¿El consumo de agua con alta concentración de arsénico provoca anemia infantil?

Se cree que la anemia es generada por la carencia de hierro, empero esta también puede ser inducida por factores: nutricionales, socioeconómicos y ambientales (consumo de agua con alta concentración de arsénico). El presente estudio modela el impacto del consumo de agua de pozo sobre la probabilidad de ausencia de anemia en niños de 6 a 36 meses de edad de la ciudad de Juliaca, Perú. La información analizada proviene de la Encuesta Demográfica y de Salud Familiar 2017, mediante modelos de respuesta ordenada se analizaron 201 observaciones correspondientes a hogares de Juliaca. Los resultados indican que el consumo de agua de pozo disminuye en 9,7% (p < 0.05) la probabilidad de ausencia de anemia, 1 miembro adicional en la familia reduce la probabilidad de ausencia de anemia en 8.7% (p < 0.01), el incremento en 1g en la hemoglobina de la madre aumenta la probabilidad de ausencia de anemia en el hijo en 6,7% (p < 0.01). En consecuencia, para mitigar la prevalencia de anemia es preciso: asegurar la calidad del agua para consumo humano, implementar actividades que mejoren los indicadores nutricionales de niños sus respectivas madres

Diversidad genética y filogenia del género Cinchona en el Parque Nacional de Cutervo, Perú

Las especies del género Cinchona son reconocidas mundialmente por su eficacia en el tratamiento contra la malaria. Para el Perú, este género reviste mayor importancia a los aspectos forestal y cívico, por representar la riqueza del recurso vegetal. Sin embargo, en la actualidad sus poblaciones se encuentran fuertemente amenazadas por diversas actividades antropogénicas. El Parque Nacional de Cutervo (PNC) es la primer Área Natural Protegida (ANP) del Perú y es considerado como unidad de conservación para el género Cinchona. Objetivo: Determinar la diversidad genética y las relaciones filogenéticas de las especies del género Cinchona presentes en el PNC. Métodos: Nosotros evaluamos 13 muestras empleando el marcador matK y se generó un árbol filogenético empleando el método de máxima verosimilitud con soporte de filogenia bootstrap. Resultados: 8 haplotipos fueron registrados, con una diversidad haplotípica (Hd) 0.859 y nucleotídica (π) 0.35 %, identificándose además a: C. calisaya, C. pubescens y C. pitayensis para el PNC; el árbol filogenético mostró que la especie C. pitayensis se encuentra bastante conservada, mientras que C. pubsecens se encuentra presente en distintos grupos con similitud variable. Conclusiones: La elevada diversidad genética de Cinchona y el registro del haplotipo de C. calisaya, especie con categoría de conservación nacional “Vulnerable”, incrementa la importancia para la conservación de la biodiversidad del PNC

Diversidad genética y filogenia del género Cinchona en el Parque Nacional de Cutervo, Perú

Species of the genus Cinchona are recognized for their effectiveness in treating malaria. For Peru, this genus is of greater importance regarding forestry and civic aspects, because it represents the richness of the plant resource. Nevertheless, nowadays Cinchona populations are strongly threatened by various anthropogenic activities. Cutervo National Park (PNC) is the Peruvian's first Protected Natural Area (ANP) and is considered as a conservation unit for the genus Cinchona. Objective: Determine the genetic diversity and phylogenetic relationships of the species of the genus Cinchona that inhabit the PNC. Methods: We tested 13 samples using the matK marker and a phylogenetic tree was generated using the maximum likelihood method and bootstrap measures of phylogenetic support. Results: 8 number of haplotypes (h) were recorded, with haplotype diversity (Hd) 0.859 and nucleotide diversity (π) 0.35%, also identifying: C. calisaya, C. pubescens and C. pitayensis for the PNC; the phylogenetic tree showed C. pitayensis as conserved specie, meanwhile C. pubsecens is present in many groups. Conclusions: The high genetic diversity of Cinchona and haplotype record of C. calisaya, species with a national conservation category of "Vulnerable", increases the importance for biodiversity conservation of the PNC.Las especies del género Cinchona son reconocidas mundialmente por su eficacia en el tratamiento contra la malaria. Para el Perú, este género reviste mayor importancia a los aspectos forestal y cívico, por representar la riqueza del recurso vegetal. Sin embargo, en la actualidad sus poblaciones se encuentran fuertemente amenazadas por diversas actividades antropogénicas. El Parque Nacional de Cutervo (PNC) es la primer Área Natural Protegida (ANP) del Perú y es considerado como unidad de conservación para el género Cinchona. Objetivo: Determinar la diversidad genética y las relaciones filogenéticas de las especies del género Cinchona presentes en el PNC. Métodos: Nosotros evaluamos 13 muestras empleando el marcador matK y se generó un árbol filogenético empleando el método de máxima verosimilitud con soporte de filogenia bootstrap. Resultados: 8 haplotipos fueron registrados, con una diversidad haplotípica (Hd) 0.859 y nucleotídica (π) 0.35 %, identificándose además a: C. calisaya, C. pubescens y C. pitayensis para el PNC; el árbol filogenético mostró que la especie C. pitayensis se encuentra bastante conservada, mientras que C. pubsecens se encuentra presente en distintos grupos con similitud variable. Conclusiones: La elevada diversidad genética de Cinchona y el registro del haplotipo de C. calisaya, especie con categoría de conservación nacional “Vulnerable”, incrementa la importancia para la conservación de la biodiversidad del PNC

Caracterización molecular de la microbiota de plantas sanas y enfermas de Theobroma cacao L. e identificación de cepas nativas de Bacillus amiloliquefaciens antagonista in vitro del hongo fitopatógeno Colletrotrichum fructicola

El cultivo de Theobroma cacao en el país tiene una gran importancia económica, siendo considerada la región Tumbes productora de cacao fino aroma y sabor con fines de exportación, Sin embargo, este cultivo es susceptible a enfermedades fúngicas, lo que ha generado el uso indiscriminado de pesticidas. Una alternativa para reducir o eliminar el uso de estos pesticidas, consiste en la aplicación de bacterias y hongos benéficos nativos con carácter de bio-controlador. Con la finalidad de conocer la diversidad bacteriana y fúngica, se realizaron diversos análisis metagenómicos, mostrando estos la predominancia de las bacterias, de los Phyla firmicutes y proteobacteria los cuales varían acorde a la etapa de infección causada por hongos, así mismo en una muestra directa de suelo rizosférico se determinó el predominio de bacterias no clasificadas. Las cepas bacterianas y fúngicas identificadas de la filósfera fueron: Leclercia, Pantoea, Enterobacter, Klebsiella, Serratia, Bacillus, Acinetobacter, Colletotrichum, Diaporthe, Macrophomina, Phomopsis, Lasiodiplodia, Neurospora, Moniliophthora y de la rizósfera Lysinibacillus, Enterobacter, Aeromonas, Pseudomonas, Bacillus, Klebsiella, Kluyvera, Pantoea y Trichoderma, Cunninghamella. Los ensayos in vitro mostraron que B. amiloliquefaciens posee actividad antagonista contra C. gloesporioides. Se concluye que estas cepas bacterianas aisladas de T. cacao tienen un gran potencial como bio controlador. Palabras clave: Theobroma cacao, Metagenómica, RizósferaFondo Nacional de Desarrollo Científico y Tecnológico - Fondecy

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P<0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P<0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially