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Vet Parasitol Reg Stud Reports ; 38: 100827, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36725157


The intensive use of anthelmintic drugs to control Fasciola hepatica infections in dairy cattle has resulted in the emergence of anthelmintic resistance. Cases of resistance to triclabendazole (TCBZ) have been reported worldwide. The main goal of this research was to evaluate the main five fasciolicides to control fasciolosis in dairy cattle in the Mantaro Valley, Peru. Two fecal egg count reduction tests were performed. In a first study, 24 naturally F. hepatica infected cattle were randomly grouped into three experimental groups (n = 8). Groups were treated with either TCBZ, nitroxynil (NTX) or closantel (CLOS). In a second experiment, 55 naturally infected cows were grouped into three experimental groups and treated with either TCBZ (n = 18), rafoxanide (RFX) + albendazole (ABZ) (n = 19) or clorsulon (CLN) + ivermectin (IVM) (n = 18). Therapeutic efficacy was determined following the WAAVP guidelines by measuring reduction in fluke egg output at days 15 and 30 post-treatment. Bootstrapping method was used to obtain the 95% confidence intervals. The efficacy of TCBZ was inadequate in both studies (≤80.8%). Closantel showed high efficacy (≥ 90%) at both days, while NTX showed 92.9% (83-100) and 82.1% (53.6-100), efficacy, at days 15 and 30, respectively. Efficacy for RFX were 92.1% (79.6-98.9) and 97.4% (94.1-99.4); and for CLN, 98.8% (97.6-100) and 80.1% (44.7-99.4), at days 15 and 30, respectively. The outcome of this study indicates reduced therapeutic efficacy of TCBZ against F. hepatica in an important dairy area of the Peruvian central highlands but also demonstrates the validity of four alternatives.

Anti-Helmínticos , Fasciola hepatica , Fasciolíase , Feminino , Bovinos , Animais , Peru , Benzimidazóis/uso terapêutico , Anti-Helmínticos/uso terapêutico , Fasciolíase/tratamento farmacológico , Fasciolíase/veterinária , Triclabendazol/uso terapêutico , Nitroxinila/uso terapêutico , Rafoxanida/uso terapêutico
Artigo em Inglês | MEDLINE | ID: mdl-36673697


Peru is currently one of the world's leading culinary destinations, whose world-renowned cuisine uses vegetables, mainly lettuce, as frequent ingredients. Vegetable consumption is promoted worldwide as a part of a healthy diet. However, vegetables, more frequently lettuce, have been implicated as a vehicle of infection for several foodborne parasites. This study aimed to determine the presence of potentially pathogenic parasites in lettuce marketed in the Central Andes of Peru. A total of 75 lettuce samples were collected from the two largest wholesale markets and the main open-air market in Jauja province, in the central Peruvian Andes. The province of provenance (coast vs. highlands), lettuce variety ("curly-leaf", "iceberg", and "butter"), and type of market were recorded. The samples were microscopically examined for detection of parasitic life forms using standard parasitological methods including direct slide smear, Lugol's iodine staining, and Modified Ziehl-Neelsen staining. The overall positivity of parasitic contamination in lettuces was 45.3% (CI 95%: 34-56.6%). Cryptosporidium spp., Isospora belli, Giardia lamblia, Balantidium coli, and Entamoeba spp. were detected in twenty-six (34.7%), six (8%), four (5.3%), two (2.7%), and two (2.7%) lettuces, respectively. I. belli was found in a significantly (p < 0.01) lower proportion in the "butter" variety, and significantly (p < 0.05) higher contamination with G. lamblia was found in lettuce sold at the open-air market. B. coli, G. lamblia, and E. histolytica/E. dispar/E. moshkovskii were detected only in lettuce from the highlands (Tarma province). This study provides important data for health authorities to develop food safety programs. This information is also of interest to the international community because of the increased visibility that Peru has gained as a tourist destination.

Criptosporidiose , Cryptosporidium , Parasitos , Animais , Humanos , Alface , Peru , Verduras , Giardia , Proteínas de Protozoários
Artigo em Inglês | MEDLINE | ID: mdl-36673776


AIM: In dental practice there is a high risk of contact with fluids that may contain SARS-CoV-2. Salivary secretions in the form of droplets are the main route of infection. The present study aimed to evaluate factors associated with epidemiological, preventive and health care knowledge of dentists from the north of the Peruvian capital about COVID-19. MATERIALS AND METHODS: This analytical, observational, cross-sectional and prospective study evaluated 142 dental professionals from the Directorate of Integrated Health Networks (DIRIS) in the north of the Peruvian capital during June to August 2022. A validated questionnaire of 20 closed multiple-choice questions was used to measure the level of epidemiological, preventive and health care knowledge about COVID-19. A logit model was used to evaluate the influence of the following variables: age, sex, marital status, children, origin, university of origin, academic degree, work modality, work status and number of training courses. In addition, a predictive model was constructed with the causal variables considering a significance level of p < 0.05. RESULTS: Epidemiological, preventive and health care knowledge about COVID-19 was fair in 17.6%, 34.5% and 57.7%, respectively. Likewise, all the variables analyzed were influential factors. It was observed that being single (OR = 0.05, CI: 0.01-0.26), having studied at a private university (OR = 0.09, CI: 0.023-0.38) and having received four to six trainings on COVID-19 related topics (OR = 0.02, CI: 0.002-0.238) were protective factors against fair knowledge. CONCLUSIONS: More than half of the dentists surveyed had fair knowledge about COVID-19. The factors that favored a good level of overall knowledge were: being single, having studied at a private university and having received 4 to 6 training courses on COVID-19-related topics. It is advisable that the competent authorities continue to educate dental professionals with training programs about infection control practices in accordance with the health care work they perform in their specialty. It will also be of utmost importance for the professional to be updated with reliable information accredited by the Centers for Disease Control and Prevention as well as the WHO.

COVID-19 , Criança , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , SARS-CoV-2 , Estudos Transversais , Peru/epidemiologia , Estudos Prospectivos , Odontólogos , Inquéritos e Questionários , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde
Health Qual Life Outcomes ; 21(1): 1, 2023 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-36593473


BACKGROUND: Preference heterogeneity in health valuation has become a topic of greater discussion among health technology assessment agencies. To better understand heterogeneity within a national population, valuation studies may identify latent groups that place different absolute and relative importance (i.e., scale and taste parameters) on the attributes of health profiles. OBJECTIVE: Using discrete choice responses from a Peruvian valuation study, we estimated EQ-5D-5L values on a quality-adjusted life-year (QALY) scale accounting for latent heterogeneity in scale and taste, as well as controlling heteroskedasticity at task level variation. METHOD: We conducted a series of latent class analyses, each including the 20 main effects of the EQ-5D-5L and a power function that relaxes the constant proportionality assumption (i.e., discounting) between value and lifespan. Taste class membership was conditional on respondent-specific characteristics and their experience with the composite time trade-off (cTTO) tasks. Scale class membership was conditional on behavioral characteristics such as survey duration and self-stated difficulty level in understanding tasks. Each analysis allowed the scale factor to vary by task type and completion time (i.e., heteroskedasticity). RESULTS: The results indicated three taste classes: a quality-of-life oriented class (33.35%) that placed the highest value on levels of severity, a length-of-life oriented class (26.72%) that placed the highest value on lifespan, and a middle class (39.71%) with health attribute effects lower than the quality class and lifespan effect lower than the length-of-life oriented class. The EQ-5D-5L values ranged from - 2.11 to 0.86 (quality-of-life oriented class), from - 0.38 to 1.02 (middle class), and from 0.36 to 1.01 (length-of-life oriented class). The likelihood of being a member of the quality-of-life class was highly dependent on whether the respondent completed the cTTO tasks (p-value < 0.001), which indicated that the cTTO tasks might cause the Peru respondents to inflate the burden of health problems on a QALY scale compared to those who did not complete the cTTO tasks. The results also showed two scale classes as well as heteroskedasticity within each scale class. CONCLUSION: Accounting for taste and scale classes simultaneously improveds understanding of preference heterogeneity in health valuation. Future studies may confirm the differences in taste between classes in terms of the effect of quality of life and lifespan attributes. Furthermore, confirmatory evidence is needed on how behavioral variables captured within a study protocol may enhance analyses of preference heterogeneity.

Nível de Saúde , Qualidade de Vida , Humanos , Peru , Análise de Classes Latentes , Inquéritos e Questionários
Sci Rep ; 13(1): 1434, 2023 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-36697477


Exposure to traumatic experiences across lifespan shapes the functioning of the hypothalamic pituitary adrenal (HPA) axis and sets individuals at risk to develop symptoms of depression and anxiety. Particularly, HPA axis regulation and the psychological health of the expectant mother have been of interest, as the health of the unborn child may be affected through changes in gestational biology. The present study investigated the potential associations between lifetime trauma, current symptoms (depression and anxiety) and hair cortisol concentrations (HCC) in pregnant women. A total of 149 pregnant women were interviewed in public outpatient clinics with varying gestational age in Greece, Spain and Perú. Lifetime trauma exposure and current symptoms of depression and anxiety were assessed. HCC was measured in scalp-near hair segments (2 cm length) reflecting cumulative cortisol secretion of the past two months. Results showed that trauma load is negatively associated with HCC and higher symptoms of depression and anxiety. There was a negative association between HCC and symptoms. The present findings support the notion that cumulative trauma exposure exerts long-lasting effects on the expectant mother's HPA axis activity functioning and mental health and may thereby potentially create risk trajectories for the unborn child via changes in gestational biology.

Hidrocortisona , Gestantes , Humanos , Feminino , Gravidez , Depressão/psicologia , Sistema Hipotálamo-Hipofisário , Grécia/epidemiologia , Peru , Espanha/epidemiologia , Sistema Hipófise-Suprarrenal , Ansiedade , Cabelo , Estresse Psicológico/psicologia
Vector Borne Zoonotic Dis ; 23(1): 9-17, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36633562


Background: Bartonella species are fastidious gram-negative vector-borne bacteria with a wide range of mammalian reservoirs. While it is understood that some species of Bartonella are human pathogens, the extent of human exposure to Bartonella species (both pathogenic and nonpathogenic) is yet to be fully understood. Materials and Methods: To this end, residual sera from participants enrolled in undifferentiated fever studies in Cambodia, Ghana, Laos, and Peru were screened for the presence of IgG antibodies against Bartonella quintana and Bartonella henselae, using the FOCUS diagnostics Dual Spot- Bartonella IgG Immunofluorescence assay. Forty-eight patients with suspected or confirmed Bartonella bacilliformis exposure or infection in Peru were screened to assess cross-reactivity of the FOCUS assay for IgG against other Bartonella species. Results: Ten of 13 patients with confirmed B. bacilliformis infection were Bartonella-specific IgG positive, and overall, 36/48 of the samples were positive. In addition, 79/206, 44/200, 101/180, and 57/100 of the samples from Peru, Laos, Cambodia, and Ghana, respectively, were Bartonella-specific IgG positive. Furthermore, ectoparasite pools from Cambodia, Laos, and Peru were tested using quantitative real-time PCR (qPCR) for the presence of Bartonella DNA. Of the sand fly pools collected in Peru, 0/196 were qPCR positive; 15/140 flea pools collected in Cambodia were qPCR positive; while 0/105 ticks, 0/22 fleas, and 0/3 louse pools collected in Laos tested positive for Bartonella DNA. Conclusion: Evidence of Bartonella in fleas from Cambodia supports the possibility that humans are exposed to Bartonella through this traditional vector. However, Bartonella species were not found in fleas, ticks, or lice from Laos, or sand flies from Peru. This could account for the lower positive serology among the population in Laos and the strictly localized nature of B. bacilliformis infections in Peru. Human exposure to the Bartonella species and Bartonella as a human pathogen warrants further investigation.

