A natural consortium of thermophilic bacteria from Huancarhuaz hot spring (Ancash-Peru) for promising lignocellulose bioconversion.

The lignocellulose bioconversion process is an eco-friendly and green-economy alternative technology that allows the reduction of pollution and global warming, so it is necessary for thermophilic and thermostable hydrolytic enzymes from natural sources. This research aimed to isolate cellulolytic and xylanolytic microbial consortia from Huancarhuaz hot spring (Peru) from sludge or in situ baiting cultured with or without sugarcane bagasse. According to the hydrolytic activities consortium T4 from in situ baiting was selected. It was cultivated in submerged fermentation at 65 °C, pH 6.5 for eight days using LB supplemented with sugar cane bagasse (SCB), pine wood sawdust (PWS), CMC, xylan of birchwood, or micro granular cellulose. Crude extract of culture supplemented with SCB (T4B) showed better endoglucanase and xylanase activities with higher activities at 75 °C and pH 6. In these conditions, cellulase activity was kept up to 57% after 1 h of incubation, while xylanase activity was up to 63% after 72 h. Furthermore, this crude extract released reduced sugars from pretreated SCB and PWS. According to metagenomic analysis of 16S rDNA, Geobacillus was the predominant genus. It was found thermostable genes: a type of endoglucanase (GH5), an endo-xylanase (GH10), and alkali xylanase (GH10) previously reported in Geobacillus sp. strains. Finally, Huancarhuaz hot spring harbors a genetic microbial diversity for lignocellulosic waste bioconversion in high temperatures, and the T4B consortium will be a promising source of novel extreme condition stable enzymes for the saccharification process.

[Spatial analysis of hypertension in Peruvian adults, 2022]. / Análisis espacial de la hipertensión arterial en adultos peruanos, 2022.

Objectives: To perform a spatial analysis of arterial hypertension in the Peruvian adult population to identify geographic patterns with a higher concentration of cases. Materials and methods: A spatial analysis was conducted using data from the Demographic and Family Health Survey (ENDES) 2022. A sample of 29,422 adults was included, and the global Moran's index and Getis-Ord Gi* analysis were used to evaluate spatial autocorrelation and cluster concentration. Results: The age-standardized prevalence of arterial hypertension was 19.2%. Clusters with a high concentration of arterial hypertension were observed in departments along the Peruvian coast such as Tumbes, Piura, Lambayeque, La Libertad, Ancash, and Lima, as well as in the northern regions of the Highlands. Clusters were also found in the regions of Loreto and Madre de Dios in the Peruvian jungle. Conclusions: This study revealed geographic patterns of arterial hypertension in Peru, with a higher concentration of cases along the Peruvian coast and in certain regions of the Highlands and Jungle. These findings highlight the need to develop strategies for the prevention and control of the disease, especially in the areas identified as high-prevalence clusters.

Single-nucleotide polymorphisms in ialB, gltA and rpoB genes of Bartonella bacilliformis isolated from patients in endemic Peruvian regions.

Bartonella bacilliformis is a Gram-negative, aerobic bacterium and the known causal agent of Carrion's disease, still considered a neglected disease. There is limited information about the nucleotide sequences of this bacterium in international databases, and few studies have addressed the genetic diversity of B. bacilliformis. We analyzed a total of 20 isolates of B. bacilliformis from the Peruvian regions of Ancash and Cajamarca. Three genes (ialB, gltA, and rpoB) were sequenced in each isolate and nucleotide sequences retrieved from GenBank (16 B. bacilliformis genomes) were also included in the study. All this information was merged in order to obtain clearer evidence of the phylogenetic relationships of B. bacilliformis. In the phylogenetic analysis conducted with the concatenated markers, four isolates (B.b-1, B. b-3, B. b- 7, B.b-8) from the Ancash region were observed to form a subgroup different from B. bacilliformis type strain KC583, showing dissimilarity levels of 5.96% (ialB), 3.69% (gltA) and 3.04% (rpoB). Our results suggest that B. bacilliformis consists of two different subgroups. Future investigations are needed to establish the taxonomic status of these subgroups.

Nutritional and antioxidant profile of the Physalis fruit grown in three Andean regions of Peru.

Background: Physalis peruviana L. fruit contains nutritional and bioactive compounds of immense importance to public health and represents a potential ingredient for the development of functional foods and beverages. Objective: This study aimed to determine the chemical and nutritional composition as well as the antioxidant capacity of the P. peruviana L. fruit grown in Peru in three areas of the Central Andean region. Material and methods: Proximal and physicochemical analyses and estimation of mineral content, vitamin C, total carotenoids, total polyphenols, and antioxidant capacity (2, 2-diphenyl-1-picrylhydrazyl [DPPH] and 2, 2'-azinobis (3-ethylbenzothiazoline-6-sulfonic acid) [ABTS] assays) were performed using standardized methods. Results: The fruits were collected from three regions of the Peruvian Andes (Ancash, Cajamarca, and Cusco). The results showed that the content of potassium (306.54-327.60 mg/100 g) and iron (12.93-14.47 mg/kg) was prominent. The Physalis fruit had high levels of vitamin C (47.20-52.20 mg/100 g), total polyphenols (68.17-83.40 mg equivalents of gallic acid/100 g), and carotenoids (1.12-1.73 mg ß-carotene/100 g). Higher values for antioxidant capacity were obtained with the ABTS method (896-1003.33 µmol Trolox/100 g) than with the DPPH method (290-309 µmol Trolox/100 g). Conclusions: This study confirms that the P. peruviana fruit has properties that could provide important health benefits and that it could be used for the development of functional foods and food supplement.

