Revista Peruana de Medicina de Experimental y Salud Publica最新文献

Background: Motivation for the study. In 2024, the World Health Organization modified the cut-off points that define anemia. The magnitude of the change in the prevalence of anemia in children aged 6-35 months in Peru, compared to the 2001 guideline, is unknown. Main findings. Between 2009 and 2023, we found significant and heterogeneous differences (a) nationally, (b) between and within regions, and (c) depending on the calculation technique (table or equation). Implications. The rationale for the 2024 guideline, while much better than that for the 2001 guideline, is not sufficient. The new guideline should be adopted with caution, both in individual care and population-related decisions.

Objectives.: To compare annual national and regional prevalence rates of anemia, using the 2001 guideline versus the new 2024 guideline in children aged 6 to 35 months residing in Peru between 2009 and 2023. To assess whether differences exist between guidelines vary by region, setting, or year.

Materials and methods.: Secondary analysis of the Demographic and Family Health Survey (continuous national random sample, stratified and clustered). Hemoglobin was measured in capillary blood using Hemocue. We applied an equation (and/or table) for altitude adjustment and a cutoff point for each guideline. We calculated 95% confidence intervals [95% CI]. Differences were evaluated according to region, setting, and/or year using a generalized linear model, calculating extremes and quartiles. Estimates and models were weighted.

Results.: We analyzed 120,711 children. The difference in prevalence was -6.3 [-6.6 to -6.0], p<0.001, varying by region (p<0.001), region-year (p=0.004), and region-setting (p<0.001), between -40.6 and 11.0. The percentage of children whose diagnosis differed was 11.0 [10.7 to 11.2], (p<0.001), varying between 0.0 and 40.6. The difference between the table and the equation was -3.8 [-4.0 to -3.6].

Conclusions.: The prevalence differs with the new guideline (generally decreasing, but may increase), with variable differences according to region, setting, and year. The percentage with a different diagnosis also varies. These differences are of great importance for health, in some cases changing the problem from severe to moderate. The table calculation underestimates the equation calculation. Literature supports the direction of the correction, but not its magnitude.

Background: Motivation for the study. In 2024, the World Health Organization modified the cut-off points that define anemia. The magnitude of the change in the prevalence of anemia in children aged 6-35 months in Peru, compared to the 2001 guideline, is unknown. Main findings. Between 2009 and 2023, we found significant and heterogeneous differences (a) nationally, (b) between and within regions, and (c) depending on the calculation technique (table or e

Background: Motivation for the study. Despite progress in tobacco control, the economic and disease burden in Peru remains high. Strengthening smoke-free regulations, implementing plain packaging, banning tobacco promotion and sponsorship, and increasing taxes could reduce it. Main findings. Tobacco use causes 22,350 deaths and 126,000 disease events annually in Peru, resulting in a loss of 1.28% of GDP. Strengthening tobacco control policies would prevent thousands of deaths and save billions in costs. Implications. Stricter tobacco control policies can reduce the health and economic costs associated with smoking for the advancement of public health and economic sustainability in Peru.

Objectives.: To estimate the economic burden and disease burden associated with tobacco use in Peru and the projected effect of strengthening specific tobacco control measures.

Materials and methods.: We used a Markov microsimulation model to assess smoking-attributable mortality, disease events, economic costs, and projected benefits over ten years, considering the implementation of measures such as plain packaging, full enforcement of smoke-free laws, a complete ban on tobacco advertising, promotion, and sponsorship, and increased cigarette taxes.

Results.: Each year in Peru, approximately 22,350 deaths and 126,000 disease events are attributable to tobacco use, accounting for 19% of all deaths from heart disease, 18% of deaths from stroke, and 515,768 years of life lost. In addition, approximately 1.28% of gross domestic product is lost annually due to smoking. Over ten years, the implementation of plain packaging could prevent 6,218 deaths, 31,700 events, and save 576 million USD. Full compliance with smoke-free places would prevent 4,982 deaths, 25,400 events, and save 461 million USD. Banning advertising, promotion, and sponsorship could prevent 8,767 deaths, 44,700 events, and save 812 million USD. Increasing cigarette prices by 50% could prevent 20,400 deaths, 658,400 healthy life years lost, and an economic benefit of more than 3.3 billion USD.

