Evidence-based indications for ivermectin in parasitic diseases: An integrated approach to context and challenges in Peru.

Ivermectin has emerged as a therapeutic option for various parasitic diseases, including strongyloidiasis, scabies, lice infestations, gnathostomiasis, and myiasis. This study comprehensively reviews the evidence-based indications for ivermectin in treating parasitic diseases, considering the unique context and challenges in Peru. Fourteen studies were selected from a systematic search of scientific evidence on ivermectin in PubMed, from 2010 to July 2022. The optimal dosage of ivermectin for treating onchocerciasis, strongyloidiasis, and enterobiasis ranges from 150 to 200 µg/kg, while lymphatic filariasis requires a higher dose of 400 µg/kg (Brown et al., 2000). However, increased dosages have been associated with a higher incidence of ocular adverse events. Scientific evidence shows that ivermectin can be safely and effectively administered to children weighing less than 15 kg. Systematic reviews and meta-analyses provide strong support for the efficacy and safety of ivermectin in combating parasitic infections. Ivermectin has proven to be an effective treatment for various parasitic diseases, including intestinal parasites, ectoparasites, filariasis, and onchocerciasis. Dosages ranging from 200 µg/kg to 400 µg/kg are generally safe, with adjustments made according to the specific pathology, patient age, and weight/height. Given Peru's prevailing social and environmental conditions, the high burden of intestinal parasites and ectoparasites in the country underscores the importance of ivermectin in addressing these health challenges.

Características clínico-epidemiológicas de COVID-19 en pacientes de la comunidad y del Hospital Regional Lambayeque, Perú

Introducción: Desde el inicio del brote de COVID-19 se han descrito diferencias entre las características clínicas, la evolución y el pronóstico de los pacientes de distintas localidades del Perú y del mundo. Objetivo: Determinar las características clínicas y epidemiológicas de la COVID-19 en pacientes de la comunidad y del Hospital Regional Lambayeque. Métodos: Se realizó un estudio de enfoque cuantitativo, nivel relacional y diseño observacional con datos secundarios. Se empleó la técnica de la documentación, se verificaron los datos recolectados en la ficha estandarizada de investigación clínica epidemiológica de COVID-19 del Ministerio de Salud del Perú. Resultados: De 4 463 pacientes analizados en el 36,4 % se detectó la presencia de SARS-CoV-2 y de éstos la mediana de edad fue de 40 años, siendo el sexo femenino el más frecuente (53,4 %). Del total de participantes, 23,7 % no registraron síntomas, sin embargo, los pacientes que declararon tos, dolor de garganta, malestar, fiebre/escalofrío, disnea, anosmia, ageusia y exudado faríngeo tenían más probabilidades de resultar infectados. De los positivos a la COVID-19, 40,2 % presentaban alguna comorbilidad. Las ocupaciones de policía/militar, ama de casa, estudiante y obrero de construcción civil tenían más probabilidades de dar positivo, mientras que, el personal sanitario tuvo 33 % menos probabilidad de infección. Conclusiones: Casi cuatro de cada 10 participantes tuvieron infección por SARS-CoV-2, existió predominio en los varones y personas en edad económicamente activa. La cuarta parte fueron asintomáticos. La tos, dolor de garganta, malestar y fiebre fueron los síntomas más frecuentes; menos frecuentes fueron la dificultad respiratoria, la anosmia, ageusia y exudado faríngeo, pero representaron mayor probabilidad de infección. Casi dos de cada 10 pacientes presentaron comorbilidad como problemas cardiovasculares, diabetes, asma y obesidad. En cuanto a las ocupaciones, el personal sanitario, policial y ama de casa fueron los grupos más afectados.

Introduction: Since the beginning of the outbreak, differences have been described between the clinical characteristics, evolution and prognosis of patients from different locations in Peru and the world. Objective: To determine the clinical and epidemiological characteristics of COVID-19 in patients from the community and the Lambayeque Regional Hospital. Methods: A study of quantitative approach, relational level and observational design with secondary data was carried out. The documentation technique was used, the data collected in the standardized COVID-19 clinical epidemiological investigation form of the Ministry of Health of Peru was verified. Results: Of 4,463 patients analyzed, 36.4 % had the presence of SARS-CoV-2, and of these the average age was 40 years, with the female sex being the most frequent (53.4 %). Of the total participants, 23.7 % had no symptoms, however, patients who reported cough, sore throat, malaise, fever/chills, dyspnea, anosmia, ageusia, and pharyngeal exudate were more likely to be infected with SARS- CoV-2. Of the positive patients for COVID-19, 40.2 % had some comorbidity. Likewise, the occupations of police/military, housewife, student and civil construction worker were more likely to test positive for COVID-19, while health personnel had a 33 % lower probability of SARS-CoV-2 infection. Conclusions: It is concluded that almost four out of 10 participants had SARS-CoV-2 infection, of which there was a predominance in men and people of economically active age. A quarter were asymptomatic. Cough, sore throat, malaise, and fever were the most frequent symptoms; likewise, respiratory distress, anosmia, ageusia, and pharyngeal exudate were less frequent, but represented a higher probability of infection. Almost two out of 10 patients had comorbidities such as cardiovascular problems, diabetes, asthma, and obesity. Regarding occupations, health personnel, police and housewives were the most affected groups.

