The Enterics for Global Health (EFGH) Shigella Surveillance Study in Peru.

Background: The Enterics for Global Health (EFGH) Peru site will enroll subjects in a periurban area of the low Amazon rainforest. The political department of Loreto lags behind most of Peru in access to improved sources of water and sanitation, per capita income, children born <2.5 kg, and infant and child mortality. Chronic undernutrition as manifested by linear growth shortfalls is common, but wasting and acute malnutrition are not. Methods: The recruitment of children seeking care for acute diarrheal disease takes place at a geographic cluster of government-based primary care centers in an area where most residents are beneficiaries of free primary healthcare. Results: Rates of diarrheal disease, dysentery, and Shigella are known to be high in the region, with some of the highest rates of disease documented in the literature and little evidence in improvement over the last 2 decades. This study will update estimates of shigellosis by measuring the prevalence of Shigella by polymerase chain reaction and culture in children seeking care and deriving population-based estimates by measuring healthcare seeking at the community level. Conclusions: Immunization has been offered universally against rotavirus in the region since 2009, and in a context where adequate water and sanitation are unlikely to obtain high standards in the near future, control of principal enteropathogens through immunization may be the most feasible way to decrease the high burden of disease in the area in the near future.

Genomic resistant determinants of multidrug-resistant Campylobacter spp. isolates in Peru.

OBJECTIVES: Antimicrobial resistant (AMR) Campylobacter is a global health threat; however, there is limited information on genomic determinants of resistance in low- and middle-income countries. We evaluated genomic determinants of AMR using a collection of whole genome sequenced Campylobacter jejuni and C. coli isolates from Iquitos, Peru. METHODS: Campylobacter isolates from two paediatric cohort studies enriched with isolates that demonstrated resistance to ciprofloxacin and azithromycin were sequenced and mined for AMR determinants. RESULTS: The gyrA mutation leading to the Thr86Ile amino acid change was the only gyrA mutation associated with fluoroquinolone resistance identified. The A2075G mutation in 23S rRNA was present, but three other 23S rRNA mutations previously associated with macrolide resistance were not identified. A resistant-enhancing variant of the cmeABC efflux pump genotype (RE-cmeABC) was identified in 36.1% (35/97) of C. jejuni genomes and 17.9% (12/67) of C. coli genomes. Mutations identified in the CmeR-binding site, an inverted repeat sequence in the cmeABC promoter region that increases expression of the operon, were identified in 24/97 C. jejuni and 14/67 C. coli genomes. The presence of these variants, in addition to RE-cmeABC, was noted in 18 of the 24 C. jejuni and 9 of the 14 C. coli genomes. CONCLUSIONS: Both RE-cmeABC and mutations in the CmeR-binding site were strongly associated with the MDR phenotype in C. jejuni and C. coli. This is the first report of RE-cmeABC in Peru and suggests it is a major driver of resistance to the principal therapies used to treat human campylobacteriosis in this setting.

Etiology of Acute Febrile Illness in the Peruvian Amazon as determined by modular formatted quantitative PCR: A Protocol for RIVERA, a Health Facility-Based Case-Control Study.

Background: The study of the etiology of acute febrile illness (AFI) has historically been designed as a prevalence of pathogens detected from a case series. This strategy has an inherent unrealistic assumption that all pathogen detection allows for causal attribution, despite known asymptomatic carriage of the principal causes of acute febrile illness in most low- and middle-income countries (LMICs). We designed a semi-quantitative PCR in a modular format to detect bloodborne agents of acute febrile illness that encompassed common etiologies of AFI in the region, etiologies of recent epidemics, etiologies that require an immediate public health response and additional pathogens of unknown endemicity. We then designed a study that would delineate background levels of transmission in the community in the absence of symptoms to provide corrected estimates of attribution for the principal determinants of AFI. Methods: A case-control study of acute febrile illness in patients ten years or older seeking health care in Iquitos, Loreto, Peru, was planned. Upon enrollment, we will obtain blood, saliva, and mid-turbinate nasal swabs at enrollment with a follow-up visit on day 21-28 following enrollment to attain vital status and convalescent saliva and blood samples, as well as a questionnaire including clinical, socio-demographic, occupational, travel, and animal contact information for each participant. Whole blood samples are to be simultaneously tested for 32 pathogens using TaqMan array cards. Mid-turbinate samples will be tested for SARS-CoV-2, Influenza A and Influenza B. Conditional logistic regression models will be fitted treating case/control status as the outcome and with pathogen-specific sample positivity as predictors to attain estimates of attributable pathogen fractions for AFI. Discussion: The modular PCR platforms will allow for reporting of all primary results of respiratory samples within 72 hours and blood samples within one week, allowing for results to influence local medical practice and enable timely public health responses. The inclusion of controls will allow for a more accurate estimate of the importance of specific, prevalent pathogens as a cause of acute illness. Study Registration: Project 1791, Registro de Proyectos de Investigación en Salud Pública (PRISA), Instituto Nacional de Salud, Perú.

Etiology of acute febrile illness in the peruvian amazon as determined by modular formatted quantitative PCR: a protocol for RIVERA, a health facility-based case-control study.

BACKGROUND: The study of the etiology of acute febrile illness (AFI) has historically been designed as a prevalence of pathogens detected from a case series. This strategy has an inherent unrealistic assumption that all pathogen detection allows for causal attribution, despite known asymptomatic carriage of the principal causes of acute febrile illness in most low- and middle-income countries (LMICs). We designed a semi-quantitative PCR in a modular format to detect bloodborne agents of acute febrile illness that encompassed common etiologies of AFI in the region, etiologies of recent epidemics, etiologies that require an immediate public health response and additional pathogens of unknown endemicity. We then designed a study that would delineate background levels of transmission in the community in the absence of symptoms to provide corrected estimates of attribution for the principal determinants of AFI. METHODS: A case-control study of acute febrile illness in patients ten years or older seeking health care in Iquitos, Loreto, Peru, was planned. Upon enrollment, we will obtain blood, saliva, and mid-turbinate nasal swabs at enrollment with a follow-up visit on day 21-28 following enrollment to attain vital status and convalescent saliva and blood samples, as well as a questionnaire including clinical, socio-demographic, occupational, travel, and animal contact information for each participant. Whole blood samples are to be simultaneously tested for 32 pathogens using TaqMan array cards. Mid-turbinate samples will be tested for SARS-CoV-2, Influenza A and Influenza B. Conditional logistic regression models will be fitted treating case/control status as the outcome and with pathogen-specific sample positivity as predictors to attain estimates of attributable pathogen fractions for AFI. DISCUSSION: The modular PCR platforms will allow for reporting of all primary results of respiratory samples within 72 h and blood samples within one week, allowing for results to influence local medical practice and enable timely public health responses. The inclusion of controls will allow for a more accurate estimate of the importance of specific prevalent pathogens as a cause of acute illness. STUDY REGISTRATION: Project 1791, Registro de Proyectos de Investigación en Salud Pública (PRISA), Instituto Nacional de Salud, Perú.

Women's perspectives on the acceptability and feasibility of an HPV screen-and-treat approach to cervical cancer prevention in Iquitos, Peru: a qualitative study.

BACKGROUND: The objective of this study was to explore women's experiences of a screen-and-treat approach with ablative therapy (referred to by the Spanish acronym TVT-TA) as a method of treatment following a positive HPV test in Iquitos, Peru. METHODS: A total of 111 in-depth interviews were conducted with 47 HPV positive women who attended the TVT-TA procedure at a primary-level healthcare facility. Interviews were conducted immediately before, immediately after, and six-weeks after TVT-TA. RESULTS: Most interviewed women reported experiencing moderate pain during ablative therapy and minimal pain immediately after and six weeks after ablative therapy. Women also stated that the pain was less intense than they had expected. The most common physical after-effects of treatment were bleeding and vaginal odor. Women experienced oscillating emotions with fear upon receiving a positive HPV result, calming after hearing about ablative therapy treatment, worry about pain from the treatment itself, relaxation with counseling about the procedure, and relief following treatment. CONCLUSIONS: Nearly all participants emphasized that they were pleased with the TVT-TA process even if they had experienced pain during TVT-TA, recommended that TVT-TA be expanded and available to more women, and stated that TVT-TA was faster and easier than expected. This study found that TVT-TA is a feasible and acceptable means of treating HPV according to the women receiving the treatment.

[Neonatal dengue in Peru: a case report]. / Dengue neonatal en el Perú: Reporte de un caso.

We present the case of a full-term female newborn, whose mother died seven days postpartum from multi-organ failure due to severe dengue confirmed by NS1 antigen detection and positive IgM. The newborn did not have any complication, but at the fourth day of life she developed fever, jaundice, signs of plasma leakage, thrombocytopenia, hepatomegaly, ascitis, and others signs of systemic inflammation response syndrome. She fully recovered with supportive treatment. The RT-PCR test of a peripheral blood sample revealed a positive result for the dengue virus serotype 2, confirming the first case of neonatal dengue reported in Peru.

Dengue neonatal en el Perú: Reporte de un caso / Neonatal dengue in Peru: a case report

Se presenta el caso de un neonato de sexo femenino, a término, producto de madre fallecida al séptimo día de su puerperio, por falla multiorgánica debido a dengue grave confirmado por detección de antígeno NS1 e IgM. La recién nacida (RN) no tuvo complicaciones, pero a partir del cuarto día de vida desarrolló fiebre, ictericia, manifestaciones de extravasación de plasma, hepatomegalia, ascitis, plaquetopenia y otros signos de síndrome de respuesta inflamatoria sistémica. Su evolución final fue favorable con tratamiento instaurado. Se demuestra con PCR en tiempo real, la presencia del virus dengue serotipo 2 en sangre de la RN, confirmándose el primer caso de dengue neonatal reportado en el Perú.

We present the case of a full-term female newborn, whose mother died seven days postpartum from multi-organ failure due to severe dengue confirmed by NS1 antigen detection and positive IgM. The newborn did not have any complication, but at the fourth day of life she developed fever, jaundice, signs of plasma leakage, thrombocytopenia, hepatomegaly, ascitis, and others signs of systemic inflammation response syndrome. She fully recovered with supportive treatment. The RT-PCR test of a peripheral blood sample revealed a positive result for the dengue virus serotype 2, confirming the first case of neonatal dengue reported in Peru.

Plantas medicinales del jardín botánico IMET - IPSS / Medicinal plants from the botanic garden IMET -IPSS

Contiene: La etnobotánica en la amazonía; Comunidades indígenas; Grupos étnicos y plantas medicinales; Curanderos y chamanes en Iquitos; Síndromes culturales; Hierberos y herboristerías en Iquitos; Catálogo de plantas IMET-EsSALUD; Conservación de la biodiversidad; Indice de especies medicinales por nombres vulgares; Indice de especies medicinales por nombre científico; Bibliografía

Toxicidad aguda de 12 especies vegetales de la Amazonía peruana con propiedades medicinales / Acute toxicity of 12 vegetables types from the peruvian Amazonia with medicinals proprierties

Estudio realizado en las plantas de: achiote, ajo sacha, chancapiedra, hierba luisa, llanten, malva, mango, manzanilla, matico, mucura, ojo de pollo y uña de gato

Bixa Orellana L.: un antiinflamatorio milenario / Bixa Orellana L.: an ancient antiinflammatory

Estudio sobre las condiciones antiinflamatorias de la planta del achiote cuyo nombre científico es el de Bixa Orellana

Informe técnico sobre prueba de toxicidad aguda de uncaria guianensis (uña de gato), realizada en el Instituto de Medicina Tradicional del IPSS-Iquitos / Technical report about test of acute toxicity of uncaria guianensis (uña de gato), in the Tradicional Medicine Institute or Peruvian Social Security Institute-Iquitos

El presente estudio nos reporta los resultados obtenidos sobre pruebas de toxicidad aguda de la especie vegetal Uncaria guianensis "Uña de gato" con ratas albinas cepa Holtzmann de ambos sexos, realizadas en el laboratorio de Farmacología del Instituto de Medicina Tradicional del Instituto Peruano de Seguridad Social. En el presente estudio se utilizó ratas albinas de 80 días de edad, de ambos sexos, que fueron divididas para 02 tipos de experimentos; el primer experimento (pruebas de toxicidad agua vía intraperitoneal), tuvo 03 grupos de animales, conformados por 05 animales cada grupo y un grupo control de 02 animales, fueron inoculados con la dosis 8, 6 y 4 gr/kg. de peso; el segundo experimento (Prueba de toxicidad aguda vía oral), tuvo tres grupos de animales, conformados por 05 animales cada grupo y un grupo control de 02 animales, fueron inoculados con la dosis 10, 8 y 6 gr/kg. de peso, inoculándose para ambos experimentos agua destilada en los grupos controles y las evaluaciones post inoculaciones en ambos grupos, fueron durante las 24, 48 y 72 horas. Durante las observaciones post inoculaciones, vía intraperitoneal, se observan muertes del 100 por ciento, en las dosis 8 y 6 gr/kg. y del 60 por ciento en las dosis 4 gr/kg. de peso, dentro de las 72 horas, mientras que por vía oral, no se observan muertes en las dosis 10, 8 y 6 gr/kg. dentro de las 72 horas.

Anemia por deficiencia de hierro en el lactante pequeño: correlación con el tipo de lactancia / Anemia by deficiency of iron in the lactant; correlation with the type of lactation

Estudia 101 lactantes nacidos en el Hospital de San Juan de Marcona (depatamento de Ica-Perú), los que se dividieron en dos grupos: el primero conformado por 50 lactantes alimentados con leche materna y el segundo por 51 alimentados con leche evaporada. Ambos grupos recibieron únicamente leche hasta los 3 meses, y luego la complementaron con alimentos no lacteo. Los dos grupos de lactantes fueron considerados sanos al nacimiento y en los controles a los 3 y 6 meses. En las fechas de control, se les practicó un minucioso examen clínico, que incluyó el pesaje y tallado. Además, se complementó con perfil hematológico que implica determianciones de hemoglobina, hematocrito, hierro sérico, transferrina, saturación de transferrina, volumen globular medio, hemoglobina glovular media y concentración de hemoglobinaa globular media. El control comprendió examen clínico y hematológico. El grupo de lactantes a biberón mostró a los 3 y 6 meses, valores promedios indicativos de deficiencia de hierro: con una media de hierro sérico inferior de 50m.c.g/dl, saturación de transferrina inferior a 16% y tendencia la micrositosis, con manifestaciones de anemia, con hemoglobina promedio inferior a 11g/dl. Los lactantes a pecho mostraron valores promedio de hierro de hemoglobina promedio superior a 11 g/dl. y normalidad en la morfología. El estudio permite afirmar que los lactantes menores de 6 meses que son alimentados con leche evaporada, tienen un rasgo mayor de desarrollar deficiência de hierro y anemia microcítica que los pacientes alimentados con leche materna