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The aim of this study was to evaluate the association between bartonellosis and selected climatic factors during the time periods 1983-1988 and 1995-99, which included two events of the El Niño phenomenon (1986-88, 1997-98), and to identify a reliable climate parameter to be used as an alert indicator for bartonellosis outbreaks in Ancash. The study site was Ancash and its province Carhuaz, Peru. Time-series cross-correlation analysis was used to assess the association between bartonellosis and climate parameters. A higher, almost 4-fold, monthly bartonellosis incidence risk in Ancash department was observed during the El Niño events of 1986-88 and 1997-98. At a regional (Ancash department) and local level (Carhuaz, Ancash), the best correlation was observed between bartonellosis and sea-surface temperature (SST). The results indicate that SST would be the best climate parameter to be used as an alert indicator for bartonellosis outbreaks in Ancash.

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Sanitary disposal of feces is vital to combat childhood diarrhea, and its promotion is key to improving health in developing countries. Knowledge of prevailing feces disposal practices is a prerequisite to formulation of effective intervention strategies. Two studies were conducted in a shantytown area of Lima, Peru. First, information was gathered through in-depth interviews with mothers and structured observations (4 hours) of young children and their caretakers. Data on beliefs and practices related to feces disposal behaviors were obtained. Excreta were deposited by animals or humans in or near the house in 82% of households observed. Beliefs about feces depended on their source and were reflected in how likely the feces were to be cleared. While 22% of children aged > or = 18 months were observed to use a potty for defecation, 48% defecated on the ground where the stools often remained. Although almost all children were cleaned after defecation, 30% retained some fecal matter on their body or clothes. Handwashing after the child's defecation was extremely rare for both children (5%) and caretakers (20%). The hygienic disposal of feces poses problems in this type of community. Nevertheless existing practices were found that show promise for promotion on a wider scale, including greater use of potties.

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This study investigated the practices followed by physicians in the clinical, therapeutic, and dietary management of children under the age of 5 with diarrhea. A total of 148 physicians were observed while they provided outpatient services at various public and private health institutions in two areas of Peru. They were also interviewed to assess their theoretical knowledge about the proper management of diarrhea in children. The physicians treated 222 children under 5 with diarrhea. It was observed that in taking their clinical histories the physicians ascertained the duration of the problem, the number of bowel movements, their consistency, and the presence of fecal mucus or blood in 175 (79%), 158 (71%), 140 (63%), and 153 (69%) cases, respectively. Antibiotics were prescribed for 130 children (58%), and 102 (46%) were not given any oral rehydration therapy (ORT). The oral rehydration salts (ORS) were recommended to only 40 (18%) of the children. On the other hand, during the interviews only 38 physicians (26%) indicated that they prescribe drugs for diarrhea, while 110 (74%) said that they recommend ORT. Fewer than half the mothers received recommendations regarding the type of food that they should give their children during the diarrhea episode. The results reveal a sizable discrepancy between theory and practice in the medical management of childhood diarrhea, which means that it is necessary to instill in physicians the importance of assessing and treating children with diarrhea according to a uniform and systematic scheme that includes careful therapeutic and dietary guidance.

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Seventy adult out-patients with tinea pedis participated in a multicentre open non-comparative study of the safety and efficacy of once-weekly doses of oral fluconazole 150 mg. A mean of 3 doses of fluconazole was administered; patients infected with Candida required an average of 2 doses compared to 3-4 doses in patients infected with other organisms. Clinical cure was obtained in 45 of 61 (74%) evaluable patients at the last post-treatment evaluation, with 15 patients being substantially improved and one patient failing clinically. At long-term follow-up, 28-30 days after the last dose was administered, 46 of 60 (77%) patients were clinically cured, 13 (22%) patients were improved and one patient failed. Trichophyton rubrum was isolated most frequently (47 of 60 mycologically evaluable patients). Mycological evidence of infection was eradicated from 52 of 60 (87%) patients post-treatment. At the long-term follow-up, infection was eradicated from 46 of 59 (78%) patients, persisted in five (8%) patients and relapsed in eight (14%) patients, six of whom were infected with T. rubrum and two of whom were infected with both T. rubrum and Candida. The number of doses received did not correlate with either the mycological response or relapse rates at long-term follow-up. The subgroup of 16 patients with infection of the sole of the foot, which is often considered to be more difficult to eradicate, responded similarly. Only 5 of 70 (7%) fluconazole-treated patients reported adverse effects, which were mild to moderate in severity, transient and did not result in discontinuation of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

