BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :People with disabilities (PWD) face several challenges accessing medical services. However, the extent to which architectural and transportation barriers impede access to healthcare is unknown. In Peru, despite laws requiring that buildings be accessible for PWD, no report confirms that medical facilities comply with such regulations. Thus, we aim to provide an association between these barriers and access to medical facilities. Data from a Peruvian disability survey were analyzed. Participants were 18 years of age and older people who reported having a physical disability. Accessibility was defined by reported struggles accessing medical facilities (health or rehabilitation centers). Absence of ramps, handrails, elevators, adapted bathrooms, and information counters in medical facilities were reported as architectural barriers. The transportation barriers analyzed included struggles using buses or trains. Poisson regression models with robust variance were used to estimate prevalence ratios (PR) and to control for confounding variables. 20,663 participants were included, their mean age was 66.5 years and 57.5% were females. Architectural and transportation barriers reported were 40% and 61%, respectively. All barriers reported were more prevalent in rural compared to urban areas (p < 0.001). Inadequacy of ramps, handrails, and adapted elevators and bathrooms were associated with limited use of rehabilitation centers (p < 0.001) but not of health centers (p > 0.05). Architectural and transportation barriers represent a hindrance to seeking treatment at rehabilitation centers. Actions to improve this situation are needed.

背景与目标： : 残疾人 (PWD) 在获得医疗服务方面面临若干挑战。然而，建筑和交通障碍阻碍获得医疗保健的程度尚不清楚。在秘鲁，尽管法律要求残疾人必须进入建筑物，但没有报告证实医疗设施符合此类规定。因此，我们的目标是在这些障碍和获得医疗设施之间提供联系。分析了秘鲁残疾调查的数据。参与者为18岁以上的老年人，他们报告有身体残疾。可访问性是由报告的进入医疗设施 (健康或康复中心) 的斗争定义的。据报道，医疗设施中没有坡道，扶手，电梯，改建的浴室和信息柜台是建筑障碍。所分析的交通障碍包括使用公共汽车或火车的挣扎。使用具有稳健方差的泊松回归模型来估计患病率比 (PR) 并控制混杂变量。包括20,663名参与者，他们的平均年龄是66.5岁，57.5% 是女性。报告的建筑和交通障碍分别为40% 和61%。与城市地区相比，农村地区的所有障碍都更为普遍 (p <0.001)。坡道，扶手以及经过改装的电梯和浴室的不足与康复中心的使用有限 (p < 0.001) 有关，但与健康中心无关 (p> 0.05)。建筑和交通障碍是在康复中心寻求治疗的障碍。需要采取行动改善这种情况。

BACKGROUND & AIMS: Objective:Describe the clinical and epidemiological characteristics and resistance profile of cases of extensively drug-resistant tuberculosis (XDR-TB) diagnosed in Peru from 2013 to 2015. Methods:This descriptive study included patients who met the definition of XDR-TB and were reported to the national epidemiological surveillance system of Peru's Ministry of Health. It used a descriptive analysis and, to identify spatial distribution, a heat map based on kernel density estimation. Results:It was estimated that XDR-TB cases diagnosed as new represented 7.3% of all multidrug-resistant tuberculosis (MDR-TB) cases reported during the study period; 74% of patients were aged 15 to 44 years old; and the male-female ratio was 1.7. Half of the country's departments reported at least one case of XDR-TB, and 42% of new cases had no history of resistance or previous treatment. In the other half of the departments, the majority had previous MDR and pre-XDR resistance. Among the cases, 57.7% presented resistance to 5 and 7 first- and second-line drugs and 41.6% presented resistance to 8 and 10 drugs. Conclusions:This study offers important details of the epidemiological profile of XDR-TB in Peru, where there has been an increase in cases of primary XDR-TB; that is, cases with no prior history of disease. Furthermore, this form of tuberculosis has spread to a greater number of departments in the country. Objetivo:Descrever as características clínico-epidemiológicas e o perfil de resistência dos casos de tuberculose extremamente resistente (TB-XDR) diagnosticados no Peru entre 2013 e 2015. Métodos:Estudo descritivo que incluiu pacientes que cumpriam a definição de TB-XDR e foram notificados ao sistema nacional de vigilância epidemiológica do Ministério da Saúde do Peru. Foi realizada uma análise descritiva e elaborado um mapa de calor (heat map) com base na estimativa de densidade de Kernel para identificar a distribuição espacial. Resultados:Estimou-se que os casos de TB-XDR diagnosticados como novos representaram 7,3% do número total de casos de tuberculose multidrogarresistente (TB-MDR) notificados no período do estudo, 74% dos casos tiveram entre 15 e 44 anos de idade, e a relação homem/mulher foi de 1,7. A metade dos departamentos notificou pelo menos um caso de TB-XDR, e 42% dos casos novos não tinham histórico de resistência ou tratamento prévio. Na outra metade dos departamentos, a maioria tinha resistência prévia do tipo MDR e pré-XDR. Ao todo, 57,7% dos casos apresentaram resistência a 5 e 7 medicamentos e 41,6% apresentaram resistência a 8 e 10 medicamentos de primeira e segunda linha. Conclusões:Este estudo apresenta detalhes importantes do perfil epidemiológico da TB-XDR no Peru, onde se observa um aumento no número de casos de TB-XDR primária, isto é, casos sem histórico de doença anterior. Além disso, esta forma de TB estendeu-se a um maior número de departamentos do país.