Factores asociados a la anemia en niños menores de cinco años de un distrito de Huaraz, Ancash / Factors associated to anemia in children below five years of age in a district of Huaraz, Ancash

Objetivos: Identificar los factores asociados a la anemia en niños menores de cinco años de edad del distrito de La Libertad, Huaraz, Ancash. Material y métodos: Estudio de tipo cuantitativo, observacional, serie de casos comparativa, retrospectiva. Cuya población de estudio fueron los niños menores de cinco años de edad del distrito de La Libertad, Huaraz, 2019. El muestreo fue de tipo probabilístico. Se recolectaron datos de la historia clínica en torno a los factores intrínsecos y extrínsecos para anemia. Se realizó un análisis exploratorio para determinar los factores asociados. Se analizó la información en hojas de cálculo del software Microsoft Excel 2013® y en el programa estadístico IBM SPSS Statistics 22. Resultados: Predominó el nivel de anemia moderado con 30%. Tanto el sexo masculino (OR=3,66; IC 95%: 1,65-8,08) y la edad mayor de 1 año (OR=13,99; IC 95%: 3,07-63,77) fueron factores intrínsecos asociados a la mayor frecuencia de anemia (p<0,05). Respecto a los factores extrínsecos, el pertenecer a un caserío diferente a Cajamarquilla (OR=3,63; IC 95%: 1,44-9,16) y el no contar con servicios básicos completos (OR=2,72; IC 95%: 1,24-5,97) se asociaron también a un incrementado número de casos (p<0,05). Conclusiones: Los factores asociados a una mayor frecuencia de casos de anemia fueron el sexo masculino, la edad mayor de 1 año, el pertenecer a un caserío diferente a Cajamarquilla y el no contar con servicios básicos completos.

SUMMARY Objectives: To identify associated factors to anemia in children under five years of age in La Libertad District, Huaraz, Ancash. Methods: It is a quantitative, observational, comparative case series, retrospective study. The population was children under five years of age in La Libertad District, Huaraz, 2019. The sampling was Probabilistic. Medical history data were collected around intrinsic and extrinsic factors for anemia. An exploratory analysis was performed to determine the associated factors. The information was analyzed in Microsoft Excel 2013 software spreadsheets® and in IBM SPSS Statistics 22 program. Results: The level of moderate anemia prevailed with 30%. Both males (OR=3.66; CI 95%: 1.65-8.08) and age older than 1 year (OR=13.99; 95% CI: 3.07-63.77) were intrinsic factors associated with the higher frequency of anemia (p<0.05). Regarding the extrinsic factors, belonging to a hamlet different to Cajamarquilla (OR=3.63; CI 95%: 1.44-9.16) and not having complete basic services (OR=2.72; CI 95%: 1.24-5.97) were also associated with a higher number of cases (p<0.05). Conclusions: The factors associated with a higher frequency of anemia cases were male sex, age over 1 year, belonging to a hamlet different to Cajamarquilla and not having complete basic services.

Calidad nutricional y evaluación biológica de la harina de arveja chata (Lathyrus sativus L) cocida en ratas / Nutritional quality and biological evaluation of cooked chata pea (Lathyrus sativus L) flour in rats

Introducción: En el mundo existen varias especies de leguminosas locales que no se exportan ni se cultivan por falta de conocimiento, a pesar de que son de buen aporte de proteínas, extracto libre de nitrógeno, fibra y bajo contenido de grasa. La arveja chata (Lathyrus sativus L.) reconocida por su alto contenido de proteínas de origen vegetal, podría contribuir a la seguridad alimentaria, a la biodiversidad de las leguminosas, a la reducción de la pobreza y del hambre.Objetivo: Determinar la calidad nutricional y evaluación biológica de la harina de arveja chata (Lathyrus sativus L.) cocida en ratas.Materiales y métodos: Se utilizó la arveja chata (Lathyrus sativus L.), que se cultiva y consume en Ancash - Perú, se realizó análisis fisicoquímicos para determinar la calidad nutricional a la harina y parámetros de evaluación biológica en 50 ratas de 28 días de edad.Resultados y discusiones: Su composición proximal tuvo una humedad de 9,28 %; proteína cruda de 23,48 %; grasa de 1,82 %; fibra de 5,64 %; cenizas de 2,74 %; extracto libre de nitrógeno de 57,04 % y 338,46 kcal. Asimismo, no se encontraron diferencias significativas (p >0,05) en los parámetros de evaluación biológica, lo que muestra que los datos se ajustan a una distribución normal, se obtuvo una digestibilidad aparente de 75,09 %, valor biológico de 69,03 %, ratio de proteína neta (NPR) de 2,25 y ratio de eficiencia proteica (PER) de 1,57.Conclusiones: Se concluyó que la arveja chata (Lathyrus sativus L.) cocida es una buena alternativa alimenticia de origen vegetal y cuando se consume con cereales y/o semillas, se obtiene una proteína completa.(AU)

Introduction: In the world there are several local legumespecies that are not exported or cultivated due to lack ofknowledge, despite the fact that they are of good protein, ni-trogen free extract, fiber and low fat content. The chata pea(Lathyrus sativus L.), recognized for their high protein contentof vegetable origin, could contribute to food security, legumebiodiversity, and the reduction of poverty and hunger.Objective: To determine the nutritional quality and biolog-ical evaluation of cooked chata pea (Lathyrus sativus L.) flourin rats.Materials & methods: The pea (Lathyrus sativus L.),which is grown and consumed in Ancash - Peru, was used,physicochemical analysis was performed to determine the nu-tritional quality of the flour and biological evaluation parame-ters in 50 rats from 28 days of age.Results and discussions: Its proximal composition had ahumidity of 9,28 %; protein of 23,48 %; fat of 1,82 %; fiber of 5,64 %; ash of 2,74 %; nitrogen free extract of 57,04 %and 338,46 kcal. Also, no significant differences (p>0,05)were found in the biological evaluation parameters, showingthat the data fit a normal distribution, apparent digestibility of75,09 %, biological value of 69,03 %, net protein ratio (NPR)of 2,25 and protein efficiency ratio (PER) of 1,57. Conclusions: It was concluded that cooked chata pea(Lathyrus sativus L.) flour is a good food alternative of veg-etable origin and when consumed with cereals and/or seeds,a complete protein is obtained.(AU)

A nationwide pilot study on breast cancer screening in Peru.

