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Objective. This study aimed to identify the areas with the highest concentration of traffic accidents and injuries in the San Salvador Metropolitan Area (SSMA). Materials and methods. Traffic accidents were analyzed spatially by point location and by the sum of events in areas of 200 m2. The point location was analyzed by "nearest neighbor analysis", while the areas with the sum of traffic accidents were analyzed by Getis-Ord Gi* to obtain the hot spots. The resulting hot spots with the highest concentration of traffic accidents in the SSMA were evaluated in the field using an observation form to collect data on infrastructure and road safety characteristics. Results. Five areas with the highest number of traffic accidents and injuries, mainly containing primary roads, were identified by analyzing 8191 traffic accidents reported between 2014-2018. Conclusion. The sites with the highest concentration of traffic accidents and injuries were characterized by considerably damaged road infrastructure and the lack of safety systems for drivers and pedestrians. The spatial analysis of traffic accidents and injuries can contribute to improve surveillance and road safety in the SSMA. [ABSTRACT FROM AUTHOR]

Primary agammaglobulinemia result from specific alterations in B cells, which lead to low antibody production. Diagnostic suspicion is established with a history of repeated infections, low immunoglobulins, and absence of CD19+ B lymphocytes. The diagnosis is confirmed by genetic analysis and the detection of a mutation linked to the X or autosomal recessive or dominant chromosome. In Peru, there is no literature on primary agammaglobulinemia and no reports on the genotype of patients with suspected primary agammaglobulinemia. Under this scenario, a study was performed to describe the genotype of patients with suspected primary agammaglobulinemia. Twenty (20) patients were found with mutations in the BTK gene and an autosomal recessive IGHM mutation. Thirteen (13) hereditary mutations and seven de novo mutations were found. It is concluded that the group of primary agammaglobulinemia are mostly mutations in the BTK gene, corresponding to X-linked agammaglobulinemia. [ABSTRACT FROM AUTHOR]

Primary immunodeficiencies (PID) are characterized by alterations in the components of the immune system. The lymphocyte population count by flow cytometry is an approach to molecular diagnosis and is expressed by immunophenotypes. The objective of the study was to describe the lymphocyte population count and immunophenotyping compatible with PID in patients with suspected PID in a Peruvian national reference hospital. Records of 261 cases meeting the Jeffrey Modell Foundation's PID clinical suspicion criteria were reviewed between April and December of 2016. Of the 261 suspected cases of PID, 54.8% were males. We found 93 patients (35.6%) with PID-compatible immunophenotyping. The common variable immunodeficiency immunophenotype was the most frequent (36.6%), followed by agammaglobulinemias (18.3%). Antibody deficiencies were the most common PID. Other molecular tests are needed for a specific genetic diagnosis. [ABSTRACT FROM AUTHOR]

The aim of this study was to detect and characterize molecularly metallo-ß-lactamase (MßL) in clinical isolates of Pseudomonas aeruginosa. We carry out a cross sectional study in six publics hospital in Lima on August 2011. 51 isolates of P. aeruginosa resistant to ceftazidime and reduced susceptibility to carbapenemes were evaluated. The phenotypic assay was performed using the approximation method with substrate disks (ceftazidime, imipenem and meropenem) and ethylenediaminetetraacetic acid (EDTA). MßL gene detection was performed using the technique of polymerase chain reaction (PCR) multiplex. Through MßL detected phenotypic method in 15.7% of isolates. Detection of genes revealed the presence of the gene in the 8 isolates blaIMP. The first report of MßL in P. aeruginosa in Peru was described, this should alert the monitoring equipment in the institutions to promote control their spread. [ABSTRACT FROM AUTHOR]

All around the world, lung cancer is the most common cancer among men and women, followed by breast, colon and rectum, stomach, and liver cancer. It affects most frequently people in their 50s and 60s, and tobacco consumption is the risk factor most strongly associated to the development of this type of cancer. It is most common among men; however, the prevalence among women has increased over the last ten years. Imaging tests for diagnosis include positron emission tomography (PET) with computed-tomography fusion, and transesophageal and bronchoscopic ultrasound, as the most relevant. Among the early detection techniques, the low-dose helical tomography stands out. However, it has not been able to prove to be useful as a screening tool. Conventional methods for diagnostic confirmation of lung cancer are bronchoscopy and percutaneous needle aspiration biopsy. The most common histologic type is the adenocarcinoma, being clinical stages III and IV being the most frequently found. At early clinical stages, surgical treatment has proven to be effective, and there is a good 5-year survival rate. In late stages, chemotherapy and radiotherapy are the most useful treatment methods to control the disease and palliate cancer signs and symptoms. Research in genomic analysis may provide a better understanding of cancer genetics, and therefore, new therapeutic strategies in the future. [ABSTRACT FROM AUTHOR]

Objectives. To determine the frequency and associated factors of nasal colonization by Staphylococcus aureus and its antibiotic susceptibility pattern in a marginal suburban population Lima, Peru. Materials and methods. A cross-sectional study was conducted among population of all ages from a marginal suburban district in northern Lima. The study used a convenience sample. Each person was surveyed and provided a swab sample of the nostrils. The swab samples were analyzed to identify Staphylococcus aureus, determining the susceptibility pattern by the Kirby Bauer disk diffusion method. Results. From the 452 participants recruited, ages between 1 and 84 years, the frequency of Staphylococcus aureus nasal colonization was 24.6%, with 0.9% of them resistant to methicillin. The only factor associated with nasal colonization was age equal or less than 11 years (OR: 3.80, 95% CI 1.42 to 10.16). Most strains were resistant to penicillin (96.4%) but also to erythromycin (10.9%), clindamycin (7.3%) and gentamicin (4.5%). Conclusions. The frequency of Staphylococcus aureus nasal colonization was similar to other studies worldwide, with predominance of methicillin-sensitive strains [ABSTRACT FROM AUTHOR]

Objetivo: Determinar la prevalencia y factores asociados a dislipidemias en niños y adolescentes del distrito de Tacna. Métodos: estudio descriptivo transversal en una muestra probabilística de 824 niños de 6 a 17 años de edad de Instituciones Educativas Públicas y Privadas del distrito Tacna. Para determinar la dislipidemia se recolectaron muestras de sangre a 434 niños de nivel primario y 431 del nivel secundario, se aplicó una encuesta para medir factores biológicos como edad, sexo, peso al nacer y estado nutricional; antecedentes familiares en padres, hermanos y abuelos de infarto cardíaco, angina de pecho, accidente cerebro vascular, colesterol, hipertensión, diabetes y obesidad; estilos de vida sobre dieta rica en grasas saturadas y en azúcares refinados, actividad física y tabaquismo. Los resultados fueron analizaron mediante el Software estadístico SPSS v.23.0 utilizando el modelo de Regresión Logística. Resultados: La prevalencia de dislipidemia fue de 10,9%, siendo en niños de nivel primario 4,1%, adolescentes de nivel secundaria 6,8% y la mayor proporción fue para el sexo masculino (13,5%) respecto a mujeres (8,3%). En niños con obesidad la prevalencia fue 55,1% y sobrepeso 11,3%. Los antecedentes familiares predominantes fueron: colesterol alto en padres (41,4%) y abuelos (46,1%), HTA en abuelos (41,9%), obesidad en padres (30,8%) y abuelos (31,8%). El análisis de regresión logística determinó que los factores asociados a la dislipidemia fue la edad menor a 10 años, peso alto al nacer y la obesidad; dolor en pecho en padres, colesterol alto en padres, diabetes mellitus en padres y abuelos, dieta rica en grasas saturadas y colesterol, actividad física inactiva o poco activa. Conclusiones: La prevalencia de dislipidemias en niños y adolescentes fue 10,9%. Existe asociación significativa con peso alto al nacer, antecedentes de dolor de pecho en padres, colesterol alto en padres, diabetes mellitus de padres y abuelos y alimentación rica en grasas saturadas y colesterol, así como actividad física inactiva/poco activa. [ABSTRACT FROM AUTHOR]

