ENSAYO DE TRES PROGRAMAS DE VACUNACIÓN ANTICLOSTRIDIAL EN ALPACAS

La enterotoxemia es la enfermedad infecciosa más importante que afecta las crías de las alpacas. El control está supeditado a la aplicación de medidas preventivas de manejo y a la aplicación de inmunoprofilaxis. En el presente trabajo se ensayaron tres programas de vacunación anticlostridial durante tres campañas de parición (2001, 2002 y 2003) en una unidad de producción de una empresa de propiedad social en Puno. Se empleó un anacultivo a base de cepas de Clostridium perfringens, predominantemente de origen ovino (cepas A, B, C y D) y de una cepa tipo A aislada de alpaca. El efecto de la vacuna se realizó comparando tasas de mortalidad total y mortalidad asociada a enterotoxemia ocurrida antes de la introducción de la vacuna (año 2000). En el primer programa (año 2001) se administró dos dosis de la vacuna a todas las madres gestantes (n=2,952) y una dosis a todas las crías. En el segundo programa (año 2002) se vacunó con una dosis a todas las crías (n=2,647), y en el tercer programa (año 2003) se vacunó con una dosis a todas las madres gestantes (n=2,760). La aplicación de la vacuna redujo la mortalidad neonatal total de 33.4 (año 2000) a 25.2 j año2001), 23.7 (año 2002) y a9.4%(&0 2003). La vacuna, igualmente, redujo la mortalidad neonatal asociadas a enterotoxemia desde 19.5 (año 2000) hasta 7.2,9.1 y l.O%para los mismos años. Se concluye que el anacultivo (vacuna) fue efectivo para el control de enterotoxemia en alpacas, independientemente del tipo de programa aplicado. Sin embargo, la reducción fue más evidente en los programas que consideraron la vacunación de madres gestantes

Implementación del sistema internacional Dupont mediante el programa trabajemos seguros para la reducción de accidentes laborales en una empresa minera

La presente investigación fue realizada en el sector minero, en la empresa Alpayana S.A., compañía que se dedica a la exploración y explotación de minerales por su propia cuenta. Sus actividades están enmarcadas en el código CIUU Nº 1320. En Alpayana S.A. se evidenció que los accidentes de trabajo ocurren principalmente por falta de capacitación, inadecuada identificación de peligros y riesgos, y por actos inseguros, motivo que nos llevó a implementar el sistema internacional Dupont, bajo las directrices de Dupont Safety y los lineamientos del comité de gestión de riesgos, disciplina operativa, auditorias comportamentales y el comité de comunicación, capacitación y motivación (CCM); el cual tuvo como pilar fundamental el “cambio de cultura” en los colaboradores de la empresa teniendo un compromiso de cero accidentes. Esta investigación se realizó durante el año 2019, teniendo como principal objetivo: implementar el sistema internacional Dupont mediante el programa “Trabajemos seguros” para reducir el número de accidentes laborales en la empresa minera

Protective effect of a clostridium polyvalent vaccine on neonatal mortality in alpacas

