Importancia cultural de la flora empleada por la comunidad nativa Asheninka Sheremashe, Ucayali, Perú / Cultural importance of the flora used by the Asheninka Sheremashe native community, Ucayali, Peru

The cultural significance of the flora used by the native Asheninka Sheremashe community in Ucayali, Peru was determined. To do this, a fieldwork of over 4 months was conducted, involving semi-structured interviews with 106 residents through non-probabilistic convenience sampling. The community utilizes 139 plant species in their daily lives, belonging to 120 genera and 52 families, with the most abundant being Fabaceae, Arecaceae, Malvaceae, Solanaceae, Poaceae, and Rutaceae. Furthermore, 25.9% of the species are of significant importance to theinhabitants according to the Cultural Index (CI), such as Manihot esculenta, Theobroma cacao, Bixa orellana, Musa paradisiaca, Ficus insipida, among others. It can be concluded that the flora plays a prominent role in the life of the community, with the categories reporting the highest number of species being: food (29.35%), medicine (28.36%), culture (9.95%), construction (9.45%), lumber (6.97%), commerce (3.48%), craftsmanship (2.49%), toxic (2.49%), and other uses (7.46%)

Se determinó la importancia cultural de la flora empleada por la comunidad nativa Asheninka Sheremashe, en Ucayali, Perú. Para ello, se realizó un trabajo de campo de más de 4 meses, donde se aplicaron entrevistas semiestructuradas a 106 habitantes mediante un muestreo no probabilístico por conveniencia. La comunidad emplea 139 especies vegetales en su día a día, pertenecientes a 120 géneros y 52 familias; siendo las más abundantes las Fabaceae, Arecaceae, Malvaceae, Solanaceae, Poaceae y Rutaceae. Además, el 25.9% de las especies tiene gran importancia para los pobladores según el Índice Cultural (IC): Manihot esculenta, Theobroma cacao, Bixa orellana, Musa paradisiaca, Ficus insipida, entre otras. Se concluye que la flora tiene un rol preponderante en la vida de la comunidad, siendo las categorías que presentaron mayor reporte de especies: alimentación (29.35%), medicina (28.36%), cultura (9.95%), construcción (9.45%), aserrío (6.97%), comercio (3.48%), artesanía (2.49%), tóxico (2.49%) y otros usos (7.46%)

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 18 (10 May 2024)

[WEEKLY SUMMARY]. Regional Situation: Over the past four epidemiological weeks (EWs), low activity levels of Influenza-Like Illness (ILI) have been noted across the Americas, exhibiting a declining trend primarily linked to North America. Simultaneously, there has been a reduction in Severe Acute Respiratory Infection (SARI) activity, which also remains low. These trends are largely associated with confirmed cases of influenza and, to a lesser extent, SARS-CoV-2. Regionally, SARS-CoV-2 activity has decreased to low levels compared to previous epidemic waves. Moreover, there has been a slight decline in seasonal influenza activity and a decrease in Respiratory Syncytial Virus (RSV) activity, both of which are currently low. North America: Over the last four EWs, ILI cases have continued to decline, predominantly due to influenza, resulting in intermediate-low activity levels. Hospitalizations due to respiratory viruses have also followed a downward trend, remaining low. While influenza has maintained epidemic circulation levels, there has been a notable decrease during this period. The most common influenza viruses have been type B/Victoria, with lesser circulation of influenza A(H3N2) and A(H1N1)pdm09. RSV activity has similarly decreased, stabilizing at low levels. SARS-CoV-2 activity has remained at low levels. By country: Canada SARS-CoV-2 activity has remained at low levels over the last four EWs. Influenza activity has sustained epidemic levels but has gradually decreased, and RSV activity has continued to decline, remaining low. In Mexico, influenza circulation has stayed fluctuating at epidemic levels, while SARS-CoV-2 activity has decreased to low levels. In the United States, influenza activity has decreased over the last four EWs but remains above the epidemic threshold. Both RSV and SARSCoV- 2 activities have continued their decline to low levels. ILI cases have decreased and are now at intermediate-low levels. Hospitalization rates for influenza, RSV, and SARS-CoV-2 have followed a decreasing trend, maintaining low levels. Caribbean: ILI and SARI cases have maintained a downward trend over the last four weeks, primarily involving influenza and, to a lesser extent, SARS-CoV-2. Influenza activity has been low but fluctuating during the last four EWs. The predominant viruses have been type A(H3N2), with concurrent circulation of influenza A(H1N1)pdm09 and to a lesser extent, B/Victoria. Both RSV and SARS-CoV-2 activities have remained low. By country: Influenza activity was noted in Belize, Jamaica, Guyana, and the Cayman Islands, while SARS-CoV-2 activity was observed in Barbados, Guyana, and Trinidad and Tobago. Central America: Over the last four epidemiological weeks (EWs), both ILI and SARI cases have maintained low activity levels, though with a slight increase, predominantly attributed to influenza cases. During this period, influenza activity has seen a slight rise, remaining at intermediate-low levels. The most prevalent influenza viruses have been type A(H3N2) along with concurrent circulation of A(H1N1)pdm09. Both Respiratory Syncytial Virus (RSV) and SARS-CoV-2 have consistently exhibited low levels of activity. By country: In El Salvador, SARI activity has been around epidemic levels, with SARS-CoV-2 maintaining low circulation and influenza activity fluctuating near the epidemic threshold. Guatemala has experienced stable ILI and SARI activities at epidemic levels throughout the last four EWs, associated with influenza cases at moderate circulation levels. Honduras has seen variable SARI activity around epidemic levels, connected to declining influenza cases at similar levels. In Nicaragua, RSV, influenza, and SARS-CoV-2 activities have all been low. Panama has reported an uptick in both ILI and SARI cases during this period, with influenza activity reaching epidemic levels. Andean Region: ILI activity has remained consistently low across the last four EWs. SARI cases have also been stable at low levels, although there has been a notable increase in RSV-positive cases and, to a lesser extent, influenza. The influenza activity has been low but fluctuating throughout this period, with type A(H3N2) and A(H1N1)pdm09 being the predominant viruses. RSV activity, while still low, has been on an upward trend. SARS-CoV-2 activity has continued to decline, maintaining low levels. By country: In Colombia, RSV, despite being at low levels, has shown an upward trend over the last four EWs, while SARS-CoV- 2 activity has decreased, staying at low levels, with influenza activity slightly increasing but remaining below the epidemic threshold. SARI activity has fluctuated around the epidemic threshold, primarily involving cases attributable to RSV and influenza. In Ecuador, following a significant increase in RSV activity in earlier EWs, there has been a reduction to medium levels; SARS-CoV-2 has also decreased to low levels, and influenza activity has exceeded the epidemic threshold. SARI activity in Ecuador is at epidemic levels, with most cases predominantly due to RSV and, to a lesser extent, influenza. In Peru, influenza activity has oscillated around the epidemic threshold, and SARS-CoV-2 activity has dropped to low levels. In Venezuela, influenza activity has been variable but generally around the epidemic threshold over the last four EWs. Brazil and the Southern Cone: In the last four EWs, there has been an increase in both ILI and SARI activities, achieving intermediate levels, with the majority of cases attributed to influenza. During this period, influenza activity has escalated to epidemic levels in most of these countries. The primary influenza viruses have been type A(H3N2) and, less frequently, A(H1N1)pdm09. RSV activity has remained low, though it has slightly increased. SARS-CoV-2 activity has persistently declined, staying at low levels. By country: In Argentina, both ILI and SARI levels have stayed below the epidemic threshold. However, influenza activity has risen above these levels, while SARS-CoV-2 positivity rates continue to decline, reaching low levels with a slight uptick in RSV positivity observed. In Brazil, SARS-CoV-2 activity has maintained low levels, and influenza activity remains below the epidemic threshold. In Chile, the last four EWs have seen a significant increase in both ILI and SARI cases, achieving extraordinary and epidemic levels respectively, predominantly driven by high levels of influenza activity. In Paraguay, SARI activity has crossed the epidemic threshold, though ILI activity continues to stay below it. Influenza activity is around the epidemic threshold, with the circulation of SARS-CoV-2 and RSV maintaining stable low levels. In Uruguay, SARI activity has exceeded the epidemic threshold, largely due to SARS-CoV-2 and influenza, both of which have also surpassed the epidemic levels.

