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1.
Materials (Basel) ; 14(15)2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34361389

RESUMO

Materials play a fundamental role in any branch of civil engineering. From ancient times to the present day, society has required enormous amounts of construction materials, which implies an excessive exploitation of the natural environment. The present research work consisted in the design and development of asphalt mixes with a partial substitution of the natural aggregate (NA) by means of recycled concrete aggregate (RCA). The mix was designed with the Marshall methodology, considering the next percentages of substitution and addition by mass: 90% NA and 10% RCA; 80% NA and 20% RCA; 70% NA and 30% RCA. The mixtures were elaborated and analysed under the international standards and the Mexican regulation of the Communications and Transport Ministry, to determine the best option regarding their performance. The materials were characterized according to the current regulations and later employed in the mixes design. A total of 38 specimens were elaborated for each mixture, determining the optimum asphalt content; after that, mechanical tests were performed to analyse and determine the best results. In the aftermath of the examination of all mixtures, we concluded that the 70%AN/30%RCA is the best alternative option according to its performance and numeric results, complying with the cited regulations, and allowing a lower content of asphalt during the process.

2.
Viruses ; 13(7)2021 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-34372606

RESUMO

As demonstrated with the novel coronavirus pandemic, rapid and accurate diagnosis is key to determine the clinical characteristic of a disease and to improve vaccine development. Once the infected person is identified, hematological findings may be used to predict disease outcome and offer the correct treatment. Rapid and accurate diagnosis and clinical parameters are pivotal to track infections during clinical trials and set protection status. This is also applicable for re-emerging diseases like dengue fever, which causes outbreaks in Asia and Latin America every 4 to 5 years. Some areas in the US are also endemic for the transmission of dengue virus (DENV), the causal agent of dengue fever. However, significant number of DENV infections in rural areas are diagnosed solely by clinical and hematological findings because of the lack of availability of ELISA or PCR-based tests or the infrastructure to implement them in the near future. Rapid diagnostic tests (RDT) are a less sensitive, yet they represent a timely way of detecting DENV infections. The purpose of this study was to determine whether there is an association between hematological findings and the probability for an NS1-based DENV RDT to detect the DENV NS1 antigen. We also aimed to describe the hematological parameters that are associated with the diagnosis through each test.


Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , Dengue/diagnóstico , Adolescente , Adulto , Ásia/epidemiologia , Criança , Pré-Escolar , Colômbia/epidemiologia , Dengue/virologia , Vírus da Dengue/isolamento & purificação , Testes Diagnósticos de Rotina/métodos , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactente , Masculino , Pandemias , Reação em Cadeia da Polimerase , Kit de Reagentes para Diagnóstico , SARS-CoV-2/isolamento & purificação , Adulto Jovem
3.
J Crit Care ; 65: 274-281, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34280657

RESUMO

PURPOSE: We sought to examine changes in acute respiratory distress syndrome (ARDS) management over a 12-year period of two successive randomized trials. METHODS: Analyses included baseline data, from eligible patients, prior to influence of trial protocols, and daily study data, from randomized patients, of variables not determined by trial protocols. Mixed linear regressions examined changes in practice year-on-year. RESULTS: A total of 2376 patients met the inclusion criteria. Over the 12-year period, baseline tidal volume index decreased (9.0 to 7.0 ml/kg, p < 0.001), plateau pressures decreased (30.8 to 29.0 cmH2O, p < 0.05), and baseline positive end-expiratory pressures increased (10.8 to 13.2 cmH2O, p < 0.001). Volume-controlled ventilation declined from 29.4 to 14.0% (p < 0.01). Use of corticosteroids increased (baseline: 7.7 to 30.3%; on study: 32.6 to 61.2%; both p < 0.001), as did neuromuscular blockade (baseline: 12.3 to 24.5%; on study: 55.5 to 70.0%; both p < 0.01). Inhaled nitric oxide use increased (24.9 to 65.8%, p < 0.05). We observed no significant change in prone positioning (16.2 to 18.9%, p = 0.70). CONCLUSIONS: Clear trends were apparent in tidal volume, airway pressures, ventilator modes, adjuncts and rescue therapies. With the exception of prone positioning, and outside the context of rescue therapy, these trends appear consistent with the evolving literature on ARDS management.