Infecções por Bartonella , Bartonella , Infestações por Pulgas , Sifonápteros , Carrapatos , Humanos , Animais , Bartonella/genética , Infecções por Bartonella/epidemiologia , Infecções por Bartonella/microbiologia , Infecções por Bartonella/veterinária , Peru/epidemiologia , Laos/epidemiologia , Camboja/epidemiologia , Gana , Infestações por Pulgas/microbiologia , Infestações por Pulgas/veterinária , Sifonápteros/microbiologia , Carrapatos/microbiologia , Mamíferos
An. psicol ; 39(1): 39-50, Ene-Abr. 2023. tab, ilus, graf
Artigo em Inglês | IBECS | ID: ibc-213836


Antecedentes: La identificación de los motivos por los cuales se consume marihuana se ha visto apoyada por instrumentos como el MMM. A pesar de su importancia, aún no se cuenta con versiones breves válidas de este en países latinoamericanos. Este trabajo busca cubrir esta carencia aportando evidencia de validez y confiabilidad, así como la invarianza estructural del MMM. Método: La muestra comprende 1164 consumidores de marihuana, varones y mujeres, con edades entre 18 y 49 años, de Lima y Callao. Resultados: El análisis factorial halló una estructura pentafactorial. La versión breve (MMM-P15) y extensa (MMM) muestran favorables propiedades de estructura y consistencia interna (ꙍ> .88, H > .84) con adecuados índices de ajuste del instrumento corto (RMSEA = .058 [IC 90% .050, .067], SRMR = .044, GFI = .99, TLI = .99, CFI = .99). Asimismo, ambas versiones mantienen la invarianza según el sexo y se encontró evidencia de validez interna (AVE > .50) y con otros constructos (CAST y SWLS). Conclusiones: El MMM-P15 evidencia propiedades psicométricas que respaldan su uso tanto en hombres y mujeres consumidores de marihuana, además es un instrumento corto, versátil y útil para fines de investigación incluso en contextos clínicos.(AU9

Background: The identification of the reasons for marijuana use has been supported by instruments such as the MMM. Despite its importance, there are still no valid brief versions of this instrument in Latin American countries. This paper seeks to fill this gap by providing evidence of validity and reliability, as well as the structural invariance of the MMM. Method:The sample consisted of 1164 male and female marijuana users, aged between 18 and 49 years, from Lima and Callao. Results: The factor analysis found a pentafactorial structure. The brief version (MMM-P15) and the wide MMM showed favorable properties from structure and reliability (ꙍ> .88, H > .84) with appropriate indicators of the short instrument adjustment (RMSEA = .058 [CI 90% .050, .067], SRMR = .044,TLI = .99, CFI = .99). Likewise, both versions maintain the invariance of the instrument according to sex and evidence of internal validity was found (AVE > .50). Aside from bringing evidence of validity with other constructs like CAST and SWLS scale. Conclusions:The MMM-P15 shows psychometric properties that support its use in both male and female marijuana users, and it is a short, versatile, and useful instrument for research pur-poses even in clinical settings.(AU)

Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Cannabis , Fumar Maconha , Psicometria , Uso da Maconha/epidemiologia , Uso da Maconha/psicologia , Psicologia , Psicologia Clínica , Psicologia Social , Análise Fatorial , Peru
Cuad. psicol. deporte ; 23(1): 89-102, ene.-abr. 2023. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-214812


El presente estudio busca conocer cómo se experimenta el afrontamiento psicosocial en partidos internacionales en jugadoras de voleibol profesional de la selección peruana. Se utilizó una metodología cualitativa con diseño fenomenológico-hermenéutico. Se realizaron doce entrevistas semiestructuradas a jugadoras profesionales de voleibol pertenecientes a la selección femenina peruana en la categoría mayores. A partir del análisis se identificaron tres categorías, nueve subcategorías y siete códigos, que conforman las 189 unidades de análisis. Los resultados mostraron que las principales estrategias deafrontamiento utilizadas por las deportistas son el análisis lógico personal y del equipo contrario, el uso del esfuerzo, la búsqueda de apoyo profesional y las imágenes mentales. Se concluye que las jugadoras profesionales de voleibol en Perú utilizan principalmente el afrontamiento orientado a la tarea, realizando actividades que les permiten sentirse capaces y que desempeñan un papel esencial en la toma de decisiones durante las competiciones. (AU)

The present study seeks to know how psychosocial coping are experienced at international matches in professional volleyball players of the Peruvian national team. A qualitative methodology with phenomenological-hermeneutic design was used. Twelve semi-structured interviews were conducted with professional volleyball players belonging to the Peruvian women's team in the senior category. From the analysis, three categories, nine subcategories and seven codes were identified, which comprise the 189 units of analysis. The results showed that the main coping strategies used by the athletes are personal logical analysis and the analysis of the opposing team, the use of effort, the search for professional support and mental imagery. It is concluded that professional volleyball players in Peru mainly use task-oriented coping, carried out activities that allow them to feel capable and play an essential role in decision-making during competitions. (AU)

O objetivo deste estudo foi conhecer como é enfrentamento psicossocial se experimenta em partidas internacionais em jogadores profissionais de voleibol da seleção peruana. Para isso, foi realizada uma investigação qualitativa e seguindo o desenho da fenomenologia hermenêutica. Foram realizadas 12 entrevistas semiestruturadas com jogadoras profissionais de voleibol pertencentes à seleção feminina do Peru na categoria sênior. A partir da análise, foram identificadas três categorias, nove subcategorias e sete códigos, que compõem as 189 unidades de análise. Os resultados mostraram que as principais estratégias de enfrentamento utilizadas pelos atletas são a análise lógica pessoal e da equipe adversária, o uso de esforço, a busca de suporte profissional e a imagética mental. Conclui-se que os jogadores profissionais de voleibol do Peru utilizam principalmente estratégias de enfrentamento orientadas para a tarefa, realizam atividades que os permitem sentir-se capazes e desempenham um papel essencial na tomada de decisões durante as competições. (AU)

Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Adaptação Psicológica , Psicologia do Esporte , Voleibol , Atletas , Peru , Entrevistas como Assunto
Enferm. glob ; 22(69): 283-308, ene. 2023. tab
Artigo em Espanhol | IBECS | ID: ibc-214866


Introducción: La atención primaria es el pilar fundamental de un sistema de salud efectivo; el incumplimiento de los atributos esenciales podría contribuir al colapso de los sistemas de salud en eventuales pandemias. Objetivo: Evaluar el cumplimiento de los atributos de la atención primaria y sus factores asociados, según perspectiva del usuario externo en el contexto de la pandemia por COVID-19, en una región del Perú. Método: Estudio transversal, que incluyó 1064 usuarios externos, seleccionados aleatoriamente. Utilizando la Encuesta se recogieron características sociodemográficas y de salud. El cumplimiento de los atributos de la atención primaria fue valorado con la versión modificada del instrumento PCAT-A10. Se realizó un análisis descriptivo y multivariado mediante modelos lineales generalizados de la familia Poisson para evaluar ciertos factores asociados al incumplimiento de los atributos de la atención primaria. Resultados: De los participantes, el 76,6% perciben que los atributos básicos esenciales se incumplen; asimismo, en el primer contacto (74,7%), continuidad (87,8%), coordinación (95,7%), globalidad (88,3%) y competencia cultural (75,9%). La condición de estudiante (p<0,001), autopercepción de salud regular (p=0,010), adulto de 30 a 59 años (p<0,001) y la condición de usuarios del centro de salud Subtanjalla (p=0,001), Parcona (p<0,001) y Guadalupe (p<0,001), se encuentran asociados a mayor percepción de incumplimiento de los atributos de la atención primaria. Conclusiones: Desde la perspectiva de los usuarios externos los atributos esenciales son incumplidos en los centros de atención primaria; existen factores asociados a mayor probabilidad de percibir que estos atribuidos son incumplidos. (AU)

Introduction: Primary care attention is the fundamental pillar of an effective health system; a failure to comply with its essential attributes could contribute to the collapse of the health systems in the event of pandemics. Objective: To evaluate the compliance of the primary attention’s attributes and its associated factors, according to the external user’s perspective in the context of the COVID-19 pandemic in a Peruvian region. Method: Cross-sectional study, which included 1064 randomly selected external users. Also, the sociodemographic and health characteristics were collected using the survey. And the compliance of the primary care attributes was valued using the modified version of the PCAT-A10 instrument. Finally, a descriptive and multivariate analysis was performed using generalized linear models of the Poisson family to evaluate certain factors associated with noncompliance with the attributes of primary care. Results: 76.6% of the participants perceive that the essential basic attributes are not met; likewise, in the first contact (74.7%), continuity (87.7%), coordination (95.7%), globality (88.3%) and cultural competence (75.9%). The student condition (p<0,001), self-perception of regular health (p=0.010), adult from 30 to 59 years old (p<0.001), and the condition of users of Subtanjalla (p=0.001), Parcona (p<0.001) and Guadalupe (p<0.001) health centers were associated with a greater perception of non-compliance with the attributes of primary health care. Conclusions: From the external user’s perspective the essential attributes are met in primary care centers; there are factors associated with a greater probability of perceiving that these attributes are not met. (AU)

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Pandemias , Infecções por Coronavirus/epidemiologia , Atenção Primária à Saúde , Sistemas de Saúde , Estudos Transversais , Assistência Integral à Saúde , Peru
Enferm. glob ; 22(69): 309-322, ene. 2023. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-214867


Introducción: El modelo epidémico SIR es útil para medir la velocidad de propagación de las cepas COVID-19 (B.1.617.2/P.1/C.37/B.1.621), en términos de umbral epidemiológico R0 a lo largo del tiempo. Objetivo: Evaluar un modelo matemático de tipo diferencial, propio del comportamiento del COVID-19 para el colectivo peruano. Métodos: Se desarrolló un modelo matemático diferencial del comportamiento de la pandemia para el colectivo peruano, partiendo de la experiencia en el control de infecciones Kermack–McKendrick. Se estimó el número de susceptibles S, infectados y diseminando la infección I y recuperados R, con el uso de conjuntos de datos oficiales de la Organización Mundial de la Salud, partiendo del histórico entre el 07 de marzo y el 12 de septiembre de 2020 y; proyectado durante 52 semanas hasta el 11 de septiembre de 2021. Resultados: La menor tasa de infectados ocurrirá a partir del 3 de abril de 2021. Evidenciando un pronóstico de menor transmisibilidad para el 29 de mayo de 2021 con una tasa de infectados (β=0.08) y umbral (R0=0,000), además se cuantificó la exactitud del modelo en 97,795 %, con 2,205 % de error porcentual medio, siendo el valor promedio temporal R0 <1, así que cada persona que contrae la enfermedad infectará a menos de una persona antes de morir o recuperarse, por lo que el brote desaparecerá. Conclusión: La curva de contagios en el Perú dependerá directamente de las medidas de mitigación para frenar la propagación de la infección y predecir una transmisión sostenida a través de la vacunación contra las cepas tipo del COVID-19; con la observancia de las personas de las medidas preventivas. (AU)

Introduction: The SIR epidemic model is useful for measuring the rate of spread of COVID-19 strains (B.1.617.2/P.1/C.37/B.1.621), in terms of epidemiological threshold R0 over time. Objective: To evaluate a mathematical model of differential type, typical of the behavior of COVID-19 for the Peruvian collective. Methods: A differential mathematical model of the behavior of the pandemic was developed for the Peruvian collective, based on the experience in the control of Kermack–McKendrick infections. The number of susceptible S, infected and spreading infection I and recovered R was estimated, using official datasets from the World Health Organization, based on the history between March 7 and September 12, 2020 and; projected for 52 weeks until September 11, 2021. Results: The lowest rate of infections will occur from April 3, 2021. Evidencing a prognosis of lower transmissibility for May 29, 2021 with an infected rate (β=0.08) and threshold (R0=0.000), the accuracy of the model was also quantified at 97.795%, with 2.205% of average percentage error, with the temporary average value being R0 <1, so each person who contracts the disease will infect less than one person before dying or recovering, so the outbreak will disappear. Conclusion: The curve of infections in Peru will depend directly on mitigation measures to curb the spread of infection and predict sustained transmission through vaccination against covid-19 type strains; with the observance of people of preventive measures. (AU)

Humanos , Pandemias , Infecções por Coronavirus/epidemiologia , Peru , Surtos de Doenças
Artigo em Inglês | PAHO-IRIS | ID: phr-57050


[ABSTRACT]. The objective of this article was to consider the vaccination challenges in Colombia and Peru and the role of pediatric combination vaccines in overcoming these challenges. Barriers to including new vaccines with more antigens remain apparent in parts of these countries, where vaccine-preventable diseases in infants continue to be a major problem. The challenges include the heterogeneity of vaccine coverage within each country and in neighboring countries, which can contribute to poor rates of vaccination coverage; the adverse impact of the inward migration of unvaccinated individuals, which has favored the re-emergence of vaccine-preventable diseases; vaccine shortages; and the impact of the severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) pandemic and the associated shifts in health care resources. To improve the coverage of pediatric vaccines in Colombia and Peru, it will be necessary to ensure the widespread integration into vaccine sched- ules of combination vaccines containing diphtheria, tetanus, acellular pertussis, inactivated poliovirus, Haemophilus influenzae type b and hepatitis B antigens with a three-dose primary series delivered at 2, 4 and 6 months of age followed by a booster at 18 months of age. Such vaccines play important roles in preventing diphtheria, tetanus and pertussis; eradicating polio; and providing boosting against H. influenzae type b.

[RESUMEN]. El objetivo de este artículo es considerar los desafíos que se enfrentan en Colombia y Perú con respecto a la vacunación y el papel de las vacunas combinadas pediátricas para superar estos desafíos. Los obstáculos para incluir vacunas nuevas con más antígenos siguen siendo evidentes en algunos lugares de estos países, donde las enfermedades prevenibles por vacunación en menores de 1 año continúan siendo un grave pro- blema. Entre los desafíos se incluye la heterogeneidad de la cobertura de vacunación en cada país y en los países vecinos, lo que puede contribuir con que se registren tasas bajas de cobertura de vacunación; el impacto adverso de la migración interna de personas no vacunadas, lo que ha favorecido la reaparición de enfermedades prevenibles por vacunación; la escasez de vacunas, y el impacto de la pandemia del corona- virus de tipo 2 causante del síndrome respiratorio agudo grave (SARS-CoV-2) y los consiguientes cambios en los recursos de atención médica. Para mejorar la cobertura de las vacunas pediátricas en Colombia y Perú será necesario integrar de manera generalizada en los calendarios de vacunación vacunas combinadas con antígenos de difteria, tétanos, tos ferina acelular, poliovirus inactivados, Haemophilus influenzae tipo b y hepatitis B con una serie primaria de tres dosis administradas a los 2, 4 y 6 meses de edad, seguida de un refuerzo a los 18 meses de edad. Esas vacunas desempeñan un papel esencial en la prevención de la difteria, el tétanos y la tos ferina; la erradicación de la polio; y el refuerzo contra H. influenzae tipo b.

[RESUMO]. O objetivo deste artigo foi avaliar os desafios da vacinação na Colômbia e no Peru e o papel das vacinas pediátricas combinadas na superação de tais desafios. Os obstáculos para incluir novas vacinas com mais antígenos permanecem visíveis em partes desses países, onde doenças imunopreveníveis em lactentes con- tinuam a ser um grande problema. Os desafios incluem a heterogeneidade da cobertura vacinal dentro de cada país e nos países vizinhos, o que pode contribuir para baixas taxas de cobertura vacinal; o impacto adverso da migração interna de pessoas não vacinadas, o que favoreceu o ressurgimento de doenças imu- nopreveníveis; a escassez de vacinas; e o impacto da pandemia de síndrome respiratória aguda grave do coronavírus 2 (SARS-CoV-2) e mudanças relacionadas nos recursos de atenção à saúde. Para melhorar a cobertura das vacinas pediátricas na Colômbia e no Peru, será necessário assegurar sua integração gen- eralizada em esquemas de vacinas combinadas contendo antígenos de difteria, tétano, pertussis acelular, poliovírus inativado, Haemophilus influenzae tipo B e hepatite B, com uma série primária de três doses aplica- das aos 2, 4 e 6 meses de idade seguidas de um reforço aos 18 meses de idade. Tais vacinas desempenham papéis importantes na prevenção da difteria, tétano e coqueluche; na erradicação da poliomielite; e no reforço contra H. influenzae tipo b.

Vacinas Combinadas , Esquemas de Imunização , Vacinas , Doenças Preveníveis por Vacina , Colômbia , Peru , Vacinas Combinadas , Esquemas de Imunização , Vacinas , Doenças Preveníveis por Vacina , Peru , Vacinas Combinadas , Esquemas de Imunização , Vacinas , Doenças Preveníveis por Vacina , Colômbia
Medwave ; 23(1): e2634, 2023 Jan 10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-36652591


Chronic inflammatory demyelinating polyradiculoneuropathy is a clinically heterogeneous group of immune- mediated peripheral neuropathies that share neurophysiological manifesta-tions of demyelination and albuminocytologic dissociation. There are typical and atypical variants of this disease, some associated with antibodies against proteins of the node of Ranvier, such as neurofascin- 155. We present the case of a 38- year- old male who presented with an eight- month history of par-esthesia and progressive weakness of four limbs associated with diplopia and dysphagia. The patient was conscious, with symmetric flaccid quadriparesis of distal predominance, hyp-otrophy in the dorsum and palm of both hands, generalized areflexia, postural low frequency, and high amplitude tremor in upper limbs of left predominance, appendicular dysmetria, dys-diadochokinesia, ophthalmoparesis to dextroversion in the right eye, absent gag reflex, ataxic gait with an increased base of support and positive Romberg's sign. Cerebrospinal fluid showed albuminocytologic dissociation, and electromyography was com-patible with primarily demyelinating sensory- motor polyneuropathy. Due to clinical suspicion, we requested anti- neurofascin- 155 antibodies, which tested positive. The patient was treated with methylprednisolone at a dose of one gram per day for five days, followed by one milligram per kilogram for three months of prednisone, with progressive de-crease, which improved diplopia and dysphagia, with no effect on limb strength and even worsening of function. For this reason, treatment with rituximab was started in doses of two grams, presenting a substantial improvement in distal muscle strength, tremor, gait stability, coordination, and functionality measured with the modified Rankin scale.

La polirradiculoneuropatía desmielinizante inflamatoria crónica, es un grupo de neuro-patías periféricas inmunomediadas clínicamente heterogéneas que comparten manifes-taciones neurofisiológicas de desmielinización y disociación albuminocitológica. Se distinguen una forma típica y variantes atípicas, algunas asociadas a anticuerpos con-tra proteínas del nodo de Ranvier, como la neurofascina- 155. Presentamos el caso de un varón de 38 años, que acudió por cuadro de ocho meses de evolución, caracterizado por parestesias y debilidad progresiva de cuatro extremidades, asociado a diplopía y disfagia. El paciente estaba despierto, con cuadriparesia flácida simétrica de predominio distal, hipotrofia en dorso y palma de ambas manos, arreflexia generalizada, temblor postural de baja frecuencia y alta amplitud en miembros superiores de predominio izquierdo, dismetría apendicular, adiadococinesia, oftalmoparesia a la dextroversión en ojo dere-cho, reflejo nauseoso ausente, marcha atáxica con aumento de base de sustentación y signo de Romberg positivo. El líquido cefalorraquideo mostró disociación albuminocitológica y la electromiografía fue compatible con polineuropatía sensitivo- motora primariamente desmielinizante. Por la sospecha clínica, solicitamos anticuerpos antineurofascina- 155, que resultaron positivos. Recibió tratamiento con metilprednisolona a dosis de un gramo al día durante cinco días, seguido de un miligramo por kilogramo durante tres meses de prednisona, con disminución progresiva con lo que mejoró la diplopía y la disfagia, sin mejoría de la fuerza en extremidades e incluso empeoramiento de la funcionabilidad. Por esta razón se inició tratamiento con rituximab en dosis de dos gramos presentando una notable mejoría en la fuerza muscular distal, el temblor, la estabilidad de la marcha, coordinación y de su funcionabilidad medida con la escala de Rankin modificado.

Transtornos de Deglutição , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica , Humanos , Masculino , Adulto , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/tratamento farmacológico , Diplopia/complicações , Transtornos de Deglutição/complicações , Tremor/complicações , Peru
PeerJ ; 11: e14319, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36655048


Ichthyomyini, a morphologically distinctive group of Neotropical cricetid rodents, lacks an integrative study of its systematics and biogeography. Since this tribe is a crucial element of the Sigmodontinae, the most speciose subfamily of the Cricetidae, we conducted a study that includes most of its recognized diversity (five genera and 19 species distributed from southern Mexico to northern Bolivia). For this report we analyzed a combined matrix composed of four molecular markers (RBP3, GHR, RAG1, Cytb) and 56 morphological traits, the latter including 15 external, 14 cranial, 19 dental, five soft-anatomical and three postcranial features. A variety of results were obtained, some of which are inconsistent with the currently accepted classification and understanding of the tribe. Ichthyomyini is retrieved as monophyletic, and it is divided into two main clades that are here recognized as subtribes: one to contain the genus Anotomys and the other composed by the remaining genera. Neusticomys (as currently recognized) was found to consist of two well supported clades, one of which corresponds to the original concept of Daptomys. Accordingly, we propose the resurrection of the latter as a valid genus to include several species from low to middle elevations and restrict Neusticomys to several highland forms. Numerous other revisions are necessary to reconcile the alpha taxonomy of ichthyomyines with our phylogenetic results, including placement of the Cajas Plateau water rat (formerly Chibchanomys orcesi) in the genus Neusticomys (sensu stricto), and the recognition of at least two new species (one in Neusticomys, one in Daptomys). Additional work is necessary to confirm other unanticipated results, such as the non-monophyletic nature of Rheomys and the presence of a possible new genus and species from Peru. Our results also suggest that ichthyomyines are one of the main Andean radiations of sigmodontine cricetids, with an evolutionary history dating to the Late Miocene and subsequent cladogenesis during the Pleistocene.

