especially those life-threatening conditions. OBJECTIVE: To share the results of the first course of vascular surgery for the non-vascular surgeon and the level of satisfaction of the participating students. METHOD: The training course used five simulation models distributed in five practical sessions. At the end of the course, the students were evaluated using the OSATS (Objective Structured Assessment of Technical Skills) scale and the arterial anastomosis time was measured; Additionally, the level of satisfaction of the course was evaluated. RESULTS: 12 students participated, 8 met the inclusion criteria, the mean age was 39.9 years, the OSATS score was 19 (± 2.1) and the anastomosis time 17.6 (± 7.9) minutes. The level of overall course satisfaction was 31.05, there were no significant differences between the satisfaction of the different practical sessions (p = 0.85). The Cronbach's alpha for the survey was 0.96 (Excellent). CONCLUSIONS: The intensive vascular training course combines different surgical scenarios based on simulation. The level of satisfaction of the course and the reliability of the survey "perception of simulation practices" were excellent.

Assuntos

RESUMO

We performed a bibliometric analysis of Latin American documents published between 1984 to 2019 in Scopus-indexed journals. A total of 1856 documents were analyzed. The annual scientific production was 64 documents per year, with an annual increase rate of 15.9%. The countries with the highest scientific production on BS were Brazil (64.7%) and Chile (14.5%). Most of the publications were original (76.6%) and review articles (11.9%). The journal with the highest publication record was "Obesity Surgery" (25.8%). The extra-regional collaboration was mainly with the USA. In conclusion, Latin American scientific production on BS has shown a significant increase in recent years. However, more participation is needed, fostering intra-regional collaboration and involving universities and health institutions in BS research.

Assuntos

RESUMO

Disease surveillance in Neotropical primates (NP) is limited by the difficulties associated with anesthetizing NP for sample collection in remote settings. Our objective was to optimize a noninvasive method of oral sampling from semicaptive NP in Peru. We offered 40 NP at Taricaya Rescue Centre in Madre de Dios, Peru ropes coated in various attractants and measured variables (acceptance of the rope, chewing time, and volume of fluid eluted from ropes) that may affect sample acquisition and quality. We preserved samples by direct freezing in liquid nitrogen or by storing samples in RNA stabilization reagent at room temperature. Sample integrity was measured by testing for mammalian cytochrome b with the use of conventional PCR. The NP successfully chewed on a rope in 82% (125/152) of trials. Overall sample integrity was high, with 96% (44/46) of samples (both directly frozen and stored in stabilization reagent) testing positive for cytochrome b. The number of times that an individual NP was exposed to the rope procedure and NP age were associated with higher acceptance rates and the NP successfully chewing on the rope. We conclude that ropes serve as a feasible noninvasive method of obtaining oral samples from NP at rescue centers and could be used in future studies to evaluate population genetics and for pathogen surveillance for population health monitoring.

Assuntos

RESUMO

OBJECTIVE.: The aim of this study was to determine the percentage of symptomatic respiratory (SR) cases, according to the programmatic definition, among people who attend medical offices at first-level health facilities of the Ministry of Health in Lima under normal circumstances. The study also aims at identifying the percentage of patients with tuberculosis among the RS and among coughers over seven days. MATERIALS AND METHODS.: Cross-sectional study of patients attending consultations at 57 health centers. Patients with cough and phlegm lasting more than seven days and RS were identified and a sputum sample was taken to rule out tuberculosis by smear and culture. RESULTS.: A total of 10,421 people was surveyed. A 2.7% had cough with phlegm for ≥7 days and only 1.1% were SR; 215 patients were screened for tuberculosis. Seven (5.9%) of the RS and eight (4.8%) of the patients with a 7-14-day cough had tuberculosis. CONCLUSIONS.: The percentage of RS in the Ministry of Health's health facilities in Lima was less than the expected 5%, ranging from 0.8% in Callao to 1.5% in Lima City. The percentage of tuberculosis among coughers (lasting 7-14 days) and RS is consistent with the findings of other local studies. Consideration should be given to lowering the RS target to less than 5% and expanding tuberculosis screening to patients with cough ≥7 days at the Health Divisions with high tuberculosis incidence.

