The fourth national anti-tuberculosis drug resistance survey in Peru.

BACKGROUND: Peru has one of the highest burdens of multidrug-resistant tuberculosis (MDR-TB), but universal drug susceptibility testing (DST) has not yet been achieved.OBJECTIVE: To estimate the proportion of drug resistance among smear-positive TB patients in Peru.DESIGN: From September 2014 to March 2015, we performed a national drug resistance survey of patients aged ≥15 years; TB was diagnosed based on sputum smear positivity. We performed DST at the National Reference Laboratory of the Peruvian National Institute of Health, Lima, Peru, using the proportion method in Middlebrook 7H10 agar for four first-line drugs and six second-line drugs, and the Wayne method for pyrazinamide.RESULTS: Of the 1908 new and 272 previously treated patients included in the analysis, 638 (29.3%) patients had resistance to at least one first-line drug. MDR-TB was diagnosed in 7.3% of new and 16.2% of previously treated patients (P < 0.001). There were five (0.2%) patients with extensively drug-resistant TB.CONCLUSION: MDR-TB has increased to 7.3% in new patients from 5.3% in the previous survey, indicating that resistance to anti-tuberculosis drugs is increasing in Peru. Ongoing community transmission of resistant strains highlights an urgent need for early diagnosis, optimised treatment and effective contact tracing of MDR-TB patients.

Evaluación del grado de buena prescripción médica en 5 Hospitales Universitarios de tercer nivel de la ciudad de La Paz (Bolivia) / Assesment of the degree of a good medical prescriptionin 5 third level University Hospitals in the city of La Paz - Bolivia

OBJETIVO: establecer el grado de cumplimiento de Buenas Prácticas de Prescripción Médica sugeridas por la Organización Mundial de la Salud (OMS) analizando recetas extendidas a pacientes de consulta externa e internados de 5 hospitales universitarios de la ciudad de La Paz (Bolivia), identificando limitaciones y deficiencias en su formulación. MÉTODOS: estudio descriptivo, retrospectivo de evaluación de recetas, según disposiciones de la ley No.1737 (1996) de Bolivia, las Normas Nacionales de Atención Clínica del Ministerio de Salud Boliviano (2013) y el Manual de la Buena Prescripción de la OMS. RESULTADOS: del análisis de 220 recetas se desprende que la proporción de recetas que cumple con la mayoría de parámetros sugeridos por la OMS para una buena prescripción médica es baja. Las recetas que tienen identificación del prescriptor son 37,27%; 66,82%, no señala el origen de la prescripción; 15% incumple con una adecuada filiación del paciente, incluyendo el nombre del paciente, 80,91% no incluían la edad del paciente, 10,91% no estaban con nombre genérico del medicamento; 11,82% estaban con nombre comercial, 5,45% no contaban con nombre completo ni firma del prescriptor; 13,64% no incluía fecha de la prescripción. Un 34,09% tenían letra poco legible y 29.54% letra no legible. Estos datos, entre otros, indican la necesidad de reflexión y actualización sobre este importante tema. CONCLUSIONES: Se registra un elevado índice de incumplimiento de las normas de buena prescripción señaladas por las regulaciones antes mencionadas, identificando la necesidad de re-orientar los hábitos de prescripción facultativa a fin que no repercutan negativamente en la salud y tratamiento de los pacientes y en las acciones del Sistema Nacional de Salud. El formato de receta médica utilizado en los diferentes servicios de salud objeto del estudio es deficiente en cuanto al modelo y guía sugerida por la OMS.