[RESUMEN SEMANAL]. Situación regional: Durante las últimas cuatro semanas epidemiológicas (SE) se han observado niveles bajos en la actividad de la Enfermedad Tipo Influenza (ETI) en la región de las Américas, con una tendencia decreciente. Ésta se ha relacionado principalmente con la actividad observada en Norteamérica. A su vez se ha observado una disminución en la actividad de Infección Respiratoria Aguda Grave (IRAG), actualmente en niveles bajos. En ambos casos la actividad observada se ha asociado a casos positivos de influenza y en menor medida de SARS-CoV-2. En cuanto a la circulación de virus respiratorios, a nivel regional la actividad de SARS-CoV-2 ha descendido a niveles bajos en comparación con olas epidémicas previas. Asimismo, se ha observado una actividad epidémica de influenza para esta época del año que se mantiene en ligero descenso, y una actividad en descenso del Virus Respiratorio Sincitial (VRS) que se encuentra actualmente en niveles bajos. América del Norte: Los casos de ETI, se han mantenido en descenso durante las cuatro últimas SE, presentando niveles intermedio-bajos y siendo la mayoría de los casos atribuibles a influenza. Las hospitalizaciones asociadas a virus respiratorios se han mantenido en descenso y en niveles bajos. La actividad de influenza se ha mantenido en niveles epidémicos de circulación, mostrando un descenso durante las cuatro últimas SE. Durante este periodo, los virus de influenza predominantes han sido del tipo B/Victoria, con circulación en menor medida de influenza A(H3N2) y A(H1N1)pdm09. La actividad del VRS ha mostrado un descenso en las últimas cuatro SE, manteniéndose en niveles bajos. La actividad del SARS-CoV-2 se ha mantenido en niveles bajos. Por países: En Canadá, la actividad del SARS-CoV-2 se ha mantenido en niveles bajos. La actividad de influenza se ha mantenido en niveles epidémicos con un descenso paulatino, y la actividad del VRS ha permanecido en descenso encontrándose en niveles bajos. En México, la circulación de influenza se ha mantenido fluctuante en niveles epidémicos en las cuatro últimas SE, y la circulación del SARS-CoV-2 ha presentado un descenso hasta niveles bajos. En Estados Unidos, la actividad de influenza ha mostrado un descenso en las cuatro últimas SE, aunque se mantiene por encima del umbral epidémico. Tanto el VRS como el SARS-CoV-2 han mantenido una actividad en descenso hasta niveles bajos. Los casos de ETI han mostrado un descenso y se mantienen en niveles medio-bajos. Las tasas de hospitalización por influenza, VRS y SARSCoV- 2 han presentado una tendencia decreciente en las cuatro últimas SE, con niveles bajos. Caribe: Los casos de ETI y de IRAG han permanecido en descenso durante las cuatro últimas semanas, siendo la mayoría de los casos positivos atribuibles a influenza y en menor medida SARS-CoV-2. La actividad de influenza se ha mantenido fluctuante en niveles bajos durante las últimas cuatro SE. Durante este periodo, los virus predominantes han sido de tipo A(H3N2), con circulación concurrente de influenza A(H1N1)pdm09 y en menor medida B/Victoria. La actividad del VRS se ha mantenido en niveles bajos. La actividad del SARS-CoV-2 ha permanecido en niveles bajos. Por países: Se ha observado actividad de influenza las últimas cuatro SE en Belice, Jamaica, Guyana y las Islas Caimán. Se ha observado actividad de SARS-CoV-2 en Barbados, Guyana y Trinidad y Tobago. América Central: Durante las cuatro últimas SE la actividad tanto de ETI como de IRAG se ha mantenido baja, aunque presentando un ligero incremento, con la mayoría de los casos positivos atribuibles a influenza. La actividad de influenza ha presentado un ligero incremento durante este periodo situándose en niveles intermedio-bajos. En las cuatro últimas SE, los virus influenza predominantes han sido de tipo A(H3N2) con circulación concurrente de A(H1N1)pdm09. La actividad del VRS y del SARS-CoV-2 ha permanecido en niveles bajos. Por países: En El Salvador, la actividad de IRAG se encuentra en torno a niveles epidémicos con una circulación de SARS-CoV-2 en niveles bajos y una actividad de influenza fluctuando en torno al umbral epidémico. En Guatemala durante las cuatro últimas SE, se ha observado una actividad de ETI e IRAG estable en niveles epidémicos, asociada a casos positivos de influenza, cuya circulación se encuentra en niveles moderados. En Honduras, en las cuatro últimas SE, se ha observado una actividad fluctuante de IRAG en torno a niveles epidémicos, asociada a casos positivos de influenza, cuya actividad se encuentra en niveles epidémicos y en descenso. En Nicaragua, la actividad tanto del VRS, influenza y SARS-CoV-2 se encuentra en niveles bajos. En Panamá los casos de ETI e IRAG han mostrado un incremento en las cuatro últimas SE, y la actividad de influenza se encuentra en niveles epidémicos. Andina: La actividad de ETI se ha mantenido estable en niveles bajos durante las cuatro últimas SE. Los casos de IRAG se han mantenido estables con niveles bajos, sin embrago se ha observado un ascenso en la proporción de casos positivos a VRS y en menor medida influenza. La actividad de influenza ha permanecido en niveles bajos en las cuatro últimas SE con una tendencia fluctuante. Durante este periodo, los virus de influenza predominantes han sido de tipo A(H3N2) con circulación concurrente de A(H1N1)pdm09. La actividad del VRS se ha mantenido en niveles bajos, aunque con una tendencia creciente. La actividad de SARS-CoV-2 se ha mantenido en descenso con niveles bajos. Por países: En Colombia, el VRS aunque en niveles bajos ha presentado un incremento e las cuatro últimas SE, la actividad de SARS-CoV-2 ha presentado un descenso situándose en niveles bajos y la actividad de influenza se ha mantenido por debajo del umbral epidémico con un ligero incremento. La actividad de IRAG se ha mantenido en torno al umbral epidémico durante este periodo, con los casos positivos atribuibles a VRS e influenza. En Ecuador, tras el marcado incremento en la actividad de VRS observado en SE previas, se ha detectado un descenso hasta niveles medios, el SARS-CoV-2 ha presentado un descenso situándose en niveles bajos y la actividad de influenza se ha ascendido superando el umbral epidémico. La actividad de IRAG se encuentra en niveles epidémicos y los casos positivos han sido atribuibles en su mayoría a VRS y en menor medida influenza. En Perú la actividad de influenza se encuentra oscilante en torno al umbral epidémico y la actividad de SARS-CoV-2 ha descendido a nieves bajos. En Venezuela, durante las últimas cuatro SE, se ha observado un una actividad fluctuante de influenza en torno al umbral epidémico. Brasil y el Cono Sur: La actividad de ETI e IRAG ha presentado un incremento en las cuatro últimas SE situándose en niveles intermedios, con la mayoría de los casos positivos atribuibles a influenza. La actividad de influenza ha presentado un incremento en las últimas cuatro SE con niveles epidémicos en la mayoría de los países. En este periodo, los virus de influenza predominantes han sido de tipo A(H3N2) y en menor medida A(H1N1)pdm09. La actividad del VRS se ha mantenido en niveles bajos, aunque con un ligero incremento. La actividad del SARS-CoV-2 se ha mantenido en descenso con niveles bajos de actividad. Por países: En Argentina, los niveles de ETI e IRAG han permanecido por debajo del umbral epidémico. La actividad de influenza ha presentado un incremento con niveles por encima del umbral epidémico y el porcentaje de positividad de SARSCoV- 2, se ha mantenido en descenso situándose en niveles bajos. A su vez se ha observado un ligero incremento en el porcentaje de positividad de VRS. En Brasil, la actividad del SARS-CoV-2 ha permanecido en descenso, con niveles bajos, y la actividad de influenza se mantiene por debajo del umbral epidémico. En Chile, tanto los casos de ETI como de IRAG han presentado un ascenso en las cuatro últimas SE situándose en niveles extraordinarios y epidémicos respectivamente; la mayoría de los casos positivos son atribuibles a influenza que circula con niveles extraordinarios. En Paraguay, la actividad de IRAG ha superado el umbral epidémico y la actividad de ETI se ha mantenido por debajo este umbral. La actividad de influenza se encuentra en torno al umbral epidémico; la circulación del SARS-CoV-2 y del VRS se encuentra estable en niveles bajos. En Uruguay, la actividad de IRAG ha superado el umbral epidémico, con la mayoría de los casos positivos atribuibles a SARS-CoV-2 e influenza, cuya actividad ha superado umbral epidémico.