Aimed at reporting markers of plasmid resistance to qnr quinolones in clinical isolates of CTX-M beta-lactamase-producing enterobacteria, a descriptive study was conducted with isolates from the strain repository of TO-06/09 project of the National Children's Health Institute. 138 isolates were recovered. Antimicrobial susceptibility was determined by the diffusion disk method, and gene identification by polymerase chain reaction. Of the 138 isolates, 67 (48.5%) were genotypically positive for qnr proteins; of these, 38 (56.7%) had qnrB determinants and 48 (71.6%) had qnrS determinants. No isolate presented qnrA determinants. qnr determinants were detected in isolates containing CTX-M beta-lactamases in a non-exposed population. [ABSTRACT FROM AUTHOR]

hat codify metallo-β-lactamases (MBL) in clinical isolates of Pseudomona aeruginosa (P. aeruginosa), a cross-sectional study was conducted in the Central Military Hospital (HMC) of Lima, Peru, between January and September, 2016. Seventy-six (76) isolates of P. aeruginosa with diminished sensitivity to carbapenemes and resistant to ceftazidime were analyzed. The phenotype detection of MBL was made by double disc synergy between imipenem and meropenem versus ethylenediaminetetraacetic acid (EDTA), and the identification of the genes was performed by polymerase chain reaction. Of the 76 isolates, 24 (31.6%) were positive for MBL by the phenotype method, genetically confirming all. The blaIMP gene was found in 23/24 (95.8%) and blaVIM in 1/24 (4.2%). No isolate had blaNDM. The blaIMP gene turned out to be the most frequent among clinical isolates of P. aeruginosa not sensitive to carbapenemics at this Hospital. [ABSTRACT FROM AUTHOR]

The objective of the study was to determine compliance with hepatitis-B virus (HBV) in newborns in Lima and Callao. A descriptive, cross-sectional, multicenter-design study was conducted in high level public and private hospitals. Information on vaccination corresponds to newborns during one week of 2015 and was obtained through consultations with parents and review of health service reports. The study was conducted in 12 health facilities including 935 mothers and newborns. Vaccination coverage within 24 hours of life was 85.1%, according to the parents' report; and 88.7%, according to the health services' report. It is concluded that the coverage of HBV vaccination in newborns within 24 hours of life was important, but still far from the ideal goals proposed by the Ministry of Health and the World Health Organization. [ABSTRACT FROM AUTHOR]

Objective. To determine the hygienic-sanitary factors associated with the microbiological contamination of chicken meat sold at the municipal markets of El Salvador. Materials and methods. An analytical cross-sectional study was conducted in 33 municipal markets of the 14 departmental capitals of El Salvador. The sample consisted of 256 out of 456 possible market stalls. A sample of chicken meat was obtained from each market stall. The microbiological analysis was conducted at the National Public Health Laboratory. Frequencies, percentages, measures of central tendency and association were calculated with SPSS version 21. Results. Escherichia coli was found in 74% of the samples, Staphylococcus aureus in 24% and Salmonella spp. in 1%. The presence of Salmonella spp. was associated with not using hand sanitizer and not using towels for drying hands. S. aureus was associated with the use of personal accessories and improper storage. The presence of S. aureus was associated with the lack of hand washing, not using a towel to dry hands and not wearing an apron. Conclusion. The hygienic-sanitary conditions of the handlers and the market stalls were associated with microbiological contamination of chicken meat marketed in El Salvador. [ABSTRACT FROM AUTHOR]

In the frame of global actions for prevention and cancer control, INEN has designed and developed new educational program strategies oriented to achieve institutional goals through health promotion, disease prevention, diagnosis and treatment, which benefits people nationwide: Excellence Schools/Centers. The INEN Excellence Center on Cervical Cancer Training became a pioneer with methodological designed interventions that search the improvement of health care competencies, and setting the standard for others Excellence Schools. In the past years, the INEN Excellence Schools/ Centers have achieved great results such as 12,194 health care providers with strengthen professional competencies in promotion, primary and secondary prevention all over the country, since 2012 to 2015. [ABSTRACT FROM AUTHOR]

