Leadcare® II Comparison with Graphite Furnace Atomic Absorption Spectrophotometry for Blood Lead Measurement in Peruvian Highlands.

Peru is one of the countries with the highest lead contamination in the world. Biological monitoring has limitations due to the shortage of laboratories with validated methodologies for the measurement of blood lead, and it is necessary to use alternative methods for its measurement in high-altitude cities. We aimed to compare the blood lead levels (BLL) measured by the LeadCare II (LC) method and Graphite Furnace Atomic Absorption Spectrometry (GF-AAS). We measured the BLL of 108 children from the city of La Oroya. The mean and median BLL for GF-AAS were 10.77 ± 4.18 and 10.44 µg/dL, respectively; for the LC method, the mean was 11.71 ± 4.28 and the median was 11.60 µg/dL. We found a positive linear correlation (Rho = 0.923) between both methods. Notwithstanding, the Wilcoxon test suggests a significant difference between both methods (ρ = 0.000). In addition, the Bland-Altman analysis indicates that there is a positive bias (0.94) in the LC method, and this method tends to overestimate the BLL. Likewise, we performed a generalized linear model to evaluate the influence of age and hemoglobin on BLL. We found that age and hemoglobin had a significant influence on BLL measured by the LC method. Finally, we used two non-parametric linear regression methods (Deming and Passing-Bablok regression) to compare the LC method with the GF-AAS. We found that these methods differ by at least a constant amount, and there would be a proportional difference between both. Although in general there is a positive linear correlation, the results of both methods differ significantly. Therefore, its use in cities located at high altitudes (higher than 2440 m.a.s.l.) would not be recommended.

Evaluation of an ozone generation system for the control of microorganisms in the indoor air of sanitary environments / Evaluación de un sistema de generación de ozono para el control de microorganismos en el aire interior de ambientes sanitarios

Objetive: Evaluate an Ozone Generating System (OGS) through of the microorganisms count and identificated in the air of the sanitary environments of the National Institute of Health (INS) from Peru. These were The study:exposed to OGS for 1 min per m2, air samples were collected at volumes of 200L, 500Land 1000Lby impaction, pre and post exposure to OGS, cultures were obtained on Plate Count Agar (PCA) and Oxytetracycline Glucose Agar (OGA) grown at 35°C±2°C for 48 hours and 25°C ± 2°C for 5 days.Adecrease Findings:in the count of fungi after exposure to OGS, the difference being statistically significant for the volumes of 200L(p=0.047) and 1000 L(p<0.005); Aspergillus spp. species were identified in most cultures, in bacteria no significant difference was observed.The OGS is a method that inhibits the Conclusions:growth of most fungi in sanitary environments.

Objetivo: Evaluar un Sistema Generador de Ozono (SGO) a través del recuento e identificación de microorganismos en el aire de los ambientes sanitarios del Instituto Nacional de Salud (INS) del Perú. El estudio: Los ambientes fueron expuestos a SGO por 1 min por m2, se recolectaron muestras de aire en volúmenes de 200L, 500L y 1000L por impactación, pre y post exposición a SGO; los cultivos se obtuvieron en Plate Count Agar (PCA) y Oxitetracicline Glucose Agar (OGA) cultivados a 35 °C ± 2 °C durante 48 horas y 25 °C ± 2 °C durante 5 días. Hallazgos: Disminución del recuento de hongos post exposición a SGO, la diferencia fue estadísticamente significativa para los volúmenes de 200L (p=0.047) y 1000 L (p<0.005); especies de Aspergillus spp. fueron identificados en la mayoría de los cultivos; en bacterias no se observaron diferencias significativas. Conclusiones: El SGO es un método que inhibe el crecimiento de la mayoría de hongos en ambientes sanitarios.

Performance of Bleach Method Sputum Smear Microscopy for the Diagnosis of Tuberculosis in a Highly Endemic District in Lima, Peru.

