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

Background: Motivation for the study. Peru has a high prevalence of tuberculosis, therefore, it is necessary to use diagnostic methods with high sensitivity and specificity to adequately identify cases and provide timely treatment. Main findings. Our results indicate that, when comparing the smear microscopy techniques commonly used in Peru with the molecular tests recommended by the WHO, direct microscopy techniques show low sensitivity, less than 50%, but high specificity, greater than 95%. Implications for public health. It is necessary to evaluate the implementation and associated costs of new rapid diagnostic alternatives that have adequate capacity to identify the majority of tuberculosis cases.

Objective.: To determine the diagnostic performance of Ziehl-Neelsen and Auramine-Rhodamine staining for pulmonary and extrapulmonary tuberculosis.

Materials and methods.: This was a cross-sectional diagnostic test study. We used a database of processed samples from patients with suspected pulmonary and extrapulmonary tuberculosis in a private laboratory in Peru between 2011 and 2022. Ziehl-Neelsen staining and Auramine-Rhodamine staining were the index tests. The reference tests were Xpert MTB/RIF and Xpert Ultra. The receiver operating characteristics and area under the curve (AUC/ROC) were calculated to determine the diagnostic performance of each staining technique.

Results.: We analyzed 908 samples processed by Ziehl-Neelsen staining and 623 samples by Auramine-Rhodamine staining, most were lung tissue samples. Using the Xpert MTB/RIF as a reference test, the Ziehl-Neelsen staining obtained an AUC=0.72, a sensitivity of 44.2% and specificity of 99.3%; and Auramine-Rhodamine staining showed an AUC=0.73, a sensitivity of 46.8% and specificity of 100%. Considering the Xpert Ultra test as a reference, the diagnostic performance for Ziehl-Neelsen showed an AUC=0.63 with a sensitivity of 26.9% and specificity of 98.5%; and an AUC=0.64 with a sensitivity of 30% and specificity of 98.2% for the Auramine-Rhodamine staining.

Conclusion.: The diagnostic performance for both staining techniques is fair, and decreases when taking Xpert Ultra as a reference. New diagnostic alternatives with adequate performance are needed to detect tuberculosis.

The clinical and microbiological characteristics of pneumococcal pneumonia in children hospitalized in Lima were analyzed, before and after the introduction of pneumococcal conjugate vaccines (PCV). We reviewed cases that occurred between 2006-2019, in the pre-PCV7 (2006-2008), post-PCV7 (2009-2011) and post-PCV13 (2016-2019) periods. Of 128 patients with positive cultures (92 blood and 36 pleural fluid), most were infants in the pre-PCV7 (77.1%) and post-PCV7 (43.3%) studies, while in the post-PCV13 study they were mostly preschoolers (62%). We found an increase in complicated pneumonia cases from 14.6% to 72% and an increase in serotype 19A (6.3% to 68%). The most frequent sequence type was ST320 (31 isolates). Resistance to penicillin and ceftriaxone was low (6% and 2%, respectively), although higher in empyema (21.4% and 14.3%, respectively). Resistance to azithromycin increased from 27% to 92%. Penicillin remains the antibiotic of choice for the treatment of uncomplicated pneumococcal pneumonia in Lima. Motivation for the study. Although studies on invasive pneumococcal disease have been conducted in Lima, the characteristics of pneumococcal pneumonia before and after the introduction of pneumococcal conjugate vaccines are unknown. Main findings. We found an increase in complicated pneumococcal pneumonia cases, particularly empyema and an increase in serotype 19A. Resistance to penicillin and ceftriaxone was found to be low; however, in cases of empyema, antibiotic resistance was higher. Public health implications. Penicillin or amoxicillin should continue to be prescribed for the empirical management of pneumococcal pneumonia; however, ceftriaxone is recommended for cases with empyema. Continued local monitoring of pneumococcal resistance and serotypes is recommended.

Background: Motivation for the study. Restrictions on advertising, promotion, and sponsorship (APS) of unhealthy food and beverage products aim to reduce their consumption and protect public health. No reviews have yet evaluated the impact of restricting APS of sugary drinks (SD). Main findings. We found that comprehensive policies that include TV advertising restrictions, as well as restrictions at points of sale and in schools, can effectively reduce SD consumption, especially among children and adolescents, decrease obesity, cardiovascular disease, diabetes, and cancer, and generate economic benefits. Implications. Evidence on the health impact of such interventions is essential to promote effective measures.