Objectives. To describe the frequency of extended-spectrum beta-lactamase (ESBL)-producing enterobacteriaceae in fecal samples at the National Institute of Child Health, Lima, Peru. Materials and methods. Stool samples received between July 2012 and March 2013 with colonies suspected to be ESBL-producing enterobacteriaceae that developed in Karmali agar were analyzed. Conventional methods were performed for biochemical identiication and the conirmation of the ESBL phenotype. Genotypic analysis to detect the beta-lactamase gene CTX-M family was performed by PCR. Results. Of the 235 fecal samples analyzed, 64.2% of ESBL-producing enterobacteria was isolated being 86.1% Escherichia coli, 7.9% Klebsiella pneumoniae, 2.6% Salmonella sp, 2.0% Enterobacter cloacae, and 1.3% Proteus mirabilis. 89.1% of the ESBL-producing enterobacteria presented the CTX-M gene. We found high resistance to nalidixic acid 84.8%, 74.2% ciproloxacin and trimethoprim-sulfamethoxazole 81.5%.The resistance to amikacin was 1.3% and all isolates were susceptible to imipenem and meropenem. Conclusions. A high frequency of ESBL-producing enterobacteria was found in fecal samples of outpatients seen in the outpatient and emergency departments of the National Institute of Child Health of Peru. [ABSTRACT FROM AUTHOR]

Cutaneous tuberculosis is a rare presentation of Mycobacterium tuberculosis infection. We present the case of a woman without important medical history, with a disease period of one year and a half, characterized by sporotrichoid-like lesions, with lymphocutaneous dissemination in the right upper limb, and with slowly progressive evolution. The histopathological tests revealed Langhans type giant cells and scarce necrosis. The patient received therapy with a sensitive antituberculous scheme, and evolved favorably. [ABSTRACT FROM AUTHOR]

Plasmodium vivax is the most common species in the Peruvian Amazon and causes 81% of all malaria cases. We present the case of an adult male patient with cerebral malaria caused by Plasmodium vivax, who started with general malaise and fever, then presented convulsions more than twice a day with loss of consciousness and motor functional limitation. Plasmodium vivax trophozoites were detected by thick blood smear; we also found low counts of all three blood cell types. Treatment began with artesunate and clindamycin for five days, then one unit of packed red blood cells was transfused; treatment then continued with primaquine for seven days. The patient showed clinical improvement with neurological sequelae in one lower limb. [ABSTRACT FROM AUTHOR]

Objectives: To describe the supply and demand of clinical fields for undergraduate students of Peru. Materials and methods. A descriptive study was considering as supply of clinical fields the total number of existing hospital beds in Peru. The demand was calculated using the total number of alumni registered in health science careers following the clinical years or the internship. We calculated the number of beds per student and the coverage of clinical fields nationally and in some selected regions (Lima, Arequipa, La Libertad and Lambayeque). Results. In 2009, Peru had 34,539 hospital beds, 78.5% of which pertained to the public sector and 48.4% are from Lima. We estimated that in 2008 44,032 alumni needed clinical fields, 70% from private universities, which grew 65% since 2005. The coverage of clinical fields, considering only interns from four careers (medicine, nursery, obstetrics and dentistry) was only 31.5% at the national level. The number of beds per student oscillated between 0.5 in La Libertad to 0.82 in Lima with a national mean of 0.45. Conclusions. The supply of clinical fields for teaching undergraduates is insufficient to satisfy the demand, which continues to grow because of private universities, and hence requires urgent regulation. [ABSTRACT FROM AUTHOR]

Objective: To determine the level of immune response after a mass vaccination campaign against rabies in two areas which presented cases of canine rabies in the last years. Materials and methods: A serologic survey was carried out in 101 and 199 dogs located respectively, in the cities of Tambo Grande (Piura) and Juliaca (Puno) and a rabies serum mouse neutralization test was perform to measure neutralizing antibodies (≥ 0,5 UI/mL) according to area of study, vaccination antecedents, age and sex of the dog. Results: After three months of the rabies campaign 32% of all dogs were properly protected, 66% had vaccination antecedents and only 44% of the vaccinated dogs had antibodies (> 0,1 UI/mL). A greater protection against rabies was found in Juliaca than in Tambo Grande in vaccinated dogs (51 vs 34%, p<0,05). Dogs older than a year old were better protected than dogs under a year old (p<0,01), but non relation was found between sex and protection (p>0,05). Conclusions: This study found that there is a poor immune response against rabies in the districts of Tambo Grande, and Juliaca, making them very susceptible to develop dog rabies outbreaks. [ABSTRACT FROM AUTHOR]