Conclusions.: The economic and disease burden of tobacco use in Peru is significant. Greater efforts to control tobacco would significantly reduce this burden.

Background: Motivation for the study. Despite progress in tobacco control, the economic and disease burden in Peru remains high. Strengthening smoke-free regulations, implementing plain packaging, banning tobacco promotion and sponsorship, and increasing taxes could reduce it. Main findings. Tobacco use causes 22,350 deaths and 126,000 disease events annually in Peru, resulting in a loss of 1.28% of GDP. Strengthening tobacco control policies would prevent thousands of deaths and save billions in costs. Implications. Stricter tobacco control policies can reduce the health and economic costs associated with smoking for the adv

Systemic mycoses, such as cryptococcosis, mainly affect the lungs and central nervous system; however, involvement of other organs, such as the adrenal glands, is rare. This has been described in some cases of primary adrenal insufficiency (PAI) of fungal origin, which are associated with high mortality. We present the case of a 65-year-old immunocompetent man who presented clinical manifestations of adrenal insufficiency. Biochemical tests confirmed PAI, and abdominal tomography revealed hyperplasia of both adrenal glands, predominantly on the left side. Left adrenalectomy was performed, and pathological examination identified granulomas and fungal structures compatible with Cryptococcus spp. The patient received hormone replacement therapy and antifungal treatment, with favorable outcome. Cryptococcal adrenalitis should be considered in the differential diagnosis of PAI, particularly in the presence of relevant epidemiological history, and timely treatment is key to improving prognosis.

Background: Motivation for the study. To contribute to the genomic surveillance of UPEC in clinical samples from Latin America, in response to the growing public health problem represented by UTIs and their resistance to antimicrobials. Main findings. Our study revealed a high frequency of high-risk clones, such as ST131 and ST1193. Critical mutations were identified in genes associated with resistance to multiple antibiotics, including fluoroquinolones, beta-lactams, and fosfomycin. Implications. Our results highlight the urgent need to strengthen UPEC surveillance in Latin America. Tracking resistant strains and implementing measures to limit their spread is crucial and has a significant impact on the effectiveness of available treatments.

Objective.: To genetically characterize clinical isolates of uropathogenic Escherichia coli (UPEC) from hospitals in Peru and contextualize them against 127 additional UPEC genomes reported in six Latin American countries between 2018 and 2023.

Materials and methods.: The genomes of 16 Peruvian UPEC isolates were sequenced, assembled and supplemented with 127 genomes available in the NCBI public database. Serotypes, sequence types (STs), antimicrobial resistance (AMR) genes, and resistance-associated mutations were identified. A phylogenetic analysis was also conducted in order to determine evolutionary relations and distribution in phylogroups.

Results.: The ST131 clone was the most prevalent (42.7%), followed by ST1193 (13.3%). Phylogroup B2 was widely predominant (83.2%), with serotype O25:H4 standing out. The resistance genes blaTEM-1, blaCTX-M-15, and blaCTX-M-27 were identified with high frequency, as well as mutations in gyrA and parC associated with fluoroquinolone resistance, especially in the ST131 clone.

Conclusion.: Our findings show high circulation of high-risk UPEC clones, such as ST131 and ST1193, in Latin America, along with a notable burden of genes and mutations linked to multidrug resistance, highlighting the need to strengthen regional genomic surveillance.

Background: Motivation for the study. To contribute to the genomic surveillance of UPEC in clinical samples from Latin America, in response to the growing public health problem represented by UTIs and their resistance to antimicrobials. Main findings. Our study revealed a high frequency of high-risk clones, such as ST131 and ST1193. Critical mutations were identified in genes associated with resistance to multiple antibiotics, including fluoroquinolones, beta-lactams, and fosfomycin. Implications. Our results highlight the urgent need to strengthen UPEC surveillance in Latin America. Tracking resistant strains and implementing measures to limit their spread is crucial and has a significant impact on the effectiveness of available treatments.

Background: Motivation for the study. There is little information on the microbiota found in the colostrum of women living in the Colombian Caribbean. Identifying and isolating microorganisms in this fluid is of interest to both medicine and industry. Main findings. The dominant bacterial genera found in colostrum were Staphylococcus, Lactobacillus, and Enterococcus. Microorganisms with probiotic potential were isolated and should be studied in greater detail. Public health implications. Understanding the microbiota found in colostrum allows us to understand its contribution to infant health and develop strategies to enhance the beneficial impact of these microorganisms on their development.

