Hiperendemicidad de fasciolosis y factores de riesgo en niños de edad escolar del distrito de Orurillo, Puno

The aim of this study was to determine the association of fasciolosis in school-age children with intestinal parasites, food consumption and animal husbandry. The research was analytical, prospective, cross-sectional, and relational. In total, 295 serological and stool samples were obtained, and an epidemiological interview was carried out on children of both sexes, aged 3 to 19 years from 23 institutions of initial, primary and secondary education, with the informed consent of their parents. The serological diagnosis was made using the IgG immunoblot technique and the IgG ELISA test and the stool diagnosis was made with the rapid sedimentation technique modified by Lumbreras. Risk factors were obtained by epidemiological interview. The prevalence of fasciolosis was 11.2% (95% CI = 7.4-14.9; 33/295). Significant differences were found between educational institutions and communities of origin. Both in univariate and multivariate analyses determined that drinking well water and raising guinea pigs were associated with fasciolosis.El objetivo del estudio fue determinar la asociación de fasciolosis en niños de edad escolar con parásitos intestinales, consumo de alimentos y crianza de animales. La investigación fue de tipo analítico, prospectivo, transversal y de nivel relacional. Se obtuvieron 295 muestras serológicas y coprológicas y se realizó una entrevista epidemiológica a niños de ambos sexos, de 3 a 19 años de 23 instituciones de educación inicial, primaria y secundaria, con el consentimiento informado de sus progenitores. El diagnóstico serológico se realizó mediante la técnica de inmunoblot IgG y la prueba de ELISA IgG y el diagnóstico coprológico se realizó con la técnica de sedimentación rápida modificada por Lumbreras. Los factores de riesgo se obtuvieron mediante entrevista epidemiológica. La prevalencia de fasciolosis fue de 11.2% (IC95%=7.4-14.9; 33/295). Se encontró diferencias significativas entre instituciones educativas y comunidades de procedencia. Tanto en análisis univariado como el multivariado determinaron que beber agua de pozo y criar cuyes estuvieron asociados a fasciolosis

Crianza de animales domésticos como factor de riesgo de fascioliasis humana

The aim of this study was to determine the association of fascioliasis with the breeding of animals, housing characteristics and food consumption of children in the district of Santa María de Chicmo, Apurimac, Peru. Serological samples were taken from 493 children aged 6 to 16 years, males and females, with the informed consent of their parents. The prevalence, determined by the immunoblot technique was 5.3% (95% CI = 3.2% -7.4%, 26/493). The univariate analysis showed that the breeding of cattle and cats, and raising three or more pigs were factors associated with fascioliasis. The breeding of more than five sheep resulted as a protection factor. Fascioliasis in children was not associated with the characteristics of the dwellings or the consumption of food. It is concluded that the district of Santa María de Chicmo is mesoendemic for fascioliasis in children, and that the rearing of some species of domestic animals involves risk of human fascioliasis.  El estudio tuvo como objetivo determinar la asociación de fascioliasis con la crianza de animales, características de la vivienda y consumo de alimentos de niños del distrito de Santa María de Chicmo, Apurímac, Perú. Se tomaron muestras serológicas a 493 niños de 6 a 16 años, de ambos sexos, con el consentimiento informado de sus padres. La prevalencia, determinada mediante la técnica de inmunoblot fue de 5.3% (IC95%=3.2%-7.4%; 26/493). El análisis univariado demostró que la crianza de bovinos y gatos, así como la crianza de tres o más cerdos fueron factores asociados a fascioliasis. La crianza de más de cinco ovinos configuró un factor de protección. La fascioliasis en niños no estuvo asociada a las características de las viviendas ni al consumo de alimentos. Se concluye que el distrito de Santa María de Chicmo es mesoendémico para fascioliasis en niños, y que la crianza de algunas especies de animales domésticos implica riesgo de fascioliasis humana

Sexual health knowledge and practices and STI/HIV prevalence among long-distance truck drivers in Peru

Objectives: HIV and other sexually transmitted infections remain a challenge globally and many key groups have yet to be studied. Evidence shows that truck drivers may have high-risk behaviors and higher sexually transmitted infection/HIV prevalence because they are a highly mobile population. However, there is little to no information on this group in Peru. Therefore, we explored the sexual health knowledge and practices and carried out sexually transmitted infection/HIV testing among male truck drivers and their assistants in Peru. Methods: We conducted a cross-sectional study utilizing cell phone-based behavioral surveys and sexually transmitted infection testing, including HIV, syphilis, gonorrhea, and chlamydia, with truck drivers and their assistants who were traveling on two major international highways in Peru. Results: A total of 1150 truck drivers and assistants participated. Participants were middle-aged men (average age = 39.8 years), 96.0% had complete secondary education, 78.4% were in stable relationships, and 88.7% earned more than minimum wage. The majority were aware of sexually transmitted infections/HIV, but very few recognized sexually transmitted infection symptoms. Few participants (under 5%) reported recent sexually transmitted infection symptoms. Prevalence of sexually transmitted infections was also low: no one had gonorrhea; 0.1% had HIV; 0.4% had recent syphilis infection (rapid plasma reagin ≥1:8); and 2.0% had chlamydia. The prevalence of these diseases is not different from that of the general population in Peru. Conclusion: When compared to other truck drivers worldwide, Peruvian truck drivers appear to have a lower risk of HIV/sexually transmitted infections. This may be since Peruvian drivers are older, more educated, have higher income, and spend fewer days away from home than their peers globally

Sexual health knowledge and practices and STI/HIV prevalence among long-distance truck drivers in Peru

Objectives: HIV and other sexually transmitted infections remain a challenge globally and many key groups have yet to be studied. Evidence shows that truck drivers may have high-risk behaviors and higher sexually transmitted infection/HIV prevalence because they are a highly mobile population. However, there is little to no information on this group in Peru. Therefore, we explored the sexual health knowledge and practices and carried out sexually transmitted infection/HIV testing among male truck drivers and their assistants in Peru. Methods: We conducted a cross-sectional study utilizing cell phone-based behavioral surveys and sexually transmitted infection testing, including HIV, syphilis, gonorrhea, and chlamydia, with truck drivers and their assistants who were traveling on two major international highways in Peru. Results: A total of 1150 truck drivers and assistants participated. Participants were middle-aged men (average age = 39.8 years), 96.0% had complete secondary education, 78.4% were in stable relationships, and 88.7% earned more than minimum wage. The majority were aware of sexually transmitted infections/HIV, but very few recognized sexually transmitted infection symptoms. Few participants (under 5%) reported recent sexually transmitted infection symptoms. Prevalence of sexually transmitted infections was also low: no one had gonorrhea; 0.1% had HIV; 0.4% had recent syphilis infection (rapid plasma reagin ≥1:8); and 2.0% had chlamydia. The prevalence of these diseases is not different from that of the general population in Peru. Conclusion: When compared to other truck drivers worldwide, Peruvian truck drivers appear to have a lower risk of HIV/sexually transmitted infections. This may be since Peruvian drivers are older, more educated, have higher income, and spend fewer days away from home than their peers globally

Durvalumab alone and durvalumab plus tremelimumab versus chemotherapy in previously untreated patients with unresectable, locally advanced or metastatic urothelial carcinoma (DANUBE): a randomised, open-label, multicentre, phase 3 trial

Background: Survival outcomes are poor for patients with metastatic urothelial carcinoma who receive standard, first-line, platinum-based chemotherapy. We assessed the overall survival of patients who received durvalumab (a PD-L1 inhibitor), with or without tremelimumab (a CTLA-4 inhibitor), as a first-line treatment for metastatic urothelial carcinoma. Methods: DANUBE is an open-label, randomised, controlled, phase 3 trial in patients with untreated, unresectable, locally advanced or metastatic urothelial carcinoma, conducted at 224 academic research centres, hospitals, and oncology clinics in 23 countries. Eligible patients were aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0 or 1. We randomly assigned patients (1:1:1) to receive durvalumab monotherapy (1500 mg) administered intravenously every 4 weeks; durvalumab (1500 mg) plus tremelimumab (75 mg) administered intravenously every 4 weeks for up to four doses, followed by durvalumab maintenance (1500 mg) every 4 weeks; or standard-of-care chemotherapy (gemcitabine plus cisplatin or gemcitabine plus carboplatin, depending on cisplatin eligibility) administered intravenously for up to six cycles. Randomisation was done through an interactive voice–web response system, with stratification by cisplatin eligibility, PD-L1 status, and presence or absence of liver metastases, lung metastases, or both. The coprimary endpoints were overall survival compared between the durvalumab monotherapy versus chemotherapy groups in the population of patients with high PD-L1 expression (the high PD-L1 population) and between the durvalumab plus tremelimumab versus chemotherapy groups in the intention-to-treat population (all randomly assigned patients). The study has completed enrolment and the final analysis of overall survival is reported. The trial is registered with ClinicalTrials.gov, NCT02516241, and the EU Clinical Trials Register, EudraCT number 2015-001633-24. Findings: Between Nov 24, 2015, and March 21, 2017, we randomly assigned 1032 patients to receive durvalumab (n=346), durvalumab plus tremelimumab (n=342), or chemotherapy (n=344). At data cutoff (Jan 27, 2020), median follow-up for survival was 41·2 months (IQR 37·9–43·2) for all patients. In the high PD-L1 population, median overall survival was 14·4 months (95% CI 10·4–17·3) in the durvalumab monotherapy group (n=209) versus 12·1 months (10·4–15·0) in the chemotherapy group (n=207; hazard ratio 0·89, 95% CI 0·71–1·11; p=0·30). In the intention-to-treat population, median overall survival was 15·1 months (13·1–18·0) in the durvalumab plus tremelimumab group versus 12·1 months (10·9–14·0) in the chemotherapy group (0·85, 95% CI 0·72–1·02; p=0·075). In the safety population, grade 3 or 4 treatment-related adverse events occurred in 47 (14%) of 345 patients in the durvalumab group, 93 (27%) of 340 patients in the durvalumab plus tremelimumab group, and in 188 (60%) of 313 patients in the chemotherapy group. The most common grade 3 or 4 treatment-related adverse event was increased lipase in the durvalumab group (seven [2%] of 345 patients) and in the durvalumab plus tremelimumab group (16 [5%] of 340 patients), and neutropenia in the chemotherapy group (66 [21%] of 313 patients). Serious treatment-related adverse events occurred in 30 (9%) of 345 patients in the durvalumab group, 78 (23%) of 340 patients in the durvalumab plus tremelimumab group, and 50 (16%) of 313 patients in the chemotherapy group. Deaths due to study drug toxicity were reported in two (1%) patients in the durvalumab group (acute hepatic failure and hepatitis), two (1%) patients in the durvalumab plus tremelimumab group (septic shock and pneumonitis), and one (<1%) patient in the chemotherapy group (acute kidney injury). Interpretation: This study did not meet either of its coprimary endpoints. Further research to identify the patients with previously untreated metastatic urothelial carcinoma who benefit from treatment with immune checkpoint inhibitors, either alone or in combination regimens, is warranted. Funding: AstraZeneca