OBJETIVO.: El objetivo de este estudio fue determinar el porcentaje de sintomáticos respiratorios (SR), según la definición programática, entre las personas que en condiciones habituales acuden a consulta en los establecimientos de salud de primer nivel del Ministerio de Salud en Lima, e identificar el porcentaje de pacientes con tuberculosis entre los SR y entre tosedores de más de siete días. MATERIALES Y MÉTODOS.: Estudio transversal en pacientes que acudieron a consulta en 57 centros de salud. Se identificó a los pacientes con tos y expectoración de más de siete días y SR, a quienes se les tomó una muestra de esputo para descarte de tuberculosis mediante baciloscopía y cultivos. RESULTADOS.: Se encuestaron 10 421 personas. El 2,7% presentaron tos con expectoración por ≥7 días y solo el 1,1% fueron SR; 215 pacientes fueron examinados para descarte de tuberculosis. Siete (5,9%) de los SR y ocho (4,8%) de los pacientes con tos de 7-14 días tuvieron tuberculosis. CONCLUSIÓN.: El porcentaje de SR en establecimientos de salud del Ministerio de Salud en Lima fue menor al 5% esperado, con un rango de 0,8% en Callao hasta 1,5% en Lima Ciudad. El porcentaje de tuberculosis entre tosedores de 7-14 días y SR concuerda con el hallado en otros estudios locales. Se debe considerar la posibilidad de disminuir la meta de SR a menos del 5% y ampliar el despistaje de tuberculosis a pacientes con tos ≥7 días en las Direcciones de Salud con altas incidencias de tuberculosis.

Assuntos

RESUMO

RESUMEN Objetivo. El objetivo de este estudio fue determinar el porcentaje de sintomáticos respiratorios (SR), según la definición programática, entre las personas que en condiciones habituales acuden a consulta en los establecimientos de salud de primer nivel del Ministerio de Salud en Lima, e identificar el porcentaje de pacientes con tuberculosis entre los SR y entre tosedores de más de siete días. Materiales y métodos. Estudio transversal en pacientes que acudieron a consulta en 57 centros de salud. Se identificó a los pacientes con tos y expectoración de más de siete días y SR, a quienes se les tomó una muestra de esputo para descarte de tuberculosis mediante baciloscopía y cultivos. Resultados. Se encuestaron 10 421 personas. El 2,7% presentaron tos con expectoración por ≥7 días y solo el 1,1% fueron SR; 215 pacientes fueron examinados para descarte de tuberculosis. Siete (5,9%) de los SR y ocho (4,8%) de los pacientes con tos de 7-14 días tuvieron tuberculosis. Conclusión. El porcentaje de SR en establecimientos de salud del Ministerio de Salud en Lima fue menor al 5% esperado, con un rango de 0,8% en Callao hasta 1,5% en Lima Ciudad. El porcentaje de tuberculosis entre tosedores de 7-14 días y SR concuerda con el hallado en otros estudios locales. Se debe considerar la posibilidad de disminuir la meta de SR a menos del 5% y ampliar el despistaje de tuberculosis a pacientes con tos ≥7 días en las Direcciones de Salud con altas incidencias de tuberculosis.

ABSTRACT Objective. The aim of this study was to determine the percentage of symptomatic respiratory (SR) cases, according to the programmatic definition, among people who attend medical offices at first-level health facilities of the Ministry of Health in Lima under normal circumstances. The study also aims at identifying the percentage of patients with tuberculosis among the RS and among coughers over seven days. Materials and Methods. Cross-sectional study of patients attending consultations at 57 health centers. Patients with cough and phlegm lasting more than seven days and RS were identified and a sputum sample was taken to rule out tuberculosis by smear and culture. Results. A total of 10,421 people was surveyed. A 2.7% had cough with phlegm for ≥7 days and only 1.1% were SR; 215 patients were screened for tuberculosis. Seven (5.9%) of the RS and eight (4.8%) of the patients with a 7-14-day cough had tuberculosis. Conclusions. The percentage of RS in the Ministry of Health's health facilities in Lima was less than the expected 5%, ranging from 0.8% in Callao to 1.5% in Lima City. The percentage of tuberculosis among coughers (lasting 7-14 days) and RS is consistent with the findings of other local studies. Consideration should be given to lowering the RS target to less than 5% and expanding tuberculosis screening to patients with cough ≥7 days at the Health Divisions with high tuberculosis incidence.

Assuntos

RESUMO

Este artículo hace breve referencia a los antecedentes del concepto de «Una Salud¼ en el contexto mundial y peruano, y la forma como esta perspectiva holística de salud sirvió de fundamento para la creación del Centro de Investigaciones, Tecnológicas, Biomédicas y Medioambientales (CITBM) en la Universidad Nacional Mayor de San Marcos. Seguidamente, describe el proyecto InterACTION Labs, una de las experiencias que usa el enfoque de «Una Salud¼, liderado por el CITBM, la Universidad de Washington y Traction, esta última una organización no gubernamental enfocada en el diseño e investigación en salud y ecología. InterACTION Labs es un programa de diseño e investigación-acción transdisciplinaria (TDAR, por sus siglas en inglés) que se desarrolla en «Claverito¼, una comunidad flotante en la ciudad de Iquitos en la Amazonía peruana, y que se sustenta en la hipótesis de que el entorno construido es determinante de la salud, tanto del ser humano como de otras especies (aves, reptiles, plantas, etc.). También, discute el concepto de entorno construido en relación a la teoría y práctica de la salud pública, la arquitectura paisajista, la epidemiología y otros campos de la salud y del medio ambiente. Finalmente, reflexiona en los logros y desafíos del proyecto que comenzó en 2015, y describe el plan de trabajo para los próximos años, en los que se propone extender el programa y el uso del enfoque de «Una Salud¼ para promover la salud humana, ecológica y ambiental en el Perú y otras partes del mundo.

This article makes brief reference to the background of the "One Health" concept in the global and Peruvian context, and to the way in which this holistic health perspective served as the foundation for the creation of the Center for Technological, Biomedical, and Environmental Research (CITBM) at Universidad Nacional Mayor de San Marcos. Additionally, it describes the InterACTION Labs project, one of the experiences using the "One Health" approach, led by CITBM, the University of Washington, and Traction, an NGO focused on design and research in health and ecology topics. InterACTION Labs is a design and transdisciplinary action-research (TDAR) program developed in "Claverito," a floating community in the city of Iquitos in the Peruvian Amazon, based on the hypothesis that the built environment is a health determinant for both humans and other species (birds, reptiles, plants, etc.). It also discusses the concept of 'built environment' as related to the theory and practice of public health, landscape architecture, epidemiology, and other health and environmental fields. Finally, it reflects on the achievements and challenges of the project that began in 2015, and describes the work plan for the coming years, with a proposal to extend the program and use the "One Health" approach to promote human, ecological, and environmental health in Peru and other parts of the world.

Assuntos

RESUMO

Objetivo: Comparar método METCOFF y peso para su edad gestacional por Capurro como factores pronóstico de morbimortalidad durante periodo neonatal precoz en recién nacido a término. Material y métodos: estudio analítico prospectivo tipo cohorte. La población fue todos recién nacidos a término por parto único vaginal. La muestra se calculó con Epidat 3.1, usando una razón de no expuestos sobre expuestos para sospecha de sepsis neonatal de 20% en evaluados con la escala CANSCORE; nivel de confianza de 95% y potencia mínima de 70%, se obtuvo 49 recién nacidos a término con malnutrición fetal y 245 recién nacidos sin malnutrición fetal. Resultados: recién nacidos con malnutrición fetal fueron 46 (15,6%) y 248 (84,4%) sin malnutrición fetal, de los cuales 32 (69,6%) y 53 (21,4%) presentaron alguna morbilidad respectivamente. Según la clasificación de peso para la edad gestacional, 239 (81,3%) fueron AEG, 46(15,6%) GEG y 9(3,1%) PEG, presentaron malnutrición fetal con el método METCOFF, 5 (55,6%), 40 (16,7%) y 1 (2,2%) de los recién nacidos PEG, AEG y GEG respectivamente. Los recién nacidos expuestos a malnutrición fetal presentaron un riesgo de 4,18 y 3,34 veces mayor para desarrollar morbilidad y policitemia respectivamente que los recién nacidos sin malnutrición fetal (p<0,05); las curvas de Kaplan Meier muestran significancia (Log Rank < 0,05) estadística para sobrevida libre de morbilidad con método METCOFF, todo lo contrario para peso para EG. Conclusión: El método de evaluación nutricional METCOFF tienen mejor valor pronóstico para morbilidad que el peso para edad gestacional.

RESUMO

A mediados del siglo XIX se empezó a enfocar el concepto de Demencia, como una entidad irreversible asociada a la edad, Esquirol fue uno de los primeros en plantear una aproximación descriptiva del cuadro clínico, y Bayle el primero en proponer Demencia como una enfermedad atribuible a lesiones en el sistema nervioso central. Fue alrededor del año 1900, que Alois Alzheimer precisó las lesiones patológicas de dos entidades clínicas distintas, la primera descrita por él mismo, y la segunda por Arnold Pick (conocidas hoy como enfermedad de Alzheimer y demencia frontotemporal respectivamente). Conforme progresaron las técnicas de imágenes cerebrales y estudios de líquido cefalo-raquídeo fueron mejorando los criterios de diagnóstico para los diversos tipos de demencia, con un enfoque clínico-biológico. Las recomendaciones más recientes, sin embargo proponen un enfoque exclusivamente biológico de la enfermedad de Alzheimer.

By the middle of the 19th Century the concept of Dementia, as an irreversible entity associated with the aging process, came into focus thanks to the work of Esquirol, who was one of the first to propose a descriptive approach to the clinical picture, and Bayle, who was the first to suggest that Dementia was an illness attributable to injuries of the Central Nervous System. Around 1900, Alois Alzheimer described the pathology of the injuries of two distinct entities, the first described by him, and the second by Arnold Pick (known today as Alzheimer´s Disease and Frontotemporal Dementia respectively). The advances in brain-imaging techniques and studies of cerebrospinal fluid led to improvements of the clinical diagnostic criteria for the diverse types of dementia, with a clinical- biological focus. Nevertheless, the most recent recommendations suggest Alzheimer´s disease to be approached from a purely biological focus.

RESUMO

Introducción: Los tumores de Intestino Delgado son muy infrecuentes, suponen menos del 2% de todas las neoplasias gastrointestinales, con una prevalencia en la población de sólo del 0,6%. Reporte de caso: se reporta el caso de paciente varón, de 71 años, con diagnóstico de Linfoma de células T primario de Duodeno, quien estando recibiendo quimioterapia desarrolló Obstrucción intestinal. Conclusión: Se presenta el caso, el manejo del cuadro agregado y se hace revisión de la literatura médica sobre esta patología y su complicación de rara presentación.

RESUMO

Rural poverty and lack of access to education has led to urban migration and fed the constant growth of urban slums in Lima, Peru. Inhabitants of these informal settlements lack land rights and access to a public water supply, resulting in poor sanitation, an inability to grow food, and suboptimal health outcomes. A repeated measures longitudinal pilot study utilizing participatory design methods was conducted in Lima between September 2013 and September 2014 to determine the feasibility of implementing household gardens and the subsequent impact of increased green space on well-being. Anthropometric data and a composite of five validated mental health surveys were collected at the baseline, 6-months, and 12-months after garden construction. Significant increases from the baseline in all domains of quality of life, including: physical (p < 0.01), psychological (p = 0.05), social (p = 0.02), environmental (p = 0.02), and overall social capital (p < 0.01) were identified 12 months after garden construction. Life-threatening experiences decreased significantly compared to the baseline (p = 0.02). There were no significant changes in parent or partner empathy (p = 0.21), BMI (p = 0.95), waist circumference (p = 0.18), or blood pressure (p = 0.66) at 6 or 12 months. Improved access to green space in the form of a household garden can significantly improve mental health in an urban slum setting.

Assuntos

RESUMO

This article makes brief reference to the background of the "One Health" concept in the global and Peruvian context, and to the way in which this holistic health perspective served as the foundation for the creation of the Center for Technological, Biomedical, and Environmental Research (CITBM) at Universidad Nacional Mayor de San Marcos. Additionally, it describes the InterACTION Labs project, one of the experiences using the "One Health" approach, led by CITBM, the University of Washington, and Traction, an NGO focused on design and research in health and ecology topics. InterACTION Labs is a design and transdisciplinary action-research (TDAR) program developed in "Claverito," a floating community in the city of Iquitos in the Peruvian Amazon, based on the hypothesis that the built environment is a health determinant for both humans and other species (birds, reptiles, plants, etc.). It also discusses the concept of 'built environment' as related to the theory and practice of public health, landscape architecture, epidemiology, and other health and environmental fields. Finally, it reflects on the achievements and challenges of the project that began in 2015, and describes the work plan for the coming years, with a proposal to extend the program and use the "One Health" approach to promote human, ecological, and environmental health in Peru and other parts of the world.

Este artículo hace breve referencia a los antecedentes del concepto de "Una Salud" en el contexto mundial y peruano, y la forma como esta perspectiva holística de salud sirvió de fundamento para la creación del Centro de Investigaciones, Tecnológicas, Biomédicas y Medioambientales (CITBM) en la Universidad Nacional Mayor de San Marcos. Seguidamente, describe el proyecto InterACTION Labs, una de las experiencias que usa el enfoque de "Una Salud", liderado por el CITBM, la Universidad de Washington y Traction, esta última una organización no gubernamental enfocada en el diseño e investigación en salud y ecología. InterACTION Labs es un programa de diseño e investigación-acción transdisciplinaria (TDAR, por sus siglas en inglés) que se desarrolla en "Claverito", una comunidad flotante en la ciudad de Iquitos en la Amazonía peruana, y que se sustenta en la hipótesis de que el entorno construido es determinante de la salud, tanto del ser humano como de otras especies (aves, reptiles, plantas, etc.). También, discute el concepto de entorno construido en relación a la teoría y práctica de la salud pública, la arquitectura paisajista, la epidemiología y otros campos de la salud y del medio ambiente. Finalmente, reflexiona en los logros y desafíos del proyecto que comenzó en 2015, y describe el plan de trabajo para los próximos años, en los que se propone extender el programa y el uso del enfoque de "Una Salud" para promover la salud humana, ecológica y ambiental en el Perú y otras partes del mundo.

Assuntos

RESUMO

We estimated the prevalence of human immunodeficiency virus (HIV) disclosure in children from a prospective observational cohort study conducted at clinical sites in Brazil, Mexico, and Peru. Fewer than half of the children in this study knew their HIV status, which highlights the need for better strategies for disclosure that are age and culturally appropriate.