Toxoplasma gondii Infection and Threatened Abortion in Women from Northern Peru.

Introduction: Toxoplasma gondii infection can cause important complications during pregnancy. Threatened abortion may be a late indicator for infection in settings with high prevalence of toxoplasmosis. We aimed to determine the association between T. gondii infection and threatened abortion in women from northern Peru. Methods: We conducted a secondary analysis of a cross-sectional study in pregnant women from a hospital and a rural community in Lambayeque, Peru. Exposure variable was serological diagnosis of toxoplasmosis, defined as the demonstration of either IgM or IgG antibodies against T. gondii. Outcome variable was threatened abortion, defined as the diagnosis of bloody vaginal discharge or bleeding during the first half of pregnancy. Prevalence ratios were estimated in simple and multiple regression analyses. Results: Of 218 pregnant women, 35.8% presented positive serology for T. gondii and 14.7% had threatened abortion in their current pregnancy. Pregnant women with positive T. gondii infection had 2.45-fold higher frequency of threatened abortion (PR: 2.45, 95% CI: 1.15-5.21). In addition, the frequency of threatened abortion decreased by 9% for each additional year of age (PR: 0.91, 95% CI: 0.86-0.97). A previous history of threatened abortion also showed a higher frequency of threatened abortion (PR: 5.22, 95% CI: 2.45-11.12). Conclusions: T. gondii infection is associated with threatened abortion. An early age of pregnancy and a previous history of abortion are also associated with this condition.

Viruela del simio: Preocupación por una zoonosis emergente / Monkeypox: Concern about an emerging zoonosis

Introducción: La viruela del simio es una enfermedad zoonótica viral, causada por el poxvirus del mismo nombre; endémica de África central y occidental. Sin embargo, su presencia se ha incrementado en otras regiones del mundo durante la última década en comparación con los 40 años anteriores. Objetivo. Describir y actualizar las características etiológicas, epidemiológicas y clínicas de la viruela del simio, así como discutir el potencial riesgo de diseminación internacional. Material y Métodos. Se realizó una revisión de literatura publicada en los últimos cinco años, utilizando los descriptores Medical Subject Headings. La búsqueda se hizo en las bases de datos MEDLINE / PubMed y LILACS, sin restricciones de idioma. Se excluyeron los estudios duplicados y aquellos que no se ajustaban al objetivo de la investigación, seleccionando 47 artículos. Resultados. El virus de la viruela del simio está emparentado con el de la viruela humana (erradicada en 1979). Se transmite desde un individuo enfermo mediante gotitas de fluido respiratorio, contacto con material de lesión cutánea y fluidos corporales; o mediante fómites contaminados. Después de 6 a 13 días de incubación aparecen los síntomas, semejantes al de la viruela humana: comenzando con un proceso febril agudo y seguido de erupción cutánea en rostro y cuerpo, que cura dejando cicatrices visibles. Conclusiones. Este virus puede ocupar el nicho ecológico dejado por el virus de la viruela humana. Actualmente se ha expandido a Europa y América, por lo que ya no debe considerarse una enfermedad limitada al África, sino una amenaza sanitaria para la salud pública global.

background:Monkeypox is a viral zoonotic disease caused by the poxvirus of the same name, endemic to central and western Africa. However, its presence has increased in other regions of the world during the last decade compared to the previous 40 years.To describe and update the etiologic, Objective.epidemiologic, and clinical features of simian pox, as well as to discuss the potential risk of international spread. . Areview of Material and Methods literature published in the last five years was performed using the descriptors Medical Subject Headings. The search was performed in the MEDLINE/PubMed and LILACS data bases, without language restrictions. Duplicate studies and those that did not fit the research objective were excluded, selecting 47 articles. Results.Simian smallpox virus is related to human smallpox virus (eradicated in 1979). It is transmitted from a sick individual by respiratory fluid droplets, contact with skin lesion material and body fluids; or by contaminated fomites. After 6 to 13 days of incubation, symptoms appear, similar to those of human smallpox: beginning with an acute febrile process and followed by a cutaneous eruption on the face and body, which heals leaving visible scars. This virus may occupy the Conclusions.ecological niche left by the smallpox virus. It has now spread to Europe and America, so it should no longer be considered a disease limited to Africa, but a health threat to global public health

Perfil microbiológico de microorganismos aislados de pacientes en Unidades de Cuidados Intensivos de un hospital de Lambayeque, Perú, 2019-2020 / Microbiological profile of isolated microorganisms from patients in intensive care units of a Hospital in Lambayeque, Peru, 2019-2020