El estudio analiza el efecto beneficioso de una vacuna multivalente a base de componentes bacterianos y toxinas inactivadas (anacultivo) en la prevención de la enterotoxemia en alpacas. La vacuna múltiple, conteniendo mayoritariamente (60%) cepas de Clostridium perfringens tipos A y Aβ2, fue introducida en el año 2001 en una unidad de producción alpaquera en el distrito de Ñuñoa (Melgar, Puno) y utilizada durante seis años consecutivos. El efecto de la vacuna fue analizado comparando las tasas de mortalidad neonatal total y específica por enterotoxemia en el año 2000 con las mortalidades presentadas durante los seis años de vacunación (2001-2006). El estudio contempló vacunar a todas las hembras preñadas y a todas las crías en el primer año (2001) y solamente a las crías en los años siguientes; sin embargo, en el 2003 se vacunó solamente a las madres gestantes. La mortalidad se calculó en base a los reportes administrativos mensuales de mortalidad de crías preparados por el personal sanitario y veterinario responsable de la unidad de producción. Los diagnósticos causales de muertes fueron basados por observaciones de campo y en algunos casos confirmados por análisis de laboratorio. La introducción de la vacuna redujo la mortalidad total de 37.4% (año 2000, sin vacuna) a 25.2, 23.7, 9.4, 12.1, 15.1 y 14.3% en los años 2001 a 2006, y la mortalidad neonatal debido a enterotoxemia de 19.5% (año 2000, sin vacuna) a 7.2, 9.1, 1.0, 0.3, 2.1 y 3.9% para los años 2001 a 2006. El anacultivo (bacteria y exotoxinas inactivadas) polivalente redujo significativamente las tasas de mortalidad neonatal general y específica debido a enterotoxemia.This paper analyse the beneficial effect of a multivalent vaccine in reducing mortality rates due to enterotoxemia in alpaca crias. The programme was implemented in 2001 and ran for six consecutive years (2001-2006) in a cooperative farm in southern Peru (Nuñoa, Puno) using a multiple anaculture (bacterine and toxoid) containing predominantly (60%) two subtypes of Clostridium perfringens (A and Aβ2). During these six years, different vaccination protocols were used including inoculating both mothers and crias in the first year and either mothers (2003) or only crias (2002, 2004-2006). The impact of the vaccination was evaluated by comparing total and specific neonatal mortality rates due to enterotoxemia relative to the same rates recorded for the year prior to initiation of the programme (2000). A reduction in total neonatal mortality was recorded from 33.4% in 2000 with no vaccination, to 25.2, 23.7, 9.4, 12.1, 15.1, and 14.3% in years 2001 to 2006. The vaccine equally reduced the mortality associated with enterotoxemia from 19.5% (2000) to 7.2, 9.1, 1.0, 0.3, 2.1, and 3.9% for 2001 through 2006. The polyvalent anaculture (bacterine and toxoid) significantly reduced total mortality rate as well as neonatal mortality rate due to enterotoxemia

Microbiological, pathological and microelement analyses in vicuñas affected with "dandruff"

Se describen 75 estudios histopatológicos en biopsias de piel (33 afectados y 42 no afectados con “caspa”), 85 análisis microbiológicos en raspados de piel (44 afectados y 41 no afectados) y 70 determinaciones séricas de zinc, selenio, cobre y molibdeno (41 afectados y 29 no afectados) de tres poblaciones de vicuñas silvestres capturadas en “Chakus” en el 2009 en las comunidades campesinas de Huaytará, Ayaví, Santa Rosa de Tambo y en una población captiva multicomunal, en Huancavelica. Los animales afectados no tenían alteraciones clínicas, pero los vellones a la postesquila presentaron escamas blanquecinas dispersas o acumuladas y fuertemente adheridas, usualmente, al dorso lateral y algunas veces por todo el vellón. Todas las muestras de piel, con mayor severidad en las afectadas, mostraron moderada hiperqueratosis ortoqueratótica laminar asociada con dermatosis inespecífica, moderada-severa dilatación de folículos pilosos y moderada-severa atrofia de vaina interna de la raíz folicular pero con ausencia de agentes patógenos e inflamación. El 63.3% (28/44) de raspados de pieles afectadas y el 41.5% (17/ 41) de las no afectadas contenían especies saprofíticas de Ulocladium spp., Penicillum spp., Hialofomicetos, Geotrichum candidum y Aspergilus flavus. Los niveles sanguíneos, en las 70 muestras (afectados y no afectados) presentaron 10 veces la concentración esperada para selenio, principalmente en vicuñas captivas en el área multicomunal (afectados 3.23 ± 1.31 μg/mL y no afectados 3.56 ± 2.27 μg/mL), posiblemente debido al sobrepastoreo de los pastizales con presencia de especies seleníferas de Astragalus spp. (“garbanzo” o “garbancillo”). Todos los animales mostraron deficiencia de cobre y los animales afectados de Huaytará y todos los de Santa Rosa de Tambo presentaron deficiencia de zinc.In recent years important economic losses have resulted from what is described as “dandruff” in vicuña fiber. With the goal of analyzing the possible cause/s was conducted an histopathological analysis of 75 skin biopsies (33 affected/42 unaffected), microbiological analysis of 85 skin/fiber scrapings (44 affected/41 unaffected), and microelement analysis (zinc, selenium, copper, molybdenum) of 70 serum samples (41 affected/ 29 unaffected), collected from three wild populations in the communities of Huaytará, Ayaví and Santa Rosa de Tambo, Huancavelica, Peru, as well as from the captive herd held jointly by these communities. The affected vicuñas were clinically normal and the presence of “dandruff” was generally detected after shearing. In these fleeces, white scales scattered or accumulated and firmly adhered to the fibers were found, especially on the flanks and backs of the animals, but also widely dispersed throughout the fleece. Histopathological analysis of the skin biopsies revealed that both affected and unaffected animals had moderate to severe dermatosis (hyperkeratosis – orthokeratosis), with moderate to severe atrophy of the inner root sheath of the follicle, but without evidence of inflammation. Microbiological analysis determined the presence of fungus species in 63.3% (28/44) of the affected and 41.5% (17/41) of unaffected animals, including Ulocladium spp., Penicillum spp., Hialofomicetos, Geotrichum candidum and Aspergilus flavus. Microelement analysis revealed 10 fold selenium concentration as compared to normal values, especially in the captive population (affected: 3.23 ± 1.31 μg/ mL; unaffected: 3.56 ± 2.27 μg/mL) possibly due to overgrazing of pastures with presence of Astragalus spp., a common seleniferous plant in the region. All animals showed cooper deficiency. Also, all animals from Santa Rosa de Tambo and affected animals from Huaytará were zinc deficient

