Population, Epidemiological, and Functional Genetics of Gastric Cancer Candidate Genes in Peruvians with Predominant Amerindian Ancestry.

BACKGROUND: Gastric adenocarcinoma is associated with chronic infection by Helicobacter pylori and with the host inflammatory response triggered by it, with substantial inter-person variation in the immune response profile due to host genetic factors. AIM: To investigate the diversity of the proinflammatory genes IL8, its receptors and PTGS2 in Amerindians; to test whether candidate SNPs in these genes are associated with gastric cancer in an admixed population with high Amerindian ancestry from Lima, Peru; and to assess whether an IL8RB promoter-derived haplotype affects gene expression. METHODS: We performed a Sanger-resequencing population survey, a candidate-gene association study (220 cases, 288 controls) and meta-analyses. We also performed an in vitro validation by a reporter gene assay of IL8RB promoter. RESULTS: The diversity of the promoter of studied genes in Native Americans is similar to Europeans. Although an association between candidate SNPs and gastric cancer was not found in Peruvians, trend in our data is consistent with meta-analyses results that suggest PTGS2-rs689466-A is associated with H. pylori-associated gastric cancer in East Asia. IL8RB promoter-derived haplotype (rs3890158-A/rs4674258-T), common in Peruvians, was up-regulated by TNF-α unlike the ancestral haplotype (rs3890158-G/rs4674258-C). Bioinformatics analysis suggests that this effect stemmed from creation of a binding site for the FOXO3 transcription factor by rs3890158G>A. CONCLUSIONS: Our updated meta-analysis reinforces the role of PTGS2-rs689466-A in gastric cancer in Asians, although more studies that control for ancestry are necessary to clarify its role in Latin Americans. Finally, we suggest that IL8RB-rs3890158G>A is a cis-regulatory SNP.

Shoulder arthralgia: case study of the Occupational Medicine clinic of Universidade Estadual de Campinas (Unicamp).

Introduction: Shoulder pain is ranked as the third most common musculoskeletal complaint in clinical practice. It is estimated that 65 to 70% of these occurrences are due to rotator cuff injuries. A significant number of rotator cuff syndrome cases are work related. Objectives: To evaluate the success or failure of therapeutic and administrative procedures for workers treated at an occupational medicine outpatient clinic. Methods: This study analyzed the medical reports of 142 workers treated for shoulder pain between January 2015 and December 2019. To homogenize the information, medical record review was necessary in some cases. Results: Rotator cuff syndrome was diagnosed in 84% of the cases after imaging exams. Conservative treatment was recommended for 88% of these patients and 58% required subsequent surgical treatment. Regarding rehabilitation, 51% of the patients were able to return to work and 49% returned to the same job function. Conclusions: Diagnosing rotator cuff syndrome requires clinical and occupational history assessment, as well as imaging examinations, and the sensitivity and specificity of ultrasound were similar to magnetic resonance imaging. Removal from work and its risks must be an integral part of treatment. Upon returning to work, the rehabilitation and reintegration process should involve activities that will not worsen the injury.

Introdução: De acordo com a literatura médica, as dores nos ombros são a terceira queixa musculoesquelética mais comum observada na prática clínica. Calcula-se que 65 a 70% dessas ocorrências sejam causadas por lesões do manguito rotador. Um número significativo de casos da síndrome do manguito rotador está relacionado ao trabalho. Objetivos: Avaliar os diagnósticos dessa síndrome e os fatores de sucesso e insucesso nas condutas terapêuticas e administrativas de trabalhadores atendidos em um ambulatório de Medicina do Trabalho. Métodos: Este estudo analisou 142 relatórios médicos de trabalhadores com queixa de dores nos ombros atendidos no ambulatório de Medicina do Trabalho, de janeiro de 2015 a dezembro de 2019. Para homogeneizar as informações, em alguns casos, foi necessária a revisão do prontuário médico. Resultados: Após a realização de exames de imagem, 84% dos casos tiveram diagnóstico confirmado de síndrome do manguito rotador. Em 88% dos casos, foi indicado tratamento conservador, e parte destes (58%) evoluiu para tratamento cirúrgico. No processo de reabilitação, 51% dos pacientes foram reinseridos em atividade compatíveis e/ou readaptados ao trabalho e 49% não tiveram mudança de função. Conclusões: Além da história clínica e ocupacional, o exame de ultrassonografia teve sensibilidade e especificidade semelhantes à ressonância magnética para o diagnóstico de síndrome do manguito rotador. O afastamento do trabalho e dos fatores de risco ergonômicos devem ser parte integrante do tratamento da síndrome do manguito rotador. No retorno ao trabalho, o processo de reinserção e reabilitação precisa considerar a atividade compatível para não haver agravamentos das lesões.