Objetivo: Describir el perfil microbiológico de los microorganismos aislados de pacientes de las unidades de cuidados críticos de un hospital de la región Lambayeque en el 2019 ­ 2020. Materiales y métodos: Estudio descriptivo, retrospectivo, transversal y de enfoque cuantitativo. Se realizó un estudio censal a 332 pacientes de las unidades de cuidados críticos con cultivo microbiológico positivo registrado en el archivo del laboratorio de microbiología del Hospital Regional Lambayeque en el 2019 - 2020. Se utilizó el software estadístico Info stat v8 para el análisis estadístico. Resultados: La mediana de edad fue de 50 años a predominio de sexo masculino (55,1%). La muestra de cultivo más frecuente fue la secreción bronquial (35,8%). Los microorganismos que se aislaron con mayor frecuencia fueron A. baumannii complex (27,7%) resistente a meropenem e imipenem con 90,7% y 89,3% respectivamente, P. aeruginosa (13,9%) resistente a cefepime con 55,8% y 61,1% para Piperacilina / tazobactam, E. coli (11,1%) resistente a ampicilina con 94,7%; y K. pneumoniae (9,9%) resistente a ampicilina/sulbactam en un 79,2%. Conclusión: Los microorganismos más frecuentes aislados de la población de estudio, fueron A. baumannii complex, P. aeruginosa, E. coli y K. pneumoniae; aislados mayoritariamente de secreciones respiratorias, de los cuales, los dos primeros presentaron alta resistencia a carbapenémicos y aminoglucósidos, y en los dos siguientes, la mitad fueron BLEE.

Objective: To describe the microbiological profile of microorganisms isolated from patients in critical care units of a hospital in the Lambayeque region in 2019-2020. Materials and methods: Descriptive, retrospective, cross-sectional study with a quantitative approach. A census study was carried out on 332 patients from critical care units with a positive microbiological culture registered in the file of the microbiology laboratory of the Lambayeque Regional Hospital in 2019-2020. The statistical software Info stat v8 was used for statistical analysis. Results: The median age was 50 years, predominantly male (55.1%). The most frequent culture sample was bronchial secretion (35.8%). The most frequently isolated microorganisms were A. baumannii complex (27.7%) resistant to meropenem and imipenem with 90.7% and 89.3% respectively, P. aeruginosa (13.9%) resistant to cefepime with 55.8% and 61.1% for Piperacillin / tazobactam, E. coli (11.1%) resistant to ampicillin with 94.7%; and K. pneumoniae (9.9%) resistant to ampicillin / sulbactam by 79.2%. Conclusion: The most frequent microorganisms isolated from the study population were the A. baumannii complex, P. aeruginosa, E. coli and K. pneumoniae; isolated mainly from respiratory secretions, of which the first two showed high resistance to carbapenems and aminoglycosides, and in the next two, half were ESBL.

Diversidad genómica en SARS-CoV-2: Mutaciones y variantes / Genomic diversity in SARS-CoV-2: Mutations and variants

Introducción: La variabilidad genética del SARS-CoV-2 ha incrementado notablemente desde que se declaró la pandemia, lo que le ha permitido representar un continuo desafió para las políticas de salud destinadas a su control. Objetivo. Describir la nomenclatura genómica utilizada para la comunicación general y científica sobre el SARS-CoV-2, así como describir las mutaciones, evolución, origen y variantes del virus. Material y Metodos. Se realizó una revisión narrativa de literatura, para el cual se realizó una búsqueda y análisis de la información hasta el 15 de diciembre de 2021. Se revisaron 74 fuentes seleccionados desde las bases de datos MEDLINE/ PubMed, SciELO, LILACS y páginas web oficiales; sin restricciones de idioma. Resultados. Las mutaciones son cambios en la secuencia de nucleótidos del genoma viral, que, al producir afectación de la dinámica epidemiológica en una población, dan lugar a variantes, y estos a su vez a clados diferenciados. Entre las variantes de interés destacan Lambda y Mu, identificadas por primera vez en Perú y Colombia, respectivamente. Mientras que, las variantes de preocupación, en orden cronológico, son la Alfa (británica), Beta (sudafricana), Gamma (brasilera), Delta (india) y recientemente Ómicron. Conclusiones. Se concluye que la diversidad genómica del SARS-CoV-2 se debe a su elevada tasa de mutaciones que pueden constituirse en variantes y clados. La mejor comprensión de esta diversidad permite tomar medidas de control más eficaces, guiando el desarrollo y uso de vacunas, terapias, diagnóstico y políticas en salud.

Introduction: The genetic variability of SARS-CoV-2 has increased markedly since the pandemic was declared, allowing it to pose a continuing challenge to health policies aimed at its control. Objective. To describe the genomic nomenclature used for general and scientific communication about SARS-CoV-2, as well as to describe the mutations, evolution, origin and variants of the virus. Material and Methods. A narrative literature review was conducted, for which a search and analysis of the information was performed until December 15, 2021. Seventy-four selected sources were reviewed from MEDLINE/PubMed, SciELO, LILACS databases and official web pages; without language restrictions. Results. Mutations are changes in the nucleotide sequence of the viral genome, which, by affecting the epidemiological dynamics in a population, give rise to variants, and these in turn to differentiated clades. Among the variants of interest are Lambda and Mu, identified for the first time in Peru and Colombia, respectively. Meanwhile, the variants of concern, in chronological order, are Alpha (British), Beta (South African), Gamma (Brazilian), Delta (Indian) and recently Omicron. Conclusions. It is concluded that the genomic diversity of SARS-CoV-2 is due to its high rate of mutations that can constitute variants and clades. A better understanding of this diversity allows more effective control measures to be taken, guiding the development and use of vaccines, therapies, diagnostics and health policies.