4.
Proc (Bayl Univ Med Cent) ; 34(4): 451-455, 2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-34219924

RESUMO

Bronchus-associated lymphoid tissue (BALT) lymphomas of the lung are uncommon, and diagnosis is often delayed due to the indolent clinical course. Often, adequate samples are difficult to obtain by bronchoscopy with transbronchial biopsy alone. This retrospective study reviewed the diagnosis and treatment of BALT lymphoma cases at our institution over the course of 19 years. Most patients were white, women, and >50 years old; the mean Charlson Comorbidity Index at the time of diagnosis was 6. Seven of 12 patients presented with solitary nodules or multiple nodules. For six cases, initial modalities were nondiagnostic; four subsequently underwent surgical biopsy, one underwent computed tomography-guided biopsy, and one underwent navigational bronchoscopy for final diagnosis of BALT lymphoma. Ultimately, 55% of cases were diagnosed with nonsurgical biopsy. One patient suffered a pneumothorax related to the initial diagnostic attempt. Ten patients received chemotherapy, radiation, and/or surgery, and 11 of the 12 are still alive. Our data confirm the previously described indolent behavior of BALT lymphomas and the challenges related to diagnosis. While previous studies have suggested surgical biopsy as the primary modality for obtaining histopathology, navigational bronchoscopy could serve as a safer alternative.

5.
BMJ Case Rep ; 14(3)2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33687930

RESUMO

A 35-year-old man was admitted to the intensive care unit with massive haemoptysis. CT of the chest revealed a necrotic right upper lobe mass. Angiography of his thoracic vasculature revealed a pseudoaneurysm in the right subclavian artery with active contrast extravasation. This anatomic deformity was stented and coiled with the assistance of interventional radiology. Bronchoscopy with lavage and brushings of the right upper lobe mass revealed fungal hyphae and positive galactomannan, supporting that the patient developed invasive pulmonary aspergillosis leading to a mycotic pseudoaneurysm of the right subclavian artery followed by massive haemoptysis.


Assuntos
Falso Aneurisma , Aneurisma , Adulto , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico por imagem , Angiografia , Hemoptise/etiologia , Humanos , Masculino , Artéria Subclávia/diagnóstico por imagem
6.
Appl Soft Comput ; 100: 106932, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33269029

RESUMO

The need to forecast COVID-19 related variables continues to be pressing as the epidemic unfolds. Different efforts have been made, with compartmental models in epidemiology and statistical models such as AutoRegressive Integrated Moving Average (ARIMA), Exponential Smoothing (ETS) or computing intelligence models. These efforts have proved useful in some instances by allowing decision makers to distinguish different scenarios during the emergency, but their accuracy has been disappointing, forecasts ignore uncertainties and less attention is given to local areas. In this study, we propose a simple Multiple Linear Regression model, optimised to use phone call data to forecast the number of daily confirmed cases. Moreover, we produce a probabilistic forecast that allows decision makers to better deal with risk. Our proposed approach outperforms ARIMA, ETS, Seasonal Naive, Prophet and a regression model without call data, evaluated by three point forecast error metrics, one prediction interval and two probabilistic forecast accuracy measures. The simplicity, interpretability and reliability of the model, obtained in a careful forecasting exercise, is a meaningful contribution to decision makers at local level who acutely need to organise resources in already strained health services. We hope that this model would serve as a building block of other forecasting efforts that on the one hand would help front-line personal and decision makers at local level, and on the other would facilitate the communication with other modelling efforts being made at the national level to improve the way we tackle this pandemic and other similar future challenges.

7.
Am J Obstet Gynecol MFM ; 2(4): 100224, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32954247

RESUMO

The severe acute respiratory syndrome coronavirus 2 pandemic has resulted in the development of various therapeutics to treat and prevent major complications related to the virus; pregnant patients are vulnerable to acquiring severe acute respiratory syndrome coronavirus 2 because of frequent contact with the healthcare setting. Despite the publication of a plethora of case series and randomized control trials of severe acute respiratory syndrome coronavirus 2 therapeutics, few have addressed treatment in the pregnant population. To date, there has been no published review of therapeutic options in the treatment of pregnant patients with severe acute respiratory syndrome coronavirus 2 infection. Here, we provide a review of available treatments for severe acute respiratory syndrome coronavirus 2, various trials with inclusion and exclusion of the pregnant patients, and potential side effects of each treatment in the pregnant patient.