Introduction: A high prevalence of advanced breast cancer (BC) is a common scenario in Latin America. In Peru, the frequency of BC at Stages III/IV is ≈50% despite implementation of a programme for breast cancer screening (BCS) along the country. We carried out a study to assess the feasibility and develop an instrument to evaluate the knowledge, barriers and perception about BCS in a nationwide pilot study in Peru among candidates for BCS. Methods: We conducted a systematic review of 2,558 reports indexed in PubMed, Scopus, Web of Science, Medline-Ovid and EMBASE, regarding to our study theme. In total, 111 were selected and a 51-items survey was developed (eight items about sociodemographic characteristics). Patients were recruited in public hospitals or private clinics, in rural and urban areas of nine departments of Peru. Results: We surveyed 488 women from: Lima (150), Cajamarca (93), Ica (59), Arequipa (56), Loreto (48), Ancash (38), Junín (15), Puerto Maldonado (15) and Huancavelica (14); 27.9% of them were from rural areas. The mean of age was 53.3 years (standard deviation ± 9.1). Regarding education level, 29.8% had primary, 33.2% secondary and 37.0% higher education. In total, 28.7% of women did not know the term 'mammogram' and 47.1% reported never receiving a BCS (36.9% from urban and 73.5% from rural population). In women that underwent BCS, only 67% knew it is for healthy women. In total, 54.1% of patients had low levels of knowledge about risk factors for BC (i.e. 87.5% of women respond that injuries in the breast produce cancer). Cultural, economic and geographic barriers were significantly associated with having a mammogram where 56.9% of participants considered a cost ≤ 7 USD as appropriate. Mammogram was perceived as too painful for 54.9% of women. In addition, women with a self-perception of low-risk for BC and a fatalistic perception of cancer were less likely to have a BCS. Conclusion: We found that it is feasible to conduct a large-scale study in Peru. The results of this pilot study highlight an urgent need of extensive education and awareness about BCS in Peru.

Psychometric properties of the Maslach Burnout Inventory in healthcare professionals, Ancash Region, Peru.

Background: Burnout syndrome (BS) among healthcare professionals in Peru demands immediate attention. Consequently, there is a need for a validated and standardized instrument to measure and address it effectively. This study aimed to determine the psychometric properties of the Maslach Burnout Inventory (MBI) among healthcare professionals in the Ancash region of Peru. Methods: Using an instrumental design, this study included 303 subjects of both sexes (77.56% women), ranging in age from 22 to 68 years (M = 44.46, SD = 12.25), selected via purposive non-probability sampling. Appropriate content validity, internal structure validity, and item internal consistency were achieved through confirmatory factor analysis, and discriminant validity for the three dimensions was obtained. Evidence of convergent validity was found for the Emotional Exhaustion (EE) and Personal Accomplishment (PA) dimensions, with reliability values (ω > .75). Results: The EE and PA dimensions exhibited acceptable levels of reliability (ω and α > .80). However, the Depersonalization (DP) dimension demonstrated significantly lower reliability (α < .60 and ω < .50). Conclusions: A correlated three-factor model was confirmed, with most items presenting satisfactory factor loadings and inter-item correlations. Nonetheless, convergent validity was not confirmed for the DP dimension.

Análisis del comportamiento epidemiológico de Leishmaniasis cutánea en Perú 2016-2021 / Analysis of the epidemiological behavior of cutaneous leishmaniasis in Peru 2016-2021

La leishmaniasis cutánea (LC) es una patología cutánea inmunomediada causada principalmente por Leishmania (L.) major, Leishmania tropica, Leishmania braziliensis, L. mexicana y L. amazonensis. La carga de la LC en términos de morbilidad y estigmas sociales se concentra en ciertos países en desarrollo de Asia, África y Sudamérica. Las personas con LC asintomática representan una gran proporción de los individuos infectados en las zonas endémicas que no presentan ninguna lesión y pueden controlar la infección mediante mecanismos aún no del todo conocidos. En la actualidad, no existe ninguna medida profiláctica de control aprobada para la LC. Este reporte epidemiológico reveló que la LC prevalecía en las áreas geográficas de Selva y Sierra de Perú, mientras que departamentos como Ancash y La Libertad, áreas de la Costa, también estuvieron involucradas en el reporte de casos en los últimos años. El patrón de casos de LC reportados en los distintos departamentos del país tuvo un comportamiento muy parecido en el periodo comprendido entre 2016 y 2021, predominando en las primeras 4 o 5 semanas epidemiológicas la mayor frecuencia de pacientes enfermos con lesiones dérmicas compatibles y corroboradas con LC. La enfermedad es endémica en muchas partes del país, por eso se necesitan más esfuerzos y enfoques integrados para combatir esta patología(AU)

Cutaneous leishmaniasis (CL) is an immune-mediated skin pathology caused mainly by Leishmania (L.) major, Leishmania tropica, Leishmania braziliensis, L. mexicana and L. amazonensis. The burden of CL in terms of disease and social stigma is concentrated in certain developing countries in Asia, Africa, and South America. People with asymptomatic CL represent a large proportion of infected individuals in endemic areas who do not have any lesions and can control the infection through mechanisms that are not fully understood. Currently, there is no approved prophylactic control measure for CL. This epidemiological report revealed that CL was prevalent in the Selva and Sierra geographic areas of Peru, while departments such as Ancash and La Libertad, coastal areas, were also involved in the reporting of cases in recent years. The pattern of CL cases reported in the different departments of the country had a very similar behavior in the period between 2016 and 2021, with the highest frequency of sick patients with skin lesions compatible and corroborated with CL predominating in the first 4 or 5 epidemiological weeks. The disease is endemic in many parts of the country, so more efforts and integrated approaches are needed to combat this pathology(AU)

Notes on Peruvian Ribes cuneifolium and Ribes ovalifolium (Grossulariaceae)

The genus Ribes (Grossulariaceae) is widespread across the northern hemisphere, but also species-rich in the tropical Andes. In the Peruvian Andes the genus is mostly found in at least seasonally moist cloud and scrub forests, subparamo habitats and hedges. However, some taxa are from more extreme habitats in semi-arid habitats of the western slope of the Andes (Andean scrub, Ribes ovalifolium) respectively high Andean puna and paramo habitats at elevations of up to 5100 m asl (Ribes cuneifolium and some doubtful segregates). These species share small, weakly divided leaves, making them quite atypical for the genus, usually with large, deeply threeto five-lobed leaves. Both the geographical ranges and the species delimitation for both taxa are poorly understood. We here propose the recognition of only two, well-differentiated species. Ribes ovalifolium can be shown to be wide-ranging from northern Ancash to Tacna, covering nearly the entire western flank of the Peruvian Andes. Similarly, Ribes cuneifolium can be shown to represent a single, wide-ranging species from high elevations of San Martín/La Libertad to Cuzco. There is considerable diversity on details of indument, flower color and leaf shape, but no clear dividing lines permitting the recognition of segregates such as Ribes incertum J.F.Macbr. The only exception are cloud-forest populations of Ribes cuneifolium in Pasco, which we propose to segregate as a new subspecies Ribes cuneifolium subsp. pascoense based on their considerably larger leaves and inflorescences.

El género Ribes (Grossulariaceae) es principalmente distribuido en el hemisferio norte, pero también presente con muchas especies en los Andes tropicales. En los Andes del Perú el género principalmente se encuentra en bosque nublado, el subpáramo, cercos vivos y matorrales de zonas por lo menos estacionalmente húmedos. Sin embargo, algunas especies son presentes en hábitats más extremos, así como matorrales del flanco occidental de los Andes (matorral Andino, Ribes ovalifolium) respectivamente la puna y el páramo altoandino hasta los 5100 m de altitud. (Ribes cuneifolium y algunos segregados dudosos). Estas especies tienen hojas pequeñas, poco divisas, muy atípicas para el género, normalmente provisto de hojas largas, con tres ó cinco lobos profundos. Tanto la distribución como la delimitación de las especies son poco entendidas. El presente estudio presenta una revisión taxonómica de las especies, proponiendo el reconocimiento de solamente dos especies bien diferenciadas. Ribes ovalifolium tiene un rango amplio desde el Norte de Ancash hasta Tacna a lo largo del flanco occidental de los Andes del Perú. Igualmente, demostramos que Ribes cuneifolium representa una sola especie de amplia distribución de grandes alturas desde San Martín/La Libertad hasta Cuzco. Ribes cuneifolium demuestra una diversidad morfológica considerable en detalles del indumento, color de las flores y morfología foliar, pero no encontramos morfotipos claramente delineados justificando la segregación de especies adicionales, como el Ribes incertum J.F.Macbr. Las únicas excepciones son las poblaciones de Ribes cuneifolium del bosque nublado de Pasco. Proponemos el reconocimiento de este material como subespecie Ribes cuneifolium subsp. pascoense basado en sus hojas e inflorescencias mucho más grandes.

Depresión en adultos mayores en el Perú: distribución geoespacial y factores asociados según ENDES 2018 - 2020 / Depression in elderly in Peru: geospatial distribution and associated factors according to ENDES 2018 - 2020

RESUMEN Introducción. La depresión en la población adulta mayor es un asunto de salud pública y escasos estudios analizan su distribución según áreas geográficas. Objetivos. Describir la distribución geoespacial y factores asociados del síndrome depresivo (SD) en adultos mayores peruanos según la ENDES 2018 al 2020. Métodos. Estudio transversal y de tipo analítico a partir de los datos de las encuestas nacionales, las cuales emplearon la escala PHQ-9 para medir el SD. Se utilizó la prueba Chi cuadrado de Pearson, regresión logística multivariada y OR con un p valor <0,05. Resultados. La prevalencia del SD en el año 2018 fue de 12,9%; 13,3% en 2019 y 10,8% en 2020. Los factores asociados al SD fueron: ser mujer, vivir en la pobreza. Bajo nivel de instrucción, residir en el área rural, proceder de la sierra y selva, vivir solo y tener 75 o más años de edad. El análisis geoespacial evidenció que el SD se concentra en departamentos de la sierra como Huancavelica, Puno, Ayacucho, Apurímac y por el norte, Ancash y Cajamarca. Conclusiones. Las políticas públicas dirigidas a la reducción del SD deben focalizarse en las mujeres, mayores de 75 años, quienes viven en área rural y fundamentalmente a los que viven en los departamentos identificados con la mayor prevalencia.

ABSTRACT Introduction. Depression in the elderly population is a public health issue and few studies analyze its distribution according to geographic areas. Objectives. To describe the geospatial distribution and associated factors of depressive syndrome (DS) in Peruvian older adults according to ENDES 2018 to 2020. Methods. Crosssectional and analytical study based on data from national surveys, which used the PHQ-9 scale to measure DS. The analysis used Pearson's Chi square test and multivariate logistic regression and OR with p < 0,05. Results. The prevalence of DS in 2018 was 12.9%; 13.3% in 2019 and 10.8% in 2020. The factors associated with DS were: being a woman, living in poverty, having secondary education, residing in rural areas, coming from the mountains and jungle, living alone and being 75 years of age or older. The geospatial analysis shows that the SD is concentrated in five departments: the coast (Lima, La Libertad, Piura) and the southern highlands (Puno, Arequipa). Conclusions. Public policies aimed at reducing DS should focus on women, older than 75 years and those who live in rural areas and fundamentally those who live in the departments identified as having the highest prevalence.

Edema agudo de pulmón asociado al mal de altitud agudo en Huaraz: estudio transversal analítico / Acute high-altitude pulmonary edema in Huaraz: an analytical cross-sectional study