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 19 (17 May 2024)

[WEEKLY SUMMARY]. Regional Situation: Over the past four epidemiological weeks (EWs), low activity levels of Influenza-Like Illness (ILI) have been noted across the Americas. Simultaneously, there has been a reduction in Severe Acute Respiratory Infection (SARI) activity, which also remains low. These trends are largely associated with confirmed cases of influenza and, to a lesser extent, SARSCoV- 2. Regionally, SARS-CoV-2 activity has decreased to low levels compared to previous epidemic waves. Additionally, influenza epidemic activity has been observed for this time of year, while Respiratory Syncytial Virus (RSV) activity is declining and currently at low levels. North America: ILI cases have continued to decline over the past four EWs, reaching intermediate-low levels, with most cases attributed to influenza. Hospitalizations associated with respiratory viruses have also declined and remain low. Influenza activity has stayed at epidemic levels, showing a decrease over the last four EWs. During this period, the predominant influenza viruses have been B/Victoria, with lesser circulation of influenza A(H3N2) and A(H1N1)pdm09. RSV activity has decreased over the past four EWs, remaining at low levels. SARS-CoV-2 activity has remained low, though with a slight increase. By country: In Canada, SARS-CoV-2 activity has stayed low. Influenza activity has remained at epidemic levels but is gradually declining, and RSV activity has continued to decrease, remaining low. In Mexico, influenza circulation has fluctuated at epidemic levels over the past four EWs, and SARS-CoV-2 circulation has decreased to low levels. In the United States, influenza activity has decreased to low levels over the past four EWs. Both RSV and SARS-CoV-2 have remained at low levels. ILI cases have shown a decline and remain at medium-low levels. Hospitalization rates for influenza, RSV, and SARS-CoV-2 have shown a decreasing trend over the past four EWs, reaching low levels. Caribbean: ILI and SARI cases have continued to decline over the past four weeks, with most positive cases attributed to influenza and, to a lesser extent, SARS-CoV-2. Influenza activity has fluctuated at low levels over the past four EWs. During this period, the predominant viruses have been type A(H3N2), with concurrent circulation of influenza A(H1N1)pdm09 and, to a lesser extent, B/Victoria. RSV activity has remained low. SARS-CoV-2 activity has shown a marked increase over the past two weeks. By country: Influenza activity has been observed over the past four EWs in Belize, Guyana, and the Cayman Islands. SARS-CoV- 2 activity has been noted in Barbados and the Cayman Islands. Central America: Over the past four EWs, both ILI and SARI activity has remained low, though with a slight increase, with most positive cases attributed to influenza. Influenza activity has shown a slight increase during this period, reaching intermediate levels. Over the past four EWs, the predominant influenza viruses have been A(H3N2) with concurrent circulation of A(H1N1)pdm09. RSV and SARS-CoV-2 activity have remained low. By country: In El Salvador, SARI activity is around epidemic levels with low circulation of SARS-CoV-2 and fluctuating influenza activity around the epidemic threshold. In Guatemala, during the past four EWs, ILI and SARI activity has been stable at epidemic levels, associated with positive influenza cases circulating at moderate levels. In Honduras, during the past four EWs, SARI activity has fluctuated around epidemic levels, associated with positive influenza cases circulating at epidemic levels and in decline. In Nicaragua, RSV, influenza, and SARS-CoV-2 activity are at low levels. In Panama, ILI and SARI cases have shown an increase over the past four EWs, with influenza activity at epidemic levels. Andean Region: ILI activity has remained stable at low levels over the past four EWs. SARI cases have remained stable at low levels; however, there has been an increase in the proportion of positive cases for RSV and, to a lesser extent, influenza. Influenza activity has remained at low levels over the past four EWs with a fluctuating trend. During this period, the predominant influenza viruses have been type A(H3N2) with concurrent circulation of type A(H1N1)pdm09. RSV activity has remained at low levels, though with an increasing trend. SARS-CoV-2 activity has continued to decline, remaining at low levels. By country: In Colombia, RSV activity, although low, has increased over the past four EWs; SARS-CoV-2 activity has decreased to low levels, and influenza activity has remained below the epidemic threshold with a slight increase. SARI activity has hovered around the epidemic threshold during this period, with positive cases attributed to RSV and influenza. In Ecuador, following a marked increase in RSV activity in previous EWs, there has been a decline to medium levels; SARS-CoV-2 activity has decreased to low levels, and influenza activity has risen above the epidemic threshold. SARI activity is at epidemic levels, with most positive cases attributed to RSV and, to a lesser extent, influenza. In Peru, influenza activity is fluctuating around the epidemic threshold, and SARS-CoV-2 activity has decreased to low levels. In Venezuela, during the past four EWs, influenza activity has fluctuated around the epidemic threshold. Brazil and the Southern Cone: ILI and SARI activity have increased over the past four EWs to intermediate-high levels, with most positive cases attributed to influenza. Influenza activity has increased over the past four EWs, reaching epidemic levels in most countries. During this period, the predominant influenza viruses have been type A(H3N2) and, to a lesser extent, A(H1N1)pdm09. RSV activity has remained low, though with a slight increase. SARS-CoV-2 activity has continued to decline, remaining at low levels. By country: In Argentina, ILI and SARI levels have remained below the epidemic threshold. Influenza activity has increased to levels above the epidemic threshold, and the positivity rate for SARS-CoV-2 has continued to decline, reaching low levels. There has also been a slight increase in the positivity rate for RSV. In Brazil, SARS-CoV-2 activity has continued to decline, reaching low levels, and influenza activity remains below the epidemic threshold. In Chile, both ILI and SARI cases have increased over the past four EWs, reaching extraordinary and epidemic levels, respectively, with most positive cases attributed to influenza circulating at extraordinary levels. In Paraguay, SARI activity has exceeded the epidemic threshold, and ILI activity has remained below this threshold. Influenza activity is at epidemic levels; SARS-CoV-2 and RSV circulation remain stable at low levels. In Uruguay, SARI activity has exceeded the epidemic threshold, with most positive cases attributed to SARS-CoV-2 and influenza, whose activity has exceeded the epidemic threshold.