Background: With the aim of isolating and identifying bacteria present in the colostrum of women in the city of Barranquilla, located in the Colombian Caribbean, we carried out a descriptive study on 55 colostrum samples, which were cultured on M17, MRS, and TOS agar and incubated under aerobic and anaerobic conditions. A total of 350 microorganisms were isolated, of which 296 were identified at the genus level by PCR-RFLP with the enzymes HaeIII and RsaI. The online program kodebio.shinyapps.io/RFLP-inator was used for the in-silico identification of the isolates. Seven hypothetical bacterial genera were identified: Staphylococcus, Lactobacillus, Enterococcus, Bifidobacterium, Corynobacterium, Streptococcus, and Leuconostoc, with Staphylococcus, Lactobacillus, and Enterococcus being the most dominant, representing 61.1% of the identified microorganisms. Our results are a starting point for understanding the microbial composition of human colostrum, considering the particular context and environmental conditions of the Colombian Caribbean.

Background: Motivation for the study. There is little information on the microbiota found in the colostrum of women living in the Colombian Caribbean. Identifying and isolating microorganisms in this fluid is of interest to both medicine and industry. Main findings. The dominant bacterial genera found in colostrum were Staphylococcus, Lactobacillus, and Enterococcus. Microorganisms with probiotic potential were isolated and should be studied in greater detail. Public health implications. Understanding the microbiota found in colostrum allows us to understand its contribution to infant health and develop strategies to enhance the beneficial impact of these microorganisms on their development.

Vildagliptin, a dipeptidyl peptidase-4 inhibitor (DPP-4i) used in the treatment of type 2 diabetes mellitus (DM2), stands out for its safety in older adults. However, it is associated with adverse reactions, such as bullous pemphigoid (BP), although no cases have been documented in Peru to date. We report the case of a 76-year-old male patient with hypertension and DM2 who started treatment with vildagliptin and metformin. After one month, he presented pruritic, bullous and ulcerated skin lesions, leading to the diagnosis of BP. BP, associated with DPP-4i, mainly affects older adults, manifesting on average about 9 months after the start of treatment. Its diagnosis is based on clinical criteria, histopathology and immunofluorescence. Treatment includes discontinuation of the drug and the use of corticosteroids. Vildagliptin, although safe and effective, can cause BP, which requires timely diagnosis and treatment due to its high mortality.

Backgroud: Motivation for the study. Chronic child malnutrition (CCM) remains a critical problem, especially in regions such as Huancavelica and Loreto. The specific factors that affect children during their first year of life are not fully understood, in spite of existing programs aimed at this issue. Main findings. Being male, bottle feeding, and using polluting fuels were identified as factors that increase the risk of CCM, while attending six or more prenatal checkups and receiving support from the JUNTOS program help prevent it. Factors such as maternal language and limited maternal participation also play a role. Implications for public health. These findings highlight the need for policies that strengthen prenatal care, promote healthy feeding practices, and empower mothers in decision-making.

Objective.: To determine the factors associated with chronic child malnutrition (CCM) in two Peruvian regions: Huancavelica and Loreto.

Materials and methods.: We analyzed four repeated cross-sectional evaluations nested in a prospective cohort of children treated in primary healthcare facilities. Data was collected on the characteristics of the child, the mother and the household, including anthropometric information, breastfeeding, complementary feeding, and socioeconomic conditions. A generalized linear model was used to calculate the prevalence ratios (PR) for each of the four quarterly evaluations of the cohort (3rd, 6th, 9th and 12th months).

Results.: Factors such as male sex, bottle feeding and the use of polluting fuels were associated with a higher risk of CCM, on the other hand, having six or more prenatal check-ups and being a beneficiary of the JUNTOS program acted as protective factors. Mothers who did not speak Spanish as their native language, who worked or studied, or who had limited participation in family decisions, were also at higher risk of CCM. In addition, we identified unexpected associations, such as food insecurity acting as a protective factor, reflecting possible biases or confounding effects.

Conclusions.: Our findings highlight the importance of addressing inequalities in prenatal care, dietary practices, and mothers' participation in household decision-making to prevent CCM in vulnerable contexts.