RESUMEN Objetivo: Describir algunas características epidemiológicas y clínicas del edema agudo de pulmón por mal de altitud (EAP) observadas en un hospital de Áncash (3052 m s. n. m.). Materiales y métodos: Estudio observacional descriptivo de 57 pacientes, quienes se presentaron en el Servicio de Emergencia del Hospital Víctor Ramos Guardia Huaraz entre enero de 1997 y enero del 2020. Todos cumplieron con los criterios diagnósticos de Lake Louise y una radiografía del tórax. La información se analizó mediante los usos de mediana y rango. Resultados: El 91,20 % de casos fueron del sexo masculino; 38,61% hicieron EAP de ascenso; 61,40 %, EAP de reascenso. El 21,10 % tuvo antecedente de EAP; 19,33 % desarrolló infección respiratoria previa; 10,53 %, un proceso patológico concomitante; 40,42 % hizo EAP durante el primer trimestre del año, y 45 % estuvo 10 días o menos a baja altitud. La presentación clínica incluyó disnea de reposo, crepitantes pulmonares, taquipnea, taquicardia y radiografía del tórax anormal en 100 % de los casos; tos productiva (96,52 %), dolor torácico (92,95 %), cefalea (56,11 %), cianosis (68,41 %), esputo rosado (42,13 %), fiebre (21,13 %) y leucocitosis (60,82 %). La mediana para la edad fue 20 años, frecuencia respiratoria 36/min, frecuencia cardiaca 124/min, PAS 100 mmHg, PAD 60 mmHg, temperatura 37,2 ºC, Hb 17,3 g/dl, Hto 53 %, recuento de leucocitos 12,500/mm3, resolución radiográfica del edema a las 48 horas. No hubo fallecidos. Conclusiones: Los factores que influyen en el EAP y sus determinantes son altura alcanzada, velocidad de ascenso, factores genéticos y antecedentes de EAP.

ABSTRACT Objective: To describe some epidemiological and clinical characteristics of acute high-altitude pulmonary edema (HAPE) observed in a hospital of the highlands of Ancash, located at 3,052 m a.s.l. Materials and methods: A descriptive observational study conducted with 57 patients who attended the emergency service of Hospital Víctor Ramos Guardia - Huaraz between January 1997 and January 2020. All patients fulfilled Lake Louise Criteria and had a chest X-ray. Median and range were used to analyze the information. Results: Male sex accounted for 91.20 %, ascent HAPE 38.61 % and re-ascent HAPE 61.40 %. Out of all patients, 21.10 % had a history of HAPE, 19.33 % developed a previous respiratory infection, 10.53 % had a concomitant disease, 40.42 % had HAPE during the first quarter of the year and 45 % had been 10 days or less at low altitude. Patients' clinical presentation included dyspnea at rest, pulmonary crackles, tachypnea, tachycardia and abnormal X-ray in 100 %; productive cough in 96.52 %; chest pain in 92.95 %; headache in 56.11 %; cyanosis in 68.41 %; pink sputum in 42.13 %; fever in 21.13 % and leukocytosis in 60.82 %. The median age was 20 years, respiratory rate 36/min, heart rate 124/min, SBP 100 mmHg, DBP 60 mmHg, temperature 37.2 °C, HGB 17.3 g/dl, HCT 53 %, WBC 12,500/mm3, radiographic resolution of the edema in 48 hours. There were no deaths. Conclusions: The factors that influence HAPE and its determinants are altitude, rate of ascent, genetic factors and history of HAPE.

Genetic diversity and genetic structure of Puya raimondii (Bromeliaceae) for its conservation in the Peruvian Andes

Resumen Puya raimondii es una especie endémica de los altos Andes de Perú y Bolivia. En el Perú se distribuye desde 8.068501°S, 16.170280°W hasta 16.180580° S, 70.658873° W, entre los 3600 y 4800 m de altitud, viviendo en condiciones climáticas extremas propias de la Puna, donde juega un papel ecológico importante. Pese a la amplia distribución de las poblaciones de P. raimondii en el Perú, aparentemente son bastante uniformes morfológicamente; por lo que surgen las siguientes preguntas: ¿Podrán las actuales herramientas moleculares mostrar diferencias entre las numerosas poblaciones? ¿Son suficientes las áreas de conservación establecidas para P. raimondii ya que albergan la variabilidad existente? Para responder a estas interrogantes, este trabajo tuvo como objetivo evaluar la diversidad genética y estructura genética en una población del norte del país, Pachapaqui (departamento de Ancash), una población del centro, Yanacancha (Junín), y una población del sur, Lampa - sector Choconchaca (Puno), utilizando marcadores microsatélites (SSR) específicos para la especie. Los parámetros de diversidad genética utilizados incluyeron número de alelos (A), alelos exclusivos (RA), heterocigosidad observada (Ho), heterocigosidad esperada (He) e índice de contenido polimórfico (PIC). Los resultados mostraron que el número total de A varió de 2 ‒ 13, los valores de He fueron 0 ‒ 0.723 y Ho 0 ‒ 0.929, con un He promedio de 0.217, indicando una diversidad genética moderada a alta, siendo la población de Lampa-sector Choconchaca, la que presentó mayor diversidad alélica y mayor diversidad genética. La prueba de Hardy-Weinberg mostró que las poblaciones se encuentran en desequilibrio HW, el análisis estadístico indica un 65% de variación genética a nivel poblacional y valores de FST (0.426) y RST (0.650) que indican alta diferenciación genética entre poblaciones, con dos grupos genéticos (K=2) que corresponden a las poblaciones del centro-norte y sur del Perú. Los resultados brindan información útil para establecer estrategias de conservación para P. raimondii, que conduzcan a la creación de una área de conservación adicional para proteger a las poblaciones del sur del Perú.

Abstract Puya raimondii is an endemic species from the high Andes of Peru and Bolivia. In Peru it is distributed from 8.068501°S, 16.170280°W to 16.180580°S, 70.658873°W, between 3600 and 4800 m, living in extreme climatic conditions typical of the Puna, where it plays an important ecological role. Despite the wide distribution of P. raimondii populations in Peru, they appear to be fairly uniform morphologically. The following questions arise: Will the current molecular tools be able to show differences between the numerous populations? Are the conservation areas established for P. raimondii sufficient since they harbor the existing variability? To answer these questions, this work aimed to evaluate the genetic diversity and genetic structure in a northern population, Pachapaqui (Ancash department), a central population, Yanacancha (Junin), and a southern population, Lampa - Choconchaca sector (Puno), using microsatellite markers (SSR) specific for the species. The genetic diversity parameters used included number of alleles (A), exclusive alleles (RA), observed heterozygosity (Ho), expected heterozygosity (He), and polymorphic content index (PIC). The results showed that the total number of A varied from 2 - 13, the He values were 0 ‒ 0.723 and Ho 0 ‒ 0.929, with an average He of 0.217, indicating a moderate to high genetic diversity, being the population of Lampa-Choconchaca sector, the one that presented the greatest allelic diversity and the greatest genetic diversity. The Hardy-Weinberg test showed that the populations are in HW disequilibrium, the statistical analysis indicates 65% of the genetic variation at the population level and values of FST (0.426) and RST (0.650) that indicate high genetic differentiation among populations, with two genetic groups (K=2) that correspond to the populations of northern-central and southern Peru. The results provide useful information to establish conservation strategies for P. raimondii, which lead to the creation of an additional conservation area to protect the populations in southern Peru.