Nursing homes are institutions with high prevalence of urinary tract infections caused by ESBL-producing E. coli with several virulence factors. The aim of this study was to determine the frequency of the blaCTX-M gene and eight virulence genes in 35 ESBL-producing uropathogenic E. coli from six nursing homes in Peru during 2018. Of the E. coli samples, 57.1% (20/35) were carriers of the blaCTX-M gene. Furthermore, we obtained frequencies of 46% (15/35) and 37% (13/35) for hly-alpha and cnf-1, respectively; we also found high presence of the iucC (63%, 22/35), aer (94%, 33/35) and chuA genes (94%, 33/34) as well as a frequency of 46% (16/35) and 91% (32/34) for the pap GII and nanA genes, respectively. The blaCTX-M gene is predominant and a high frequency of exotoxins gives it a competitive advantage for spreading into the bloodstream. [ABSTRACT FROM AUTHOR]

We carried out an observational, retrospective and descriptive study in order to identify the clinical and epidemiological characteristics of children with SARS-CoV-2 infection admitted to a Peruvian national referral hospital. We included patients from one month old to fourteen years old hospitalized between March and August 2020. A total of 125 patients with SARS-CoV-2 infection were admitted, 18.4% (n = 23) had critical illness and 16.8% (n = 21) had multisystem inflammatory syndrome (MIS-C). The absence of comorbidities and previous history of epidemiological contact were more frequent in patients with MIS-C. Patients in critical condition and patients with MIS-C had lower lymphocyte and platelet counts, and higher C-reactive protein, ferritin and D-dimer values than patients who did not have said conditions. Six (4.8%) out of 125 children died, as well as 3 (13%) children from the group of patients in critical condition. None of the children with MIS-C died. [ABSTRACT FROM AUTHOR]

Descriptive study conducted in order to determine the presence of the fimH and afa genes in urinary isolates of extended-spectrum beta-lactamases (ESBL) producing Escherichia coli. Isolates from project TO-06/09 of the Instituto Nacional de Salud del Niño in Lima, Peru were used. A total of 75 urinary isolates of Escherichia coli were included. Gene identification was performed by polymerase chain reaction. From the 75 isolates, 74 (98.7%) were positive for the fimH gene and 6 (8.0%) were positive for the afa gene. Virulence factors produced by the fimH and afa genes were evident in urinary isolates of ESBL producing Escherichia coli. [ABSTRACT FROM AUTHOR]

In order to determine the profile of sensitization to aeroallergens in pediatric patients with asthma and / or allergic rhinitis, a cross-sectional study was carried out in 411 patients using an allergy skin test. Age, sex, total IgE level and eosinophils were analyzed. The mean age was 8.1 ± 3.7 years and 60.6% were male. The average of the eosinophils and the level of total IgE was 450.1 ± 377.3 cells / mm³ and 861.7 ± 757.6 IU / mL, respectively. Mites were the most frequent sensitizing allergens (79.8%) and Dermatophagoides farinae (65.2%) was the most common. Polysensitization was present in 76.2% of patients. Sensitization was evident in the majority of patients with asthma and / or allergic rhinitis and was associated with age, age groups and total IgE level. [ABSTRACT FROM AUTHOR]

