Pictorial evidence of endemic trachoma in Peru.

<p>(A) Everted upper eyelid showing scarring trachoma (TS) in an individual from San Francisco de Yarinacocha in 1985 [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0004116#pntd.0004116.ref021" target="_blank">21</a>] and (B) in another individual from Santa Teresita in 1986 [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0004116#pntd.0004116.ref022" target="_blank">22</a>], two indigenous Shipibo-Conibo communities settled along the banks of the Ucayali river, Pucallpa, department of Ucayali. The field studies were performed from 1983 to 2001 and were led by one of the authors (CW).</p

Map of Peru with geographical areas where trachoma was reported after the 1980s.

<p>Only included are the studies that reported more than ten individuals with any sign of trachoma. Areas (o) in the main map denote the department of Peru, followed by the district or community in parentheses and its reference in brackets. (A) Magnification of the department of San Martin showing five districts or communities and references in brackets. Surveys performed between 1983 and 2000. (B) Magnification of the department of Ucayali showing five districts or communities and references in brackets. Surveys performed between 1985 and 2001.</p

Timeline.

<p>Dates of publication of different sources of trachoma in Peru.</p

Association of <i>Fasciola hepatica</i> Infection with Liver Fibrosis, Cirrhosis, and Cancer: A Systematic Review

<div><p>Background</p><p>Fascioliasis has been sporadically associated with chronic liver disease on previous studies. In order to describe the current evidence, we carried out a systematic review to assess the association between fascioliasis with liver fibrosis, cirrhosis and cancer.</p><p>Methodology and Principal Findings</p><p>A systematic search of electronic databases (PubMed, LILACS, Scopus, Embase, Cochrane, and Scielo) was conducted from June to July 2015 and yielded 1,557 published studies. Among 21 studies that met inclusion and exclusion criteria, 12 studies explored the association of <i>F</i>. <i>hepatica</i> with liver fibrosis, 4 with liver cirrhosis, and 5 with cancer. Globally these studies suggested the ability of <i>F</i>. <i>hepatica</i> to promote liver fibrosis and cirrhosis. The role of <i>F</i>. <i>hepatica</i> in cancer is unknown. Given the heterogeneity of the studies, a meta-analysis could not be performed.</p><p>Conclusions</p><p>Future high-quality studies are needed to determine the role of <i>F</i>. <i>hepatica</i> on the development of liver fibrosis, liver cirrhosis, and cancer in humans.</p></div

Schematic representation of liver fibrosis and cirrhosis associated with fascioliasis.

<p>(A) Normal architecture of a sheep's liver. Haematoxylin and eosin (HE) staining. Taken from Ref. [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0004962#pntd.0004962.ref019" target="_blank">19</a>]. (B) Juvenile parasite migrating in the peritoneal cavity causing destruction and haemorrhages in case (HE stain, magnification x100). The biopsy in the peritoneum was performed due to clinical suspicion of metastases Taken from Ref. [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0004962#pntd.0004962.ref048" target="_blank">48</a>]. (C) Typical microscopic appearance (400X) of liver from the infected sheep at 8 weeks post infection, massive infiltration of inflammatory cells and deposition of collagen can be observed. Taken from Ref. [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0004962#pntd.0004962.ref019" target="_blank">19</a>]. (D) Liver cirrhosis caused by <i>F</i>. <i>hepatica</i> infection. Trichrome stain (100x). Rat. Authors’ photo gallery. (E) Extensive fibrosis (Fi) with formation of fibrotic nodules (FN), architectural disruption of the liver and regeneration; stage IV or F4 (cirrhosis). Trichrome stain. Rats. Authors’ photo gallery.</p

Trend of mean scores of total knowledge, socio-demographic and epidemiological knowledge (block I) and clinical knowledge (block II) by year of study at medical school.

<p>ANOVA statistics for (A) “Total score”, p<0.001 (B) “Block I score”, p<0.001 (C) “Block II score”, p<0.001 (D) Separately analysis of block I: “Block I score from 1^st to 4^th year”, p<0.001; “Block I score from 4^th to 7^th year”, p = 0.66.</p