Characterisation of extended-spectrum b-lactamases among Klebsiella pneumoniae isolates causing bacteraemia and urinary tract infection in Mozambique

The aim of this study was to determine the prevalence of extended-spectrum b-lactamase (ESBL)- producing Klebsiella pneumoniae isolated from urinary tract and bloodstream infections in a rural hospital in Manhic¸a, Mozambique. ESBLs were investigated among ceftriaxone-non-susceptible K. pneumoniae clinical isolates recovered between 2004 and 2009. Characterisation of blaCTX-M, blaSHV, blaOXA and blaTEM genes was performed by PCR and sequencing. Epidemiological relationships were established by phylogenetic analysis, repetitive extragenic palindromic PCR (REP-PCR), pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST), whilst plasmid transferability was evaluated by conjugation. In addition,the presence of class 1 and 2 integrons was studied.A total of 19 K. pneumoniae were analysed. The blaCTX-M-15 gene was found in all strains. Other ESBL genes were found concomitantly, including blaSHV-5, blaSHV-2, blaSHV-2A, blaSHV-12 and blaSHV-38. In addition, other b-lactamases such as blaTEM-1 and blaOXA-30 were also detected. REP-PCR identified 15 different epidemiological profiles. MLST analysis also showed great variability of sequence types. The blaCTX-M-15 gene showed a high transfer capacity. The presence of class 1 integrons was high. High levels of multidrug resistance were also found. In conclusion, these data show the dominance of the CTX-M-type ESBL, particularly CTX-M-15, supporting its worldwide dissemination, including in areas with limited access to third-generation cephalosporins. This finding is a matter of concern for clinical management as third-generation cephalosporins are an alternative for treating severe cases of multidrug-resistant infections in this community.
Authors: Pons, Maria J.; Vubil, Delfino; Guiral, Elisabet; Jaintilal, Dinis; Fraile, Oscar; Soto, Sara M.; Sigauque, Betuel; Nhampossa, Tacilta; Aide, Pedro; Alonso, Pedro L.; Vila, Jordi; Mandomando, Inacio; Ruiz, Joaquim
Source: Journal of Global Antimicrobial Resistance

URL: http://hdl.handle.net/10757/347017

Incidence of Respiratory Viruses in Peruvian Children With Acute Respiratory Infections

Acute respiratory infections are responsible for high morbi–mortality in Peruvian children. However, the etiological agents are poorly identified. This study, conducted during the pandemic outbreak of H1N1 influenza in 2009, aims to determine the main etiological agents responsible for acute respiratory infections in children from Lima, Peru. Nasopharyngeal swabs collected from 717 children with acute respiratory infections between January 2009 and December 2010 were analyzed by multiplex RT-PCR for 13 respiratory viruses: influenza A, B, and C virus; parainfluenza virus (PIV) 1, 2, 3, and 4; and human respiratory syncytial virus (RSV) A and B, among others. Samples were also tested with direct fluorescent-antibodies (DFA) for six respiratory viruses. RT-PCR and DFA detected respiratory viruses in 240 (33.5%) and 85 (11.9%) cases, respectively. The most common etiological agents were RSV-A (15.3%), followed by influenza A (4.6%), PIV-1 (3.6%), and PIV-2 (1.8%). The viruses identified by DFA corresponded to RSV (5.9%) and influenza A (1.8%). Therefore, respiratory syncytial viruses (RSV) were found to be the most common etiology of acute respiratory infections. The authors suggest that active surveillance be conducted to identify the causative agents and improve clinical management, especially in the context of possible circulation of pandemic viruses
Authors: Valle Mendoza, Juana del; Cornejo Tapia, Ángela; Weilg, Pablo; Verne, Eduardo; Nazario Fuertes, Ronald; Ugarte, Claudia;del Valle, Luis J.; Pumarola, Toma´ s
Source: Journal Medical Virology (J. Med. Virol)