Objetivo: determinar el cumplimiento de la vacunación contra la Infección del Virus de la Hepatitis B (VHB) a Recién Nacidos (RN) durante las primeras 24 horas de vida en los hospitales de tercer nivel de la ciudad de Lima y Callao. Métodos: estudio de diseño transversal, multicéntrico, y descriptivo. Se incluyó a todos los RN de Hospital de tercer nivel o más, públicos o privados, de Lima y Callao. En primer lugar, se identificaron durante una semana todos los RN en los servicios de atención inmediata, realizándoles un seguimiento hasta el alta o durante 72 horas de vida, actualizando diariamente su situación vacunal. La información sobre la vacunación, datos epidemiológicos del RN, madre y datos de la institución de estudio fueron recogidos de la Historia Clínica Neonatal, Historia Clínica Materna, información del personal de salud a cargo de la administración de la vacuna, y de la madre del RN. Se realizó un análisis descriptivo de los datos. El estudio fue revisado y aprobado en por el Comité de Ética del INS. Resultados: el estudio se realizó en 12 establecimientos de Salud de Lima y el Callao incluyéndose a 935 madres y RNs. Respecto al reporte de la hora de vacunación un 79.6% (744/935) tuvieron reporte de padres, servicios de salud (SS) o de ambos correspondiendo al 20.4% (191/935) los casos que no tuvieron reporte de la hora de vacunación. La cobertura de vacunación antes de las 24 horas de vida fue de 85.2% según el reporte de padres y 88.9% según el reporte de SS. La vacunación antes de las 12 horas de vida fue 39.7% según el reporte de padres y 48.6% según reporte de los SS. Se identificó un establecimiento, clínica privada, donde no se realizó ninguna vacunación. También se identificó un establecimiento con vacunación del 100% en las primeras horas 2 horas de vida (reporte de SS), pero con mayor proporción de padres sin información previa. Conclusiones: se encuentra una alta cobertura de vacunación contra el VHB en RNs antes de las 24 horas de vida, mayores a la meta propuesta por el MINSA (79%); sin embargo, es necesario algunas mejoras en algunos establecimientos, para una mejora den la calidad de atención de salud. [ABSTRACT FROM AUTHOR]

In order to establish the reference intervals (RIs) of peripheral blood lymphocyte subsets (PBL) in healthy adults in Lima (Peru), a cross-sectional study was conducted among blood donors taken in between 2011 and 2012. Based on the criteria obtained from the guidelines of the Clinical and Laboratory Standards Institute (CLSI C28-A3), 318 samples were processed, 61.9% (197/318) coming from male donors. For PBL count, a low cytometer with a simple platform was used. The RIs are established for each PBL in adults based on sex with their respective reference limits and 90% conidence intervals. Differences were found in CD3+ percentage counts (p=0.001) and in CD3-CD56+ absolute (p=0.003) and percentage counts (p?0.001). The RIs found are different to those described in studies conducted in other countries due to the characteristics of the population and the study model. [ABSTRACT FROM AUTHOR]

Objectives. To study the variability in the composition and enzymatic activity of venom from adult Bothrops atrox specimens. Materials and methods. We used venoms from adult snakes from Amazonas, Junín and Ucayali. Each of the venom samples underwent analysis for protein and number of bands by pagesds. Phospholipase A2, hemolytic, amidolytic, coagulant, hemorrhagic activity were analyzed, also and proteolytic activity on casein and by zymogram. Additionally, immunodiffusion and neutralization assays in vitro were done with a polyvalent botropic serum from the national institute of health of Peru. Results. The amidolytic, coagulant, hemorrhagic, proteolytic by zymogram, phospholipase A2, and indirect hemolytic activity were variable, demonstrating increased activity in the venoms from Amazonas, regarding proteolytic by zymogram, phospholipase A2, and indirect hemolytic activity. While the amount of protein electrophoretic bands and proteolytic activity on casein did not demonstrated differences. Regarding neutralization tests, a 0.5 dose of antivenom was sufficient to effectively neutralize (>50%) the coagulant activity and phospholipase A2 of all samples analyzed. Conclusions. Some biological properties of the venom from adult Bothrops atrox of Peru are variable, without interference with the in vitro neutralization by the polyvalent botropic serum on coagulant and phospholipase A2 properties of the venom [ABSTRACT FROM AUTHOR]

CRASH-2 is a pragmatic clinical trial which evaluates the efficacy of a widely available, low cost antifibrinolytic for the prevention of mortality and bleeding in patients with trauma. In this article we present some issues related to the magnitude of the problem as well as the need for research in trauma relevant to the Peruvian context. The rationale for the CRASH-2 trial and the Peruvian experience up to date are also discussed. [ABSTRACT FROM AUTHOR]