Assuntos
Antivirais/farmacologia , COVID-19/terapia , Complicações Infecciosas na Gravidez/tratamento farmacológico , SARS-CoV-2/efeitos dos fármacos , Anticoagulantes/farmacologia , COVID-19/diagnóstico , COVID-19/tratamento farmacológico , Feminino , Humanos , Imunização Passiva/métodos , Seleção de Pacientes , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico
8.
BMC Urol ; 20(1): 65, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503502

RESUMO

BACKGROUND: Encrustation of ureteral double J stents is a common complication that may affect its removal. The aim of the proposed study is to evaluate the efficacy and safety of a new oral composition to prevent double J stent encrustation in indwelling times up to 8 weeks. METHODS: A double-blinded, multicenter, placebo-controlled trial was conducted with 105 patients with indwelling double J stents enrolled across 9 public hospitals in Spain. The patients were randomly assigned (1:1) into intervention (53 patients) or placebo (52 patients) groups for 3 to 8 weeks and both groups self-monitored daily their morning urine pH levels. The primary outcome of analysis was the degree of stent ends encrustation, defined by a 4-point score (0 - none; 3 - global encrustation) using macroscopic and electron microscopy analysis of crystals, after 3 to 8-w indwelling period. Score was exponentially transformed according to calcium levels. Secondary endpoints included urine pH decrease, stent removal, and incidence of adverse events. RESULTS: The intervention group benefits from a lower global encrustation rate of stent ends than placebo group (1% vs 8.2%; p < 0.018). Mean encrustation score was 85.12 (274.5) in the placebo group and 18.91 (102.27) in the intervention group (p < 0.025). Considering the secondary end points, treated patients reported greater urine pH decreases (p = 0.002). No differences in the incidence of adverse events were identified between the groups. CONCLUSIONS: Our data suggest that the use of this new oral composition is beneficial in the context of ureteral double J indwelling by decreasing mean, as well as global encrustation. TRIAL REGISTRATION: This trial was registered at www.clinicaltrials.gov under the name "Combined Use of a Medical Device and a Dietary Complement in Patient Urinary pH Control in Patients With an Implanted Double J Stent" with date 2nd November 2017, code NCT03343275, and URL.


Assuntos
Calcinose/etiologia , Calcinose/prevenção & controle , Metionina/administração & dosagem , Ácido Fítico/administração & dosagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Stents/efeitos adversos , Ureter/cirurgia , Administração Oral , Adulto , Cristalização , Método Duplo-Cego , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Falha de Prótese , Urina/química
9.
Am J Trop Med Hyg ; 102(6): 1279-1285, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32207402

RESUMO

Drinking water contamination is a frequent problem in developing countries and could be associated with bacterial pathogen carriage in feces. We evaluated the association between the risk of drinking water and bacterial carrier status in children younger than 5 years in a cross-sectional study conducted in 199 households from three Peruvian rural communities. Fecal samples from children were screened for pathogenic Aeromonas, Campylobacter, and Vibrio species, as well as for Enterobacteriaceae, including pathogenic Escherichia coli. The drinking water risk was determined using E. coli as an indicator of contamination. Nineteen (9.5%) children were colonized with pathogens and classified as carriers, all without diarrhea symptoms. Of 199 drinking water samples, 38 (19.1%) were classified as very high risk because of high fecal contamination (> 100 E. coli/100 mL). Shared-use water sources, daily washing of containers, and washing using only water were associated with higher prevalence of bacterial carriage, whereas there was no association between households reporting boiling and chlorination of water and carrier status. The prevalence of carriage in children exposed to very high-risk water was 2.82 (95% CI: 1.21-6.59) times the prevalence of those who consumed less contaminated water, adjusted by the water source and daily washing. Our results suggest that household drinking water plays an important role in the generation of carriers with diarrheal pathogens. Our findings also highlight the importance of interventions to ensure the safety of drinking water. Further studies are needed to validate the observed association and determine its significance with respect to diarrhea in the community.