背景与目标：

BACKGROUND & AIMS: :Six strains of extremely halophilic bacteria were isolated from several crystallizer ponds of the Maras solar salterns in the Peruvian Andes. On the basis of 16S rRNA gene sequence similarity, G+C contents and DNA-DNA hybridization results, the six isolates constituted a genomically homogeneous group affiliated with the Gammaproteobacteria. The closest relatives were members of the halophilic genera Halovibrio and Halospina, which showed 16S rRNA gene sequence similarities below 97 % and whole-genome hybridization levels below 33 % for the type strain, 7Sm5(T). From the genomic and phenotypic properties of the six novel isolates and phylogenetic reconstruction based on 16S rRNA gene sequence analysis, they can be considered to represent a novel genus within the Gammaproteobacteria. On the basis of the taxonomic study, a novel genus, Salicola gen. nov., is proposed containing the single species Salicola marasensis sp. nov., which is the type species. The type strain of Salicola marasensis is 7Sm5(T) (=CECT 7107(T)=CIP 108835(T)).

背景与目标： : 从秘鲁安第斯山脉的Maras太阳盐沼的几个结晶器池中分离出六株极嗜盐细菌。根据16S rRNA基因序列相似性，G C含量和dna-dna杂交结果，这六个分离株构成了与Gammaproteobacteria相关的基因组同质组。最接近的近亲是嗜盐属Halovibrio和Halospina的成员，它们在类型菌株7Sm5(T) 的情况下显示16S rRNA基因序列相似性低于97%，全基因组杂交水平低于33%。根据六个新分离株的基因组和表型特性以及基于16S rRNA基因序列分析的系统发育重建，可以认为它们代表了Gammaproteobacteria中的一个新属。在分类学研究的基础上，提出了一个新的属Salicola gen。11月，其中包含单一物种Salicola marasensis sp。11月，这是类型种。盐藻的类型菌株为7Sm5(T) (= CECT 7107(T)= CIP 108835(T))。