Arvicolinae , Sigmodontinae , Animais , Filogenia , Evolução Biológica , Peru
Am J Primatol ; 85(2): e23464, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36642976


The Tropical Andes Biodiversity Hotspot holds a remarkable number of species at risk of extinction due to anthropogenic habitat loss, hunting, and climate change. One of these species, the critically endangered yellow-tailed woolly monkey (Lagothrix flavicauda), was recently observed in the region Junín, 206 km south of its previously known distribution. This range extension, combined with continued habitat loss, calls for a reevaluation of the species distribution, and available suitable habitat. Here, we present novel data from surveys at 53 sites in the regions of Junín, Cerro de Pasco, Ayacucho, and Cusco. We encountered L. flavicauda at 9 sites, all in Junín, and the congeneric Lagothrix lagotricha tschudii at 20 sites, but never in sympatry. Using these new localities along with all previous geographic localities for the species, we made predictive species distribution models based on ecological niche modeling using a generalized linear model and maximum entropy. Each model incorporated bioclimatic variables, forest cover, vegetation measurements, and elevation as predictor variables. The model evaluation showed >80% accuracy for all measures. Precipitation was the strongest predictor of species presence. Habitat suitability maps illustrate potential corridors for gene flow between the southern and northern populations, although much of this area is inhabited by L. l. tschudii whereas L. flavicauda has yet to be officially confirmed in these areas, by these or any other scientific surveys. An analysis of the current protected area (PA) network showed that ~75% of remaining suitable habitat is unprotected. With this, we suggest priority areas for new PAs or expansions to existing reserves that would conserve potential corridors between L. flavicauda populations. Further surveys and characterization of the distribution in intermediate areas, combined with studies on gene flow through these areas, are still needed to protect this species.

Atelinae , Ecossistema , Animais , Peru , Atelinae/genética , Florestas
Artigo em Inglês | MEDLINE | ID: mdl-36674168


The aim of this study was to determine the relationship between the altitude of residence and the low birth weight (LBW) of the children of pregnant Peruvian women using a nationally representative database. An analysis of individual-level data from the last 13 years (from 2009 to 2021) of the Demographic and Family Health Survey was performed. The outcome variable was LBW, defined as birth weight less than 2500 g, while the independent variable was the altitude of residence in meters above sea level (masl). To estimate the association between the two variables, the crude and adjusted generalized linear model of the Poisson family with a log link was used along with crude and adjusted prevalence ratios, which were estimated with their respective 95% confidence interval. A total of 151,873 women aged 15-49 years were included between 2009 and 2021. The pooled proportion of LBW was 7.0%. As the main finding, the children of mothers residing at an altitude from 2500 to 3499 masl and ≥3500 masl had a higher probability of LBW. It was found that the children of mothers residing at an altitude above 2500 masl were more likely to have LBW. Our results will help to strengthen the cultural practice of maternal health care and increase its coverage in women residing in high-altitude regions.

Altitude , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Humanos , Feminino , Criança , Peru/epidemiologia , Peso ao Nascer , Mães
BMC Oral Health ; 23(1): 51, 2023 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-36717821


BACKGROUND: Epilepsy is a chronic neurological disease that could indirectly affect oral health, and it is necessary for dentists to be familiar with the specific needs of patients with epilepsy. Therefore, aim of the present study was to assess the factors associated with the level of knowledge about management of epileptic patients in Peruvian dental students. METHODS: This analytical, observational, cross-sectional and prospective study assessed 312 dental students from a Peruvian university during February to April 2022. A validated questionnaire of 20 closed multiple-choice questions was used to measure the level of knowledge about dental management in epileptic patients. A logit model was used to assess the influence of variables: gender, age, year of study, marital status, place of origin and area of residence, with the level of knowledge in dental students considering a significance level of p < 0.05. RESULTS: Of the total, 28.8%, 36.2% and 34.9% had a poor, fair and good level of knowledge, respectively, about the dental treatment of epileptic patients. On the other hand, it was observed that being a woman (OR = 0.44, CI 0.26-0.75) and being a third year student (OR = 0.39, CI 0.21-0.74) and fourth year student (OR = 0.43, CI 0.23-0.89) constituted a protective factor against poor knowledge about the dental management of epileptic patients, while being from the capital city constituted a risk factor. Finally, age, marital status and the students' area of residence were not considered influential factors (p > 0.05). CONCLUSION: Most of the students showed a poor and fair level of knowledge about the dental management of epileptic patients, with gender, academic year and place of origin being influential factors. It is advisable that authorities and teachers in the dental profession organize recurrent training programs on the care of patients with chronic diseases requiring special attention, since knowing general concepts, pharmacological management and dental care of epileptic patients will allow future dentists to develop competencies to improve and implement good quality care protocols for this group of patients.

Epilepsia , Estudantes de Odontologia , Feminino , Humanos , Estudos Transversais , Epilepsia/terapia , Peru , Estudos Prospectivos , Fatores Sociodemográficos , Inquéritos e Questionários , Conhecimentos, Atitudes e Prática em Saúde
Medwave ; (23): e2575, 2023 Jan 18.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-36720108


Introduction: For the diagnosis of joint hypermobility, the Beighton test is commonly used; this requires a professional for the physical examination. The "Five- part questionnaire on hypermobility" is a self- administered tool that allows early identification of joint hypermobility. Objective: To carry out the cultural adaptation and test- retest reliability of the "Five- part questionnaire on hypermobility" to the Peruvian context through translation into spanish, linguistic adaptation, and verification of test- retest reliability in students from 13 to 17 years of age and teachers/ad-ministrators from 24 to 60 years of age. Methods: A translation and back- translation were performed with two translators and two back- translators, followed by a linguistic adaptation with ten experts. Once the adapted version of the question-naire was obtained, a comprehensibility analysis was carried out with 50 subjects. Finally, test- retest reliability was estimated in two groups: adolescents aged 13 to 17 and adults aged 24 to 60. Results: The translated version of the questionnaire was obtained and underwent a linguistic adaptation process in which ten experts performed a concordance analysis (Aiken's V coefficient = 1), and a comprehensibility analysis with a scale of zero to ten obtained an average of ten points. Subsequently, this version was back- translated and checked against the original. In the reliability analysis, the results of the test- retest application found high reliability between the total score of both applications for both the group of 65 adults (Kappa 0.795; 95% CI: 0.777 to 0.819) and the group of 71 adolescents (Kappa 0.946; 95% CI: 0.908 to 0.982). Conclusions: The translated instrument "Five- part questionnaire (5pq) on hypermobility" was adapted to the Peruvian cultural context, and high reliability was found for the study groups 13 to 17 years and 24 to 60 years. Concurrent validation is recommended to consider its application in clinical and research settings.