Assuntos
Diarreia/microbiologia , Água Potável/microbiologia , Fezes/microbiologia , População Rural , Microbiologia da Água , Bactérias/classificação , Bactérias/isolamento & purificação , Pré-Escolar , Diarreia/epidemiologia , Feminino , Humanos , Lactente , Masculino , Peru/epidemiologia , Saneamento/métodos , Poluentes da Água , Abastecimento de Água
10.
Rev Salud Publica (Bogota) ; 20(2): 215-220, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30570004

RESUMO

OBJECTIVES : To establish the correlation between hypothyroidism and blood pesticide levels. MATERIALS AND METHODS : Cross-sectional study in agricultural workers and their permanent partners in plantain and coffee producing municipalities as reference population. A representative sample was estimated and thyroid function tests were performed using ELISA Stat Fax 303/Plus reader, at a wavelength of 450 nm. Organochlorine pesticide residuality was determined, a dispersive liquid-liquid microextraction (DLLME) assisted by sonication was implemented, and a gas chromatography-micro-electron capture detector (GC-pECD) was used for the analysis. RESULTS : 819 participants, 58.7% men and 41.3% women were included; their average age was 48.1 years. Prevalence of symptomatic hypothyroidism (1.2%) and subclinical hypothyroidism (6.7%) was observed, with a higher prevalence in people older than 60 years (2.6% and 8.9%, respectively). Non-causal association was found between subclinical hypothyroidism and the organochlorine pesticides 4,4'-DDE (sig.0,006), Heptachlor (sig.0,04), and Endosulfan I (sig.0,02). Antiperoxidase (Anti TPO) antibodies ≥60 lU/ml were associated with subclinical hypothyroidism (OR 2.6). CONCLUSIONS : The prevalence of hypothyroidism in the studied population is similar to that reported in the literature, and lower than in urban areas. In turn, the prevalence of subclinical hypothyroidism is higher and positive anti-TPO values are related to risk of progression to frank hypothyroidism, which is why follow-up is required in these patients. Three organochlorine pesticides were associated with subclinical hypothyroidism. TSH screening is recommended in people aged 40 and over, especially if they are exposed to the aforementioned agrochemicals.


Assuntos
Doenças dos Trabalhadores Agrícolas/induzido quimicamente , Café , Hidrocarbonetos Clorados/toxicidade , Hipotireoidismo/induzido quimicamente , Exposição Ocupacional/efeitos adversos , Praguicidas/toxicidade , Plantago , Adulto , Doenças dos Trabalhadores Agrícolas/sangue , Doenças dos Trabalhadores Agrícolas/diagnóstico , Doenças Assintomáticas/epidemiologia , Cromatografia Gasosa , Colômbia/epidemiologia , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Hidrocarbonetos Clorados/sangue , Hipotireoidismo/sangue , Hipotireoidismo/diagnóstico , Hipotireoidismo/epidemiologia , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/análise , Praguicidas/sangue , Prevalência
11.
Am J Trop Med Hyg ; 99(2): 331-337, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29869605

RESUMO

Cutaneous leishmaniasis is endemic to South America where diagnosis is most commonly conducted via microscopy. Patients with suspected leishmaniasis were referred for enrollment by the Ministry of Health (MoH) in Lima, Iquitos, Puerto Maldonado, and several rural areas of Peru. A 43-question survey requesting age, gender, occupation, characterization of the lesion(s), history of leishmaniasis, and insect-deterrent behaviors was administered. Polymerase chain reaction (PCR) was conducted on lesion materials at the Naval Medical Research Unit No. 6 in Lima, and the results were compared with those obtained by the MoH using microscopy. Factors associated with negative microscopy and positive PCR results were identified using χ2 test, t-test, and multivariate logistic regression analyses. Negative microscopy with positive PCR occurred in 31% (123/403) of the 403 cases. After adjusting for confounders, binary multivariate logistic regression analyses revealed that negative microscopy with positive PCR was associated with patients who were male (adjusted odds ration [OR] = 1.93 [1.06-3.53], P = 0.032), had previous leishmaniasis (adjusted OR = 2.93 [1.65-5.22], P < 0.0001), had larger lesions (adjusted OR = 1.02 [1.003-1.03], P = 0.016), and/or had a longer duration between lesion appearance and PCR testing (adjusted OR = 1.12 [1.02-1.22], P = 0.017). Future research should focus on further exploration of these underlying variables, discovery of other factors that may be associated with negative microscopy diagnosis, and the development and implementation of improved testing in endemic regions.