Objectives.: To summarize the evidence on the impact of the implementation of the ban on the advertising, promotion and sponsorship (APS) of sugar-sweetened beverages (SSBs) in terms of decreased consumption, advertising exposure and relevant clinical outcomes.

Materials and methods.: Systematic review of articles published between 2001-2021 in the PubMed, Embase, Global Health, CINAHL and LILACS databases written in English, Portuguese or Spanish. We included experimental, observational and economic model studies. Risk of bias was assessed using RoB2, Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group and Consolidated Health Economic Evaluation Reporting Standards 2022. We carried out a descriptive synthesis of the studies.

Results.: We selected 11 out of 1146 identified studies. Due to the heterogeneity of the outcomes, it was not possible to conduct a meta-analysis. The interventions corresponded to a comprehensive policy; restrictions on television advertising, promotions, point-of-sale advertising and advertising in schools. We found changes in clinical outcomes (obesity, cardiovascular disease, diabetes, cancer), economic outcomes (purchase, sale, cost-effectiveness, other economic outcomes), exposure and consumption. Most of the effect measures decreased as a result of the interventions. More studies on effectively implemented policies are still needed. The results of the included studies should be interpreted taking into account their methodological limitations.

Conclusions.: Policies to restrict the APS of SSBs may be effective, particularly in reducing their consumption in children and adolescents, with a positive impact on their health.

We described the nutritional content of vitamin and mineral dietary supplements for children on the Peruvian market and their compliance to the recommended dietary intake. A cross-sectional study was carried out with the information declared on the packaging of 34 products sold in pharmacies during 2022. The daily doses of each micronutrient were calculated according to the manufacturer's instructions; we also estimated the compliance with the recommended dietary allowance (RDA) and the tolerable upper intake level (UL) by age group. The most common micronutrients were vitamins C (n=23), D (n=22), A (n=16), zinc (n=15) and B6 (n=14). In all groups, vitamin D, thiamine, riboflavin, folate, vitamin B12 and vitamin C exceeded the RDA. Zinc and copper also exceeded the recommendations in some groups. Vitamin A and folate most frequently exceeded the UL. Our findings highlight the need for greater health surveillance.

Objectives.: To evaluate the ability of the Risk Factor Scale for Preeclampsia Complications (RFSPC) and the fullPIERS (Pre-eclampsia Integrated Estimate of RiSk) scale to predict complications of preeclampsia in pregnant women diagnosed with preeclampsia who were admitted to the obstetrics and gynecology department of a referral hospital, from October 2021 to December 2022.

Materials and methods.: This was a retrospective cohort design study. Data was collected from the medical records of patients diagnosed with preeclampsia, and both scales (RFSPC and fullPIERS) were applied. With these results, the sensitivity, specificity and the area under the ROC curve (AUC) were obtained by taking different cut-off points. The best score was selected as the one with the highest AUC. The differences between the scales were explored by comparing their AUCs.

Results.: We included 367 pregnant women. The RFSPC had a sensitivity of 71%, a specificity of 73% and an AUC of 0.722 with a cutoff point of 3 points. Whereas the fullPIERS scale showed 76%, 84% and 0.804 respectively with a cutoff point of 0.75%.

Conclusions.: Both scales can be useful for identifying pregnant women at risk of complications with cutoff points different from those defined internationally.

The standard for diagnosing invasive pneumococcal disease (IPD) is to isolate pneumococcus in culture. However, the etiological agent cannot be identified in some patients, especially those who received empirical antibiotic therapy. This study aimed to detect pneumococcus in normally sterile fluids by qPCR in patients with suspected IPD hospitalized in Lima. qPCR had a detection limit of 1.2 x 101 genome copies/uL. Of the 71 clinical samples (51 were pleural fluid [PF] and 20 were cerebrospinal fluid [CSF]), 29.4% (28/71) were positive for pneumococcus by culture and 71.8% (51/71) were positive by qPCR, including 78.4% (40/51) in PF and 55.0% (11/20) in CSF. Of the positive samples, 13/51 were serotype 19A. The detection of pneumococcus was almost double by qPCR compared to the conventional microbiological method. Therefore, molecular methods such as qPCR should be implemented to improve the identification and timely treatment of IPD in Peru and in the region. Motivation for the study. Invasive pneumococcal disease (IPD) is usually diagnosed by microbiological culture to detect pneumococcus. However, this is sometimes not possible, particularly in patients who have previously received antibiotics. This study sought to detect pneumococcus using a molecular technique such as qPCR in hospitalized patients in Lima with suspected IPD. Main findings. qPCR detected a higher frequency of pneumococcus than the standard microbiological technique. Implications for public health. These findings suggest that the implementation of qPCR could significantly improve the identification and treatment of IPD in Peru.