Introducción: Para el diagnóstico de hiperlaxitud articular se emplea comúnmente el Test de Beighton que requiere de un profesional para la exploración física. Por su parte, el instrumento es una herramienta autoadministrada que permite identificar de forma temprana la presencia de hiperlaxitud articular. Objetivos: Realizar la adaptación cultural y confiabilidad test-retest del instrumento The Five-part questionnaire on hypermobility al contexto peruano, por medio de la traducción al español, adaptación lingüística y verificación de la confiabilidad test--retest en estudiantes de 13 a 17 años y docentes/administrativos de 24 a 60 años. Métodos: Se realizó una traducción-retrotraducción con dos traductores, dos retrotraductores y la adaptación lingüística con 10 expertos. Obtenida la versión adaptada del cuestionario, se aplicó un análisis de comprensibilidad a 50 sujetos. Finalmente se estimó la confiabilidad test-retest en dos grupos: en adolescentes de 13 a 17 años y en adultos de 24 a 60 años. Resultados: Se obtuvo la versión traducida del cuestionario, el cual pasó por un proceso de adaptación lingüística donde 10 expertos realizaron un análisis de concordancia (Coeficiente V de Aiken = 1) y un análisis de comprensibilidad con una escala de 0 a 10 que obtuvo una media de 10 puntos. Posteriormente, esta versión fue retro traducida y cotejada con el original. En el análisis de confiabilidad, los resultados de la aplicación del test-retest encontraron una confiabilidad alta entre el puntaje total de ambas aplicaciones tanto para el grupo de 65 adultos (Kappa 0,795; intervalo de confianza al 95%: de 0,777 a 0,819) y el de 71 adolescentes (Kappa 0,946; intervalo de confianza al 95%: de 0,908 a 0,982). Conclusiones: Se adaptó el instrumento traducido cuestionario corto al contexto cultural de Perú y se encontró alta confiabilidad para los grupos de estudio de 13 a 17 años y de 24 a 60 años. Se recomienda la validación concurrente para considerar su aplicación en clínica y en investigación.

Instabilidade Articular , Adulto , Adolescente , Humanos , Adulto Jovem , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Peru , Inquéritos e Questionários , Traduções , Comparação Transcultural
J Neurol Sci ; 445: 120543, 2023 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-36634580


BACKGROUND: Previous studies have shown that multimorbidity is a risk factor for cognitive dysfunction (CD).Type 2 diabetes mellitus (T2DM) and hypertension (HT) are very common risk factors.The association between multimorbidity due to both diseases and CD has been understudied in low and middle-income countries, in which the strength of the association might be stronger. AIM: To evaluate the association between multimorbidity due to T2DM and HT with CD among adults ≥50 years in Tumbes. MATERIALS AND METHODS: A secondary analysis of a population-based cross-sectional study was conducted. The exposure variable was the presence of both T2DM and HT, split into categories: without HT or T2DM, only T2DM, only HT, and with T2DM and HT; whereas CD was the outcome variable, defined as a score ≤26 in the Leganes Cognitive Test. Crude and adjusted generalized linear models were used to estimate the association of interest, and prevalence ratio (PR) and 95% confidence interval (95%CI) were reported. RESULTS: 688 participants were analyzed. The prevalence of CD was 39.1%. There was a 56.1% of participants without TDM2 nor HT, 8.3% with T2DM, 28.9% with HT and 6.7% with both diseases. A significant association was found between multimorbidity and CD (PR = 1.43, 95%CI 1.04-1.97). Multimorbidity had a statistically significant association with CD in the group of participants with ≥7 years of education (PR = 2.56,95%CI 1.55-4.21), but no in the group with <7 years. CONCLUSIONS: There is association between the morbidity of T2DM and HT, and CD among adults ≥50 years of age in Tumbes. Education was an effect modifier of the association between HT and T2DM on the presence of CD.

Disfunção Cognitiva , Diabetes Mellitus Tipo 2 , Hipertensão , Adulto , Humanos , Diabetes Mellitus Tipo 2/epidemiologia , Multimorbidade , Peru/epidemiologia , Estudos Transversais , Hipertensão/epidemiologia , Prevalência , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia
PLoS One ; 18(1): e0280039, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36689405


We conducted research to understand online trade in jaguar parts and develop tools of utility for jaguars and other species. Our research took place to identify potential trade across 31 online platforms in Spanish, Portuguese, English, Dutch, French, Chinese, and Vietnamese. We identified 230 posts from between 2009 and 2019. We screened the images of animal parts shown in search results to verify if from jaguar; 71 posts on 12 different platforms in four languages were accompanied by images identified as definitely jaguar, including a total of 125 jaguar parts (50.7% posts in Spanish, 25.4% Portuguese, 22.5% Chinese and 1.4% French). Search effort varied among languages due to staff availability. Standardizing for effort across languages by dividing number of posts advertising jaguars by search time and number of individual searches completed via term/platform combinations changed the proportions the rankings of posts adjusted for effort were led by Portuguese, Chinese, and Spanish. Teeth were the most common part; 156 posts offered at least 367 teeth and from these, 95 were assessed as definitely jaguar; 71 of which could be linked to a location, with the majority offered for sale from Mexico, China, Bolivia, and Brazil (26.8, 25.4, 16.9, and 12.7% respectively). The second most traded item, skins and derivative items were only identified from Latin America: Brazil (7), followed by Peru (6), Bolivia (3), Mexico (2 and 1 skin piece), and Nicaragua and Venezuela (1 each). Whether by number of posts or pieces, the most commonly parts were: teeth, skins/pieces of skins, heads, and bodies. Our research took place within a longer-term project to assist law enforcement in host countries to better identify potential illegal trade and presents a snapshot of online jaguar trade and methods that also may have utility for many species traded online.

Panthera , Animais , Bolívia , Brasil , México , Peru , Conservação dos Recursos Naturais