[RESUMEN SEMANAL]. Situación regional: Durante las últimas cuatro semanas epidemiológicas (SE) se han observado niveles bajos en la actividad de la Enfermedad Tipo Influenza (ETI) en la región de las Américas, con una tendencia decreciente. A su vez se ha observado una disminución en la actividad de Infección Respiratoria Aguda Grave (IRAG), actualmente en niveles bajos. En ambos casos la actividad observada se ha asociado a casos positivos de influenza y en menor medida de SARS-CoV-2. En cuanto a la circulación de virus respiratorios, a nivel regional la actividad de SARS-CoV-2 ha descendido a niveles bajos en comparación con olas epidémicas previas. Asimismo, se ha observado una actividad epidémica de influenza para esta época del año, y una actividad en descenso del Virus Respiratorio Sincitial (VRS) que se encuentra actualmente en niveles bajos. América del Norte: Los casos de ETI, se han mantenido en descenso durante las cuatro últimas SE, presentando niveles intermedio-bajos y siendo la mayoría de los casos atribuibles a influenza. Las hospitalizaciones asociadas a virus respiratorios se han mantenido en descenso y en niveles bajos. La actividad de influenza se ha mantenido en niveles epidémicos de circulación, mostrando un descenso durante las cuatro últimas SE. Durante este periodo, los virus de influenza predominantes han sido del tipo B/Victoria, con circulación en menor medida de influenza A(H3N2) y A(H1N1)pdm09. La actividad del VRS ha mostrado un descenso en las últimas cuatro SE, manteniéndose en niveles bajos. La actividad del SARS-CoV-2 se ha mantenido en niveles bajos, aunque con un ligero incremento. Por países: En Canadá, la actividad del SARS-CoV-2 se ha mantenido en niveles bajos. La actividad de influenza se ha mantenido en niveles epidémicos con un descenso paulatino, y la actividad del VRS ha permanecido en descenso encontrándose en niveles bajos. En México, la circulación de influenza se ha mantenido fluctuante en niveles epidémicos en las cuatro últimas SE, y la circulación del SARS-CoV-2 ha presentado un descenso hasta niveles bajos. En Estados Unidos, la actividad de influenza ha mostrado un descenso en las cuatro últimas SE hasta niveles bajos. Tanto el VRS como el SARS-CoV- 2 han mantenido niveles bajos. Los casos de ETI han mostrado un descenso y se mantienen en niveles medio-bajos. Las tasas de hospitalización por influenza, VRS y SARS-CoV-2 han presentado una tendencia decreciente en las cuatro últimas SE, con niveles bajos. Caribe: Los casos de ETI y de IRAG han permanecido en descenso durante las cuatro últimas semanas, siendo la mayoría de los casos positivos atribuibles a influenza y en menor medida SARS-CoV-2. La actividad de influenza se ha mantenido fluctuante en niveles bajos durante las últimas cuatro SE. Durante este periodo, los virus predominantes han sido de tipo A(H3N2), con circulación concurrente de influenza A(H1N1)pdm09 y en menor medida B/Victoria. La actividad del VRS se ha mantenido en niveles bajos. La actividad del SARS-CoV-2 ha presentado un marcado incremento en las dos últimas semanas. Por países: Se ha observado actividad de influenza las últimas cuatro SE en Belice, Guyana y las Islas Caimán. Se ha observado actividad de SARS-CoV-2 en Barbados y las Islas Caimán. América Central: Durante las cuatro últimas SE la actividad tanto de ETI como de IRAG se ha mantenido baja, aunque presentando un ligero incremento, con la mayoría de los casos positivos atribuibles a influenza. La actividad de influenza ha presentado un ligero incremento durante este periodo situándose en niveles intermedios. En las cuatro últimas SE, los virus influenza predominantes han sido de tipo A(H3N2) con circulación concurrente de A(H1N1)pdm09. La actividad del VRS y del SARS-CoV-2 ha permanecido en niveles bajos. Por países: En El Salvador, la actividad de IRAG se encuentra en torno a niveles epidémicos con una circulación de SARS-CoV-2 en niveles bajos y una actividad de influenza fluctuando en torno al umbral epidémico. En Guatemala durante las cuatro últimas SE, se ha observado una actividad de ETI e IRAG estable en niveles epidémicos, asociada a casos positivos de influenza, cuya circulación se encuentra en niveles moderados. En Honduras, en las cuatro últimas SE, se ha observado una actividad fluctuante de IRAG en torno a niveles epidémicos, asociada a casos positivos de influenza, cuya actividad se encuentra en niveles epidémicos y en descenso. En Nicaragua, la actividad tanto del VRS, influenza y SARS-CoV-2 se encuentra en niveles bajos. En Panamá los casos de ETI e IRAG han mostrado un incremento en las cuatro últimas SE, y la actividad de influenza se encuentra en niveles epidémicos. Andina: La actividad de ETI se ha mantenido estable en niveles bajos durante las cuatro últimas SE. Los casos de IRAG se han mantenido estables con niveles bajos, sin embrago se ha observado un ascenso en la proporción de casos positivos a VRS y en menor medida influenza. La actividad de influenza ha permanecido en niveles bajos en las cuatro últimas SE con una tendencia fluctuante. Durante este periodo, los virus de influenza predominantes han sido de tipo A(H3N2) con circulación concurrente de A(H1N1)pdm09. La actividad del VRS se ha mantenido en niveles bajos, aunque con una tendencia creciente. La actividad de SARS-CoV-2 se ha mantenido en descenso con niveles bajos. Por países: En Colombia, el VRS aunque en niveles bajos ha presentado un incremento en las cuatro últimas SE, la actividad de SARS-CoV-2 ha presentado un descenso situándose en niveles bajos y la actividad de influenza se ha mantenido por debajo del umbral epidémico con un ligero incremento. La actividad de IRAG se ha mantenido en torno al umbral epidémico durante este periodo, con los casos positivos atribuibles a VRS e influenza. En Ecuador, tras el marcado incremento en la actividad de VRS observado en SE previas, se ha detectado un descenso hasta niveles medios, el SARS-CoV-2 ha presentado un descenso situándose en niveles bajos y la actividad de influenza se ha ascendido superando el umbral epidémico. La actividad de IRAG se encuentra en niveles epidémicos y los casos positivos han sido atribuibles en su mayoría a VRS y en menor medida influenza. En Perú la actividad de influenza se encuentra oscilante en torno al umbral epidémico y la actividad de SARS-CoV-2 ha descendido a nieves bajos. En Venezuela, durante las últimas cuatro SE, se ha observado un una actividad fluctuante de influenza en torno al umbral epidémico. Brasil y el Cono Sur: La actividad de ETI e IRAG ha presentado un incremento en las cuatro últimas SE situándose en niveles intermedio-altos, con la mayoría de los casos positivos atribuibles a influenza. La actividad de influenza ha presentado un incremento en las últimas cuatro SE con niveles epidémicos en la mayoría de los países. En este periodo, los virus de influenza predominantes han sido de tipo A(H3N2) y en menor medida A(H1N1)pdm09. La actividad del VRS se ha mantenido en niveles bajos, aunque con un ligero incremento. La actividad del SARS-CoV-2 se ha mantenido en descenso con niveles bajos de actividad. Por países: En Argentina, los niveles de ETI e IRAG han permanecido por debajo del umbral epidémico. La actividad de influenza ha presentado un incremento con niveles por encima del umbral epidémico y el porcentaje de positividad de SARSCoV- 2, se ha mantenido en descenso situándose en niveles bajos. A su vez se ha observado un ligero incremento en el porcentaje de positividad de VRS. En Brasil, la actividad del SARS-CoV-2 ha permanecido en descenso, con niveles bajos, y la actividad de influenza se mantiene por debajo del umbral epidémico. En Chile, tanto los casos de ETI como de IRAG han presentado un ascenso en las cuatro últimas SE situándose en niveles extraordinarios y epidémicos respectivamente; la mayoría de los casos positivos son atribuibles a influenza que circula con niveles extraordinarios. En Paraguay, la actividad de IRAG ha superado el umbral epidémico y la actividad de ETI se ha mantenido por debajo este umbral. La actividad de influenza se encuentra en niveles epidémicos; la circulación del SARS-CoV-2 y del VRS se encuentra estable en niveles bajos. En Uruguay, la actividad de IRAG ha superado el umbral epidémico, con la mayoría de los casos positivos atribuibles a SARSCoV- 2 e influenza, cuya actividad ha superado umbral epidémico.