Assuntos

RESUMO

Puente Abadía es una zona cafetera por excelencia, del municipio de Villavicencio, Departamento del Meta, Colombia, donde se cultivan sistemas de café orgánico (SCO). El manejo agronómico del cultivo puede influir en las propiedades químicas de sus suelos. El análisis multivariado permitirá definir algunas limitantes químicas de los suelos y será un insumo futuro importante, para optimizar el manejo de nutrientes. Se muestrearon en la zona 12 SCO, que presentaban similitud en cuanto a tipo de sistema de producción, manejo agronómico y condiciones ambientales. Los datos fueron analizados, a través de estadística descriptiva, correlaciones lineales y los métodos multivariados de clúster y análisis de componentes principales (ACPs). En los SCO, se confirmó que existe una alta heterogeneidad en las propiedades químicas de los suelos. El Mg presentó el coeficiente de variación (CV) más alto (135,09%). El ACPs mostró que los dos primeros componentes principales explicaron más del 50% de la varianza total. El análisis de clúster de los SCO mostró alta heterogeneidad en las propiedades químicas de los suelos, conformándose dos grupos: el grupo 1 reunió a los SCO, dominados por una alta acidez intercambiable, incluyendo 3 de los 12 SCO y, el grupo 2, reunió a 9 de los SCO, definidos, principalmente, por altos contenidos de materia orgánica del suelo (MOS). La alta variabilidad encontrada fue influenciada, posiblemente, por el encalado y la fertilización orgánica.

Puente Abadía is for excellence a coffee growing area of the municipality of Villavicencio, department Meta, Colombia, where organic coffee systems OCS are cultivated. The agronomic management of the crop can influence its soil chemical properties. Multivariate analysis can permit to define some chemical soil limits and will be a future input to optimize the nutrient management. Twelve OCS were sampled in the zone that showed similarity in terms of production system, agronomic management and environmental conditions. Data were analyzed by descriptive statistics, linear correlations and multivariate clustered and principal components PC methods. High variability in OCS chemical properties were detected. The highest variation coefficient CV was presented in Mg 135.09%. The analysis of the principal components (APCs) showed that the first two PC explained more than 50% of the total variance. The cluster analysis of the OCS revealed high variability, defined in two large groups: group 1 brought together OCS dominated by interchangeable Al3+ including 3 of the 12 OCSs and group 2 brought together 9 of the OCS, mainly defined by high content in soil organic matter (SOM). The variability showed was possibly influenced by liming and organic fertilization.

RESUMO

[English]. Objetivo. Determinar la efectividad de la Estrategia para el Crecimiento y Desarrollo Integral (ECDI) de World Vision Perú sobre la anemia, desnutrición, desarrollo psicomotor y cuidado y protección infantil en niños menores de tres años de edad que residían en tres comunidades rurales de la Región Ayacucho del Perú. Métodos. Se realizó un estudio cuasiexperimental en tres distritos rurales de la región Ayacucho, Perú. La medición de anemia se realizó con sangre capilar y el analizador HemoCue®, con ajuste de los valores de hemoglobina según a la altitud. La desnutrición se midió a través de los indicadores antropométricos de talla y peso; para ello se utilizó la herramienta Anthro de la Organización Mundial de la Salud. El desarrollo psicomotor se midió mediante el Test Abreviado del Ministerio de Salud del Perú. El cuidado y protección de los niños se midió a través de una ficha especialmente elaborada para este fin. Se realizaron tres mediciones, la línea basal en mayo del 2013, la medición intermedia en noviembre del mismo año y la final en mayo del 2014. En total, 283 niños tuvieron dos o más mediciones incluida la medición final y 205 tuvieron las tres mediciones. Resultados. El análisis multivariado para medidas repetidas mostró una efectividad estimada de la ECDI para reducir la anemia de 33,1% (intervalo de confianza del 95%: 1,0%-54,7%) ajustada para la edad, sexo, consumo de alimentos ricos en hierro, consumo de alimentos potenciadores de la absorción de hierro, consumo de alimento inhibidores de la absorción de hierro, haber recibido suplementación de hierro en los últimos seis meses y haber participado del Programa Cuna Más. Conclusiones. La ECDI fue efectiva para mejorar la nutrición de los menores de 36 meses de edad a través de la reducción de la anemia y el incremento del consumo de potenciadores de la absorción de hierro. Las intervenciones que incluyen componentes educativos y de seguimiento comunitarios podrían ser de gran ayuda para combatir la anemia en los niños menores de 36 meses de edad en comunidades rurales.