Assuntos
Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/epidemiologia , Microscopia/normas , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , DNA de Protozoário/genética , Feminino , Humanos , Lactente , Recém-Nascido , Leishmania/genética , Leishmania/isolamento & purificação , Masculino , Microscopia/métodos , Pessoa de Meia-Idade , Peru/epidemiologia , Reação em Cadeia da Polimerase , Prevalência , Vigilância de Evento Sentinela , Inquéritos e Questionários , Adulto Jovem
12.
Rev. salud pública ; 20(2): 215-220, mar.-abr. 2018. tab
Artigo em Espanhol | LILACS | ID: biblio-978976

RESUMO

RESUMEN Objetivos Determinar relación entre hipotiroidismo y plaguicidas en sangre. Metodología Estudio de corte transversal, en agricultores y sus compañeros(as) permanentes en municipios productores de plátano y café. Se calculó muestra representativa. Se realizaron pruebas de función tiroidea, se utilizó un lector de ELISA Stat Fax 303/Plus, en una longitud de onda 450 nm. Se determinó la residualidad de plaguicidas organoclorados, se implementó un método de microextracción dispersiva en fase líquida (DLLME) asistida por sonicación, y se empleó cromatografía de gases con detector de micro captura de electrones (GC-µECD) para el análisis. Resultados Se incluyeron 819 participantes, 58,7% hombres y 41,3% mujeres; promedio de edad 48,1 años. Prevalencia de hipotiroidismo manifiesto 1,2% y de hipotiroidismo subclínico 6,7%, mayor prevalencia en personas mayores de 60 años (2,6% y 8,9% respectivamente). Se encontró asociación no causal de hipotiroidismo subclínico con plaguicidas organoclorados 4,4'-DDE (sig.0,006), Heptacloro (sig.0,04), y Endosulfán I (sig.0,02). Los anticuerpos antiperoxidasa (Anti TPO) ≥ 60 lU/ml se asociaron con h. subclínico, OR 2,6. Conclusiones La prevalencia de hipotiroidismo hallada es similar a lo referido en la literatura, es menor que en áreas urbanas; la prevalencia de hipotiroidismo subclínico es mayor y con riesgo de progresión a hipotiroidismo franco cuando se relaciona con Anti-TPO positivos, razón por la cual se requiere seguimiento en estos pacientes. Se asociaron a h. subclínico 3 plaguicidas organoclorados. Se recomienda tamizaje de TSH en personas de 40 y más años sobre todo si están expuestas a los agroquímicos mencionados.(AU)


ABSTRACT Objectives To establish the correlation between hypothyroidism and blood pesticide levels. Materials and Methods Cross-sectional study in agricultural workers and their permanent partners in plantain and coffee producing municipalities as reference population. A representative sample was estimated and thyroid function tests were performed using ELISA Stat Fax 303/Plus reader, at a wavelength of 450 nm. Organochlorine pesticide residuality was determined, a dispersive liquid-liquid microextraction (DLLME) assisted by sonication was implemented, and a gas chromatography-micro-electron capture detector (GC-pECD) was used for the analysis. Results 819 participants, 58.7% men and 41.3% women were included; their average age was 48.1 years. Prevalence of symptomatic hypothyroidism (1.2%) and subclinical hypothyroidism (6.7%) was observed, with a higher prevalence in people older than 60 years (2.6% and 8.9%, respectively). Non-causal association was found between subclinical hypothyroidism and the organochlorine pesticides 4,4'-DDE (sig.0,006), Heptachlor (sig.0,04), and Endosulfan I (sig.0,02). Antiperoxidase (Anti TPO) antibodies ≥60 lU/ml were associated with subclinical hypothyroidism (OR 2.6). Conclusions The prevalence of hypothyroidism in the studied population is similar to that reported in the literature, and lower than in urban areas. In turn, the prevalence of subclinical hypothyroidism is higher and positive anti-TPO values are related to risk of progression to frank hypothyroidism, which is why follow-up is required in these patients. Three organochlorine pesticides were associated with subclinical hypothyroidism. TSH screening is recommended in people aged 40 and over, especially if they are exposed to the aforementioned agrochemicals.(AU)