Análisis del desempeño presupuestario del sector salud en el período 2019-2021. Resultados para Chile, Colombia, Guatemala, Honduras, Panamá, Perú, República Dominicana y Uruguay

Esta publicación analiza el grado de alineamiento entre la necesidad de priorizar el primer nivel de atención con el desempeño presupuestario en salud y la capacidad de absorción del sector salud del incremento de los recursos financieros en el periodo 2019 a 2021. La Estrategia de OPS/OMS para el Establecimiento de Sistemas de Salud Resilientes enfatiza la necesidad de priorizar las inversiones en el primer nivel de atención por su incidencia en los niveles de acceso y cobertura. En este ámbito, los presupuestos públicos sirven como el mecanismo por excelencia de revisión de políticas públicas donde se plasman las prioridades de los gobiernos y los diferentes actores del sistema de salud, se articula el modelo de atención y se reasignan recursos ante eventos de emergencia sanitaria. La relevancia del presupuesto público se manifiesta también en la propuesta de incrementar la inversión en salud proveniente de recursos públicos, principalmente ingresos generales (o impuestos) acercándose al 6% del PIB incluido en la estrategia de Salud Universal de la OPS/OMS. El periodo de análisis de esta publicación se caracterizó por un incremento sin precedentes en el flujo de recursos financieros hacia el sector salud para asegurar la capacidad de respuesta del sistema de salud frente a la emergencia sanitaria originada por la pandemia de la Covid-19. La mayor priorización de recursos públicos para salud se viabilizó a través de la implementación de diferentes mecanismos de expansión fiscal, y la utilización de recursos de emergencia; así como a través de las innovaciones en las reglas de gestión financiera pública. Del análisis en este documento elaborado para ocho países de la región utilizando información presupuestaria de acceso público se obtienen varias lecciones que relevan la importancia de fortalecer capacidades de gestión para una asignación más rápida, eficaz y equitativa que se traduzca a la vez en una ejecución presupuestaria más eficiente y equitativa de acuerdo con los objetivos sanitarios. Queda asimismo como tarea pendiente, el relacionar la asignación y uso de estos recursos con las barreras de acceso no-financieras y la interrupción de los servicios esenciales durante el mismo periodo.

Building momentum through networks: Bioimaging across the Americas.

In September 2023, the two largest bioimaging networks in the Americas, Latin America Bioimaging (LABI) and BioImaging North America (BINA), came together during a 1-week meeting in Mexico. This meeting provided opportunities for participants to interact closely with decision-makers from imaging core facilities across the Americas. The meeting was held in a hybrid format and attended in-person by imaging scientists from across the Americas, including Canada, the United States, Mexico, Colombia, Peru, Argentina, Chile, Brazil and Uruguay. The aims of the meeting were to discuss progress achieved over the past year, to foster networking and collaborative efforts among members of both communities, to bring together key members of the international imaging community to promote the exchange of experience and expertise, to engage with industry partners, and to establish future directions within each individual network, as well as common goals. This meeting report summarises the discussions exchanged, the achievements shared, and the goals set during the LABIxBINA2023: Bioimaging across the Americas meeting.

Risk factors of anastomotic leak in colorectal cancer: a multicentric study in a Latin American country.

Introduction: The anastomotic leak (AL) is one of the most feared complications of colorectal surgery, since it is associated with a high rate of morbidity, mortality, length of hospital stay and cost of care. Our aim was to determine the risk factors associated with anastomosis leak in colorectal cancer patients who underwent surgical resection with anastomosis. Methods: A multicentre observational, analytical, retrospective and case-control study was carried out. For each case, two controls were included from three national hospitals from Lima, Peru during the period 2021-2022. To determine the degree of association, multivariate logistic regression model was carried out. Results: A total of 360 patients were included, 120 from each hospital. The mean age of the population was 68.03 ± 14.21 years old. The majority were 65 years old or older (66.1%), 52.8% were female, and 63.3% had clinical stage III. The 40% of the patients had albumin levels lower than 3.5 g/dL. Regarding the surgery, 96.4% were elective, 68.9% underwent open approach, and 80.8% had an operative time of more than 180 minutes. Most of them had right colon cancer (50.8%). In the multivariate analysis, a significant association was found with the age variable (OR = 2.48; 95%CI:1.24-4.97), clinical tumour level (OR = 2.71; 95%CI:1.34-5.48), American Society of Anesthesiologists (ASA) Score (OR = 3.23; 95%CI:1.10-9.50), preoperative serum albumin (OR = 22.2; 95%CI:11.5-42.9). Conclusion: The most important independent risk factors associated with AL among patients with colorectal cancer were pre-operative such as lower preoperative serum albumin levels, followed by a higher ASA Score, clinical-stage III-IV, and an age ≥65 years old.

Internet-based self-administered intervention to reduce anxiety and depression symptomatology and improve well-being in 7 countries: protocol of a randomized control trial.

Background: Online psychological interventions have emerged as a treatment alternative because they are accessible, flexible, personalized, and available to large populations. The number of Internet interventions in Latin America is limited, as are Randomized Controlled Trials (RCTs) of their effectiveness and a few studies comparing their effectiveness in multiple countries at the same time. We have developed an online intervention, Well-being Online, which will be available to the public free of charge in 7 countries: Mexico, Ecuador, Peru, Chile, Brazil, Spain, and the Netherlands. We expect a reduction in depression and anxiety symptoms and an increase in well-being of the participants. Methods: A multi-country, randomized controlled trial will be conducted. The intervention is multicomponent (Cognitive Behavioral Therapy, Behavioral Activation Therapy, Mindfulness, Acceptance and Commitment Therapy, and Positive Psychology), with 10 sessions. In each country, eligible participants will be randomized to one of three groups: Enriched Intervention (interactive web design with videos, infographics, text, audio, and forum), Text Intervention (text on the website), and Wait List (control group). Repeated measures will be obtained at 5-time points. Our primary outcomes will be anxiety symptomatology, depressive symptomatology, and mental well-being. MANOVA analysis will be used for our main analysis. Discussion: This protocol describes the design of a randomized trial to evaluate the efficacy of a web-based intervention to reduce anxiety and depression symptomatology and increase subjective well-being. The intervention will be made available in four languages (Spanish, Portuguese, Dutch, and English). Its results will contribute to the evidence of effectiveness in terms of randomized trials and Internet interventions, mainly in Latin America and Europe.

Circulation of DENV-2 serotype associated with increased risk of cumulative incidence of severe dengue and dengue with warning signs: A 16-year retrospective study in Peru.

Background: Dengue poses a significant public health challenge in Peru and other endemic countries worldwide. While severe dengue is known to be associated with secondary infection at the individual level, the factors that elevate the risk of severe dengue at the population level remain poorly understood. This study leverages over 16 years of secondary data from a Peruvian dengue surveillance system to assess which type of serotype-specific circulation is associated with an increased risk of cumulative incidence of severe dengue or dengue with warning signs (SD-DWS). Methodology: This is a retrospective analysis of secondary data using the Peruvian Ministry of Health databases of dengue cases and serotyping. A mixed negative binomial regression model for repeated measures over time was employed to estimate the association between the cumulative incidence of reported SD-DWS cases per 100,000 inhabitants and serotype-specific circulation. Crude and adjusted incidence ratios (IRR) were estimated. Principal findings: The study analyzed data from 2007 to 2022 across 19 regions of Peru, totaling 304 region-years. Data from nearly 58,000 serotype identification reports and 57,966 cases of SD-DWS were analyzed. The regions with most cumulative incidence of SD-DWS per 100,000 inhabitants during 2007 to 2022 were Madre de Dios (3859), Loreto (1518), Ucayali (1492), Tumbes (1335), and Piura (722). The adjusted model revealed a higher risk of cumulative incidence of SD-DWS when there was specific circulation of DENV-123 (aIRR 7.57 CI 4.00 - 14.31), DENV-12 (aIRR 4.66 CI 2.57 - 8.44), DENV-23 (aIRR 3.55 CI 1.75 - 7.21), or when there was circulation of DENV-2 alone or co-circulating with other serotypes (aIRR 27.7 CI 15.46 -49.63). Conclusions: Circulation of DENV-2 was associated with higher average incidence rate ratios of SD-DWS. Author summary: We investigated how the circulation of different dengue virus (DENV) serotypes are associated with the incidence of severe dengue and dengue with warning signs in Peru, a country where dengue is endemic. We analyzed 16 years of data from the dengue surveillance system, including nearly 58,000 serotype identification reports and 57,966 cases of severe dengue and dengue with warning signs. We found that regions with specific circulation of DENV-2, either alone or in combination with other serotypes, had higher incidence rates of severe dengue and dengue with warning signs. Our findings highlight the importance of monitoring DENV serotype circulation to manage and prevent severe dengue, especially in regions where DENV-2 is prevalent.