OBJECTIVE: to establish the degree of compliance with good medical prescription practices suggested by the World Health Organization (WHO) analyzing prescriptions issued to outpatients and admitted patients of 5 university hospitals in the city of La Paz (Bolivia), identifying limitations and deficiencies in its formulation. METHODS: descriptive, longitudinal, retrospective study of prescription assesment, according to provisions of Law No.1737 (1996) of Bolivia, the National Standards for Clinical Care Bolivian Ministry of Health (2013) and the Manual of Good Prescription the World Health Organization (WHO). RESULTS: analysis of 220 prescriptions show that the proportion of prescriptions that meet most of the parameters suggested by WHO for a good prescription is down. 37,27% of prescriptions have prescriber identification; 66.82%, do not indicate the origin of the prescription, 15% fail to comply with proper affiliation of the patient, including the patient's name, 80.91% did not have included patient age, 10.91% of prescriptions were not made by generic drug name; 11.82% were prescribed with trade name, 5.45% had no full name or signature of the prescriber; 13.64% did not include prescription date. 36.36% were made legibly a 34.09% with little legibly and 29.54% with no legible. These data, among others, indicate the need for reflection and update on this important topic. CONCLUSIONS: it has been registered a high rate of non-compliance with good prescription for the above mentioned regulations, identifying the need to re-direct professional prescription habits so that no negative impact on the health and treatment of patients and the actions of the National Health System (NHS) is done. The format of prescription used in various health services under study is deficient in terms of model and guide suggested by the WHO.

Programmatic implementation of rapid DST for Mycobacterium tuberculosis in Peru.

BACKGROUND: Performance characteristics of novel rapid drug susceptibility tests (DST) for Mycobacterium tuberculosis may change when moving from research to implementation in actual public health practice. We describe the performance characteristics of a direct, rapid DST when implemented in Lima, Peru. METHODS: A district laboratory validated conventional proportions and nitrate reductase methods. We collected data on samples submitted for DST from January 2005 to June 2007 and calculated frequency of testing and results, and median time to test results. RESULTS: A total of 4102 DSTs were performed by conventional DST and 895 by nitrate reductase. Results were obtained from 72.8% of samples by conventional DST and from 70.2% of those processed by Griess; respectively 26.4% and 31.5% were multidrug-resistant tuberculosis. The median time from sample collection to test result was 31 days for Griess vs. 99 days for conventional DST. CONCLUSIONS: Preliminary experience with the Griess method demonstrates favorable performance under program conditions.

[Mirror writing secondary to left parietal-occipital infarction]. / Escritura en espejo secundaria a infarto parietooccipital izquierdo.

INTRODUCTION: Mirror writing is a rare disorder in which the patient's handwriting is done backwards and a mirror is needed to be able to read it. Although mirror writing presents both spontaneously and pathologically, it is mainly due to cerebrovascular lesions in the dominant hemisphere. CASE REPORT: A right-handed 62-year-old female who, following a left parietal-occipital infarction, evidenced by computerized tomography scanning, developed mirror writing with the left hand associated with mnemonic, gnosic and praxic disorders. The symptoms continued for a year after the episode. CONCLUSIONS: Mirror writing and other associated disorders are a consequence of a dysfunction of the left parietal-occipital lobe and the optic thalamus on the same side.

Frecuencia de microbacterias identificadas en el laboratorio de referencia de tuberculosis del Perú (1989 - 1990) / Frequency of mycobacteries identification in the laboratory of reference of tuberculosis at Peru (1989 - (1990)

Se estudiaron 954 cepas cuyo aislamiento primario se realizó de muestras clínicas provenientes de todas las regiones del país durante 1989-1990. El objetivo del estudio fue determinar la frecuencia de microbacterias tuberculosas y no tuberculosas en el Laboratorio Nacional de Referencia de Tuberculosis del Perú. Para el aislamiento se utilizó el medio de Lowenstein Jensen. El mayor número de muestras y sus cultivos correspondientes fueron de secreciones pulmonares (97 por ciento); hubo 3 micobacterias no tuberculosas de muestras de orina. La frecuencia de aislamientos de micobacterias tuberculosas en 1989 y 1990 fue de 100 por ciento y 99.3 por ciento respectivamente. Se encontró 4 micobacterias no tuberculosas que correspondieron a M. fortuitum. Los resultados permiten afirmar que M. tuberculosis sigue siendo la micobacteria aislada con mayor frecuencia en las muestras estudiadas.