Early detection of gastric cancer using global, genome-wide and IRF4, ELMO1, CLIP4 and MSC DNA methylation in endoscopic biopsies.

Clinically useful molecular tools to triage gastric cancer patients are not currently available. We aimed to develop a molecular tool to predict gastric cancer risk in endoscopy-driven biopsies obtained from high-risk gastric cancer clinics in low resource settings.We discovered and validated a DNA methylation biomarker panel in endoscopic samples obtained from 362 patients seen between 2004 and 2009 in three high-risk gastric cancer clinics in Lima, Perú, and validated it in 306 samples from the Cancer Genome Atlas project ("TCGA"). Global, epigenome wide and gene-specific DNA methylation analyses were used in a Phase I Biomarker Development Trial to identify a continuous biomarker panel that combines a Global DNA Methylation Index (GDMI) and promoter DNA methylation levels of IRF4, ELMO1, CLIP4 and MSC.We observed an inverse association between the GDMI and histological progression to gastric cancer, when comparing gastritis patients without metaplasia (mean = 5.74, 95% CI, 4.97-6.50), gastritis patients with metaplasia (mean = 4.81, 95% CI, 3.77-5.84), and gastric cancer cases (mean = 3.38, 95% CI, 2.82-3.94), respectively (p < 0.0001). Promoter methylation of IRF4 (p < 0.0001), ELMO1 (p < 0.0001), CLIP4 (p < 0.0001), and MSC (p < 0.0001), is also associated with increasing severity from gastritis with no metaplasia to gastritis with metaplasia and gastric cancer.Our findings suggest that IRF4, ELMO1, CLIP4 and MSC promoter methylation coupled with a GDMI>4 are useful molecular tools for gastric cancer risk stratification in endoscopic biopsies.

Delayed stress-induced antinociceptive effect of nitric oxide synthase inhibition in the dentate gyrus of rats.

Stimulation of the hippocampal formation can modulate nociceptive mechanisms, whereas painful stimuli can activate this structure. Stress exposure can produce plastic changes in the hippocampus. Nitric oxide (NO) is an important neuroregulatory agent present in the hippocampus. The objective of the present study was to investigate the effects of intrahippocampal administration of N(omega)-nitro-L-arginine methyl ester hydrochloride (L-NAME), an inhibitor of NO synthase (NOS), on nociceptive processes in stressed and nonstressed rats. Male Wistar rats (n=6-11/group) received unilateral microinjection of L-NAME (50-300 nmol/0.2 microl) into the dentate gyrus (DG) of the dorsal hippocampus. Immediately after the injection tail-flick reflex latency was measured. Stressed animals were submitted to 2 h of restraint and tested immediately or 1, 2, 5 or 10 days later. L-NAME failed to modify nociception in nonstressed rats. However, 5 days after, restraint L-NAME, at all doses tested, produced an antinociceptive effect (ANOVA, P<.05). The dose-response curve had an inverted U shape. L-NAME antinociceptive effect was antagonized by previous treatment with L-arginine (150 nmol/0.2 microl, P<.05). The results suggest that the modulation of nociceptive processes by NO in the dorsal hippocampus is dependent on previous stress exposure and on poststress interval.

Socioeconomic and nutritional factors account for the association of gastric cancer with Amerindian ancestry in a Latin American admixed population.

Gastric cancer is one of the most lethal types of cancer and its incidence varies worldwide, with the Andean region of South America showing high incidence rates. We evaluated the genetic structure of the population from Lima (Peru) and performed a case-control genetic association study to test the contribution of African, European, or Native American ancestry to risk for gastric cancer, controlling for the effect of non-genetic factors. A wide set of socioeconomic, dietary, and clinic information was collected for each participant in the study and ancestry was estimated based on 103 ancestry informative markers. Although the urban population from Lima is usually considered as mestizo (i.e., admixed from Africans, Europeans, and Native Americans), we observed a high fraction of Native American ancestry (78.4% for the cases and 74.6% for the controls) and a very low African ancestry (<5%). We determined that higher Native American individual ancestry is associated with gastric cancer, but socioeconomic factors associated both with gastric cancer and Native American ethnicity account for this association. Therefore, the high incidence of gastric cancer in Peru does not seem to be related to susceptibility alleles common in this population. Instead, our result suggests a predominant role for ethnic-associated socioeconomic factors and disparities in access to health services. Since Native Americans are a neglected group in genomic studies, we suggest that the population from Lima and other large cities from Western South America with high Native American ancestry background may be convenient targets for epidemiological studies focused on this ethnic group.