The Association Between Pre-Pregnancy and First-Trimester Hair Cortisol and Preterm Birth: A Causal Inference Model.

Background Adverse life events and chronic psychological distress before and during pregnancy have frequently been associated with preterm birth (PTB) but the biological underpinnings remain unclear. We investigated the association between corticosteroid levels in pre-pregnancy and first-trimester hair and the risk of PTB. Methods We followed 1,808 pregnant women from a prospective pre-birth cohort study in Lima, Perú. Hair samples were taken at the end of the first pregnancy trimester. The two most proximal 3cm segments to the scalp (representing pre-pregnancy and first-trimester) were analyzed to obtain hair cortisol and cortisone concentrations (HCC and HCNC). PTB was defined as birth < 37 completed gestational weeks. We constructed four generalized propensity scores for pre-pregnancy and first-trimester HCC and HCNC to create corresponding inverse probability weights before fitting marginal structural models for estimating the effect of HCC and HCNC on PTB risk. Results Pre-pregnancy Log HCC was not independently associated with PTB risk (RR = 0.97; 95%CI: 0.79, 1.19). In contrast, one SD increase from the mean first-trimester Log HCC was independently associated with a 37% (95%CI: 1.11, 1.69) increased risk of PTB. Although imprecise, pre-pregnancy Log HCNC was negatively associated with PTB risk (RR = 0.84; 95%CI: 0.58, 1.20), whereas the association between first-trimester Log HCNC and PTB risk was positive (RR = 1.20; 95%CI: 0.87, 1.65). Conclusions Our findings show that chronic corticosteroid levels in early pregnancy are causally linked to PTB risk in pregnant Peruvian women. This finding contributes to understanding the biological underpinnings of PTB better to enhance PTB prevention.

HIV Risk Behaviors and the Use of Geosocial Networking Dating Apps among Men Who have Sex with Men and Transgender Women in Lima, Peru: a Cross-Sectional Study.

Geosocial networking dating apps (GSN apps) are an increasingly widespread technology used by populations throughout the world to facilitate sexual encounters. Studies from a variety of settings suggest a possible association between GSN app use and HIV risk behaviors, including among sexual and gender minority populations such as men who have sex with men (MSM) and transgender women (TW). However, it remains unclear to what extent GSN apps play a causal role. We explored the relationship between GSN app use and sexual risk behaviors among MSM and TW in Lima, Peru by analyzing data from a multi-site cross-sectional survey assessing both general and partner-specific sexual behaviors. We performed bivariate analysis to estimate the association of GSN app use with different individual and partner-specific factors, then fit multivariable regression models adjusting for age and education. Among 741 total participants (698 MSM, 43 TW), 64% met at least one sex partner in the prior three months using a GSN app. GSN app users were significantly more likely to report engaging in HIV risk behaviors in general, including condomless receptive anal sex, group sex, transactional sex, and sex under the influence of alcohol or drugs. Having condomless anal sex with a given partner was not associated with meeting that partner via GSN app. These findings highlight GSN app users as a particularly vulnerable subpopulation among MSM and TW in Lima. GSN apps could provide a useful vehicle for targeted HIV prevention efforts for priority populations in Peru.

RESUMEN: Las aplicaciones de citas de redes geosociales (aplicaciones GSN) son una tecnología con creciente alcance en todo el mundo usadas para facilitar encuentros sexuales. Diferentes estudios sugieren una posible relación entre uso de aplicaciones GSN y comportamientos de riesgo para VIH entre hombres que tienen sexo con hombres (HSH) y mujeres transgénero (MT). No es claro hasta qué punto aplicaciones GSN tendrían un papel causal directo. Exploramos la relación entre uso de aplicaciones GSN y comportamientos sexuales de riesgo entre HSH y MT en Lima, Perú, analizando datos de una encuesta transversal que evaluó comportamientos sexuales en general y en parejas específicas. Realizamos análisis bivariable para estimar la asociación del uso de aplicaciones GSN con diferentes factores individuales y específicos de la pareja. También aplicamos modelos de regresión multivariables ajustados por edad y educación. Entre 741 participantes totales (698 HSH, 43 MT), 64% conoció al menos a una pareja sexual en los últimos tres meses mediante una aplicación GSN. Los usuarios de aplicaciones GSN fueron significativamente más propensos a reportar comportamientos de riesgo de VIH en general, incluyendo sexo anal receptivo sin condón, y sexo grupal, transaccional y bajo influencia de alcohol o drogas. Tener sexo anal sin condón con una pareja determinada no se asoció con conocer a esa pareja mediante aplicación GSN. Estos hallazgos muestran a usuarios de aplicaciones GSN como una subpoblación particularmente vulnerable entre HSH y MT en Lima. Aplicaciones GSN podrían ser útiles para iniciativas de prevención del VIH en poblaciones prioritarias en Perú.

Ecological risk of metals in Andean water resources: A framework for early environmental assessment of mining projects in Peru.

Metallic contaminants in Andean water resources influenced by mining activities poses risks to aquatic ecosystems and a challenge to regulatory agencies responsible for environmental compliance. In this study, the Ecological Risk Assessment (ERA) framework was adapted to assess dissolved heavy metal concentrations at 283 surface water monitoring stations near to six mining projects during the dry and wet seasons. Reports from OEFA-Peru on Early Environmental Assessment (EEA) were used to apply various criteria and non-parametric statistical tests. They included ecological, ecotoxicological, chemical, and regulatory factors. The main goal of this research was to identify, analyze, characterize, and compare the risks present at different trophic levels. These levels were categorized as T1 (Microalgae), T2 (Zooplankton and Benthic invertebrates), and T3 (Fish). Individual risk (IR) was estimated using the quotient model, while total risk (TR) was assessed using the additive probability rule. Rainbow trout (Oncorhynchus mykiss), representing trophic level T3, showed the highest sensitivity to Fe and Cu. Statistical tests ranked the IR as Fe > Cu > Zn > Mn > Pb (p < 0.01). The TR was more prevalent during the wet season compared to the dry season (p < 0.01). Notably, around 50 % of the monitoring stations (n = 142) were classified as high risk, and 9 % (n = 13) showed extremely high-risk values for Cu and Fe. The adapted ERA framework demonstrated great effectiveness in identifying critical points of metal contamination in high Andean aquatic ecosystems under mining influence. However, specialized studies are suggested that allow the sources of pollution to be associated with specific regulatory actions.

Cerebral hemodynamics and optic nerve sheath diameter acquired via neurosonology in critical patients with severe coronavirus disease: experience of a national referral hospital in Peru.