BACKGROUND & AIMS: OBJECTIVES:Chlamydia trachomatis, which is asymptomatic in most women, causes significant adverse effects for pregnant women and neonates. No programmes conduct antenatal screening in Latin America. We determined chlamydia prevalence, feasibility and acceptability of chlamydia screening, and adherence to treatment in pregnant women in two urban public hospitals in Lima, Peru. METHODS:We offered chlamydia screening using self-collected vaginal swabs to pregnant women ≥ 16 years of age during their first antenatal visit. Chlamydia-infected women were contacted within 14 days and asked to bring partners for counselling and directly observed therapy with oral azithromycin. Unaccompanied women received counselling, directly observed therapy, and azithromycin to take to partners. Test of cure was performed ≥ 3 weeks after treatment. RESULTS:We approached 640 women for the study and enrolled 600 (93.8%). Median age was 27.3 years (range 16-47), median lifetime partners 2.3 (range 1-50), and median gestational age 26.1 weeks (range 4-41). Chlamydia prevalence was 10% (95% CI 7.7% to 12.7%). Of 60 infected patients, 59 (98%) were treated with one dose of azithromycin. Fifty-two of 59 (88%) returned for test of cure, all of whom were treated successfully, with 46 (86%) achieving negative test of cure with one dose of azithromycin, and 6 (12%) after retreatment with a second dose. CONCLUSIONS:C. trachomatis screening and treatment in pregnancy was feasible and highly acceptable in two urban hospitals in Peru. Chlamydia prevalence was high. Clinical trials to evaluate efficacy and cost-effectiveness of chlamydia screening, and treatment of pregnant women to prevent adverse pregnancy outcomes in low-resource settings, are warranted.

背景与目标：

BACKGROUND & AIMS: :Surface-mediated disease transmission is understudied in developing countries, particularly in light of the evidence that surface concentrations of fecal bacteria typically exceed concentrations in developed countries by 10- to 100-fold. In this study, we examined fecal indicator bacterial contamination of dinner plates at 21 households in four peri-urban communities in the Peruvian Amazon. We also used surveys to estimate household use of and demand for surface disinfectants at 280 households. Despite detecting total coliform, enterococci, and Escherichia coli on 86%, 43%, and 24% of plates sampled, respectively, less than one-third of households were regularly using bleach to disinfect surfaces. Among non-users of bleach, only 3.2% of respondents reported a new demand for bleach, defined as a high likelihood of using bleach within the next year. This study highlights the potential for marketing approaches to increase use of and demand for surface disinfectants to improve domestic hygiene.

背景与目标： : 在发展中国家，对表面介导的疾病传播的研究不足，特别是鉴于有证据表明，粪便细菌的表面浓度通常比发达国家的浓度高出10至100倍。在这项研究中，我们检查了秘鲁亚马逊地区四个城市周围社区的21户家庭的餐盘粪便指示细菌污染。我们还使用调查来估计280家庭对表面消毒剂的家庭使用和需求。尽管分别在86%，43% 和24% 采样的平板上检测到总大肠菌群，肠球菌和大肠杆菌，但仍有不到3分之1的家庭定期使用漂白剂对表面进行消毒。在非漂白剂使用者中，只有3.2% 的受访者报告了对漂白剂的新需求，定义为在下一年内使用漂白剂的可能性很高。这项研究强调了营销方法的潜力，以增加对表面消毒剂的使用和需求，以改善家庭卫生。

BACKGROUND & AIMS: :Most candidate HIV vaccines are directed at priming memory T cell responses and are being evaluated on their effects on post acquisition viremia and/or disease progression. These vaccines are being studied in areas of high HIV-1 prevalence. As such, we evaluated the frequency of CD4+ T cell decline and time course of opportunistic infections of patients presenting at a major metropolitan hospital in Lima, Peru, an area where such candidate vaccines are being tested. We examined 92 patients with untreated HIV-1 in calendar year 2002: 35% presented with CD4+ T cell counts of <200, 25% between 201 and 400, and 17% with >400 cells/mm3, 30 of 92 patients presented with overt AIDS, 6 were without an AIDS defining OI but CD4 counts <200. Over the course of follow-up, CD4 count decreased by a mean of 31 cells/mm3/year in women and 28 in men (p>0.5). Among persons presenting with CD4 counts >250 cells/mm3, the median time to first OI was 3.5 years. If clinical endpoints are required to evaluate the clinical effectiveness of T cell based vaccines, extended clinical follow-up of subjects enrolled in such trials will be required.