Uso de la imagen radiológica y serología por Western Blot para el diagnóstico de la neurocisticercosis en un hospital del norte del Perú / Use of radiological imaging and serology by Western Blot for the diagnosis of neurocysticercosis in a hospital in northern Peru

Introducción: La neurocisticercosis (NCC) es una zoonosis parasitaria del sistema nervioso central causada por el céstodo Taenia solium, y que afecta a países en desarrollo y con escaso saneamiento básico. Objetivo: Describir el uso y la concordancia de la imagen radiológica por tomografía (TAC) o resonancia magnética (RM) y serología por western Blot (WB) en el diagnóstico de la NCC en un hospital del norte del Perú. Material y Métodos: Estudio observacional retrospectivo. La historia clínica fue la unidad de análisis. Los casos se buscaron en la oficina de Epidemiología mediante el CIE-10- B69 y registro del Laboratorio de Parasitología, Metaxénicas y Zoonosis del mismo hospital, en el periodo del año 2015 al 2017. Resultados: Se estudiaron 67 historias clínicas, que cumplían con los criterios diagnósticos absolutos de NCC. Los pacientes fueron varones en el 55,2 % y tuvieron una media de edad de 40,2 (±17,8) años. El 35,9% tuvieron un resultado positivo por WB (19/39), las lesiones quísticas con escólex fueron observada en el 25,4% de las TAC y en el 29,6 de las RM. La concordancia observada entre la prueba serológica con TAC y RM fue escasa, siendo (Kappa=0,073, IC95%: 0,053 ­ 1,084) y (Kappa=0,112, IC95%: 0,092 ­ 1,092) y un porcentaje de acuerdo de 42,0% y 45,7% respectivamente. Conclusiones: Se observó uso diferenciado y escasa concordancia entre la prueba serológica por WB e imagen radiológica en pacientes con diagnóstico de neurocisticercosis en la población estudiada.

Background: Neurocysticercosis (NCC) is a parasitic zoonosis of the central nervous system caused by the tapeworm Taenia solium, which affects developing countries with poor basic sanitation. Objective: To describe the use and concordance of radiological tomography (CT) or magnetic resonance imaging (MRI) and western blot (WB) serology in the diagnosis of NCC in a hospital in northern Peru. Material and Methods: Retrospective observational study. The medical history was the unit of analysis. The cases were searched in the Epidemiology office using the ICD-10-B69 and registry of the Laboratory of Parasitology, Metaxenics and Zoonoses of the same hospital, in the period from 2015 to 2017. Results: 67 medicales records were studied, which complied with the absolute diagnostic criteria for NCC. The patients were men in 55.2% and had a mean age of 40.2 (± 17.8) years. 35.9% had a positive result by WB (19/39), cystic lesions with scolex were observed in 25.4% of the CTand in 29.6 of the MRI. The concordance observed between the serological test with CTand MRI was poor, with (Kappa = 0.073, 95% CI: 0.053 - 1.084) and (Kappa = 0.112, 95% CI: 0.092 - 1.092) and a percentage of agreement of 42.0% and 45.7% respectively. Conclusions: Differentiated use and poor concordance between the WB serological test and radiological imaging are performed in patients with a diagnosis of neurocysticercosis in the studied population.

Infección por Toxoplasma gondii y factores asociados en donantes de sangre de un hospital de la selva peruana / Toxoplasma gondii infection and associated factors in blood donors from hospital II-2 Tarapoto, Peru, July to December 2019

Introducción: La toxoplasmosis es una infección parasitaria de distribución mundial causada por Toxoplasma gondii transmisible mediante transfusiones sanguíneas. Objetivo: Determinar la frecuencia y los factores asociados de la infección por T. gondii en donantes de sangre del Hospital II-2 Tarapoto, Perú, julio a diciembre del 2019. Métodos: Estudio transversal analítico realizado en una muestra de 92 donantes. La infección se determinó mediante la detección anticuerpos séricos IgM e IgG anti T. gondii por la técnica de Elisa. Los factores sociodemográficos, ambientales y hábitos se recolectaron mediante la aplicación de una entrevista. Resultados: La muestra de donantes se caracterizó por una mediana de edad fue de 30 años, género masculino (76,1 %), zona domiciliaria urbana (81,5 %) y ocupación estudiante (34,8 %); asimismo el 29,4 % manifestó ingerir agua no potable y el 61,9% tener contacto con tierra o arena. El 77,2% (IC95 %: 68,6 - 85,8) de donantes presentaron infección pasada. No se observó casos de infección activa. El contacto con gatos y animales domésticos estuvo asociado con la infección por T. gondii (p=0,037; RP=1,28 e IC95 %=1,02 ­ 1,61). Conclusiones: Donantes de sangre del Hospital II-2 Tarapoto presentaron alta frecuencia de infección crónica por T. gondii. Se sugiere la posible transmisión del parásito mediante transfusión sanguínea, por lo que recomienda valorar la inclusión de la toxoplasmosis como prueba de tamizaje.

Introduction: Toxoplasmosis is a worldwide parasitic infection caused by Toxoplasma gondii that can be transmitted through blood transfusions. Objectives: To determine the frequency and associated factors of T. gondii infection in blood donors from Hospital II-2 Tarapoto, Peru, July to December 2019. Methods: Analytical cross-sectional study carried out in a sample of 92 donors. Infection was determined by detecting serum IgM and IgG anti T. gondii antibodies by the Elisa technique. Sociodemographic, environmental and habit factors were collected by applying an interview to each volunteer participant. Results: The donor sample was characterized by a median age of 30 years, male gender (76.1%), urban home area (81.5%) and student occupation (34.8%); likewise, 29.4% stated that they ingested non-potable water and 61.9% had contact with earth or sand. 77.2% (95% CI: 68.6 - 85.8) of donors had past infection. No cases of active infection were observed. Contact with cats and domestic animals was associated with infection by T. gondii (p = 0.037; PR = 1.28 and 95% CI = 1.02 - 1.61). Conclusions: Blood donors from Hospital II-2 Tarapoto presented a high frequency of chronic infection by T. gondii. The possible transmission of the parasite through blood transfusion is suggested, for which reason it is recommended to assess the inclusion of toxoplasmosis as a screening test.

Genomic Sequences and Analysis of Five SARS-CoV-2 Variants Obtained from Patients in Lambayeque, Peru.

Here, we report the genomic sequences of five severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains obtained from nasopharyngeal samples from five tested coronavirus disease 2019 (COVID-19)-infected patients from the Lambayeque region in Peru during early April 2020.

Hypoglycemic effect of Moringa oleifera (moringa) compared with Smallanthus sonchifolius (yacon) on Rattus norvegicus with induced diabetes mellitus. / Efecto hipoglicemiante de Moringa oleifera (moringa) comparado con smallanthus sonchifolius (yacón) en Rattus norvegicus con diabetes mellitus inducida.

OBJECTIVE: To compare the hypoglycemic effect of the aqueous extract of Moringa oleifera (moringa), Smallanthus sonchifolius (yacon) and metformin on Rattus norvegicus, albino variety, with induced diabetes mellitus. MATERIALS AND METHODS: Preclinical, experimental, controlled and randomized study. Diabetes was induced intraperitoneally with a dose of alloxan at 130 mg/kg. A total of 24 male Rattus norvegicus, albino variety, Holfzman strain (6 per group) were used. They were divided as follows: control group (no treatment), metformin group (14 mg/kg), M. oleifera group (200 mg/kg), and S. sonchifolius group (140 mg/kg), treatments were administered via orogastric tube for 15 days. Glycemia levels were determined using an Accu-Chek® Instant electronic glycometer (Roche). RESULTS: Decreased glycemia was observed in the treatment groups: M. oleifera (p = 0.009), S. sonchifolius (p = 0.002) and metformin (p = 0.002), by 313 mg/dL, 281.5 mg/dL and 415 mg/dL, respectively. When comparing glycemia in the treated and control groups, no difference was observed (P > 0.05) at 24 hours and four days of treatment; while at the eighth (P < 0.05) and fifteenth day (P < 0.01) the treated groups had lower glycemia than the control group, but it was similar among them. CONCLUSION: The aqueous extract of S. sonchifolius, M. oleifera, and metformin presented similar hypoglycemic effect in experimental rats with induced diabetes.

OBJETIVO: Comparar el efecto hipoglicemiante del extracto acuoso de Moringa oleifera (moringa), Smallanthus sonchifolius (yacón) y metformina en Rattus norvegicus, variedad albina, con diabetes mellitus inducida. MATERIALES Y MÉTODOS: Estudio preclínico, experimental controlado y aleatorizado. La diabetes se indujo por vía intraperitoneal con una dosis de aloxano a 130 mg/kg de peso vivo (PV); se emplearon 24 Rattus norvegicus, variedad albina, machos, cepa Holfzman (seis por grupo). Se dividieron de la siguiente manera: grupo control (sin tratamiento), grupo metformina (14 mg/kg PV), grupo M. oleifera (200 mg/kg PV), y grupo S. sonchifolius (140 mg/kg PV), los tratamientos fueron administrados mediante sonda orogástrica durante 15 días. Los niveles de glicemia fueron determinados usando un glucómetro electrónico Accu-Chek® Instant (Roche). RESULTADOS: Se observó reducción de la glicemia en los tratamientos: M. oleifera (p = 0,009), S. sonchifolius (p = 0,002) y metfotmina (p = 0,002), en 313 mg/dL, 281,5 mg/dL y 415 mg/dL, respectivamente. En cuanto a la comparación de la glicemia en los grupos tratados y control, se observó que a las 24 horas y cuatro días de tratamiento no hubo diferencia (p > 0,05); mientras que al octavo (p < 0,05) y décimo quinto día (p < 0,01) los grupos tratados tuvieron menor glicemia respecto al control, pero similares entre ellos. CONCLUSIÓN: El extracto acuoso de S. sonchifolius y de M. oleifera, y la metformina presentaron similar efecto hipoglicemiante en ratas de experimentación con diabetes inducida.