Assuntos
Humanos , Disruptores Endócrinos , Inseticidas Organoclorados/efeitos adversos , Hipotireoidismo/etiologia , Estudos Transversais/instrumentação , Estudos de Coortes , Colômbia , Endossulfano/sangue , Heptacloro/sangue
13.
Am J Trop Med Hyg ; 96(2): 304-311, 2017 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-27879461

RESUMO

The reemergence of malaria in the last decade in Madre de Dios, southern Peruvian Amazon basin, was accompanied by ecological, political, and socioeconomic changes related to the proliferation of illegal gold mining. We conducted a secondary analysis of passive malaria surveillance data reported by the health networks in Madre de Dios between 2001 and 2012. We calculated the number of cases of malaria by year, geographic location, intensity of illegal mining activities, and proximity of health facilities to the Peru-Brazil Interoceanic Highway. During 2001-2012, 203,773 febrile cases were identified in Madre de Dios, of which 30,811 (15.1%) were confirmed cases of malaria; all but 10 cases were due to Plasmodium vivax Cases of malaria rose rapidly between 2004 and 2007, reached 4,469 cases in 2005, and then declined after 2010 to pre-2004 levels. Health facilities located in areas of intense illegal gold mining reported 30-fold more cases than those in non-mining areas (ratio = 31.54, 95% confidence interval [CI] = 19.28, 51.60). Finally, health facilities located > 1 km from the Interoceanic Highway reported significantly more cases than health facilities within this distance (ratio = 16.20, 95% CI = 8.25, 31.80). Transmission of malaria in Madre de Dios is unstable, geographically heterogeneous, and strongly associated with illegal gold mining. These findings highlight the importance of spatially oriented interventions to control malaria in Madre de Dios, as well as the need for research on malaria transmission in illegal gold mining camps.


Assuntos
Malária/epidemiologia , Mineração , Adulto , Feminino , Ouro , Humanos , Malária/transmissão , Malária Falciparum/epidemiologia , Malária Falciparum/transmissão , Malária Vivax/epidemiologia , Malária Vivax/transmissão , Masculino , Peru/epidemiologia , Estações do Ano
14.
Am J Trop Med Hyg ; 95(6 Suppl): 133-144, 2016 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-27799639

RESUMO

Malaria in Peru, dominated by Plasmodium vivax, remains a public health problem. The 1990s saw newly epidemic malaria emerge, primarily in the Loreto Department in the Amazon region, including areas near to Iquitos, the capital city, but sporadic malaria transmission also occurred in the 1990s-2000s in both north-coastal Peru and the gold mining regions of southeastern Peru. Although a Global Fund-supported intervention (PAMAFRO, 2005-2010) was temporally associated with a decrease of malaria transmission, from 2012 to the present, both P. vivax and Plasmodium falciparum malaria cases have rapidly increased. The Peruvian Ministry of Health continues to provide artemesinin-based combination therapy for microscopy-confirmed cases of P. falciparum and chloroquine-primaquine for P. vivax Malaria transmission continues in remote areas nonetheless, where the mobility of humans and parasites facilitates continued reintroduction outside of ongoing surveillance activities, which is critical to address for future malaria control and elimination efforts. Ongoing P. vivax research gaps in Peru include the following: identification of asymptomatic parasitemics, quantification of the contribution of patent and subpatent parasitemics to mosquito transmission, diagnosis of nonparasitemic hypnozoite carriers, and implementation of surveillance for potential emergence of chloroquine- and 8-aminoquinoline-resistant P. vivax Clinical trials of tafenoquine in Peru have been promising, and glucose-6-phosphate dehydrogenase deficiency in the region has not been observed to be a limitation to its use. Larger-scale challenges for P. vivax (and malaria in general) in Peru include logistical difficulties in accessing remote riverine populations, consequences of government policy and poverty trends, and obtaining international funding for malaria control and elimination.