URL: http://hdl.handle.net/10757/347016

Childhood Abuse and Early Menarche Among Peruvian Women

Purpose: Childhood abuse has been associated with age of menarche in some studies, but not all, and few have assessed the independent associations of sexual and physical abuse with early menarche. We examined the association between childhood abuse and early menarche among pregnant women in Lima, Peru. Methods: Multinomial logistic regression procedures were used to estimate odds ratios (OR) and 95% confidence intervals (CIs) for early menarche ( 11 years) in relation to any physical or sexual childhood abuse, physical abuse only, sexual abuse only, and both physical and sexual abuse in a cohort of 1,499 pregnant (first trimester) women. Results: Approximately 69% of participants reported experiencing physical or sexual abuse in childhood. The frequencies of physical abuse only, sexual abuse only, and both physical and sexual abuse were 37.4%, 7.7%, and 24.5%, respectively. Compared with women who reported no childhood abuse, those who reported any childhood abuse had a 1.38-fold increased odds of early menarche (95% CI, 1.01e1.87). Compared with no abuse, the odds of early menarche was 1.60-fold among women with childhood sexual abuse only (OR, 1.60; 95% CI, .93e2.74) and 1.56-fold for those with both physical and sexual abuse (OR, 1.56; 95% CI, 1.07e2.25) during childhood. Isolated physical abuse was weakly associated with early menarche (OR, 1.23; 95% CI, .87e1.74). There was no clear evidence of association of childhood abuse with late menarche ( 15 years). Conclusions: Childhood abuse, particularly joint physical and sexual abuse, is associated with early menarche. Our findings add to an expanding body of studies documenting the enduring adverse health consequences of childhood abuse.
Authors: Barrios, Yasmin V.; Sánchez, Sixto E.; Nicolaidis, Christina; Garcia, Pedro J.; Gelaye, Bizu; Zhong, Qiuyue; Williams, Michelle A.
Source: Journal of Adolescent Health

URL: http://hdl.handle.net/10757/345745

China in Latin America: the cases of Ecuador and Peru between the years 2009-2012, Is it possible a commitment to the future?

A diferencia de hace algunas décadas, el dinamismo económico actual de China ha impulsado un mayor nivel de actividad en sus relaciones con los países de América Latina. Al interior de América Latina (AL), en la región andina, Ecuador y Perú cuentan con una cada vez mayor presencia de capitales de origen chino que buscan asegurar las materias primas necesarias para sostener la que hoy es la “fábrica del mundo”, todo ello basado en una visión economicista del fenómeno chino que invisibiliza la coyuntura político-social del gigante asiático. El presente artículo revisa el desarrollo histórico de la política exterior china hacia AL, desde la fundación de la República Popular China (RPC) por Mao Zedong en 1949, hasta hoy a inicios del siglo XXI, y describe, a través de los casos de Ecuador y Perú, las características actuales de la relación de China con los países de América Latina. Si bien el contexto sugiere una creciente amenaza china para las economías latinoamericanas, de ser ella estudiada minuciosamente, podría sentar las bases para una integración pragmática y urgente en la región.
Authors: Terán Samanamud, Germán
Source: Anuario Mexicano de Derecho Internacional

URL: http://hdl.handle.net/10757/345760

Educar por competencias a los profesionales de la salud para transformar la salud

Este número de la Revista Peruana de Medicina Experimental y Salud Pública tiene como tema central la educación en salud, tema de gran importancia por la estrecha relación que existe entre la calidad de la atención de salud y la calidad de la formación de los profesionales que la brindan. Al respecto, la OMS señala que el factor humano es indispensable para reforzar los sistemas de salud y que hay numerosas experiencias que demuestran que el número, la densidad y la calidad de los trabajadores sanitarios están efectivamente relacionados con la calidad de salud de la población (1). La relación entre educación y salud toma especial relevancia cuando los sistemas de salud en países ricos y pobres están en un proceso de reforma que demandará profesionales con un nuevo perfil. La principal razón para la reforma es que, actualmente, existen millones de personas que no tienen acceso a la salud. El gran reto del siglo XXI para la humanidad es lograr que todas las personas, sin distinción, tengan acceso a la salud (2). Con este propósito está en marcha la reforma de los sistemas de salud, a nivel global, basada en la estrategia de atención primaria de la salud (APS), la cual integra la reparación, prevención y promoción de la salud y acerca los servicios a la población. Una de las mayores dificultades para llevar a cabo dicha reforma en todos los países, es el número insuficiente de profesionales de la salud, mal distribuidos y con competencias no alineadas con las necesidades de salud de la población (3). En nuestro país el gobierno impulsa la reforma del sector salud orientada a lograr el aseguramiento universal, con base en un nuevo modelo de atención integral de salud basado en familia y comunidad que se sustenta en la estrategia de APS (4-5).
Authors: Risco de Domínguez, Graciela
Source:  Instituto Nacional de Salud
URL:  http://hdl.handle.net/10757/345759