Frecuencia y susceptibilidad antifúngica de Candida spp. (no C. albicans ) aislada de pacientes de unidades de cuidados críticos de un hospital de tercer nivel del norte del Perú / Frequency and antifungal susceptibility of Candida spp. (other than C. albicans ) isolated from patients admitted to critical care units of a third-level hospital in northern Peru

RESUMEN Objetivo Determinar la frecuencia y susceptibilidad antifúngica de Candida spp. (no C. albicans) aisladas de muestras de pacientes en cuidados críticos de un hospital de tercer nivel del norte del Perú. Materiales y métodos Se realizó un estudio transversal entre febrero del 2018 y mayo del 2019 en 232 muestras de pacientes hospitalizados en unidades de cuidados críticos del Hospital Regional Lambayeque (HRL). Candida ssp. (no C. albicans) fue identificada mediante las pruebas fenotípicas. La susceptibilidad antifúngica al fluconazol y voriconazol se determinó según la interpretación de los puntos de corte del documento M44-A2 del CLSI (por sus siglas en inglés, Clinical and Laboratory Standards Institute). Resultados Se estudiaron 232 muestras. La frecuencia de Candida spp. (no C. albicans) fue de 19,82 % (46) y C. albicans de 11,20 % (26). Las especies de Candida spp. (no C. albicans) fueron las siguientes: Treintaiuna de C. tropicalis (67,39 %), ocho de C. glabrata (17,39 %), cinco de C. parapsilosis (10,86 %) y dos de C. krusei (4,34 %). Los pacientes en quienes se aisló Candida spp. (no C. albicans) se caracterizaron por ser, en su mayoría, mujeres (56,52 %), que previamente habían usado antimicrobianos (67,39 %), y de 60 años a más (36,95 %). La muestra en la que se aisló en microorganismo con mayor frecuencia fue la orina (45,65 %). Respecto a la susceptibilidad antifúngica de las especies de Candida spp. (no C. albicans), encontramos resistencia a fluconazol (19,56 %) y a voriconazol (21,73 %). Conclusiones La alta frecuencia y predominio de especies de Candida spp. (no C. albicans) en pacientes de unidades de cuidados críticos de un hospital de tercer nivel en Chiclayo, y la resistencia que muestran a la acción de fluconazol y voriconazol son características de gran importancia en la morbilidad y mortalidad en estos pacientes.

ABSTRACT Objective To determine the frequency and antifungal susceptibility of Candida spp. (other than C. albicans) isolated from samples of patients admitted to critical care units of a third-level hospital in northern Peru. Materials and methods A cross-sectional study was conducted between February 2018 and May 2019 in 232 samples of patients admitted to critical care units of the Hospital Regional Lambayeque (HRL). Candida spp. (other than C. albicans) were identified using phenotypic tests. The antifungal susceptibility to fluconazole and voriconazole was determined according to the epidemiological cut-off values of CLSI document M44-A2. Results Two hundred thirty-two (232) samples were analyzed. The frequency of Candida spp. (other than C. albicans) was 19.82 % (46/232) and C. albicans was 11.20 % (26/232). Candida spp. (other than C. albicans) were the following: C. tropicalis (67.39 %, 31/46), C. glabrata (17.39 %, 8/46), C. parapsilosis (10.86 %, 5/46) and C. krusei (4.34 %, 2/46). Patients from whom Candida spp. (other than C. albicans) were isolated were mostly females (56.52 %), had a history of antimicrobial drugs consumption (67.39 %) and were 60 years of age and older (36.95 %). Most microorganisms were isolated from urine samples (45.65 %). Regarding the antifungal susceptibility of Candida spp. (other than C. albicans), 19.56 % and 21.73 % were resistant to fluconazole and voriconazole, respectively. Conclusions The high incidence and prevalence of Candida spp. (other than C. albicans) in patients admitted to critical care units of a third-level hospital in Chiclayo, together with resistance to fluconazole and voriconazole, are significant in the morbidity and mortality of these patients.

Lophomonas sp. in the upper and lower respiratory tract of patients from a hospital in Lambayeque, Peru: clinical case studies.

Infections with protozoans, mainly due to immunodeficiency, are common all over the world. However, pulmonary infections with protozoans are less frequent. Lophomonas sp. is a flagellated protozoan that lives in the gastrointestinal tract of some species of cockroaches. Some cases, that show the presence of Lophomonas in populations whose lungs are affected, have been reported. Case report: The medical records of nine patients were studied: seven adult patients and two pediatric patients who were in the Intensive Care Unit (ICU) and in the Neonatal Intensive Care Unit (NICU), respectively. The samples were taken from tracheal aspirations and bronchoalveolar lavages. The patients' ages were between 9 and 95 years, and 60% of them were male. Some of the patients were healthy, a priori, and others were immunosuppressed. There were found three patients with neoplasia, two patients with diabetes mellitus and four patients with no systemic pathologies. It is concluded that Lophomonas sp. is a protozoa parasite which emerges from the upper and lower respiratory tract of hospitalized patients. However, its pathogenic role is still controversial in all cases, that's why it merits further study for its understanding and possible treatment.