Assuntos
Malária Vivax/epidemiologia , Plasmodium vivax , Animais , Anopheles/parasitologia , Anopheles/fisiologia , Antimaláricos/administração & dosagem , Antimaláricos/uso terapêutico , Doenças Endêmicas , Humanos , Incidência , Insetos Vetores , Peru/epidemiologia , Variantes Farmacogenômicos , Plasmodium vivax/genética , Saúde Pública , Fatores de Tempo
15.
Am J Trop Med Hyg ; 95(5): 1026-1030, 2016 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-27621304

RESUMO

The transmission dynamics of many arboviruses in the Amazon Basin region have not been fully elucidated, including the vectors and natural reservoir hosts. Identification of blood meal sources in field-caught mosquitoes could yield information for identifying potential arbovirus vertebrate hosts. We identified blood meal sources in 131 mosquitoes collected from areas endemic for arboviruses in the Peruvian Department of Loreto by sequencing polymerase chain reaction amplicons of the cytochrome b gene. Psorophora (Janthinosoma) albigenu, Psorophora (Grabhamia) cingulata, Mansonia humeralis, Anopheles oswaldoi s.l., and Anopheles benarrochi s.l. had mainly anthropophilic feeding preferences; Aedes (Ochlerotatus) serratus, and Aedes (Ochlerotatus) fulvus had feeding preferences for peridomestic animals; and Culex (Melanoconion) spp. fed on a variety of vertebrates, mainly rodents (spiny rats), birds, and amphibians. On the basis of these feeding preferences, many mosquitoes could be considered as potential enzootic and bridge arbovirus vectors in the Amazon Basin of Peru.


Assuntos
Arbovírus/isolamento & purificação , Comportamento Alimentar , Interações Hospedeiro-Patógeno , Mosquitos Vetores/virologia , Aedes/virologia , Anfíbios/sangue , Anfíbios/parasitologia , Anfíbios/virologia , Animais , Anopheles/virologia , Aves/sangue , Aves/parasitologia , Aves/virologia , Culex/virologia , Citocromos b/genética , Citocromos b/metabolismo , Peru , Ratos , Roedores/sangue , Roedores/parasitologia , Roedores/virologia
16.
Nat Genet ; 48(8): 953-8, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27348298

RESUMO

Plasmodium vivax is a major public health burden, responsible for the majority of malaria infections outside Africa. We explored the impact of demographic history and selective pressures on the P. vivax genome by sequencing 182 clinical isolates sampled from 11 countries across the globe, using hybrid selection to overcome human DNA contamination. We confirmed previous reports of high genomic diversity in P. vivax relative to the more virulent Plasmodium falciparum species; regional populations of P. vivax exhibited greater diversity than the global P. falciparum population, indicating a large and/or stable population. Signals of natural selection suggest that P. vivax is evolving in response to antimalarial drugs and is adapting to regional differences in the human host and the mosquito vector. These findings underline the variable epidemiology of this parasite species and highlight the breadth of approaches that may be required to eliminate P. vivax globally.


Assuntos
Resistência a Medicamentos/genética , Marcadores Genéticos/genética , Malária Vivax/parasitologia , Metagenômica/métodos , Plasmodium vivax/genética , Seleção Genética/genética , Transcriptoma/genética , Antimaláricos/farmacologia , Humanos , Malária Vivax/tratamento farmacológico , Malária Vivax/genética , Plasmodium vivax/efeitos dos fármacos , Plasmodium vivax/patogenicidade , Seleção Genética/efeitos dos fármacos
17.
Malar J ; 14: 478, 2015 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-26620122

RESUMO

Two Plasmodium vivax recurrences in a Peruvian sailor with weight above the 60 kg (cap for primaquine dosage) highlight the importance of adequate radical cure weight dosage for patient treatment and control efforts, particularly within the military.


Assuntos
Antimaláricos/administração & dosagem , Malária Vivax/diagnóstico , Malária Vivax/tratamento farmacológico , Primaquina/administração & dosagem , Adulto , Peso Corporal , Genótipo , Técnicas de Genotipagem , Humanos , Malária Vivax/patologia , Masculino , Repetições de Microssatélites , Militares , Peru , Plasmodium vivax/genética , Plasmodium vivax/isolamento & purificação , Recidiva
18.
Am J Trop Med Hyg ; 93(2): 340-346, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26078320

RESUMO

Military personnel deployed to the Amazon Basin are at high risk for cutaneous leishmaniasis (CL). We responded to an outbreak among Peruvian Army personnel returning from short-term training in the Amazon, conducting active case detection, lesion sample collection, and risk factor assessment. The attack rate was 25% (76/303); the incubation period was 2-36 weeks (median = 8). Most cases had one lesion (66%), primarily ulcerative (49%), and in the legs (57%). Real-time polymerase chain reaction (PCR) identified Leishmania (Viannia) braziliensis (59/61 = 97%) and L. (V.) guyanensis (2/61 = 3%). Being male (risk ratio [RR] = 4.01; P = 0.034), not wearing long-sleeve clothes (RR = 1.71; P = 0.005), and sleeping in open rooms (RR = 1.80; P = 0.009) were associated with CL. Sodium stibogluconate therapy had a 41% cure rate, less than previously reported in Peru (~70%; P < 0.001). After emphasizing pre-deployment education and other basic prevention measures, trainees in the following year had lower incidence (1/278 = 0.4%; P < 0.001). Basic prevention can reduce CL risk in deployed militaries.