Assessment of gait dynamics in rats submitted to limb ischemia.

PURPOSE: To describe a method for the assessment of gait dynamics in rats submitted to limb ischemia. METHODS: Twenty-four male Wistar rats (150-160g) were used. Twelve animals were submitted to limb ischemia by ligation of the common left iliac artery (ischemic group: n = 12); and a sham-operated group was used as control (n=12). After a recovery period of 6 weeks, gait dynamics was assessed by counting the complete footprints and the number of hindlimb-floor contacts during a treadmill test for five minutes at a speed of 12 m.min(-1) and angulation of 15°. The number of contacts of the left hindlimb was divided by the right hindlimb values (LRR) for group comparisons. Ischemic disability was quantified by comparing the area under curve (AUC) created by plotting each contact versus time for each hindlimb. The left hindlimb ischemic disability index (LHDI), which was compared between groups, was defined by the formula: LHDI = (1- AUC (left) / AUC (right)) x 100. RESULTS: Surgery was well tolerated by all animals. Rats did not suffer tissue loss or ulcerations. Complete footprint LRR was 0.3 ± 0.08 for the ischemic group and 1.3 ± 0.9 for controls (p=0.0043). Number of contacts LLR was 0.5 ± 0.2 for the ischemic group and 1.0 ± 0.1 for the control group (p=0.0051). LHDI was 56.83 ± 10.67 for the ischemic group and 2.50 ± 13.10 for the control group (P = 0.031). CONCLUSION: Assessment of gait dynamics in rats submitted to limb ischemia could be done by footprint analysis and hindlimb contact recording during a treadmill test.

Assessment of gait dynamics in rats submitted to limb ischemia / Avaliação da dinâmica da marcha em ratos submetidos à isquemia de membro

PURPOSE: To describe a method for the assessment of gait dynamics in rats submitted to limb ischemia. METHODS: Twenty-four male Wistar rats (150-160g) were used. Twelve animals were submitted to limb ischemia by ligation of the common left iliac artery (ischemic group: n = 12); and a sham-operated group was used as control (n=12). After a recovery period of 6 weeks, gait dynamics was assessed by counting the complete footprints and the number of hindlimb-floor contacts during a treadmill test for five minutes at a speed of 12 m.min-1 and angulation of 15°. The number of contacts of the left hindlimb was divided by the right hindlimb values (LRR) for group comparisons. Ischemic disability was quantified by comparing the area under curve (AUC) created by plotting each contact versus time for each hindlimb. The left hindlimb ischemic disability index (LHDI), which was compared between groups, was defined by the formula: LHDI = (1- AUC left / AUC right) x 100. RESULTS: Surgery was well tolerated by all animals. Rats did not suffer tissue loss or ulcerations. Complete footprint LRR was 0.3 ± 0.08 for the ischemic group and 1.3 ± 0.9 for controls (p=0.0043). Number of contacts LLR was 0.5 ± 0.2 for the ischemic group and 1.0 ± 0.1 for the control group (p=0.0051). LHDI was 56.83 ± 10.67 for the ischemic group and 2.50 ± 13.10 for the control group (P = 0.031). CONCLUSION: Assessment of gait dynamics in rats submitted to limb ischemia could be done by footprint analysis and hindlimb contact recording during a treadmill test.

OBJETIVO: Descrever um método para avaliar a dinâmica da marcha em ratos submetidos à isquemia de membro pélvico. MÉTODOS: Vinte e quatro ratos Wistar machos (150-160g) foram utilizados neste estudo experimental. Doze animais foram submetidos à isquemia de membro pélvico por meio da ligadura da artéria ilíaca comum esquerda (grupo isquêmico: n=12); e doze animais foram submetidos à cirurgia simulada e usados como controle (grupo controle: n=12). Após seis semanas de recuperação, foi realizada avaliação da dinâmica da marcha por meio da contagem de impressões plantares e da contagem de contatos pata-solo durante teste com esteira durante cinco minutos, velocidade 12 m.min-1 e angulação de 15°. Os valores do número de contatos do membro pélvico esquerdo foram divididos pelos do membro pélvico direito (razão esquerda-direita - LRR) para comparação entre os grupos. A quantificação da incapacitação isquêmica foi feita comparando a área sob a curva (AUC) da representação gráfica dos contatos versus tempo para cada membro pélvico. O índice de incapacitação isquêmica do membro pélvico esquerdo (LHDI), que foi comparado entre os grupos, foi definido pela fórmula: LHDI = (1- AUC esquerda / AUC direito) x 100. RESULTADOS: A cirurgia foi bem tolerada por todos os animais. Nenhum rato apresentou necrose tecidual ou ulceração. A LRR das impressões plantares completas foi 0,3 ± 0,08 no grupo isquêmico e 1,3 ± 0,9 no grupo controle (p=0,0043). A LRR do número de contatos foi 0,5 ± 0,2 no grupo isquêmico e 1,0 ± 0,1 no grupo controle (p=0,0051). O LHDI foi 56,83 ± 10,67 no grupo isquêmico e 2,50 ± 13,10 no grupo controle (p=0,031). CONCLUSÃO: Avaliação da dinâmica da marcha em ratos submetidos à isquemia de membro pélvico pôde ser feita por meio da contagem de impressões plantares e da contagem de contatos pata-solo durante teste com esteira.

[Serologic prevalence of HCV antibodies in health personnel in Peru]. / Prevalencia serológica de anticuerpos al virus de la hepatitis c en personal de salud en el Perú.

In Peru, new cases of asymptomatic HCV infection are reported with certain frequency in patients with or without antecedents of blood transfusion. Although serologic screening has improved notoriously in the last years, there is still a population of polytransfused patients with high HCV risk (e.g. hemodialyzed patients), making up a major reservoir. Based on this premise, we decided to study the risk of the health worker population in Peru as another major HCV risk group. A total of 2,769 health workers from 7 Public Hospitals and 2 Private Hospitals in the City of Lima and from 7 Public Hospitals in 4 major/main cities of Peru (Chiclayo, Trujillo, Arequipa, and Cusco) were studied. All those workers, who due to their area of work had higher contact with blood and/or blood derivatives (Surgery, ICU, Traumatology, Gynecology, Gastroenterology, Hemodialysis and Laboratories-Blood Banks) were studied. The studied population accounts for 30% of the total health worker population in these services. All serums underwent the EIA-3 test (HCV-Cobas-Core, Lab. Roche, USA). The positive results were confirmed by RT-HCV (Ampiclor, Roche). The positive serums were confirmed by PCR and the positive results with high viral load underwent HCV genotyping (AMPICLOR-Roche Diagnostic, IGEN Diagnostic USA). Of the 2,769 health workers studied in Peru, 32 were positive for HCV antibodies (1.16% of the total number). Lima showed a prevalence slightly higher than the provinces: 26 out of 2,112 vs. 6 out of 657, or 1.23% vs. 0.91%, respectively. The higher risk is assumed by professional with higher level of contact with blood: 2 physicians (Hemodialysis), 5 nurses (HD) and Lab-Blood Bank technicians. The physicians and nurses share the same risk. If we segregate Lima from provinces, it can be seen that the highest risk is in Lima (1.34% compared to 1.07% in provinces). There is a major risk in health workers and the figures are slightly above those that were suspected for Peru (between 0.4 and 1.0). Finally, we can conclude that the group with the highest HCV risk among health workers is the group specialized in hemodialysis, followed by laboratory (1.79%), surgery (1.40%), and gastroenterology (0.8%). This is the first report at national level of HCV sero-prevalence in Peru.