Primary adrenal insufficiency is the result of impaired steroid synthesis, adrenal destruction or abnormal development of the adrenal gland affecting the adrenal cortex. Tuberculosis is one of the main causes in developing countries. We present the case of a 10-year-old male patient diagnosed with adrenal insufficiency two years earlier with regular treatment, who was admitted for adrenal crisis. A thoraco-abdominal tomography was carried out during hospitalization, which showed cylindrical and traction bronchiectasis associated with cicatricial atelectasis in the right upper pulmonary lobe, enlarged adrenal glands with foci of calcification, as well as a dense posterior perivertebral mediastinal collection also involving vertebral bodies with lytic resorptive foci, findings consistent with systemic tuberculosis. Treatment for tuberculosis started based on this diagnosis. During course of the disease, the first phase was completed with four drugs, and the second phase included isoniazid and rifampicin with favorable clinical response.

Pseudomonas aeruginosa is an opportunistic pathogen associated with health care infections, it has high levels of antimicrobial resistance and is associated with hospital outbreaks. Early outbreak detection is a usual problem in hospitals, therefore, this study aimed to assess the clonal relationship of carbapenemase-producing P. aeruginosa in a tertiary hospital in Lima, Peru. Twenty-four metallo β-lactamase-producing P. aeruginosa strains isolated from hospitalized patients were collected. The clonal relation was determined using the REP-PCR technique. REP-PCR band profiles were normalized, analyzed and combined using BioNumerics version 7.6 software. Molecular identification showed 19 different profiles and four clonal groups. We determined polyclonality among isolates. We did not find clonal dissemination among the metallo-β-lactamase-producing P. aeruginosa strains circulating in the hospital. Motivation for the study. The isolation of carbapenemase-producing Pseudomonas aeruginosa in different wards of a tertiary care hospital prompted the identification of the clonality of the isolates and to determine whether they corresponded to an intrahospital outbreak. Main findings. The REP-PCR technique grouped the 24 strains of metallo-β-lactamase-producing P. aeruginosa isolated from patients in different hospital wards into 19 profiles. The greatest clonal diversity was found in the medical ward. Public health implications. Molecular typing by REP-PCR could be a practical and rapid alternative for the surveillance and control of hospital outbreaks.

Objective.: To determine the molecular characterization of Panstrongylus chinai from northern Peru and its phylogenetic relationship with Ecuadorian populations using the Cytochrome C Oxidase Subunit I (COI) gene.

Materials and methods.: We analyzed three adult female P. chinai specimens from populations reared under laboratory conditions, from rural localities in the department of Piura. The legs of each specimen were dissected from the coxa to the tibia, discarding the tarsi and nails, then the DNA was extracted, and a polymerase chain reaction (PCR) of the COI gene was carried out. The PCR products were sequenced by Sanger and analyzed with DNA sequences of the COI gene of P. chinai from Ecuador, obtained from the NCBI portal, Genbank. The DNA sequences of the study, together with similar sequences found in the NCBI database, were inserted into the MEGA v.11 software to construct a phylogenetic tree. They were then transferred to the DnaSP v.5 software for molecular characterization by haplotypes.

Results.: Molecular characterization revealed the presence of three haplotypes circulating in the department of Piura, different from the haplotype previously reported in Ecuador. Likewise, phylogenetic analysis suggests the emergence of the evolutionary process of cladogenesis, in which the Ecuadorian variant may have originated from populations of P. chinai from northern Peru.

Conclusions.: P. chinai from Ecuador and northern Peru have different molecular characteristics and a descending phylogeny, which infer distribution from Peru to Ecuador.

Guillain-Barré syndrome is a potentially severe autoimmune inflammatory polyneuropathy, which is usually associated with previous infections. Dengue is the most common arbovirus infection worldwide, being endemic in tropical and subtropical areas such as Peru. Scientific literature shows some reports of dengue with neurological complications, but its pathophysiology is not well understood. We present the case of a woman from an area endemic for dengue with Guillain-Barré syndrome with a disability scale of 4/6 on the Hughes scale, confirmed by albumin-cytological dissociation, and previous infection with dengue virus confirmed with a positive serum ELISA IgM test. The patient's progress was favorable after receiving intravenous immunoglobulin. It is important to consider this viral infection as a probable risk factor for developing Guillain-Barré syndrome.