Knowledge and practices of tour guides in Cuzco on the prevention and treatment of traveler's diarrhea

Objectives: To describe the knowledge and practices among tour guides in Cuzco, Peru regarding prevention and treatment of traveler's diarrhea. Methods: The main tour guide association in Cuzco organized a mandatory re-certification course for tour guides in February 2004. We invited tour guides attending this course to participate in the study. Those aged 18 to 50 who had worked as a tour guide for at least one year were asked to complete a brief anonymous questionnaire. Results: A total of 173 questionnaires were returned; 137 met the inclusion criteria and were included in the analysis. The median age was 31 years (interquartile range (IQR): 28-34 years), and 56.7% were male. The median number of foreign languages spoken by subjects included was 1, being English (91.9%) the most common, followed by French (17.9%) and Italian (16.8%). The median time working as a tour guide was 4 years (IQR: 2-8 years). Tour guidance was a full-time job for 47.1% of the subjects, and for 82.4% Inca Trail was the most commonly covered route. Traveler's diarrhea was considered a food-borne disease by 85.4%, but only 60.6% considered it a water-borne disease. The majority of subjects identified raw salads (84.4%), cold sauces (81.5%) and tap water (81.1%) as risky products whereas hot soups (77 8%) and bread (75.0%) were mainly considered as safe. Most of the tour guides considered bloody stools (84.8%) and fever (60.6%) as indications to seek medical attention. The medications most frequently recommended by tour guides were oral re-hydration solutions ( 85.1%), trimethoprim-sulphamethoxazole (26.1%) and loperamide (20.1%). Conclusions: Tour guides have a basic knowledge about traveler's diarrhea. However, more training is necessary to improve management while trekking outside of Cuzco The recommendation to seek pharmacists should be particularly addressed

High Prevalence of Primary Multidrug Resistant Tuberculosis in Persons with No Known Risk Factors

INTRODUCTION: In high multidrug resistant (MDR) tuberculosis (TB) prevalence areas, drug susceptibility testing (DST) at diagnosis is recommended for patients with risk factors for MDR. However, this approach might miss a substantial proportion of MDR-TB in the general population. We studied primary MDR in patients considered to be at low risk of MDR-TB in Lima, Peru. METHODS: We enrolled new sputum smear-positive TB patients who did not report any MDR-TB risk factor: known exposure to a TB patient whose treatment failed or who died or who was known to have MDR-TB; immunosuppressive co-morbidities, ex prison inmates; prison and health care workers; and alcohol or drug abuse. A structured questionnaire was applied to all enrolled participants to confirm the absence of these factors and thus minimize underreporting. Sputum from all participants was cultured on Lowenstein-Jensen media and DST for first line drugs was performed using the 7H10 agar method. RESULTS: Of 875 participants with complete data, 23.2% (203) had risk factors for MDR-TB elicited after enrolment. Among the group with no reported risk factors who had a positive culture, we found a 6.3% (95%CI 4.4-8.3) (37/584) rate of MDR-TB. In this group no epidemiological characteristics were associated with MDR-TB. Thus, in this group, multidrug resistance occurred in patients with no identifiable risk factors. CONCLUSIONS: We found a high rate of primary MDR-TB in a general population with no identifiable risk factors for MDR-TB. This suggests that in a high endemic area targeting patients for MDR-TB based on the presence of risk factors is an insufficient intervention

Clinical Prediction Rule for Stratifying Risk of Pulmonary Multidrug-Resistant Tuberculosis

Multidrug-resistant tuberculosis (MDR-TB), resistance to at least isoniazid and rifampin, is a worldwide problem.To develop a clinical prediction rule to stratify risk for MDR-TB among patients with pulmonary tuberculosis.Derivation and internal validation of the rule among adult patients prospectively recruited from 37 health centers (Perú), either a) presenting with a positive acid-fast bacillus smear, or b) had failed therapy or had a relapse within the first 12 months.Among 964 patients, 82 had MDR-TB (prevalence, 8.5%). Variables included were MDR-TB contact within the family, previous tuberculosis, cavitary radiologic pattern, and abnormal lung exam. The area under the receiver-operating curve (AUROC) was 0.76. Selecting a cut-off score of one or greater resulted in a sensitivity of 72.6%, specificity of 62.8%, likelihood ratio (LR) positive of 1.95, and LR negative of 0.44. Similarly, selecting a cut-off score of two or greater resulted in a sensitivity of 60.8%, specificity of 87.5%, LR positive of 4.85, and LR negative of 0.45. Finally, selecting a cut-off score of three or greater resulted in a sensitivity of 45.1%, specificity of 95.3%, LR positive of 9.56, and LR negative of 0.58.A simple clinical prediction rule at presentation can stratify risk for MDR-TB. If further validated, the rule could be used for management decisions in resource-limited areas

Choosing best practices for managing impacts of trawl fishing on seabed habitats and biota

Bottom trawling accounts for almost one quarter of global fish landings but may also have significant and unwanted impacts on seabed habitats and biota. Management measures and voluntary industry actions can reduce these impacts, helping to meet sustainability objectives for fisheries, conservation and environmental management. These include changes in gear design and operation of trawls, spatial controls, impact quotas and effort controls. We review nine different measures and actions and use published studies anda simple conceptual model to evaluate and compare their performance. The risks and benefits of these management measures depend on the extent to which the fishery is already achieving management objectives for target stocks and the characteristics of the management system that is already in place. We offer guidance on identifying best practices for trawl-fisheries management and show that best practices and their likelihood of reducing trawling impacts depend on local, national and regional management objectives and priorities, societal values and resources for implementation. There is no universalbest practice, and multiple management measures and industry actions are required to meet sustainability objectives and improve trade-offs between food production and environmental protection

Two-layer model for photopyroelectric spectroscopy

This paper presents a one-dimensional theory which describes the dependence of the photopyroelectric induced signal on the optical and thermal properties of a two-layer sample, for example a thin film deposited on a substrate. Several computer simulations were performed in order to determine the validity of this model for a wide range of wavelengths and modulation frequencies

The changing pattern of methicillin-resistant Staphylococcus aureus clones in latin America: Implications for clinical practice in the region

Methicillin-resistant Staphylococcus aureus (MRSA) clones belonging to the Brazilian, Pediatric, Cordobes/Chilean and New York/Japan clonal complexes are widely distributed across Latin America, although their individual distribution patterns and resistance to antimicrobial drugs are constantly changing. Furthermore, clones with increased virulence are beginning to appear more frequently both in hospital and community settings, and there is evidence that virulence factors can be transferred between hospital- and community-associated clones through recombination. These changing patterns have significant implications for clinical practice in the region. Most importantly, clinicians need to be aware of the changing antimicrobial resistance profile of circulating MRSA clones in their region in order to choose the most appropriate empiric antimicrobial therapy. Thus, regional molecular epidemiology programs are required across the region to provide accurate identification and characterization of circulating MRSA clones