背景与目标： : 大多数候选HIV疫苗都针对启动记忆T细胞反应，并正在评估其对获取后病毒血症和/或疾病进展的影响。这些疫苗正在HIV-1高流行的地区进行研究。因此，我们评估了在秘鲁利马的一家主要大都会医院就诊的患者的CD4 T细胞下降的频率和机会性感染的时间过程，该地区正在测试此类候选疫苗。我们在日历2002年中检查了92例未经治疗的HIV-1患者: 35% 例CD4 T细胞计数 <200，25% 201至400之间，17% 例> 400细胞/mm3，92例患者中有30例患有明显的AIDS，6例没有定义OI的AIDS，但CD4计数 <200。在随访过程中，女性CD4计数平均减少31个细胞/mm3/年，男性减少28个 (p>0.5)。在CD4计数> 250细胞/mm3的人中，首次OI的中位时间为3.5年。如果需要临床终点来评估基于T细胞的疫苗的临床有效性，则需要对参加此类试验的受试者进行长期的临床随访。

BACKGROUND & AIMS: :Several potyviruses are found infecting sweet potato (Ipomoea batatas) in Peru, of which sweet potato feathery mottle virus (SPFMV, genus Potyvirus) is the most common. However, sequence data for these viruses are not available from Peru. In this study, the 3'-terminal approximately 1,800 nucleotide sequences of 17 potyvirus samples collected from the six main sweet potato-producing areas of Peru over the past 20 years were determined and analyzed. Results of sequence comparisons and phylogenetic analysis showed that three of the four recognized SPFMV strain groups, including the East African strain, are established in Peru as well as two other potyviruses: sweet potato virus G (SPVG) and sweet potato virus 2 (SPV2). The analysis further revealed that SPFMV, SPVG and SPV2 are related and form an Ipomoea-specific phylogenetic lineage within the genus Potyvirus and identified for the first time recombination events between viruses from different strain groups of SPFMV.

背景与目标： : 在秘鲁发现了几种poty病毒感染甘薯 (Ipomoea batatas)，其中甘薯羽毛状斑驳病毒 (SPFMV，Poty病毒属) 最常见。但是，这些病毒的序列数据无法从秘鲁获得。在这项研究中，确定并分析了过去20年从秘鲁六个主要甘薯产区收集的17个马铃薯病毒样品的3' 末端约1,800个核苷酸序列。序列比较和系统发育分析的结果表明，在秘鲁建立了四个公认的SPFMV毒株组中的三个，包括东非毒株，以及另外两个poty病毒: 甘薯病毒G (SPVG) 和甘薯病毒2 (SPV2)。分析进一步表明，SPFMV，SPVG和SPV2是相关的，并在Potyvirus属内形成了番薯特异性系统发育谱系，并首次鉴定了来自SPFMV不同毒株组的病毒之间的重组事件。

BACKGROUND & AIMS: : Background: Helicobacter pylori prevalence and gastric cancer rates are remarkably high in Peru. Effective antimicrobial regimens are essential for successful H. pylori eradication. We aimed at assessing antimicrobial resistance rates to first- and second-line therapeutic agents in H. pylori strains detected in gastric biopsy samples. Materials and Methods: Gastric biopsy samples (antrum and corpus) were collected from therapy-naive patients (n = 154). H. pylori presence in the samples was confirmed by histopathology. Genotypic resistance to clarithromycin and quinolones was determined by real-time PCR. Results: Histology results were 100% concordant with PCR results (97/154; 63% H. pylori-positive in both). In 6% (6/97) of the patients, we found discordant results of H. pylori infection in antrum and corpus samples from the same patient. Resistance rates to clarithromycin and quinolone were 34% (33/97) and 68% (56/82), respectively. Antimicrobial resistance to both antimicrobials was 30% (25/82). Conclusion: Antimicrobial resistance rates of H. pylori to clarithromycin and quinolones are very high in Lima, Peru. Many first- and second-line, empiric eradication regimens may not be recommended for Peruvian patients.

背景与目标：

BACKGROUND & AIMS: SETTING:In 2003, Peru and Bolivia reported the highest annual tuberculosis (TB) incidence rates in the Americas. Neighboring Colombia and Chile had lower annual incidence rates despite their proximity. OBJECTIVE:To determine what factors contribute to differences in TB incidence rates among Chile, Colombia, Bolivia and Peru. DESIGN:Multiple sources of literature dating between 1990 and 2005 were used and World Health Organization TB control guidelines were consulted for policy level comparisons. RESULTS:Comprehensive implementation of the DOTS strategy is the main factor explaining the differences in TB incidence rates, even after considering socio-economic factors. CONCLUSION:Cross-national comparisons suggest ways to improve regional DOTS implementation.

背景与目标：

BACKGROUND & AIMS: :We investigated the prevalence and molecular epidemiology of human T cell lymphotropic virus type 1 in Peruvian HIV-1-positive subjects, and found a 10.1% prevalence in a consecutive series of 318 HIV-1-positive patients living in Lima. Phylogenetic analysis of the long terminal repeat of 10 patient isolates showed that all of them belonged to the HTLV-1aA (Transcontinental) subgroup. Although the majority of the Peruvian sequences included in the analysis formed a clade with other Latin American sequences, the isolates of three patients clustered significantly with South African strains. These data show a high prevalence of HTLV-1 infection in HIV-1-positive subjects living in Lima and confirm the presence in Latin America of HTLV-1 strains probably arising from South Africa.

背景与目标： : 我们调查了秘鲁HIV-1-positive受试者中1型人类T细胞淋巴细胞病毒的患病率和分子流行病学，并在连续318名HIV-1-positive患者中发现了10.1% 的患病率。对10个患者分离株的长末端重复序列的系统发育分析表明，它们全部属于HTLV-1aA (跨大陆) 亚组。尽管分析中包含的大多数秘鲁序列与其他拉丁美洲序列形成了进化枝，但三名患者的分离株与南非菌株显着聚集。这些数据表明，生活在利马的HIV-1-positive受试者中HTLV-1感染的患病率很高，并证实了拉丁美洲可能来自南非的HTLV-1菌株的存在。

BACKGROUND & AIMS: :Tuberculosis control is hampered by the widespread increase in multidrug resistance. Rapid drug susceptibility testing would greatly aid in the adequate treatment of the disease. This study evaluates the usefulness of the colorimetric method using Alamar Blue for the rapid detection of resistance to rifampicin and isoniazid in 63 clinical isolates of Mycobacterium tuberculosis in Peru. Results obtained by receiver operating characteristic curve analysis and measures of gain in certainty showed greater diagnostic accuracy than with the gold standard, the proportion method on Löwenstein-Jensen medium.

背景与目标： : 多药耐药性的广泛增加阻碍了结核病的控制。快速的药物敏感性测试将极大地帮助该疾病的适当治疗。这项研究评估了使用Alamar Blue的比色法在秘鲁63种结核分枝杆菌临床分离株中快速检测对利福平和异烟肼的耐药性的有用性。通过接收器工作特性曲线分析和确定性增益测量获得的结果显示出比金标准 (Löwenstein-Jensen培养基上的比例方法) 更高的诊断准确性。

BACKGROUND & AIMS: :Balamuthia mandrillaris is an opportunistic free-living amoeba that has been reported to cause skin lesions and the fatal Balamuthia amoebic encephalitis (BAE) in humans and other animals. Currently, around 200 human BAE cases have been reported worldwide, although this number is considered to be underestimated. The highest number of BAE cases has been reported in the American continent, mainly in the southwest of the USA. Peru seems to be another hotspot for BAE with around 55 human cases having been identified, usually involving cutaneous infection, especially lesions in the central face area. The isolation of Balamuthia from environmental sources has been reported on only three prior occasions, twice from Californian soils and once from dust in Iran and so it seems that this amoeba is relatively rarely encountered in samples from the environment. We investigated that possibility of finding the amoebae in soil samples from different regions where clinical cases have been reported in Peru. Twenty-one samples were cultured in non-nutrient agar plates and were checked for the presence of B. mandrillaris-like trophozoites and/or cysts. Those samples that were positive for these amoebae by microscopic criteria were then confirmed by PCR amplification and DNA sequencing of the mitochondrial 16S rDNA gene of B. mandrillaris. We have detected the presence of B. mandrillaris in four samples collected in the regions of Piura (3) and Lima (1) where infection cases have been previously reported. We hypothesize that B. mandrillaris is present in Peru in soil and dust which therefore constitutes a source of the infection for the BAE cases previously reported in this country. Further studies should be carried out in the area to confirm the generality of this finding.

背景与目标： : Balamuthia mandrillaris是一种机会主义的自由生活的变形虫，据报道会在人类和其他动物中引起皮肤病变和致命的Balamuthia阿米巴脑炎 (BAE)。目前，全世界已经报道了大约200例人类BAE病例，尽管这一数字被认为被低估了。在美洲大陆，主要是在美国西南部，报告的BAE病例数量最多。秘鲁似乎是BAE的另一个热点，已发现约55例人类病例，通常涉及皮肤感染，尤其是中央面部区域的病变。以前只有三次报道过从环境中分离出Balamuthia，两次是从加利福尼亚的土壤中分离出来的，一次是从伊朗的灰尘中分离出来的，因此似乎在环境样品中很少遇到这种变形虫。我们调查了在秘鲁报道了临床病例的不同地区的土壤样品中发现变形虫的可能性。在非营养琼脂平板中培养了21个样品，并检查了曼氏杆菌样滋养体和/或囊肿的存在。然后通过PCR扩增和对曼氏杆菌线粒体16S rDNA基因进行DNA测序，确认了通过显微镜标准对这些变形虫呈阳性的样品。我们已经在Piura (3) 和Lima (1) 地区收集的四个样本中检测到曼氏杆菌的存在，这些地区以前曾报道过感染病例。我们假设秘鲁的土壤和灰尘中存在曼氏杆菌，因此构成了该国先前报道的BAE病例的感染源。应在该地区进行进一步研究，以确认这一发现的普遍性。

BACKGROUND & AIMS: PURPOSE:Preterm birth (PTB) is a major cause of neonatal mortality. The vaginal microbiome is associated with PTB, but results vary across racial/ethnic populations. Some evidence suggests gestational age affects this association. We investigated these associations in a novel population, conducting a post hoc analysis assessing if associations differed between women swabbed at different gestational ages. METHODS:We compared vaginal microbiomes from women with PTB (n = 25) to a random sample of women with term births (n = 100) among participants in the Pregnancy Outcomes, Maternal and Infant Study, conducted in Lima, Peru. Using DADA2, we identified taxa from 16S DNA sequencing and used Dirichlet multinomial mixture models to group into community state types (CSTs). RESULTS:If gestational age at sampling was not considered, no CST (diverse, Lactobacillus-dominated or Lactobacillus iners-dominated), was associated with PTB. Among women sampled before 12 weeks' gestation, women with Lactobacillus-dominated CSTs were less likely to have a PTB than those with a diverse CST. Among those swabbed between 12 and 16 weeks' gestation, the reverse was true. CONCLUSIONS:Our study supports previous literature suggesting that what constitutes a healthy vaginal microbiome varies by race/ethnicity. Longitudinal studies are necessary to disentangle effects of vaginal microbiome differences over gestation.

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BACKGROUND & AIMS: INTRODUCTION:Embryo donation displays special characteristics within the Latin American context, where spare cryopreserved embryos are not currently available as is the case of industrialized countries. The Catholic church also plays a significant role. The need to regulate ethically and legally the practice of embryo donation suggests that we need to take into account the opinions from the main key players: patients, health professionals, and society. The objective of this study is to explore the patients perceptions vis a vis potential embryo donation for research purposes. MATERIALS AND METHODS:A descriptive, cross-sectional design included a tape recorded semi-structured interview administered to 32 patients attending a private clinic in Lima, Peru. Participants had undergone complex techniques of assisted fertilization (FIV and ICSI). The verbal Gottschalk analytical method was used to identify predominant anxiety manifestations in the interviews. RESULTS:The most common types of anxiety associated with embryo donation for research in this group of participants were guilt, separation anxiety and shame. Divided by gender, the more common types of anxiety reported by men were guilt, shame and separation anxiety. Women reported guilt, separation anxiety and shame.

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