Efecto hipoglicemiante de Moringa oleifera (moringa) comparado con smallanthus sonchifolius (yacón) en Rattus norvegicus con diabetes mellitus inducida / Hypoglycemic effect of Moringa oleifera (moringa) compared with Smallanthus sonchifolius (yacon) on Rattus norvegicus with induced diabetes mellitus

RESUMEN Objetivo: Comparar el efecto hipoglicemiante del extracto acuoso de Moringa oleifera (moringa), Smallanthus sonchifolius (yacón) y metformina en Rattus norvegicus, variedad albina, con diabetes mellitus inducida. Materiales y métodos: Estudio preclínico, experimental controlado y aleatorizado. La diabetes se indujo por vía intraperitoneal con una dosis de aloxano a 130mg/kg de peso vivo (PV); se emplearon 24 Rattus norvegicus, variedad albina, machos, cepa Holfzman (seis por grupo). Se dividieron de la siguiente manera: grupo control (sin tratamiento), grupo metformina (14mg/kg PV), grupo M. oleifera (200mg/kg PV), y grupo S. sonchifolius (140 mg/kg PV), los tratamientos fueron administrados mediante sonda orogástrica durante 15 días. Los niveles de glicemia fueron determinados usando un glucómetro electrónico Accu-Chek® Instant (Roche). Resultados: Se observó reducción de la glicemia en los tratamientos: M. oleifera (p=0,009), S. sonchifolius (p=0,002) y metfotmina (p=0,002), en 313 mg/dL, 281,5 mg/dL y 415 mg/dL, respectivamente. En cuanto a la comparación de la glicemia en los grupos tratados y control, se observó que a las 24 horas y cuatro días de tratamiento no hubo diferencia (p>0,05); mientras que al octavo (p<0,05) y décimo quinto día (p<0,01) los grupos tratados tuvieron menor glicemia respecto al control, pero similares entre ellos. Conclusión: El extracto acuoso de S. sonchifolius y de M. oleifera, y la metformina presentaron similar efecto hipoglicemiante en ratas de experimentación con diabetes inducida.

ABSTRACT Objective: To compare the hypoglycemic effect of the aqueous extract of Moringa oleifera (moringa), Smallanthus sonchifolius (yacon) and metformin on Rattus norvegicus, albino variety, with induced diabetes mellitus. Materials and methods: Preclinical, experimental, controlled and randomized study. Diabetes was induced intraperitoneally with a dose of alloxan at 130 mg/kg. A total of 24 male Rattus norvegicus, albino variety, Holfzman strain (6 per group) were used. They were divided as follows: control group (no treatment), metformin group (14 mg/kg), M. oleifera group (200 mg/kg), and S. sonchifolius group (140 mg/kg), treatments were administered via orogastric tube for 15 days. Glycemia levels were determined using an Accu-Chek® Instant electronic glycometer (Roche). Results: Decreased glycemia was observed in the treatment groups: M. oleifera (p = 0.009), S. sonchifolius (p = 0.002) and metformin (p = 0.002), by 313 mg/dL, 281.5 mg/dL and 415 mg/dL, respectively. When comparing glycemia in the treated and control groups, no difference was observed (P > 0.05) at 24 hours and four days of treatment; while at the eighth (P < 0.05) and fifteenth day (P < 0.01) the treated groups had lower glycemia than the control group, but it was similar among them. Conclusion: The aqueous extract of S. sonchifolius, M. oleifera, and metformin presented similar hypoglycemic effect in experimental rats with induced diabetes.

Seroprevalence of toxoplasmosis in pregnant women and its associated factors among hospital and community populations in Lambayeque, Peru.

INTRODUCTION: Toxoplasmosis is a zoonosis caused by Toxoplasma gondii. This study investigated the prevalence and factors associated with toxoplasmosis among pregnant women. METHODS: We followed an analytical observational study. From July 2016 to June 2017, 218 pregnant women were selected. The infection was detected through serological dosage of anti-T.gondii Immunoglobulin(Ig) M and IgG antibodies. RESULTS: The seroprevalence was 35.8%; the factors associated with infection were consumption of non-drinking water, residence in an urban area, and threatened abortion during the current pregnancy. CONCLUSIONS: The seroprevalence of toxoplasmosis among pregnant women is high. The risk factors are dependent on environmental determinants.

Seroprevalencia de brucelosis y leptospirosis en pobladores urbanos con crianza traspatio en el distrito de José Leonardo Ortiz de Chiclayo / Seroprevalence of brucellosis and leptospirosis in urban citizens with backyard breeding in the district of José Leonardo Ortiz, Chiclayo

Resumen Objetivo: Describir la seroprevalencia de brucelosis y leptospirosis y los factores asociados, en pobladores urbanos con crianza traspatio en el distrito de José Leonardo Ortiz de Chiclayo, Perú. Material y métodos: Estudio prospectivo, transversal y analítico realizado en 90 personas durante los meses de octubre a diciembre del 2016. Se determinaron anticuerpos IgM e IgG específicos para brucelosis y leptospirosis mediante la técnica de ELISA indirecto. Los factores asociados se recolectaron usando una encuesta estructurada. Resultado: La seroprevalencia de brucelosis fue 2,2% y de leptospirosis 28,9%. Las características ambientales más frecuentes en la población fueron, disposición de excretas en letrinas (73,3%), contacto con agua estancada (83,3%) contacto con roedores (62,2%). No se encontró asociación entre los factores evaluados y las enfermedades. Conclusiones: Se evidencia una alta seroprevalencia de leptospirosis y baja para brucelosis en personas con crianza traspatio del distrito de José Leonardo Ortiz de Chiclayo, revelando un problema de salud pública vigente. Se recomienda continuar con estudios longitudinales que permitirían evaluar factores de riesgo y realizar intervenciones preventivas.