Aim: We aimed to describe the neurosonological findings related to cerebral hemodynamics acquired using transcranial Doppler and to determine the frequency of elevated ICP by optic nerve sheath diameter (ONSD) measurement in patients with severe coronavirus disease (COVID-19) hospitalized in the intensive care unit of a national referral hospital in Peru. Methods: We included a retrospective cohort of adult patients hospitalized with severe COVID-19 and acute respiratory failure within the first 7 days of mechanical ventilation under deep sedoanalgesia, with or without neuromuscular blockade who underwent ocular ultrasound and transcranial Doppler. We determine the frequency of elevated ICP by measuring the diameter of the optic nerve sheath, choosing as best cut-off value a diameter equal to or >5.8 mm. We also determine the frequency of sonographic patterns obtained by transcranial Doppler. Through insonation of the middle cerebral artery. Likewise, we evaluated the associations of clinical, mechanical ventilator, and arterial blood gas variables with ONSD ≥5.8 mm and pulsatility index (PI) ≥1.1. We also evaluated the associations of hemodynamic findings and ONSD with mortality the effect size was estimated using Poisson regression models with robust variance. Results: This study included 142 patients. The mean age was 51.39 ± 13.3 years, and 78.9% of patients were male. Vasopressors were used in 45.1% of patients, and mean arterial pressure was 81.87 ± 10.64 mmHg. The mean partial pressure of carbon dioxide (PaCO2) was elevated (54.08 ± 16.01 mmHg). Elevated intracranial pressure was seen in 83.1% of patients, as estimated based on ONSD ≥5.8 mm. A mortality rate of 16.2% was reported. In the multivariate analysis, age was associated with elevated ONSD (risk ratio [RR] = 1.07). PaCO2 was a protective factor (RR = 0.64) in the cases of PI ≥ 1.1. In the mortality analysis, the mean velocity was a risk factor for mortality (RR = 1.15). Conclusions: A high rate of intracranial hypertension was reported, with ONSD measurement being the most reliable method for estimation. The increase in ICP measured by ONSD in patients with severe COVID-19 on mechanical ventilation is not associated to hypercapnia or elevated intrathoracic pressures derived from protective mechanical ventilation.

Agronomic performance of forage corn for cattle feeding in Amazonas, Peru.

Corn (Zea mays) silage is an important and popular feed for dairy production in the Amazon region, so it is necessary to evaluate the agronomic performance of forage varieties of corn for cattle feeding in Amazonas. For this purpose, three corn varieties were evaluated (variety 1: Yellow Starchy Corn, variety 2: Chuska INIA 617, and variety 3: DOW 2B710), with two planting densities (density 1: 30 × 80 cm and density 2: 35 × 75 cm) and two fertilization conditions: with fertilization (F1) and without fertilization (F2). The parameters evaluated were plant height, number of leaves, leaf length and width, stem diameter, fresh forage, and dry matter. Student t-tests, correlation analysis of variables, and principal component analysis using R software version 4.1.3 were used for data analysis. The results indicated that variety 2 obtained the best values for the variables leaf width (12.33 cm) and stem diameter (3.25 cm), fresh forage (17.77 kg/m2), and dry matter (4.8 kg/m2), which would explain the directly proportional correlation found between leaf width and stem diameter with fresh forage and dry matter. The principal component analysis showed constant height and leaf length increases, and the best-evaluated parameters were associated with applying fertilizer. The variety that showed the best agronomic performance under Chachapoyas conditions was Chuska INIA 617, emerging as a potential feed for cattle.

Trends in childhood leukemia incidence in urban countries and their relation to environmental factors, including space weather.

Leukemia is the most common cancer in children. Its incidence has been increasing worldwide since 1910th, suggesting the presence of common sources of the disease, most likely related to people's lifestyle and environment. Understanding the relationship between childhood leukemia and environmental conditions is critical to preventing the disease. This discussion article examines established potentially-carcinogenic environmental factors, such as vehicle emissions and fires, alongside space weather-related parameters like cosmic rays and the geomagnetic field. To discern the primary contributor, we analyze trends and annual variations in leukemia incidence among 0-14-year-olds in the United States, Canada, Australia, and Russia from 1990 to 2018. Comparisons are drawn with the number of vehicles (representing gasoline emissions) and fire-affected land areas (indicative of fire-related pollutants), with novel data for Russia introduced for the first time. While childhood leukemia incidence is rising in all countries under study, the rate of increase in Russia is twice that of other nations, possibly due to a delayed surge in the country's vehicle fleet compared to others. This trend in Russia may offer insights into past leukemia levels in the USA, Canada, and Australia. Our findings highlight vehicular emissions as the most substantial environmental hazard for children among the factors examined. We also advocate for the consideration of potential modulation of carcinogenic effects arising from variations in cosmic ray intensity, as well as the protective role of the geomagnetic field. To support the idea, we provide examples of potential space weather effects at both local and global scales. The additional analysis includes statistical data from 49 countries and underscores the significance of the magnetic field dip in the South Atlantic Anomaly in contributing to a peak in childhood leukemia incidence in Peru, Ecuador and Chile. We emphasize the importance of collectively assessing all potentially carcinogenic factors for the successful future predictions of childhood leukemia risk in each country.

Highly pathogenic avian influenza H5N1 virus infections in pinnipeds and seabirds in Uruguay: Implications for bird-mammal transmission in South America.

The highly pathogenic avian influenza viruses of clade 2.3.4.4b have caused unprecedented deaths in South American wild birds, poultry, and marine mammals. In September 2023, pinnipeds and seabirds appeared dead on the Uruguayan Atlantic coast. Sixteen influenza virus strains were characterized by real-time reverse transcription PCR and genome sequencing in samples from sea lions (Otaria flavescens), fur seals (Arctocephalus australis), and terns (Sterna hirundinacea). Phylogenetic and ancestral reconstruction analysis showed that these strains have pinnipeds most likely as the ancestral host, representing a recent introduction of clade 2.3.4.4b in Uruguay. The Uruguayan and closely related strains from Peru (sea lions) and Chile (sea lions and a human case) carry mammalian adaptative residues 591K and 701N in the viral polymerase basic protein 2 (PB2). Our findings suggest that clade 2.3.4.4b strains in South America may have spread from mammals to mammals and seabirds, revealing a new transmission route.

Irritable bowel syndrome and erectile dysfunction in medical students at a Peruvian university: an analytical cross-sectional analysis.

Background: There is inconclusive evidence regarding the role of irritable bowel syndrome (IBS) in the development of erectile dysfunction (ED), especially among medical students due to high academic stress. Aim: To determine the association between IBS and ED in medical students from a Peruvian university in 2022. Methods: An analytical cross-sectional study was conducted with secondary data analysis on 133 medical students from a university in northern Peru during the 2021-II academic semester. The dependent variable was ED as measured with the 5-item International Index of Erectile Function, and the exposure variable was IBS as assessed with the Rome IV-Bristol questionnaire. Outcomes: The results were the prevalence rates of IBS and ED and the association of these variables. Results: Of the 133 medical students surveyed, the median age was 22 years (IQR, 19-24). The median score on the 5-item International Index of Erectile Function was 21 (IQR, 10-24). The prevalence of ED was 38.4% (95% CI, 30.05%-47.17%). Among the medical students 3% and 9% displayed moderate and severe ED, respectively, and 24.8%, 13.5%, and 24.1% showed moderate depressive, anxious, and severe symptoms. An overall 10.5% had IBS. Medical students with IBS had a 108% higher prevalence of ED than those without the syndrome (prevalence ratio, 2.08; 95% CI, 1.06-4.06). Other confounding variables were not significantly associated (P > .05). Clinical Implications: The results underline the importance of comprehensive sexual and mental health assessment, with an emphasis on the relationship between IBS and ED in medical students. Strengths and Limitations: Strengths include the use of validated and reliable instruments and rigorous biostatistical methods, and this is the first Peruvian investigation to explain the association between IBS and ED in medical students. Limitations include the cross-sectional design and nonprobability sampling, and there may be bias in applying the instruments. Conclusion: This study reveals a significant association between IBS and a higher prevalence of ED in these students.

Epidemiology of Pelvic Floor Dysfunction in the Tacna Region of Peru, 2023.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is highly prevalent in the general population, with numerous studies conducted in Europe and North America. However, there is a scarcity of data regarding its prevalence and sociodemographic factors in the southern region of Peru. There is an association between sociodemographic factors-such as age, educational level, body mass index, number of pregnancies, parity, mode of delivery, weight of the newborn-along with lifestyle factors such as physical effort, coffee and tobacco consumption with pelvic floor dysfunction (PFD). We anticipate that this association will negatively impact women's quality of life. METHODS: This was a quantitative study, with a non-experimental, descriptive, cross-sectional correlational design. A sample consisting of 468 women between 30 and 64 years old. A previously tested survey was applied to explore prevalence, symptoms, associated factors, and quality of life. RESULTS: The prevalence of PFD was 73.9%. UI was the most common. There is a significant association with overweight, obesity, parity, route of delivery, and physical effort. Even though a large percentage of participants presented with PFD, they reported that their quality of life was not affected (65.9% urinary discomfort, 96.5% colorectal-anal discomfort and 92.2% pelvic organ prolapse discomfort) and only in the case of urinary discomfort did they state that the impact was mild (28.6%) and moderate (5.5%). CONCLUSIONS: Pelvic floor dysfunction in women is very common and it is strongly associated with overweight, obesity, parity, route of delivery, and physical exertion. The impact on quality of life was mild and moderate for those who had urinary discomfort.

[Undiagnosed arterial hypertension in a Latin American country, 2019 to 2021]. / Hipertensión arterial no diagnosticada en un país de Latinoamérica, 2019 a 2021.

Objective: To determine the factors associated with undiagnosed hypertension. Method: A quantitative, observational, retrospective, cross-sectional and analytical study was carried out in people aged 15 years and over included in the Demographic and Family Health Survey from 2019 to 2021 in Peru. A statistical analysis was carried out using the corrected F test, and crude and adjusted prevalence ratio (aPR), with a 95% confidence interval (95%CI) for inferential analysis, through Poisson regression with robust variance. Likewise, the CSPLAN analysis was carried out for complex samples according to the sample design and taking into account the weighting factor. Results: In the multivariate analysis, a significant association was found between the factors male sex (aPR: 1.22; 95%CI: 1.19-1.26), age from 30 to 49 years (aPR: 0.94; 95%CI: 0.92-0.96), native ethnicity (aPR: 1.07; 95%CI: 1.04-1.10), having health insurance (aPR: 0.91; 95%CI: 0.89-0.93), suffering from some permanent limitation (aPR: 0.83; 95%CI: 0.76-0.91) and diabetes mellitus (aPR: 0.59; 95%CI: 0.55-0.64). No significant association was found with educational level, language, Afro-Peruvian ethnicity, or alcohol or tobacco consumption (p > 0.05). Conclusions: The prevalence of undiagnosed arterial hypertension is high, 69.5%. The associated factors are male sex, native ethnicity, age between 30 and 49 years, having health insurance, suffering from some permanent limitation and having diabetes mellitus.

Objetivo: Determinar los factores asociados a hipertensión arterial no diagnosticada. Método: Estudio de tipo cuantitativo, observacional, retrospectivo, transversal y analítico, en personas de 15 y más años de edad contenidas en la Encuesta Demográfica y Salud Familiar de 2019 a 2021 en Perú. Se realizó un análisis estadístico haciendo uso de la prueba F corregida y la razón de prevalencia cruda y ajustada (RPa), con un intervalo de confianza del 95% (IC95%) para el análisis inferencial, a través de regresión de Poisson con varianza robusta. Asimismo, se realizó el análisis CSPLAN para muestras complejas de acuerdo con el diseño de la muestra y teniendo en cuenta el factor de ponderación. Resultados: En el análisis multivariado se halló una asociación significativa de los factores sexo masculino (RPa: 1.22; IC95%: 1.19-1.26), edad de 30 a 49 años (RPa: 0.94; IC95%: 0.92-0.96), etnia nativa (RPa: 1.07; IC95%: 1.04-1.10), tenencia de un seguro de salud (RPa: 0.91; IC95%: 0.89-0.93), sufrir alguna limitación permanente (RPa: 0.83; IC95%: 0.76-0.91) y diabetes mellitus (RPa: 0.59; IC95%: 0.55-0.64). No se encontró asociación significativa con el nivel de instrucción, el idioma, la etnia afroperuana ni el consumo de alcohol o tabaco (p > 0.05). Conclusiones: La prevalencia de hipertensión arterial no diagnosticada es alta, del 69.5%. Los factores asociados son el sexo masculino, la etnia nativa, la edad entre 30 y 49 años, la tenencia de un seguro de salud, sufrir alguna limitación permanente y tener diabetes mellitus.

Mood and Sleep Quality in Peruvian Medical Students During COVID-19 Pandemic.

INTRODUCTION: The prolongation and consequences of the COVID-19 pandemic have led to an uncertain and devastating panorama in many populations, and the evidence shows a high prevalence of mental health problems in medical students. The objective was to evaluate the association between mood disorders and sleep quality (SQ) in Peruvian medical students during the COVID-19 pandemic. METHODS: A cross-sectional study was conducted on 310 medical students from a private university in Peru. The SQ was measured using the Pittsburgh Sleep Quality Index (PSQI), while mood disorders were evaluated using the Depression Anxiety and Stress Scale-21 (DASS-21). All information was collected by online surveys and then analysed in the R programming language. RESULTS: The SQ results measured by PSQI were poor in 83.9% of the medical students. In the Poison regression analysis, the results of the bivariate analysis in men show that all mood disorders found the prevalence of poor SQ. However, in the multivariate analysis only stress (PRa=1.30; 95% CI, 1.08-1.57; P<0.01) and anxiety (PRa=1.34; 95% CI, 1.09-1.56; P <0.01) increased the prevalence of poor SQ. Women had a similar pattern in bivariate analysis, whereas in multivariate analysis, only severe stress (PRa=1.15; 95% CI, 1.01-1.29; P <0.05) increased the prevalence of poor SQ. CONCLUSIONS: This study allows us to observe the consequences that the COVID-19 pandemic is having on medical students in Peru. It also revealed a population group vulnerable to poor quality of sleep and bad mood, which in the future will impact on health. It is suggested to educate medical students about the importance of proper sleep hygiene and the consequences of poor sleep hygiene practices.

Emergence of carbapenem-resistant Pseudomonas aeruginosa ST179 producing both IMP-16 and KPC-2: a case study of introduction from Peru to Spain.

We describe four cases of a novel carbapenem-resistant Pseudomonas aeruginosa ST179 clone carrying the blaKPC-2 or blaKPC-35 gene together with blaIMP-16, imported from Peru to Spain and isolated from leukemia patients. All isolates were multidrug-resistant but remained susceptible to fosfomycin, cefiderocol, and colistin. Whole-genome sequencing revealed that blaKPC-2 and blaKPC-35 were located in an IncP6 plasmid, whereas blaIMP-16 was in a chromosomal type 1 integron. This study highlights the global threat of multidrug-resistant P. aeruginosa clones and underscores the importance of monitoring and early detection of emerging resistance mechanisms to guide appropriate treatment strategies. The importation and spread of such clones emphasize the urgent need to implement strict infection control measures to prevent the dissemination of carbapenem-resistant bacteria. IMPORTANCE: This is the first documented case of a Pseudomonas aeruginosa ST179 strain carrying the blaKPC-35 gene, and it represents the first report of a P. aeruginosa co-harboring blaIMP-16 and either blaKPC-2 or blaKPC-35, which wre imported from Peru to Spain, highlighting a threat due to the capacity of spreading carbapenem-resistance via plasmid conjugation.