AVANCES EN EL ESTUDIO DE LA PATOGÉNESIS Y PREVENCIÓN DE LA ENTEROTOXEMIA DE LAS ALPACAS.

The results of our recent research work on enterotoxemia in Peruvian alpacas are presented. Microbiological and molecular analyses found that the majority of the isolates corresponded to Clostridium perfringens and contained the cpa coding gene for α toxin (A genotype) while 0.4% contained both the cpa and cpb genes of the α and β toxins (C genotype). A parallel study revealed that 8.5% of the genotype A isolates also had cpb2, but the cpe (enterotoxin) gene was absent in all cases. These results highly suggest that the exotoxins secreted by C. perfringens are the virulent factors in enterotoxemia, rather than the endogenous enterotoxin. Additionally, an histopathological study of intestinal samples from fatal cases showed that 30.6% had abundant immature structures of Eimeria macusaniensis affecting deep mucosa and cryptic gland epithelia, primarily in the jejune and ileum, suggesting that eimeriosis is likely a triggering or predisposing factor for the development of enterotoxemia. The microbiological studies allowed the design and progressive improvement of an inactivated enterotoxemia vaccine containing primarily the bacterial component plus exotoxins of types A, Aβ2 and C isolated from natural fatal cases of the disease. During six years of field tests in southern Peru, the vaccine has steadily reduced specific neonatal mortality rates due to enterotoxemia from 19.5% (2000, without vaccine) to less than 5% in 2006.Se revisan las investigaciones recientes realizadas por nuestro grupo de investigadores sobre enterotoxemia de las alpacas en el Perú. Estudios microbiológicos y moleculares demostraron que la mayoría de las cepas aisladas fueron de Clostridium perfringens y estas contienen únicamente el gen cpa de la toxina α (C. perfringens genotipo A) y solamente el 0.4% tienen genes cpa y cpb de las toxinas α y β (genotipo C). En análisis paralelo, se encontró que el 8.5% de los genotipos A contenían, adicionalmente, el gen cpb2, pero ninguna cepa tenía el gen cpe de la enterotoxina. Estos resultados evidencian que las exotoxinas secretadas, y no las endotoxinas (cpe), serían los probables factores de virulencia clostridiales en la enterotoxemia de la alpaca. Adicionalmente, en el análisis histopatológico de intestinos infectados, el 30.6% de las muestras presentó abundantes estructuras parasitarias inmaduras correspondientes a Eimeria macusaniensis, afectando la mucosa y epitelio de las glándulas crípticas intestinales, sugiriendo a las infecciones coccidiales como uno de los posibles factores desencadenantes o predisponentes de la enterotoxemia. Estos resultados microbiológicos permitieron diseñar, preparar y mejorar una vacuna convencional inactivada que contiene, mayoritariamente, componentes bacterianos y exotoxinas A, Aβ2 y C aislados de casos fatales de la enfermedad. Desde su introducción en una empresa alpaquera del sur peruano en 2001, la vacuna ha logrado reducir progresivamente los índices de mortalidad por enterotoxemia de 19.5% (2000, sin vacuna) hasta alcanzar tasas menores al 5% en 2006

