Prevalence and impact of asthma among school-aged students in Lima, Peru.

SETTING AND OBJECTIVE: The International Study of Asthma and Allergies in Childhood (ISAAC) reported asthma prevalence in Peru to be among the highest in the world. We assessed the prevalence and morbidity of self-reported asthma in an underserved, peri-urban area of Lima, Peru, with limited medical access. DESIGN: The study was conducted in the outskirts of Lima from March to May 2011. Five hundred children aged 6-18 years were selected through cluster sampling. Parents completed a modified version of the ISAAC questionnaire. Children underwent spirometry testing. Those with a forced expiratory volume in one second (FEV1% predicted) 80% were tested for reversibility using salbutamol. RESULTS: Of the 500 children selected, 71% participated. The prevalence of asthma was 16.7%. Asthma symptoms were associated with self-reported asthma (P < 0.001); 52.5% of children with asthma had ever used an inhaler (P < 0.001), and 27.1% had never been to the doctor for respiratory problems (P < 0.001). CONCLUSION: We found a high prevalence of self-reported asthma and high morbidity related to asthma symptoms in the previous 12 months among the study cohort. Symptoms were poorly controlled due to limited availability of medication and access to medical services.

Evaluation of a mobile health system for supporting postoperative patients following day surgery.

A system based on mobile phones with built-in cameras has been developed for the postoperative management of patients sent home after day surgery. The system allows patients to send pictures and pulse oximetry measurements to a hospital server in a few seconds. Health professionals can then see what patients are describing and make a more objective estimate of the patients' status. Over a five-month period, a total of 49 patients used the system. A total of 222 images were sent, the average image delivery time being 29 s (SD 11). In nine cases (18%), the availability of images modified the treatment, and a visit to an emergency unit was avoided in eight of them who had blood-stained dressings and normal haematomas. The patients who had their treatment modified sent more images (an average of 5.4/patient) than those for whom images confirmed the correct treatment (3.1/patient). Each telephone call lasted for a mean duration of 18 min (range 8-34). The patient satisfaction data showed that all the aspects studied were evaluated in a very positive way, with 96% of the patients completely satisfied with the attention received by the mobile health application.

[Our findings in the sleep endoscopy exams]. / Nuestros hallazgos en la videofibrosomnoscopia.

INTRODUCTION: Sleep endoscopy is a technique that allows a direct visualization of the pharynx during drug-induced sleep. It allows an assessment of the anatomical site of obstruction or vibration in habitual snorers. MATERIALS AND METHODS: A total of 51 patients underwent sleep endoscopy. All answered a standard questionnaire and underwent an otolaryngological exam as a part of the diagnostic procedure. RESULTS: The most frequent site of obstruction was the palate in 90.4%, followed by the base of the tongue in 38.5%. Obstruction at multiple levels was found in 60.7% of patients. No correlations were found between the level of the obstruction found in the ENT examination and the one found during the sleep endoscopy. CONCLUSIONS: Sleep endoscopy is useful for the assessment of the usual snorer and we recomend it to label the patient's obstruction.

Seroprevalence of and risk factors for HIV-1 infection among South American men who have sex with men.

OBJECTIVES: Sex among men constitutes an important route of transmission for HIV type 1 (HIV-1) in Latin America. Seeking better understanding of risk behaviours in this region, we determined the seroprevalence, potential risk factors, and geographic distribution of HIV-1 among groups of men who have sex with men (MSM). METHODS: Seroepidemiological, cross sectional studies of 13,847 MSM were conducted in seven countries of South America during the years 1999-2002. Volunteers were recruited in city venues and streets where anonymous questionnaires and blood samples were obtained. HIV-1 infection was determined by enzyme linked immunosorbent assay (ELISA) screening and western blot (WB) confirmatory tests. RESULTS: HIV-1 seroprevalence varied widely (overall 12.3%, range 11.0%-20.6%). The highest HIV-1 seroprevalence was noted in Bolivia (20.6%) and the lowest in Peru (11.0%). Predictors of HIV-1 infection varied among countries; however, a history of previous sexually transmitted disease (STD) was associated with a consistent increased risk (ORs=1.9-2.9, AORs=1.8-2.7). Multiple weekly sexual contacts was found to represent a secondary risk factor in Ecuador, Peru, and Argentina (ORs=1.6-2.9, AORs=1.6-3.1), whereas use of drugs such as cocaine was found to increase risk in Bolivia, Uruguay, and Paraguay (ORs=2.5-6.5, AORs=2.6-6.1). CONCLUSION: The results of this study illustrate an elevated HIV-1 seroprevalence among MSM participants from Andean countries. A previous STD history and multiple partners predicted HIV-1 infection in the seven countries of South America. In Southern Cone countries, HIV-1 infection was also associated with use of illegal drugs such as cocaine.

[Video fiber endoscopy during induced sleep]. / Videofibrosomnoscopia.

Video-fiberoscopy is the exploration of upper respiratory airways used in our diagnostic protocol in patients with chronic snoring and obstructive sleep apnea syndrome (OSAS). We perform a fibroscopy during propofol induced sleep without tracheal intubation; video recording and monitoring of level of sleep, pulse oximetry, blood pressure, ECG, etc. is used. This exploration allows us to asses upper respiratory airways when the patient is asleep as well as the areas of collepse and vibration both from a functional and anatomical points of view.

Diverse BF recombinants have spread widely since the introduction of HIV-1 into South America.

OBJECTIVE: To describe the genetic diversity of HIV-1 in South America by full genome sequencing and analysis. METHODS: Purified peripheral blood mononuclear cell DNA from HIV-infected individuals in Argentina, Uruguay and Bolivia was used to amplify full HIV-1 genomes. These were sequenced using the ABI 3100 automated sequencer and phylogenetically analysed. RESULTS: Twenty-one HIV-1 strains from three South American countries, 17 of which were pre-screened by envelope heteroduplex mobility assay (HMA), were studied. Ten out of 10 HMA subtype F and four out of seven HMA subtype B strains were actually BF recombinants upon full genome analysis. Two BF recombinants from Argentina and two from Uruguay had the same structure, representing a new circulating recombinant form termed CRF12_BF(ARMA159). Twelve other BF recombinants had structures related to CRF12 but with additional segments of subtype B; each was unique. BF recombinants were temporally and geographically widespread, found as early as 1986-1987 in vertically infected Argentinian children and in Argentina, Uruguay, and Bolivia.

[Intrahepatic lithiasis]. / Litiasis intrahepatica.

The intrahepactic lithisis is unusual in the Occidental hemisphere. The prevalence in Venezuela in unknown. We study all the edoscipic retrograde cholangiography carried for lithiasic pathology, in the Servicio de Gastroenterología, Hospital Universitario de Caracas, since January 1993 until April 1995. Over 342 patients, 9 were intrahepatic lithisis (1.16%). Seven cases of Caracas and two refered of the rest of the country. The sex was female in seven patients and males in two. The age range was 15 to 67 years old. The clinic feature much frequent was abdominal pain. The diagnosis was ultrasound and endoscopic retrograde cholangiography. The treatment was endoscopic with sphincterotomy and removal stones and surgical with resection in two cases, and choledocotomy in the other four cases.