[Español]. Objective. Determine the effectiveness of the Integrated Growth and Development Strategy (ECDI, Spanish acronym) of World Vision Peru on anemia, malnutrition, psychomotor development, and child care and protection in children aged <3 years living in three rural communities of Ayacucho Region, Peru. Methods. A quasi-experiment was carried out in three rural districts of Ayacucho Region, Peru. Anemia was measured using capillary blood and the HemoCue® analyzer, with hemoglobin values adjusted for altitude. Malnutrition was measured with anthropometric indicators for height and weight, using the World Health Organization’s Anthro software. Psychomotor development was measured with the Abbreviated Test of the Ministry of Health of Peru. Child care and protection was measured using a form specifically designed for this purpose. Three measurements were carried out: baseline in May 2013, midpoint in November 2013, and final in May 2014. In total, 283 children had two or more measurements including the final measurement, and 205 had all three measurements. Results. Multivariate analysis for repeated measures showed that ECDI had an estimated 33.1% effectiveness in reducing anemia (95% CI: 1.0%-54.7%), adjusted for age, sex, consumption of iron-rich foods, consumption of iron-absorption-enhancing foods, consumption of iron-absorption-inhibiting foods, having received iron supplementation in the last six months, and having participated in the Cuna Más Program. Conclusions. ECDI was effective in improving nutrition in children aged <36 months through anemia reduction and increased consumption of iron-absorption enhancers. Interventions that include educational and community monitoring components could be of great assistance to combating anemia in children aged <36 months in rural communities.

[Português]. Objetivo. Determinar a efetividade da Estratégia de Crescimento e Desenvolvimento Integral (ECDI) da World Vision Peru para anemia, desnutrição, desenvolvimento psicomotor e atenção e proteção infantis em crianças menores de 3 anos de idade em três comunidades rurais. Métodos. Foi realizado estudo quase-experimental em três distritos rurais da região de Ayacucho, no Peru. A avaliação da anemia foi realizada em sangue capilar com o uso do analisador HemoCue®, com correção dos valores de hemoglobina Segundo a altitude. A desnutrição foi avaliada segundo indicadores antropométricos de tamanho e peso, com o uso da ferramenta Anthro elaborada pela Organização Mundial da Saúde (OMS). O desenvolvimento psicomotor foi avaliado com o Teste Abreviado do Ministério da Saúde do Peru. A atenção e a proteção infantis foram avaliadas com o uso de uma ficha elaborada para esta finalidade. Foram realizadas três avaliações, com a linha de base em maio de 2013, a avaliação intermediária sendo realizada em novembro deste mesmo ano e a avaliação final, em maio de 2014. Ao todo, 283 crianças passaram por duas ou mais avaliações, incluindo a avaliação final, e 205 passaram por três avaliações. Resultados. Na análise multivariada de medidas repetidas, a efetividade estimada da ECDI de reduzir a anemia foi de 33,1% (intervalo de confiança de 95%: 1,0%-54,7%), corrigida para idade, sexo, consumo de alimentos ricos em ferro, consumo de alimentos potenciadores da absorção de ferro, consumo de alimentos inibidores da absorção de ferro, suplementação de ferro nos últimos seis meses e participação no Programa Cuna Más (programa nacional de desenvolvimento infantil). Conclusões. A ECDI demonstrou efetividade para melhorar a nutrição das crianças menores de 36 meses com a redução da anemia e o aumento do consumo de potenciadores da absorção de ferro. Intervenções com componentes educacionais e acompanhamento comunitário podem contribuir consideravelmente para combater a anemia em crianças menores de 36 meses em comunidades rurais.

Assuntos