Descripción de las causas conocidas de mortalidad en pacientes pediátricos de la Unidad de Cuidados Intensivos del Instituto Nacional de Salud del Niño / Description of the known causes of mortality in the pediatric intensive care unit at the National Institute of Child Health

La falta de información respecto a las características propias de la mortalidad en UCIP no permite una apreciación de las causas ya conocidas, e impide realizar comparaciones clínicas o epidemiológicas de las patologías presentadas con otros servicios pediátricos. El objetivo fue describir las causas conocidas de mortalidad en el servicio de UCIP del INSN. El trabajo de investigación fue de tipo retrospectivo, transversal, descriptivo y observacional, La muestra la conformaron los pacientes fallecidos en el servicio de UCIP del INSN de enero a julio del 2010. Se tuvo como criterio de inclusión: pacientes hospitalizados y fallecidos en la UCIP del INSN de enero a julio del 2010. Se extrajeron los datos en fichas de recolección. La tasa de mortalidad hallada fue de 26 por cada 100 pacientes hospitalizados en UCIP. De los pacientes fallecidos se vio que existía igual proporción en ambos sexos. La edad media fue de 46,95 meses, aproximadamente 4 años. Se agrupó la muestra según grupos etarios, existiendo en mayor proporción los lactantes (36 por ciento) y preescolares (28 por ciento). En las causas básicas de fallecimiento se encontró a la neumonía (14 por ciento) y cardiopatías congénitas (12 por ciento). Dentro de las causas terminales de fallecimiento resaltó el shock séptico (62 por ciento), seguido de la insuficiencia respiratoria aguda con un 14 por ciento y la FOMS con un 10 por ciento

The lack of information regarding the characteristics of mortality in the ICU does not allow an assessment of the known causes of mortality and, just as preventing clinical or epidemiological comparisons with other pediatric services. The aim was to describe the known causes of death in the ICU in the INSN. The research was retrospective, transversal, descriptive and observational. The sample consisted of patients who died in the service of ICU of the INSN from January to July of 2010. Were taken as inclusion criteria: patients admitted and died in the ICU of the INSN from the January to July of 2010. Data were extracted in collection sheets. The mortality were around 26 per 100 patients hospitalized at UCIP from the deceased patients were similar proportions between both sex. The average age was 46,95 months, approximately 4 years. The sample was grouped according to age groups, existing in major proportion the breast-fed babies (36 per cent) and pre-school (28 per cent). Between the basic reasons of death there were pneumonia (14 per cent) and congenital cardiopathies (12 per cent). Inside the terminal reasons of death it highlighted glaringly the septic shock with a percentage of 62 per cent, followed by the respiratory sharp insufficiency with 14 per cent and the FOMS with 10 per cent

¿Son necesarios los granulomas para el diagnóstico definitivo de enfermedad de Crohn? / Are the granulomas necessary for a final diagnosis of Crohn disease?

Se presenta el caso de un paciente varón de 38 años, natural y procedente de Lima, con un tiempo de enfermedad de 3 años, caracterizado por dolor abdominal, diarrea, baja ponderal y fiebre. Se le practica una colonoscopia, siendo el diagnóstico endoscópico cáncer de colon por lo que es operado. El diagnóstico histopatológico concluyó severa ileocolitis aguda y crónica ulcerada, segestiva de enfermedad de Crohn. Un mes después vuelve a presentar dolor abdominal, diarrea y fiebre, por lo que se realiza otra colonoscopia consistente con enfermedad de Crohn: úlceras múltiples en ileon y área anastomótica. La biopsia reveló proceso inflamatorio agudo y crónico . Se realizó también estudio radiográfico de colon, el que demostró defecto de relleno e irregularidad en ciego. En la endoscopia alta se encontraron úlceras esofágicas. Además se realizaron coprocultivo, VIH, y BK en esputo y heces, y dosaje de CEA, siendo los resultados negativos; asimismo la radiografía de tórax normal fue normal. El diagnóstico se define como enfermedad de Crohn y se da tratamiento con mesalacina, siendo la evolución favorable, aumenta de peso y sale de alta 7 días después. La anatomía patológica nunca confirmó el diagnóstico, por ello se plantea la pregunta: ¿siempre es necesario los granulomas para el diagnóstico definitivo de enfermedad de Crohn?.

Síndrome de inmunodeficiencia adquirida (SIDA): predominancia de las manifestaciones digestivas en su perfil clínico de presentación en Lima / Adquired immunodeficiency syndrome (AIDS): digestive manifestations dominance in its clinical profile of presentation in Lima, PE