Summary Objective: To describe the seroprevalence of and risk factors for brucellosis and leptospirosis in urban citizens with backyard breeding in the district of José Leonardo Ortiz, Chiclayo. Methods: Cross-sectional study including 90 citizens during the month of October and December of 2016. IgM and IgG specific antibodies for brucellosis and leptospirosis were determined using the indirect ELISA method. Factors associated with these diseases were gathered using a structural survey. Results: The seroprevalence of brucellosis and leptospirosis was 2.2% and 28.9%, respectively. The most common environmental features of the population were that 73.3% use latrines 83.3% had contact with stagnant water and 62.2% had contact with rodents. No association between the variables looked for and these two diseases were found. Conclusions: We found a high seroprevalence of leptospirosis but a low prevalence of brucellosis in this setting. We suggest performing longitudinal studies that may identify risk factors to prevent these diseases.

Seroprevalence of toxoplasmosis in pregnant women and its associated factors among hospital and community populations in Lambayeque, Peru

Abstract INTRODUCTION Toxoplasmosis is a zoonosis caused by Toxoplasma gondii. This study investigated the prevalence and factors associated with toxoplasmosis among pregnant women. METHODS We followed an analytical observational study. From July 2016 to June 2017, 218 pregnant women were selected. The infection was detected through serological dosage of anti-T.gondii Immunoglobulin(Ig) M and IgG antibodies. RESULTS The seroprevalence was 35.8%; the factors associated with infection were consumption of non-drinking water, residence in an urban area, and threatened abortion during the current pregnancy. CONCLUSIONS The seroprevalence of toxoplasmosis among pregnant women is high. The risk factors are dependent on environmental determinants.

Frecuencia y etiología de la enteroparasitosis en pacientes con virus inmunodeficiencia humana en un hospital de Lambayeque, Perú / Frequency and etiology of enteroparasitosis in patients with human immunodeficiency virus at a hospital of Lambayeque, Peru

RESUMEN Introducción: A pesar de terapia antiretroviral aún es común encontrar la presencia de infecciones oportunistas, tales como enteroparásitos que causan un gran impacto en salud y economía de los pacientes. Objetivos: Determinar la frecuencia, etiología y factores asociados a las enteroparasitosis en pacientes con VIH, en un hospital referencial de Lambayeque, Perú. Material y Métodos: Se realizó un estudio prospectivo tipo observacional en pacientes diarreicos con infección por VIH de un hospital de Lambayeque desde enero a junio del 2016. Tanto la recolección y transporte, como el análisis de las muestras siguieron las recomendaciones del Manual de procedimientos para el diagnóstico de las parasitosis humanas del Instituto Nacional de Salud. Resultados: La mediana de edad fue 28 años, predominó el sexo masculino y el porcentaje de parasitismo fue de 73,08%. Pacientes con carga viral > 1000 fueron 69,2% y pacientes en TARGA fueron 55,8%. Blastocystis hominis fue el parásito más frecuente (30,77%), seguida de Cryptosporidium spp. y Cystoisospora belli con el 21,2% y 11,5% respectivamente. El análisis bivariado entre carga viral y TARGA con parasitismo, demostró asociación con el parasitismo. Conclusiones: La enteroparasitosis es frecuente en pacientes con VIH y diarrea, predominando las infecciones oportunistas por encima de las no oportunistas.

ABSTRACT Introduction: Despite antiretroviral therapy, it is still common to find the presence of opportunistic infections such as enteroparasites, which cause a big impact on the health and economy of patients. Objetive: To determine the frequency, etiology and factors associated with enteroparasitosis in patients with HIV at a reference hospital in Lambayeque, Peru. Material and Methods: A prospective observational study was conducted in diarrheic patients with HIV infection in a hospital in Lambayeque from January to June, 2016. The study was a census. Both the collection and transport as well as the analysis of the samples followed the recommendations of the Manual of procedures for the diagnosis of human parasitosis of the National Institute of Health. Results: The meadian age was 28 years, the male sex predominated, and the percentage of parasitism was 73.08%. Patients with viral load >1000 were 69.2% and patients with HAART were 55.8%. Blastocystis hominis was the most frequent parasite (30.77%), followed by Cryptosporidium spp. and Cystoisospora belli with 21.2% and 11.5%, respectively. The bivariate analysis between viral load and HAART with parasitism, demonstrated an association with parasitism. Conclusions: Enteroparasitosis is frequent in patients with HIV and diarrhea, predominating opportunistic infections over non opportunistic ones.