Impact of infection control measures to control an outbreak of multidrug-resistant tuberculosis in a human immunodeficiency virus ward, Peru

Multidrug-resistant tuberculosis (MDRTB) rates in a human immunodeficiency virus (HIV) care facility increased by the year 2000-56% of TB cases, eight times the national MDRTB rate. We reported the effect of tuberculosis infection control measures that were introduced in 2001 and that consisted of 1) building a respiratory isolation ward with mechanical ventilation, 2) triage segregation of patients, 3) relocation of waiting room to outdoors, 4) rapid sputum smear microscopy, and 5) culture/drug-susceptibility testing with the microscopic-observation drug-susceptibility assay. Records pertaining to patients attending the study site between 1997 and 2004 were reviewed. Six hundred and fifty five HIV/TB-coinfected patients (mean age 33 years, 79% male) who attended the service during the study period were included. After the intervention, MDRTB rates declined to 20% of TB cases by the year 2004 (P = 0.01). Extremely limited access to antiretroviral therapy and specific MDRTB therapy did not change during this period, and concurrently, national MDRTB prevalence increased, implying that the infection control measures caused the fall in MDRTB rates. The infection control measures were estimated to have cost US$91,031 while preventing 97 MDRTB cases, potentially saving US$1,430,026. Thus, this intervention significantly reduced MDRTB within an HIV care facility in this resource-constrained setting and should be cost-effective

Prognostic value of neutrophil-to-lymphocyte ratio in COVID-19 patients: A systematic review and meta-analysis

Background: Neutrophil-to-lymphocyte ratio (NLR) is an accessible and widely used biomarker. NLR may be used as an early marker of poor prognosis in patients with COVID-19. Objective: To evaluate the prognostic value of the NLR in patients diagnosed with COVID-19. Methods: We conducted a systematic review and meta-analysis. Observational studies that reported the association between baseline NLR values (ie, at hospital admission) and severity or all-cause mortality in COVID-19 patients were included. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS). Random effects models and inverse variance method were used for meta-analyses. The effects were expressed as odds ratios (ORs) and their 95% confidence intervals (CIs). Small study effects were assessed with the Egger's test. Results: We analysed 61 studies (n = 15 522 patients), 58 cohorts, and 3 case-control studies. An increase of one unit of NLR was associated with higher odds of severity (OR 6.22; 95%CI 4.93 to 7.84; P <.001) and higher odds of all-cause mortality (OR 12.6; 95%CI 6.88 to 23.06; P <.001). In our sensitivity analysis, we found that 41 studies with low risk of bias and moderate heterogeneity (I2 = 53% and 58%) maintained strong association between NLR values and both outcomes (severity: OR 5.36; 95% CI 4.45 to 6.45; P <.001; mortality: OR 10.42 95% CI 7.73 to 14.06; P =.005). Conclusions: Higher values of NLR were associated with severity and all-cause mortality in hospitalised COVID-19 patients.Revisión por pare

Clinical-epidemiologic variation in patients treated in the first and second wave of COVID-19 in Lambayeque, Peru: A cluster analysis

"Objectives: To identify differences in the clinical and epidemiologic characteristics of patients during the first and second waves of the COVID-19 pandemic at the EsSalud Lambayeque health care network, Peru. Methods: An analytical cross-sectional study of 53,912 patients enrolled during the first and second waves of COVID-19 was conducted. Cluster analysis based on clustering large applications (CLARA) was applied to clinical-epidemiologic data presented at the time of care. The two pandemic waves were compared using clinical-epidemiologic data from epidemiologic surveillance. Results: Cluster analysis identified four COVID-19 groups with a characteristic pattern. Cluster 1 included the largest number of participants in both waves, and the participants were predominantly female. Cluster 2 included patients with gastrointestinal, respiratory, and systemic symptoms. Cluster 3 was the “severe” cluster, characterized by older adults and patients with dyspnea or comorbidities (cardiovascular, diabetes, obesity). Cluster 4 included asymptomatic, pregnant, and less severe patients. We found differences in all clinical-epidemiologic characteristics according to the cluster to which they belonged. Conclusion: Using cluster analysis, we identified characteristic patterns in each group. Respiratory, gastrointestinal, dyspnea, anosmia, and ageusia symptoms were higher in the second COVID-19 wave than the first COVID-19 wave

Cytokines and T-Lymphocute count in patients in the acute and chronic phases of Bartonella bacilliformis infection in an endemic area in peru: a pilot study

Human Bartonellosis has an acute phase characterized by fever and hemolytic anemia, and a chronic phase with bacillary angiomatosis-like lesions. This cross-sectional pilot study evaluated the immunology patterns using pre- and post-treatment samples in patients with Human Bartonellosis. Patients between five and 60 years of age, from endemic areas in Peru, in the acute or chronic phases were included. In patients in the acute phase of Bartonellosis a state of immune peripheral tolerance should be established for persistence of the infection. Our findings were that elevation of the anti-inflammatory cytokine IL-10 and numeric abnormalities of CD4+ and CD8+ T-Lymphocyte counts correlated significantly with an unfavorable immune state. During the chronic phase, the elevated levels of IFN-γ and IL-4 observed in our series correlated with previous findings of endothelial invasion of B. henselae in animal models

Concentración de Pólvora para Determinar la Distancia de un Disparo de Arma de Fuego

OBJECTIVE: To assess an appropriate diagnostic method by measurements of the gunpowder amount around the entrance hole on the skin. METHODOLOGY: Using a caliber-38 revolver with FAME bullets, and from pre-established distances, five series of gunshots were performed on clothed fragments of pigskin. Then, we verified the presence of gunpowder tattoos, both, over the skin and clothes. To determine the amount of gunpowder particles present on the skin, microphotografies of the specimens were taken. All firing distances drew a clean zone (peripheral to the bullet entrance hole); followed by the gunpowder tattoo, which were divided into three concentric areas. These areas are closely related to the firing distance and inversely related to the concentration of gunpowder particles. CONCLUSION: It´s possible to make an accurate asessment of firing distance (range: 30 to 100 cm), through the measurement of gunpowder residues around the entrance hole on the skin, as showed in microphotographies. We propose the term "target-like tattoo" for these skin images.OBJETIVO: Ensayar un método de diagnóstico adecuado con la medición de la concentración de partículas de pólvora incrustadas en los tejidos periféricos al orificio de entrada (OE) para precisar la probable distancia de disparo. METODOLOGÍA: Usando un revólver calibre 38 con munición FAME se realizó cinco series de disparos contra fragmentos de piel de cerdo con cobertura de tela desde distancias conocidas, verificándose la presencia del tatuaje sobre la piel y la tela. Las muestras fueron microfotografiadas para cuantificar los gránulos de pólvora presentes sobre la piel. RESULTADOS: Para todas las distancias de disparo se establece un espacio claro periférico al OE, un inicio del tatuaje, una extensión del tatuaje y un final del tatuaje o zona clara postatuaje, variando esta relación de modo directamente proporcional a la distancia del disparo e inversamente a la concentración de restos de pólvora. CONCLUSIÓN: Puede determinarse con mayor precisión la distancia aproximada de disparo, en un rango de 30 a 100 cm, midiendo la concentración de partículas de pólvora incrustadas en la superficie cutánea por medio del método de microfotografía estereoscópica. Se propone el término "Tatuaje en Escarapela" para referirse a este tipo de distribución