Flora microbiana en el conducto auditivo externo en estudiantes de medicina de la Universidad de San Martín de Porres, en la ciudad de Lima - Perú, durante el período de Agosto a Octubre 2012

OBJETIVOIdentificar a los microorganismos que conforman la flora normal del conducto auditivo externo.MATERIAL Y MÉTODOSe analizaron 100 muestras tomadas del conducto auditivo externo de estudiantes de primer, segundo y tercer año de la Facultad de Medicina Humana de la Universidad de San Martin de Porres.RESULTADOSEn el 97 % de las muestras obtenidas del conducto auditivo externo se observó crecimiento bacteriano, en el 92,8 % de las muestras se aisló una bacteria y en 7,2 % se aislaron dos bacterias. En 49 muestras se aisló Staphylococcus aureus, en 48 muestras Staphylococcus epidermidis, en cuatro muestras Klebsiella y en tres muestras Escherichia coli.CONCLUSIONESEn las muestras obtenidas del conducto auditivo externo la bacteria Gram positiva más frecuente fue Staphylococcus aureus y la bacteria Gram negativa más frecuente fue Klebsiella. (Horiz Med 2013; 13(1): 19-24

Interventions to promote adherence to antiretroviral therapy in Africa: a network meta-analysis

Background: Adherence to antiretroviral therapy (ART) is necessary for the improvement of the health of patients and for public health. We sought to determine the comparative effectiveness of different interventions for improving ART adherence in HIV-infected people living in Africa. Methods: We searched for randomised trials of interventions to promote antiretroviral adherence within adults in Africa. We searched AMED, CINAHL, Embase, Medline (via PubMed), and ClinicalTrials.gov from inception to Oct 31, 2014, with the terms “HIV”, “ART”, “adherence”, and “Africa”. We created a network of the interventions by pooling the published and individual patients\u27 data for comparable treatments and comparing them across the individual interventions with Bayesian network meta-analyses. The primary outcome was adherence defined as the proportion of patients meeting trial defined criteria; the secondary endpoint was viral suppression. Findings: We obtained data for 14 randomised controlled trials, with 7110 patients. Interventions included daily and weekly short message service (SMS; text message) messaging, calendars, peer supporters, alarms, counselling, and basic and enhanced standard of care (SOC). Compared with SOC, we found distinguishable improvement in self-reported adherence with enhanced SOC (odds ratio [OR] 1·46, 95% credibility interval [CrI] 1·06–1·98), weekly SMS messages (1·65, 1·25–2·18), counselling and SMS combined (2·07, 1·22–3·53), and treatment supporters (1·83, 1·36–2·45). We found no compelling evidence for the remaining interventions. Results were similar when using viral suppression as an outcome, although the network contained less evidence than that for adherence. Treatment supporters with enhanced SOC (1·46, 1·09–1·97) and weekly SMS messages (1·55, 1·01–2·38) were significantly better than basic SOC. Interpretation: Several recommendations for improving adherence are unsupported by the available evidence. These findings can inform future intervention choices for improving ART adherence in low-income settings. Funding: None

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000-2018

BACKGROUND: Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15-59 years across SSA. METHODS: We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. RESULTS: We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. CONCLUSIONS: As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA

Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000–2018

Background: Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15–59 years across SSA. Methods: We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. Results: We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. Conclusions: As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA