Comparison of the biometric characteristics after long term implantation of iris-fixated phakic intraocular lens in explanted and non-explanted groups of eyes.

PURPOSE: To evaluate and compare the biometric characteristics of the anterior chamber of a group of patients with significant endothelial cell loss (ECL) that required phakic IOL (pIOL) explantation and a group of patients who did not fulfill the explantation criteria related to corneal decompensation. DESIGN: Retrospective consecutive interventional case series METHODS: The study included all consecutive patients implanted with pIOL at Oftalmosalud Instituto de Ojos, Lima, Peru, between 2001 and 2012. The explanted group (E-group) consisted of eyes in which the pIOLs were explanted due to ECL and the non-explanted group (NE-group) consisted of eyes randomly selected in which the pIOL was not explanted with a minimum follow-up time of eight years. Slit-lamp biomicroscopy, visual acuity, refraction, endothelial cells count, and anterior segment OCT were assessed at the preoperative evaluation for both groups and before explantation in the E-group and eight years post implantation in the NE-group. RESULTS: 265 eyes were implanted with pIOL. The annual percentage of ECL was 1.47% and 5.55% in the NE-group and the E-group, respectively (p < .001). The mean minimum endothelial lens distance (min-ELD) was 1.44 ± 0.22 mm and 1.05 ± 0.23 mm in the NE-group and the E-group, respectively (p < 0.001). The mean time for explantation was 12.58 ± 3.79 years for the NE-group. Annual ECL could accurately discriminate between NE-group and E-group, a cutoff point of 3.5 (%/year) or 86.5 (cells/years) had a 100% sensitivity and specificity. A cutoff of 1.21 mm in the min-ELD, has a 91% sensitivity and 79% specificity to discriminate between E-group and NE-group. CONCLUSION: pIOL explantation due to ECL occurs in eyes with a significantly postoperative lower min-ELD. Annual ECL and min-ELC can effectively discriminate between explanted and non-explanted groups.

Repeatability of Corneal Deformation Response Parameters by Dynamic Ultra High-speed Scheimpflug Imaging in Normal and Keratoconus Eyes.

PURPOSE: To assess the repeatability of corneal dynamic response (CDR) parameters in normal and keratoconus (KC) eyes using ultra high-speed Scheimpflug imaging. METHODS: Prospective, comparative, observational study, including eyes of 112 patients that underwent high-speed Scheimpflug imaging analysis (Corvis ST, OCULUS). Twenty-one CDR parameters were evaluated to asses repeatability using: coefficient of repeatability (CR), coefficient of variation, intraclass correlation coefficient (ICC) and within-subject SD. Three consecutive measurements by the same operator were performed for each eye. RESULTS: There were no significant differences between the three consecutive measurements for all parameters in both normal and KC eyes. 71.42% (15 of the 21 parameters evaluated) and 85.71% (18 of the 21 parameters) were highly repeatable in the normal and KC group, respectively. The tomographic biomechanical index (TBI), corneal biomechanical index (CBI), and stiffness parameter (SPA1) showed an ICC of 0.978, 0.954, and 0.958 in normal and 0.982, 0.892, and 0.978 in KC eyes, respectively. The CR in normal eyes for TBI, CBI, and SPA1 were 0.169, 0.242, and 14.12, respectively, and for KC eyes 0.06, 0.23, and 13.64, respectively. CONCLUSIONS: Most of the corneal dynamic response parameters were highly repeatable in normal and KC eyes.

[Methodology for estimating total direct costs of comprehensive care for non-communicable diseases]. / Metodología para la estimación de costos directos de la atención integral para enfermedades no trasmisibles.

RESUMEN Diseases like diabetes mellitus (DM) and hypertension (HT) generate high costs and are the most common cause of mortality in the Americas. In the case of Peru, given demographic and epidemiological changes, particularly the alarming increase in overweight and obesity, the burden of these diseases is constantly increasing, resulting in the need to budget more financial resources to the health services. The total care costs of these diseases and their complications represent a financial burden that should be considered very carefully by health institutions when they draft their budgets. With this aim, the Pan American Health Organization has assisted the Ministry of Health (MINSA) with a study to estimate these costs. This article graphically describes the methodology developed to estimate the direct costs of comprehensive care for DM and HT to the health services of MINSA and regional governments.

Metodología para la estimación de costos directos de la atención integral para enfermedades no trasmisibles / Methodology for estimating total direct costs of comprehensive care for non-communicable diseases

RESUMEN Enfermedades como la diabetes mellitus (DM) y la hipertensión arterial (HTA) generan altos costos y son la causa más frecuente de mortalidad en la región de las Américas. En el caso del Perú, dados los cambios demográficos y epidemiológicos, y particularmente el aumento alarmante del sobrepeso y la obesidad, la carga de estas enfermedades tiene un crecimiento constante que implica la necesidad de asignar cada vez más recursos financieros a los servicios de salud. Los costos de la atención integral de estas enfermedades y sus complicaciones representan una carga económica que debe ser considerada por las instituciones de salud al elaborar su presupuesto. Con ese propósito, la Organización Panamericana de la Salud (OPS) ha apoyado al Ministerio de Salud (MINSA) con la realización de un estudio para la estimación de estos costos. En el presente artículo se describe esquemáticamente la metodología desarrollada para la estimación de los costos directos en la atención integral de la DM e HTA en los servicios de salud del MINSA y gobiernos regionales.

RESUMEN Diseases like diabetes mellitus (DM) and hypertension (HT) generate high costs and are the most common cause of mortality in the Americas. In the case of Peru, given demographic and epidemiological changes, particularly the alarming increase in overweight and obesity, the burden of these diseases is constantly increasing, resulting in the need to budget more financial resources to the health services. The total care costs of these diseases and their complications represent a financial burden that should be considered very carefully by health institutions when they draft their budgets. With this aim, the Pan American Health Organization has assisted the Ministry of Health (MINSA) with a study to estimate these costs. This article graphically describes the methodology developed to estimate the direct costs of comprehensive care for DM and HT to the health services of MINSA and regional governments.

Relationship of regulatory T cells to Plasmodium falciparum malaria symptomatology in a hypoendemic region.

BACKGROUND: Previous data have suggested that regulatory T cells (Tregs) balance protective immune responses with immune mediated pathology in malaria. This study aimed to determine to test the hypothesis that Treg proportions or absolute levels are associated with parasitaemia and malaria symptoms. METHODS: Treg cells were quantified by flow cytometry as CD4+ CD25+, Foxp3+, CD127(low) T cells. Three patient groups were assessed: patients with symptomatic Plasmodium falciparum malaria (S), subjects with asymptomatic P. falciparum parasitaemia (AS) and uninfected control individuals (C). RESULTS: S, AS and C groups had similar absolute numbers and percentage of Tregs (3.9%, 3.5% and 3.5% respectively). Levels of parasitaemia were not associated with Treg percentage (p = 0.47). CONCLUSION: Neither relative nor absolute regulatory T cell numbers were found to be associated with malaria-related symptomatology in this study. Immune mechanisms other than Tregs are likely to be responsible for the state of asymptomatic P. falciparum parasitaemia in the Peruvian Amazon; but further study to explore these mechanisms is needed.

Modelado del efecto de la variabilidad climática local sobre la transmisión de dengue en Medellín (Colombia) mediante análisis de series temporales / Modelling the effect of local climatic variability on dengue transmission in Medellin (Colombia) by means temporary series analysis

ntroducción. El dengue es una enfermedad de transmisión vectorial de gran impacto en la salud pública. La transmisión del dengue es afectada por factores entomológicos, socioculturales y económicos. Además, la variabilidad climática juega un importante papel en la dinámica de transmisión. Un amplio consenso científico ha indicado que la fuerte asociación entre la enfermedad y las variables climáticas podría ser empleada para desarrollar modelos que expliquen la incidencia de la enfermedad. Objetivo. Desarrollar un modelo que permita comprender la dinámica de transmisión del dengue en Medellín y predecir incrementos en la incidencia de la enfermedad. Materiales y métodos. Se empleó la incidencia de dengue como variable dependiente y como variables independientes, los factores climáticos (temperatura máxima, media y mínima, humedad relativa y precipitación) registrados a escala semanal. Se utilizó el programa Expert Modeler para desarrollar un modelo que explique mejor el comportamiento de la enfermedad. Mediante modelos ARIMA, se seleccionaron las variables climáticas que tuvieron una relación significativa con la variable dependiente. Resultados. El 34 % de la variabilidad observada se explicó por el modelo. La precipitación fue la variable climática que mostró una asociación estadísticamente significativa con la incidencia del dengue, pero con un rezago de 20 semanas. Conclusiones. La transmisión del dengue en Medellín se vio afectada por la variabilidad climática, en particular, por la precipitación. La fuerte asociación entre el dengue y la precipitación permitió construir un modelo que ayuda a comprender la dinámica de transmisión, información que será de gran utilidad para el desarrollo de adecuadas y oportunas estrategias de control.

Introduction: Dengue fever is a major impact on public health vector-borne disease, and its transmission is influenced by entomological, sociocultural and economic factors. Additionally, climate variability plays an important role in the transmission dynamics. A large scientific consensus has indicated that the strong association between climatic variables and disease could be used to develop models to explain the incidence of the disease. Objective: To develop a model that provides a better understanding of dengue transmission dynamics in Medellin and predicts increases in the incidence of the disease. Materials and methods: The incidence of dengue fever was used as dependent variable, and weekly climatic factors (maximum, mean and minimum temperature, relative humidity and precipitation) as independent variables. Expert Modeler was used to develop a model to better explain the behavior of the disease. Climatic variables with significant association to the dependent variable were selected through ARIMA models. Results: The model explains 34% of observed variability. Precipitation was the climatic variable showing statistically significant association with the incidence of dengue fever, but with a 20 weeks delay. Conclusions: In Medellin, the transmission of dengue fever was influenced by climate variability, especially precipitation. The strong association dengue fever/precipitation allowed the construction of a model to help understand dengue transmission dynamics. This information will be useful to develop appropriate and timely strategies for dengue control.

[Modelling the effect of local climatic variability on dengue transmission in Medellin (Colombia) by means of time series analysis]. / Modelado del efecto de la variabilidad climática local sobre la transmisión de dengue en Medellín (Colombia) mediante análisis de series temporales.

INTRODUCTION: Dengue fever is a major impact on public health vector-borne disease, and its transmission is influenced by entomological, sociocultural and economic factors. Additionally, climate variability plays an important role in the transmission dynamics. A large scientific consensus has indicated that the strong association between climatic variables and disease could be used to develop models to explain the incidence of the disease. OBJECTIVE: To develop a model that provides a better understanding of dengue transmission dynamics in Medellin and predicts increases in the incidence of the disease. MATERIALS AND METHODS: The incidence of dengue fever was used as dependent variable, and weekly climatic factors (maximum, mean and minimum temperature, relative humidity and precipitation) as independent variables. Expert Modeler was used to develop a model to better explain the behavior of the disease. Climatic variables with significant association to the dependent variable were selected through ARIMA models. RESULTS: The model explains 34% of observed variability. Precipitation was the climatic variable showing statistically significant association with the incidence of dengue fever, but with a 20 weeks delay. CONCLUSIONS: In Medellin, the transmission of dengue fever was influenced by climate variability, especially precipitation. The strong association dengue fever/precipitation allowed the construction of a model to help understand dengue transmission dynamics. This information will be useful to develop appropriate and timely strategies for dengue control.

Respuesta inmune en pacientes con bartonelosis humana en un área endémica de Perú / Immune response in patients with human Bartonella infection in an endemic area of Peru

Se llevó a cabo un estudio piloto en una zona de bartonelosis endémica humana en el Perú, con la captación de pacientes en fase aguda y crónica para el mejor conocimiento de su respuesta inmunitaria.

Cytokines and T-Lymphocute count in patients in the acute and chronic phases of Bartonella bacilliformis infection in an endemic area in peru: a pilot study.

Human Bartonellosis has an acute phase characterized by fever and hemolytic anemia, and a chronic phase with bacillary angiomatosis-like lesions. This cross-sectional pilot study evaluated the immunology patterns using pre- and post-treatment samples in patients with Human Bartonellosis. Patients between five and 60 years of age, from endemic areas in Peru, in the acute or chronic phases were included. In patients in the acute phase of Bartonellosis a state of immune peripheral tolerance should be established for persistence of the infection. Our findings were that elevation of the anti-inflammatory cytokine IL-10 and numeric abnormalities of CD4(+) and CD8(+) T-Lymphocyte counts correlated significantly with an unfavorable immune state. During the chronic phase, the elevated levels of IFN-γ and IL-4 observed in our series correlated with previous findings of endothelial invasion of B. henselae in animal models.

Cytokines and T-Lymphocute count in patients in the acute and chronic phases of Bartonella bacilliformis infection in an endemic area in peru: a pilot study / Citoquinas y recuento de Linfocitos T en pacientes en fase aguda y crónica de infección por Bartonella bacilliformis, en una área endémica del Perú: estudio piloto

Human Bartonellosis has an acute phase characterized by fever and hemolytic anemia, and a chronic phase with bacillary angiomatosis-like lesions. This cross-sectional pilot study evaluated the immunology patterns using pre- and post-treatment samples in patients with Human Bartonellosis. Patients between five and 60 years of age, from endemic areas in Peru, in the acute or chronic phases were included. In patients in the acute phase of Bartonellosis a state of immune peripheral tolerance should be established for persistence of the infection. Our findings were that elevation of the anti-inflammatory cytokine IL-10 and numeric abnormalities of CD4+ and CD8+ T-Lymphocyte counts correlated significantly with an unfavorable immune state. During the chronic phase, the elevated levels of IFN-γ and IL-4 observed in our series correlated with previous findings of endothelial invasion of B. henselae in animal models.

La Bartonelosis Humana, tiene una fase aguda caracterizada por fiebre y anemia hemolítica, así como una fase crónica con lesiones semejantes a angiomatosis bacilar. En un estudio transversal piloto los patrones inmunológicos en pacientes con Bartonelosis Humana fueron estudiados mediante muestras pre y post tratamiento. Pacientes entre 5 y 60 años en fase aguda y crónica fueron incluidos en área endémica del Perú. En aquellos pacientes con fase aguda, una fase de tolerancia inmunológica periférica es necesaria para la persistencia de la infección. Los hallazgos de significativa elevación de citoquina anti-inflamatoria (IL-10) y anormalidades numéricas en el recuentos de Linfocitos T CD4+ y CD8+ correlacionan con un estado inmune que favorece la infección. Durante la fase crónica, elevados niveles de INF-γ y IL-4 observados en la serie de pacientes correlacionan con previos hallazgos en modelos animales que favorecen la invasión del endotelio por B. henselae.

Novel hypertonic saline-sodium hydroxide (HS-SH) method for decontamination and concentration of sputum samples for Mycobacterium tuberculosis microscopy and culture.

This study evaluated a new decontamination and concentration (DC) method for sputum microscopy and culture. Sputum samples from patients with suspected pulmonary tuberculosis (TB) (n=106) were tested using the proposed hypertonic saline-sodium hydroxide (HS-SH) DC method, the recommended N-acetyl-L-cysteine-sodium citrate-sodium hydroxide (NALC-NaOH) DC method and unconcentrated direct smear (Ziehl-Neelsen) techniques for the presence of mycobacteria using Löwenstein-Jensen culture and light microscopy. Of 94 valid specimens, 21 (22.3%) were positive in culture and were further characterized as Mycobacterium tuberculosis. The sensitivity for acid-fast bacilli (AFB) smears was increased from 28.6% using the direct method to 71.4% (HS-SH) and 66.7% (NALC-NaOH) using DC methods. Both concentration techniques were highly comparable for culture (kappa=0.794) and smear (kappa=0.631) for AFB. Thus the proposed HS-SH DC method improved the sensitivity of AFB microscopy compared with a routine unconcentrated direct smear; its performance was comparable to that of the NALC-NaOH DC method for AFB smears and culture, but it was methodologically simpler and less expensive, making it a promising candidate for evaluation by national TB control programmes in developing countries.

Evaluation of rifampicin and isoniazid susceptibility testing of Mycobacterium tuberculosis by a mycobacteriophage D29-based assay.

Conventional methods for determining drug susceptibility of Mycobacterium tuberculosis require several weeks to obtain results, limiting their usefulness; automated methods and those based on molecular biology techniques have been able to reduce the turnaround time, but their high cost and need for sophisticated equipment restrict their use in developing countries. The goal of the present study was to evaluate the diagnostic accuracy of a rapid (3-4 days) low-cost test based on the use of mycobacteriophage D29 to determine the susceptibility of strains of M. tuberculosis to rifampicin (RIF) and isoniazid (INH). Results obtained show that susceptibility testing for RIF has a high diagnostic accuracy as compared to the standard indirect proportion method on Löwenstein-Jensen medium (sensitivity 100% and specificity 98%). Given the association between the resistance to RIF and INH, which define multidrug resistance (MDR), this test seems suitable for rapid detection of MDR tuberculosis strains (kappa=0.978). Susceptibility testing for INH using mycobacteriophage D29 had a good but lower diagnostic accuracy as compared to the standard method (sensitivity 80.4% and specificity 80.8%); the test would then be of limited usefulness in the management of tuberculosis patients. Further studies to determine the relationship of mycobacteriophage D29 tests to in vivo correlates of sensitivity to specific antituberculosis drugs are warranted.

Multicenter evaluation of the nitrate reductase assay for drug resistance detection of Mycobacterium tuberculosis.

The performance of the nitrate reductase assay was evaluated in a multicenter laboratory study to detect resistance of Mycobacterium tuberculosis to the first-line anti-tuberculosis drugs rifampicin, isoniazid, ethambutol and streptomycin using a set of coded isolates. Compared with the gold standard proportion method on Löwenstein-Jensen medium, the assay was highly accurate in detecting resistance to rifampicin, isoniazid and ethambutol with an accuracy of 98%, 96.6% and 97.9%, respectively. For streptomycin, discrepant results were obtained with an overall accuracy of 85.3%. The assay proved easy to be implemented in countries with limited laboratory facilities.

Evaluación de la actividad antibacteriana in vitro de los extractos de Caesalpinia spinosa tara y Eucalyptus sp. eucalipto / Evaluation of the antibacterial activity in vitro of the extracts of Caesalpinia spinosa tare and Eucalyptus sp. eucalyptus

Se evalúo in vitro la actividad antibacteriana de extractos de Caesalpinia spinosa "tara" y Eucalyptus sp. "eucalipto" utilizando cepas bacterianas Gram positivas (Staphylococcus aureus y Bacillus subtilis) y Gram negativas (Escherichia coli, Klebsiella sp. y Shigella flezneri). Se utilizó como solvente de extracción una mezcla de alcohol-acetona (1:1) y la actividad biológica de los extractos obtenidos se evaluó mediante la técnica de difusión en disco. La cáscara del fruto de Caesalpini spinosa y las hojas del Eucalyptus sp. mostraron una actividad selectiva sobre las bacterias Gram positivas evaluadas.

The antibacterian activity of extract of Caesalpinia spinosa and Eucalyptus sp. "eucalipto" was valued using bacterials capes gram positives (Staphylococcus aureus and Bacyllus subtilis) and gram negatives (Escherichia coli, Klebsiella sp, Shigella flexneri). For the investigation was used as extraction solvent a mixture of aIcohol-acetona (1:1), the biological activity of the obtained extracts was valued using the disc diffusion technique. The fruit peel of Caesalpinia spinosa and the leaves of Eucalyptus sp show a selective activity over the valued grampositives bacteriums.