Se estudian nueve casos de Síndrome de Inmunodeficiencia Adquirida (SIDA), en el Hospital Nacional "Edgardo Rebagliati Martins" - Instituto Peruano de Seguridad Social de Lima-Perú, observados en el curso de los últimos veintiocho meses y que cumplen con los requisitos propuestos por el "Center for Disease Control" (CDC) de Atlanta. Ocho pacientes (89%) fueron homosexuales, los cuales referían contacto íntimo con extranjeros: en USA (dos) y en Lima (seis). La única mujer tenía el antecedente de múltiples transfusiones hace tres años en un hospital de París (Francia). La edad promedio fué de 39 años y el tiempo de enfermedad promedio fué de 8 meses. La mayoría se presentó con: diarrea crónica (100%), baja de peso (100%), síndrome general (100%), fiebre (77%), muguet oral (78%) y molestias proctológicas (45%). Los exámenes auxiliares mostraron anemia (78%), velocidad de sedimentación incrementada (100%), hipoalbuminemia (78%), linfopenia periférica (100%) y definida anergia cutánea (100%). El estudio de las subpoblaciones de linfocitos T (OKT4 y OKT8) se encontró alterado en 9/9 (100%), lo que demostró la severa depresión de la inmunidad celular; la detección de anticuerpos contra el Virus de la Inmunodeficiencia humana (HIV) 9/9 (100%) y la prueba de Western blot positiva 6/6 (100%) fueron diagnósticas. Candidiasis oral y/o esofágica presentaron 78%; infecciones intestinales severas y recurrentes con enteropatógenos "clasicos" en nuestro medio (Salmonella, Shigella, E. coli, etc.) 56%; infestación recurrente con Giardia lamblia 33%; un paciente presentó meningitis por Cryptococcus neoformans, que luego se diseminó, el mismo paciente fué atacado sistémicamente por el Citomegalovirus (CMV); otro paciente mostró evidencias de CMV en orina y títulos diagnósticos de actividad de este virus en sangre...

Prevalencia serológica de anticuerpos al virus de la Hepatitis C en personal de salud en el Perú / Serologic prevalence of HCV antiobodies in health personnel in Peru

En el Perú se reporta con cierta frecuencia nuevos casos de Hepatitis Viral C (HVC) asintomática en pacientes con o sin antecedentes de transfusión. Sin embargo a pesar que en los últimos años, los despistajes serológicos han mejorado notablemente, aún persiste una población de politransfundidos con alto riesgo de HCV (hemodializados (HD) por ejemplo), representando un importante reservorio. Partiendo de esta premisa es que decidimos estudiar cuál es el riesgo que tiene la población de trabajadores de salud (TS) en el Perú como otro importante grupo de riesgo a la infección por por HCV. Se estudió 2,769 TS de 8 Hospitales Generales y 2 Clínicas privadas de la ciudad de Lima y de 7 Hospitales generales de cuatro ciudades importantes del Perú (Chiclayo, Trujillo, Arequipa y Cusco). Se estudió a todos aquellos trabajadores que por su especialidad, tienen mayor contacto con sangre y/o derivados (Cirugía, UCI, Traumatología, Ginecología, Gastroenterología, Hemodiálisis y Laboratorio-Banco de sangre BS). La población estudiada corresponde a 30 por ciento de los TS total de los servicios. Todos los sueros fueron procesados por el test EIA-3 (HCV-Cobas-Core, Lab. Roche, USA) los positivos fueron confirmados por RT-HCV (Amplicor-Roche) : los sueros positivos fueron confirmados por PCR y los positivos con carga viral alta se les hizo genotipaje HCV (Amplicor-Roche Diagnostic, IGEN Diagnostic USA). De los 2,769 trabajadores de salud estudiados en el Perú, 32 fueron positivos para anticuerpos HCV (1.16 por ciento del total). Lima presentó una prevalencia ligeramente mayor que los de provincia: 26 de 2,112 vs 6 de 657 ó 1.23 por ciento vs 0.91 por ciento respectivamente. El mayor riesgo lo tienen los profesionales con mayor contacto con sangre: 2 Médicos de HD, 5 enfermeras de HD y 3 técnicos de laboratorio-BS. Los médicos y las enfermeras comparten el mismo riesgo. Si separamos provincias de Lima, vemos que el mayor riesgo lo tienen ésta última (1.34 por ciento contra 1.07 por ciento en provincias). Existe un riesgo importante en trabajadores de salud y las cifras están ligeramente más elevadas de los valores que se sospechaban en el Perú (entre e. 0.4 y 1.0). Finalmente, podemos concluir que el grupo de mayor riesgo de HCV en trabajadores de salud (TS) están en el personal de hemodiálisis (3.1 por ciento), le siguen los de laboratorio (1.79 por ciento), el de cirugía (1.40 por ciento) y gastroenterología (0.8 por ciento).