Background: Sputum smear microscopy (SSM) is a screening test used to diagnose tuberculosis (TB); however, its performance and sensitivity are relatively low, which can lead to false negatives. We designed a cross-sectional study to estimate the performance of SSM that includes a pretreatment based on sputum digestion with bleach (sodium hypochlorite) for the diagnosis of TB. Methods: We evaluated 73 sputum samples from patients with a diagnosis of TB confirmed by the Xpert MTB/RIF test and 114 samples from patients without TB. We performed sputum digestion using a 5% sodium hypochlorite solution, centrifuged at 2000 rpm for 15 min. We prepared smears for direct and bleach-treated SSM and used Ziehl−Neelsen staining. Results: The bleach-treated SSM obtained absolute identification of the cases of TB confirmed by the Xpert test, compared to 95.9% identified by the direct smear method (without bleach treatment). We also found a significant increase (p < 0.001) in the recovery of acid-fast bacilli (AFB) obtained by the bleach-treated SSM (293.8 ± 215.1 AFB) compared to the direct SSM method (222.9 ± 195.5 AFB). The AUC of the bleach-treated SSM and direct SSM was 100% and 96.6%, respectively. Conclusion: The bleach-treated SSM performs better than the direct SSM in identifying AFB and increasing the bacillary count in the sputum samples.

Magnitud y Factores asociados a complicaciones de diabetes tipo 2: Análisis de un Sistema de Vigilancia de Diabetes Mellitus / Magnitude and Factors associated with complications of type 2 diabetes: Analysis of a Diabetes Mellitus Surveillance System

Introducción: Las complicaciones por diabetes tipo 2 (DT2) están incrementando la demanda de servicios especializados en la Seguridad Social Peruana por lo que se torna necesario determinar la magnitud y factores asociados a complicación crónica por DT2 en esta población. Material y Métodos: Estudio transversal-analítico basado en 7875 registros de pacientes con DT2 ≥ 18 años atendidos por consulta externa durante 2016-2017 y notificados en el Sistema de Vigilancia de Diabetes Mellitus de EsSalud. Se evaluaron variables sociodemográficas, clínicas y de comorbilidad mediante un análisis bivariado y un modelo de regresión de Poisson con varianza robusta para determinar la razón de prevalencia a complicación crónica por DT2. Resultados: La complicación microvascular de DT2 estuvo asociado a sexo masculino (RP=1,25; 95%IC: 1,10-1,42; p<0,01), HbA1c>9,0% (RP=1,25; 95%IC: 1,08-1,46; p<0,01), hipertensión arterial (RP=1,30; 95%IC: 1,14-1,49; p<0,01), anemia (RP=1,57; 95%IC: 1,31-1,88; p<0,01), enfermedad tiroidea (RP=1,48; 95%IC: 1,07-2,03; p=0,02), cáncer (RP=1,70; 95%IC: 1,26-2,30; p<0,01) e hígado graso (RP=1,78; 95%IC: 1,28-2,48; p<0,01). El recibir educación para el autocuidado de DT2 mostró asociación negativa con complicación microvascular (RP=0,84; 95%IC: 0,73-0,96; p<0,01). La complicación macrovascular de DT2 estuvo asociado a sexo masculino (RP=1,52; 95%IC: 1,21-1,91; p<0,01), hipertensión arterial (RP=2,72; 95%IC: 1,90-3,91; p<0,01), anemia (RP=1,98; 95%IC: 1,33-2,95; p<0,01) e hígado graso (RP=1,92; 95%IC: 1,03-3,62; p=0,04), mientras que la educación en DT2 mostró asociación negativa (RP=0,47; 95%IC: 0,36-0,61; p<0,01). Conclusiones: La educación en DT2 mostró asociación consistentemente con ausencia de complicación micro y macrovascular, sugiriendo ser un importante factor preventivo. Consideramos necesario evaluar el impacto de la educación mediante diseños apropiados.