Assuntos
Surtos de Doenças , Leishmania braziliensis/isolamento & purificação , Leishmaniose Cutânea/epidemiologia , Militares , Adolescente , Gluconato de Antimônio e Sódio/uso terapêutico , Feminino , Humanos , Leishmania guyanensis/isolamento & purificação , Leishmaniose Cutânea/tratamento farmacológico , Masculino , Peru/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real , Inquéritos e Questionários , Adulto Jovem
19.
J Epidemiol Community Health ; 69(7): 715-8, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25987723

RESUMO

OBJECTIVE: To compare all-cause and cause-specific mortality among 3 distinct groups: within-country, rural-to-urban migrants, and rural and urban dwellers in a longitudinal cohort in Peru. METHODS: The PERU MIGRANT Study, a longitudinal cohort study, used an age-stratified and sex-stratified random sample of urban dwellers in a shanty town community in the capital city of Peru, rural dwellers in the Andes, and migrants from the Andes to the shanty town community. Participants underwent a questionnaire and anthropomorphic measurements at a baseline evaluation in 2007-2008 and at a follow-up visit in 2012-2013. Mortality was determined by death certificate or family interview. RESULTS: Of the 989 participants evaluated at baseline, 928 (94%) were evaluated at follow-up (mean age 48 years; 53% female). The mean follow-up time was 5.1 years, totalling 4732.8 person-years. In a multivariable survival model, and relative to urban dwellers, migrant participants had lower all cause mortality (HR=0.30; 95% CI 0.12-0.78), and both the migrant (HR=0.07; 95% CI 0.01-0.41) and rural (HR=0.06; 95% CI 0.01-0.62) groups had lower cardiovascular mortality. CONCLUSIONS: Cardiovascular mortality of migrants remains similar to that of the rural group, suggesting that rural-to-urban migrants do not appear to catch up with urban mortality in spite of having a more urban cardiovascular risk factor profile.


Assuntos
Doenças Cardiovasculares/mortalidade , Saúde da População Rural/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Saúde da População Urbana/estatística & dados numéricos , Adulto , Doenças Cardiovasculares/etiologia , Causas de Morte/tendências , Comorbidade , Atestado de Óbito , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Entrevistas como Assunto , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Peru/epidemiologia , Fatores de Risco , Fumar/epidemiologia , Inquéritos e Questionários
20.
Am J Trop Med Hyg ; 92(6): 1090-9, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25846293

RESUMO

Much debate exists regarding the need, acceptability, and value of humanitarian medical assistance. We conducted a cross-sectional study on 457 children under 5 years from four remote riverine communities in the Peruvian Amazon and collected anthropometric measures, blood samples (1-4 years), and stool samples. Focus groups and key informant interviews assessed perspectives regarding medical aid delivered by foreigners. The prevalence of stunting, anemia, and intestinal parasites was 20%, 37%, and 62%, respectively. Infection with multiple parasites, usually geohelminths, was detected in 41% of children. The prevalence of intestinal parasites both individual and polyparasitism increased with age. Participants from smaller communities less exposed to foreigners expressed lack of trust and fear of them. However, participants from all communities were positive about foreigners visiting to provide health support. Prevalent health needs such as parasitic infections and anemia may be addressed by short-term medical interventions. There is a perceived openness to and acceptability of medical assistance delivered by foreign personnel.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Missões Médicas , Aceitação pelo Paciente de Cuidados de Saúde , Fatores Etários , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Coinfecção , Feminino , Nível de Saúde , Humanos , Lactente , Enteropatias Parasitárias/epidemiologia , Malária/epidemiologia , Masculino , Doenças Parasitárias/epidemiologia , Peru/epidemiologia , Rios , População Rural/estatística & dados numéricos
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