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Setenta pacientes adultos ambulatoriais com tinea pedis participaram de um estudo nao comparativo aberto multicentrico a fim de avaliar a seguranca e eficacia de doses orais semanais de fluconazol 150 mg. Uma media de 3 doses de fluconazol foi administrada; pacientes infectados com Candida necessitaram de uma media de 2 doses enquanto 3-4 doses foram empregadas em pacientes infectados com outros organismos. A cura clinica foi obtida em 45 de 61 (74%) pacientes avaliados na ultima avaliacao posterior ao tratamento, havendo 15 pacientes com melhora clinica significativa e um paciente apresentando insucesso terapeutico. No seguimento a longo prazo 28-30 dias apos a administracao da ultima dose, 46 de 60 (77%) pacientes foram dados como clinicamente curados, 13 (22%) dos pacientes como melhorados e um paciente apresentou falha terapeutica. Trichophyton rubrum foi isolado com maior frequencia (47 de 60 pacientes com avaliacao micologica). Evidencias micologicas de infeccao foram erradicadas em 52 de 60 (87%) pacientes apos o tratamento. No seguimento a longo-prazo, a infeccao foi erradicada em 46 de 59 (78%) pacientes, persistiu em 5 (8%) dos pacientes e recidivou em oito (14%), seis dos quais estavam infectados com T. rubrum e 2, com ambos, Trubum e Candida. O numero de doses recebidas nao se correlacionou nem com a resposta micologica nem com os episodios de recidiva no seguimento a longo-prazo. O subgrupo de 16 pacientes com infeccao na sola do pe, a qual e considerada geralmente mais dificil de se erradicar, responderam de maneira semelhante. Somente 5 de 70 (7%) pacientes tratados com fluconazol apresentaram efeitos adversos, os quais foram de severidade leve a moderada, transitorios e nao resultaram em descontinuacao da terapeutica. O alto grau de tolerancia ao fluconazol em comparacao com outros antifugicos orais e a conveniencia de um regime de administracao de uma dose semanal oral se comparada a das terapias topicas e orais existentes, tornam as doses unicas orais semanais de fluconazol uma valiosa alternativa para o tratamento da tinea pedis

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Longitudinal studies of acute and persistent diarrhea in 677 children less than 3 years old were conducted for 27 months in an underprivileged, periurban community near Lima, Peru. Incidence rates and accurate durations of diarrhea were obtained by twice-weekly community-based surveillance and clinical and laboratory features of diarrheal episodes were documented. Study children had an overall incidence of diarrhea of 8.1 episodes per child-year and an incidence of persistent (greater than 14 days) diarrhea of 0.25 episodes per child-year. Episodes of longer duration were associated with young age (0-5 months) and more severe illness (greater than or equal to 6 diarrheal stools per day) in the first week. None of the laboratory tests performed in the first week of illness (fecal leukocytes, blood, reducing substances, pH, or fat) proved of value to identify episodes that would become persistent. Although steatorrhea was commonly present in the acute phase of the illness, it became less frequent by the third or subsequent week of illness in the persistent diarrheas. These results suggest that there are no clinical or laboratory features of acute diarrhea that are strongly predictive of the subset of diarrheas that persist. Thus, it is important that all diarrheal episodes should have appropriate fluid and dietary management and follow-up to detect the persistent diarrheas that may need special intervention.

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A randomized placebo-controlled double-blind field trial of RIT 4237 attenuated rotavirus vaccine in Lima, Peru, evaluated the protection against diarrheal illness by one, two, or three doses of vaccine. There were 391 children, 2-18 months old, studied for the occurrence of diarrhea during the 18 months after vaccination. Three doses of the vaccine provided 40% protection against any diarrheal illness associated with rotavirus alone but 58%-75%; protection against the more severe rotaviral illnesses. The vaccine appeared to be more efficacious when it was administered to children in the first year of life. Three doses provided up to 89% efficacy against more severe diseases due to serotype 1 rotavirus, and one dose also afforded significant protection. The protection was lower, even with three doses, against serotype 2 rotavirus. This vaccine trial has provided important insights on how such trials should be conducted and on the serotype-specificity of protection from rotavirus infection. Future vaccines should be able to protect against severe disease caused by all rotavirus serotypes and must work in developing countries where rotavirus is the most important cause of diarrheal mortality.

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To assess the hydration status of 40 exclusively breast-fed Peruvian infants, their milk intake and urinary volume and concentration were measured during 8-hour daytime observations. Maximum home temperatures ranged between 26 degrees and 33 degrees C; environmental relative humidity ranged between 49% and 96%. The infants consumed between 105 and 528 gm milk during the observation period; the standardized intakes ranged between 4.0 and 12.1 gm/kg body weight per hour (mean +/- SD 7.5 +/- 1.7 gm). The infants voided between 0.9 and 6.3 ml urine per kilogram of body weight per hour (mean +/- SD 3.4 +/- 1.3 ml). The maximum urinary specific gravity in each infant ranged between 1.003 and 1.017. We conclude that healthy infants can maintain adequate hydration status while exclusively breast-fed under these environmental conditions.

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A review of critical abdominal complications is made in 150 patients operated on for hydrocephalus in the surgical and neurosurgical services of the Hospital Infantil Legaria through the years 1975--1976. We found 3 colonic perforations (cecum, transverse and rectum), one abdominal perforation, one through the umbilicus, one in vagina, 1 case of plastic peritonitis and two with ascitis. In the majority of cases, such complications were satisfactorily solved; sometimes by extraction of the derivative systems, and some others by primary closure of the lesions. We only had one death. In a larger percentage, other complications were observed, being in order of frequency the following: distal catheter obstruction, proximal obstruction, infection and abdominal wall cysts. We analysed the association with spina bifida (meningocele o myelomeningocele), frequency related to age, sex, etiology and type of shunt. We reviewed the literature and suggest general measures tending to avoid such complications.

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Two cases of South American Blastomycosis are presented; the disease is not frequent in our country; the cases are a segmentary and difuse type primitive localized in the colon. In both of them the colonoscopy was a very important aid in the diagnosis.

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