Background: Type 2 diabetes (DT2) complications has been increased the demand for specialized services in Peruvian Social Security(EsSalud), so it is necessary to determine the magnitude and factors associated with chronic complication due to DT2 in this population. Material and Methods: Cross-sectional study based on 7875 patients with DT2≥18 years attended by ambulatory care during 2016-2017, notified in the Diabetes Mellitus Surveillance System of EsSalud. Sociodemographic, clinical and comorbidity variables were evaluated using a bivariate analysis and Poisson regression model with robust variance to determine the prevalence ratio of chronic complication due to DT2. Results: The microvascular complication of DT2 was associated with male sex (PR=1.25; 95% CI:1.10-1.42; p<0.01), HbA1c>9.0% (PR=1.25; 95% CI:1.08-1.46; p<0.01), hypertension (PR=1.30; 95% CI: 1.14-1.49; p<0.01), anemia (PR=1.57; 95% CI: 1.31-1.88; p <0.01), thyroid disease (PR=1.48; 95% CI:1.07-2.03; p=0.02), cancer (PR=1.70; 95% CI: 1.26-2.30; p<0.01) and fatty liver (PR=1.78; 95% CI:1.28-2.48; p<0.01). Receiving education for DT2 self-care showed a negative association with microvascular complication (RR=0.84; 95% CI:0.73-0.96; p<0.01). DT2 ́s macrovascular complication was associated with male sex (PR=1.52; 95% CI:1.21-1.91; p <0.01), arterial hypertension (PR=2.72; 95% CI:1.90-3.91; p <0.01), anemia (PR=1.98; 95% CI:1.33-2.95; p<0.01) and fatty liver (PR=1.92; 95% CI:1.03-3.62; p=0.04), while education in DT2 showed a negative association (PR=0.47; 95% CI: 0.36-0.61; p <0,01). Conclusions: Education in DT2 showed an association consistently with the absence of micro and macrovascular complications, suggesting that it is an important preventive factor. We consider it necessary to evaluate the impact of education through appropriate designs.

Factores asociados a complicaciones crónicas de diabetes mellitus tipo 2 en pacientes de un hospital general del Seguro Social de Salud del Perú / Associated factors with chronic complications of type-2-diabetes mellitus among patients from a general hospital of the Peruvian social health insurance

RESUMEN Introducción. Las complicaciones crónicas por diabetes mellitus tipo 2 (DMT2) elevan la mortalidad y carga de enfermedad en Perú, siendo necesario evaluar su prevalencia y factores asociados. Métodos. Estudio transversal, analítico, en registros de 212 pacientes adultos con DMT2 atendidos por consulta externa en un hospital general del Seguro Social del Perú, durante el año 2017. Resultados. El 71,6% de los pacientes fueron mayores de 60 años y con un tiempo de enfermedad menor de 6 años (40,5%). El 38,7% de los pacientes tuvieron alguna complicación crónica, principalmente nefropatía (48,8%) y neuropatía (45,1%). La hipertensión arterial (52,4%) y la obesidad (43,7%) fueron las comorbilidades más frecuentes en pacientes con complicaciones crónicas. Las complicaciones por DMT2 estuvieron asociadas al número de consultas médicas y monitoreo glicémico. Conclusiones. Existen factores de riesgos asociados a las complicaciones crónicas de DMT2.

ABSTRACT Introduction. The chronic complications of type-2-diabetes mellitus (T2DM) increase mortality and burden of disease in Peru, then it is necessary to evaluate its prevalence and associated factors. Methods. Cross-sectional study in records of 212 adult outpatients with T2DM attended by a social security general hospital in Peru, during 2017. Results. 71,6% of patients were older than 60 years and with a time of illness less than 6 years (40,5%). 38,7% of the patients had any chronic complication, mainly nephropathy (48,8%) and neuropathy (45,1%). Hypertension (52,4%) and obesity (43,7%) were the most frequent comorbidities in outpatients with chronic complications. Complications from DMT2 were associated with the medical consultations and glycemic monitoring. Conclusions. There are risk factors associated to chronic complications of DMT2.