Neumomediastino espontáneo de reentrada en la altitud: reporte de dos casos

Se describen dos casos de neumomediastino espontáneo (NME) en adolescentes varones, saludables y nativos de la altura cuando retornaron a sus hogares provenientes del nivel del mar. Ambos acudieron por el Servicio de Emergencia del hospital Víctor Ramos Guardia de Huaraz, Ancash (3052 m s. n. m.) en el mes de febrero del 2020. El primer caso es el de un joven de 16 años que retornó a su hogar (a 2964 m s. n. m.) luego de permanecer doce días a nivel del mar, en Lima. Seis horas después del regreso fue a trabajar a la chacra, se sintió cansado y empezó a toser, y luego empezó el dolor torácico, la disnea y el enfisema subcutáneo. El segundo caso corresponde a un varón de 17 años, que volvió a su hogar (3140 m s. n. m.) después de pasar dos semanas a nivel del mar (Barranca); doce horas después del retorno, va a trabajar a la chacra y presenta tos, disnea, dolor torácico, dolor de garganta y enfisema subcutáneo. Ambos jóvenes desarrollaron una hipoxemia. El neumomediastino espontáneo se diagnosticó con las radiografías de tórax. En el segundo paciente, el cuadro se asoció a un leve edema pulmonar de altura. Ninguno de los pacientes tenía antecedentes de traumatismos, uso de drogas ilícitas, comorbilidad o de enfermedades previas asociadas a la altura. El manejo de la enfermedad fue conservador, sintomático, de soporte y observación clínica. Cuando un paciente joven y saludable acude a la emergencia con dolor torácico, disnea y enfisema subcutáneo, el neumomediastino espontáneo se debe considerar como un posible diagnóstico y, de inmediato, solicitar radiografías torácicas, frontal y lateral, que abarquen la región cervical. El diagnóstico diferencial permite un manejo adecuado y preciso para los pacientes con neumomediastino espontáneo.

We describe two cases of spontaneous pneumomediastinum (SPM) that occurred in healthy, high-altitude native adolescent males when returning to their home from sea level. Both attended the Emergency Department of the Hospital Víctor Ramos Guardia in Huaraz, Ancash (3,052 m a.s.l.), in February 2020. Case 1 was a 16-year-old man who returned home (2,964 m a.s.l.) after twelve days at sea level (Lima). Six hours after returning, he went to work in the field. He then presented fatigue, cough, chest pain, dyspnea, and subcutaneous emphysema. Case 2 was a 17-year-old man who returned home (3,140 m a.s.l.) two weeks after staying at sea level (Barranca). Twelve hours after returning, he went to work in the field. He then presented cough, dyspnea, chest pain, sore throat, and subcutaneous emphysema. Both patients developed hypoxemia, and SPM was diagnosed with the help of chest X-rays. Case 2 was associated with mild high-altitude pulmonary edema. Both patients had no previous history of trauma, illicit drug use, comorbidity, and high-altitude-related diseases. Disease management was conservative, symptomatic, supportive, and based on clinical observation. When a healthy young patient comes to an emergency department because of chest pain, dyspnea, and subcutaneous emphysema, we should consider the possibility of SPM and immediately request frontal and lateral chest X-rays that include the cervical region. A differential diagnosis enables physicians to provide adequate and accurate treatment to patients with SPM.

Quality of Life and Depressive Symptoms Among Peruvian University Students During the COVID-19 Pandemic.

Objective: To determine the factors associated with quality of life and depressive symptoms in Peruvian university students during the COVID-19 pandemic. Methods: Multicentre study in 1,634 students recruited by convenience sampling. The quality of life (QoL) was assessed with the European Quality of Life-5 Dimensions at three levels (EQ-5D-3L) and depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9). To assess factors associated with QoL and depressive symptoms, linear regressions and fitted regressions were used, with robust coefficients of variance information (ß). Results: A 345 (21.1%) reported problems in performing daily activities, 544 (33.3%) reported pain and discomfort, 772 (47.2%) were moderately/very anxious or depressed. Furthermore, 207 (12.7%) had moderate-severe and severe depressive symptoms. Men reported better QoL than women (ß: 3.2; 95% CI: 1.1, 5.4; p = 0.004) and fewer depressive symptoms (ß: -0.7; 95% CI: -1.3, -0.2; p = 0.011). Ayacucho's residents had more depressive symptoms than Ancash's residents (ß: 0.8; 95% CI: 0.1, 1.5; p = 0.022) and Piura's residents had fewer depressive symptoms than Ancash's residents (ß: -1.195% CI: -1.8, -0.3, p = 0.005). Students who left home during quarantine reported more depressive symptoms (ß: 0.7, 95% CI: 0.2, 1.2, p = 0.006). Conclusion: Problems performing daily activities, pain and discomfort, as well as mild to severe depressive symptoms were found in more than three-quarters of the sample. Authorities could consider depression care to improve quality of life in regions where high rates of infection occurred during the pandemic.

Satisfaction of Quechua-speaking women in climacteric stage with the care provided by midwives.

OBJECTIVE: To determine the satisfaction of Quechua-speaking women in climacteric stage of a rural Peruvian area with respect to primary health care provided by midwives. METHOD: Descriptive cross-sectional observational study, with a total of 690 Quechua-speaking women in climacteric stage from the rural community of Macashca (3,384 masl), Huaraz province, Ancash-Peru, whose primary health care was carried out by midwives. A questionnaire was applied between October 2019 and February 2020. The information was processed using the IBM SPSS version 22.0® statistical package, applying a descriptive statistical analysis. RESULTS: 72.1% of the women were totally satisfied with the health care provided by midwives, highlighting the interest shown in the health status of the users (71.3%), use of the Quechua language (75.4%), treatment received (74.3%), resolution of doubts (69.5%), information on the relief of climacteric symptoms (67.1%) and home follow-up (74.9%). CONCLUSIONS: The majority of Quechua-speaking women in climacteric stage stated that they were fully satisfied with the primary health care provided by midwives, where the most highly valued aspects were the use of the Quechua language, home follow-up, treatment received, and interest shown in the health status of the women; being able to consider improvements with respect to the information on the relief of climacteric symptoms and the resolution of doubts.

Burnout syndrome, anxiety, depression and occupational well-being among Peru hospital staff during the COVID-19 pandemic / Síndrome de Burnout, ansiedad, depresión y bienestar laboral en personal hospitalario de Perú durante la pandemia de COVID-19

Introduction: The COVID-19 pandemic has had serious consequences for the mental health of individuals, especially health care providers, who have experienced symptoms of stress, anxiety and depression that affect their personal, family and social lives. This situation has led health entities to evaluate the negative effects and to design interventions. Objective: To establish the relationship between burnout syndrome, anxiety, depression and work well-being, considering sociodemographic and work variables, including differences according to the type of work. Methods: The present study is non-causal, comparative, cross-sectional and prospective. The sampling was intentional non-probabilistic, with a total of 366 participants from three hospitals in Ancash (Peru) under COVID-19 conditions during the second wave. For the measurement of the variables, the Maslach Burnout Inventory, the Goldberg anxiety/depression subscales and the Sánchez-Cánovas work well-being subscales were used. Results: The results indicated multiple relationships among burnout syndrome, anxiety, depression and work well-being (p <0.05). Likewise, these relationships were also presented considering some sociodemographic and labor variables (p <0.05). Conclusions: The variables studied have a significant relationship in the health care personnel examined. Based on these findings, it is possible to have a baseline of the mental health of health personnel to plan interventions that emphasize those variables and groups at risk that require special attention(AU)

Introducción: La pandemia de COVID-19 ha tenido graves consecuencias para la salud mental de las personas, especialmente de los profesionales de la salud, quienes han experimentado síntomas de estrés, ansiedad y depresión que afectan su vida personal, familiar y social. Esta situación ha llevado a las entidades de salud a evaluar los efectos negativos y diseñar intervenciones. Objetivo: Establecer la relación entre el síndrome de Burnout, la ansiedad, la depresión y el bienestar laboral, considerando variables sociodemográficas y laborales, incluyendo diferencias según el tipo de trabajo. Métodos: El presente estudio es no causal, comparativo, transversal y prospectivo. El muestreo fue no probabilístico intencional, con un total de 366 participantes de tres hospitales de Ancash (Perú) en condiciones de COVID-19 durante la segunda ola. Para la medición de las variables se utilizaron el Inventario de Burnout de Maslach, las subescalas de ansiedad/depresión de Goldberg y las subescalas de bienestar laboral de Sánchez-Cánovas. Resultados: Los resultados indicaron múltiples relaciones entre síndrome de burnout, ansiedad, depresión y bienestar laboral (p<0,05). Asimismo, estas relaciones también se presentaron considerando algunas variables sociodemográficas y laborales (p<0,05). Conclusiones: Las variables estudiadas tienen una relación significativa en el personal sanitario examinado. Con base en estos hallazgos, es posible tener una línea de base de la salud mental del personal de salud para planificar intervenciones que enfaticen aquellas variables y grupos en riesgo que requieren atención especial(AU)

[Enteroparasitosis in Peru and its relation to the Human Development Index]. / Enteroparasitosis en Perú y su relación con el Índice de desarrollo humano.

BACKGROUND: Diseases related to enteroparasites are a serious public health problem. OBJECTIVE: To assess the prevalence of enteroparasites in Peru and its relationship with the Human Development Index (HDI). MATERIAL AND METHODS: A coproparasitological study using the direct method from children and adults from the communities of Pamplona Alta in Lima, the province of San Sebastián de Quera, Castillo Grande, Pillco Marca and Puelles in Huánuco, Llupa-Huaraz in Ancash, and Machaguay in Arequipa, Peru, was carried out from 2012 to 2016. RESULTS: 864 samples were analyzed, and a total prevalence of 23.03% (199 cases) was found. The non-pathogenic protozoan Entamoeba coli, with 10.42% (90 cases), and the nematode Ascaris lumbricoides, with 6.37% (55 cases), were the most prevalent. PERMANOVA analysis based on the prevalences of enteroparasites in urban and rural areas of Peru showed differences among communities. The overall prevalence of urban communities was similar to that of the rural ones. CONCLUSIONS: Enteroparasitosis in Peru are not related to HDI. However, the levels of infestation by enteroparasites varied between the different communities, and they were related to the bioecological characteristics of parasites.

INTRODUCCIÓN: las enfermedades relacionadas con enteroparásitos son un grave problema de salud pública. OBJETIVO: evaluar la prevalencia de enteroparásitos en el Perú y su relación con el Índice de desarrollo humano (IDH). MATERIAL Y MÉTODOS: se realizó un estudio coproparasitológico por el método directo en niños y adultos de las comunidades de Pamplona Alta en Lima, de la provincia de San Sebastián de Quera, Castillo Grande, Pillco Marca y Puelles en Huánuco, Llupa-Huaraz en Ancash y Machaguay en Arequipa, Perú, de 2012 a 2016. RESULTADOS: se analizaron 864 muestras y se encontró una prevalencia total del 23.03% (199 casos). El protozoario no patógeno Entamoeba coli con 10.42% (90 casos) y el nematodo Ascaris lumbricoides con 6.37% (55 casos) fueron los más prevalentes. La prevalencia de protozoos fue mayor que la de los helmintos. No se observó asociación entre el IDH frente a la prevalencia total ni frente a las cuatro especies de enteroparásitos más frecuentes. El análisis PERMANOVA a partir de las prevalencias de enteroparásitos en áreas urbanas y rurales de Perú mostró diferencias entre las comunidades. La prevalencia total de las comunidades urbanas fue similar a la de las rurales. CONCLUSIONES: la enteroparasitosis en el Perú no se relaciona con el IDH. Sin embargo, los niveles de infestación por enteroparásitos variaron entre las diferentes comunidades y se relacionaron con las características bioecológicas de los parásitos.

Factores de riesgo en población rural andina con COVID-19: un estudio de cohorte retrospectivo / Risk factors in rural Andean population with COVID-19: a retrospective cohort study

Resumen Objetivo: Determinar los factores de riesgo en adultos con COVID-19 en población rural andina durante 2020. Métodos: En este estudio de cohorte retrospectivo multicéntrico, incluimos a 184 pacientes adultos (≥18 años) con pruebas serológicas y moleculares para CO VID-19 de tres hospitales de la sierra peruana (Ancash y Apurímac) incluidos con sospecha clínica entre abril y junio. Se utilizó análisis descriptivos y regresión logística univariable para explorar los factores de riesgo asociados a los pacientes con COVID-19. Resultados: Del total de pacientes, 14 (7.6%) tuvieron SARS-CoV-2. En los pacientes infectados 12 (85.7%) fueron varones con promedio de edad de 47.3±21 años. Las comorbilidades estuvieron presentes en cerca de la tercera parte de pacientes, siendo la hipertensión y diabetes las más frecuentes (ambas 14.3%), y la sinto matología más frecuentes fueron fiebre y cefalea (57.2%). La regresión univariable mostró mayores probabilidades de infección con SARS-CoV-2 en la población rural andina asociada con la edad avanzada (OR: 1.1 IC95% 0.7-1.8; p=0,019), comorbilidades previas (OR: 1.7, IC95% 0.32-9.39; p=0,006), y sintomatología previa (OR: 49.8, IC95% 5.6-436.9; p=0,0011). Conclusiones: Los posibles factores de riesgo como la edad avanzada, las comorbilidades y sintomatología previas están relacionados con el desarrollo de CO VID-19 en población rural andina de Perú.

Abstract Objective: To determine the risk factors in adults with COVID-19 in the rural Andean population during 2020. Methods: This multicenter retrospective cohort study included 184 adult patients (≥18 years) with COVID-19's serological and molecular tests from three Hospitals in the Peruvian mountains (Ancash and Apurímac) included with clinical suspicion between April and June. Descriptive analysis and univariate logistic regression were used to explore the risk factors associated with patients with COVID-19. Results: Of total of patients, 14 (7.6%) had a SARS-CoV-2. In infected patients 12 (85.7%) were men with an average age of 47.3±21 years. Comorbidities were present in about a third of patients, with hypertension and diabetes being the most frequent (both 14.3%), and the most frequent symptoms were fever and hea dache (57.2%). Univariate regression showed higher probabilities of infection with SARS-CoV-2 in the rural Andean population associated with advanced age (OR: 1.1 95% CI 0.7 - 1.8; p = 0.019), previous comorbidities (OR: 1.7, 95%CI 0.32 - 9.39; p = 0.006), and previous symptoms (OR: 49.8, 95%CI 5.6 - 436.9; p = 0.0011). Conclusions: Possible risk factors such as advanced age, comorbidities and previous symptoms are related to the development of COVID-19 in the rural Andean population of Peru.

Factores asociados a seropositividad para SARS-CoV-2 en pacientes atendidos en un hospital de zona altoandina peruana / Factors associated with seropositivity for SARS-CoV-2 in patients treated at a hospital in the Peruvian highlands

Introducción:El COVID 19 es una enfermedad infecciosa causada por el SARS-CoV-2 que ha afectado en gran escala al Perú. No están documentados los potenciales factores clínicos y/o epidemiológicos que están relacionados a la positividad de SARS-CoV-2 en población altoandina. Determinar los factores asociados a positividad de SARS-Cov-2 en Objetivo:personas que viven en Ancash. Estudio transversal analítico. Se Material y métodos:utilizaron los registros de pacientes atendidos por sospecha de COVID-19 en un hospital público de Huaraz en marzo-mayo 2020. Se estimaron razones de prevalencia (RP) con intervalos de confianza. En el análisis de regresión simple, se estimaron razones de prevalencia e intervalos de confianza al 95%, utilizando familia de distribución Poisson, función de enlace log y varianza robusta De 903 pacientes, 13,7% pacientes Resultados:resultaron positivos a SARS-CoV-2. En la regresión simple, resultó que el sexo masculino (RP=2,98), presentar tos (RP=2,27), dificultad respiratoria (RP=2,97), diarrea (RP=2,69), malestar general (RP=1,82), odinofagia (RP=1,69) se asociaron positivamente a tener prueba SARS-CoV-2 positiva. En la regresión múltiple se mantuvo la asociación en cuatro características: ser varón (RP=2,7), presentar tos (RP=1,45), dificultad respiratoria (RP=2,15) y diarrea (RP=1,89). :En zona altoandina, los casos positivos en su Conclusiónmayoría presentan síntomas típicos. Los factores asociados a la positividad fueron el sexo masculino y la presencia de dificultad tos, respiratoria y diarrea

Background:COVID 19 is an infectious disease caused by SARS-CoV-2 that has affected Peru on a large scale. Potential clinical and/or epidemiological factors that are related to the positivity of SARS-CoV-2 in the high Andean population are not documented. Objective: To determine factors associated with positivity of SARS-CoV-2 in people living in Ancash. Material and methods: Analytical transversal study. We used the records of patients treated for suspected COVID-19 in a public hospital in Huaraz in March-May 2020. Prevalence ratios (PR) with confidence intervals were estimated. In simple regression analysis, prevalence ratios and 95% confidence intervals were estimated, using Poisson distribution family, log-link function and robust variance. Out of 903 patients, Results: 13.7% tested positive for SARS-CoV-2. In simple regression, male (RP=2.98), cough (RP=2.27), respiratory distress (RP=2.97), diarrhea (RP=2.69), general malaise (RP=1.82), odynophagia (RP=1.69) were positively associated with having a positive SARS-CoV-2 test. In the multiple regressions, the association was maintained in four characteristics: being male (RP=2.7), having a cough (RP=1.45), respiratory distress (RP=2.15), and diarrhea (RP=1.89). Conclusion: In high Andean areas, most positive cases present typical symptoms. The factors associated with positivity were male sex and the presence of cough, respiratory difficulty and diarrhea.