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Diagnosis of sputum-scarce HIV-associated pulmonary tuberculosis in Lima, Peru.

Sputum induction, bronchoalveolar lavage, or gastric aspiration are often needed to produce adequate diagnostic respiratory samples from people with HIV in whom tuberculosis is suspected. Since these procedures are rarely appropriate in less-developed countries, we compared the performances of a simple string test and the gold-standard sputum induction. 160 HIV-positive adults under investigation for tuberculosis, and 52 asymptomatic HIV-positive control patients underwent the string test followed by sputum induction. The string test detected tuberculosis in 14 patients in whom this disease was suspected; sputum induction detected only eight of them (McNemar's test, p=0.03). These preliminary data suggest that the string test is safe and effective for retrieval of useful clinical specimens for diagnosis of pulmonary tuberculosis, and is at least as sensitive as sputum induction.

AIDS-Related Opportunistic Infections↗

Non-specific ileojejunitis in Arequipa, Peru.

Non-specific ileojejunitis, characterised by mild to moderate structural changes in the intestinal mucosa and often associated with asymptomatic malabsorption, is known to occur in the tropics and in countries with hot climates. This acquired condition is probably related to environmental factors, and some consider it to be a subclinical form of tropical sprue. Changes in the intestinal mucosa typical of non-specific ileojejunitis were found in 10 indigenous Indians as well as 5 people of Latin stock living in the Southern Peruvian sierra, where tropical sprue has not as yet been demonstrated and which has a temperate climate.

Adolescent↗

Helicobacter pylori and epidemic Vibrio cholerae O1 infection in Peru.

In a cross-sectional study of the 1991 Peruvian cholera epidemic, Vibrio cholerae O1 infection was associated with Helicobacter pylori infection, particularly in young children. These data support the hypothesis that hypochlorhydria induced by H. pylori is important in the pathogenesis of diarrhoeal disease.

Achlorhydria↗

With the help of one's neighbors: externalities in the production of nutrition in Peru.

Both public and private resources contribute to the nutritional status of children. In addition, the investments made by one household may contribute to the health of other households in the neighborhood through improvements in the sanitation environment and through increases in shared knowledge. This paper measures the externalities of investments in nutrition by indicating the impact of the education of women in Peruvian neighborhoods on the nutrition of children in other households, after controlling for the education and income of those households. We find that in rural areas this shared knowledge has a significant impact on nutrition, with the coefficient of an increase in the average education of women in the neighborhood being appreciable larger than the coefficient of education in isolation. In addition, we indicate the impact of the water and sanitation environment in the neighborhood, again controlling for the household's own access to sanitation and water. In both urban and rural areas, we observe externalities from investments in such household level infrastructure with the evidence particularly strong for sanitation made by neighboring households.

Body Height↗

Influence of arteriolar hyalinization on arterial intimal fibroplasia in the renal cortex of subjects in the United States, Peru, and Bolivia, applicable also to other populations.

Microvasculopathies of nephrosclerosis progress with age in contrasting patterns. Arterial intimal fibroplasia (R(r) and R(c), respectively, in small and large interlobular arteries) previously showed close linkages to hypertension and to "nephrosclerosis," defined by fibrous replacement of atrophied nephrons, whereas hyalinization of arterioles (Hy) failed to show consistent linkages. In this study, renal samples from seven populations, three newly assembled and four reassessed from archived data, were evaluated for R(r), R(c), and Hy in forensic autopsies of basal subjects (ie, those lacking conditions known to correlate with hypertension or nephrosclerosis, mostly deaths by violence). The patterns of progression on age were alike in all populations, but the rates of progression differed greatly. The observed ranges indicate a 547% higher rate for Hy in the fastest compared with the slowest population, a 49% higher rate for R(c), and a 107% higher rate for R(r). About one third of variation in R(r) and R(c) between populations can be attributed to the correlation with Hy, leaving a substantial residual effect independent of Hy. The findings suggest that the etiology propelling hyalinization in arterioles seems somehow to accelerate the progression of intimal fibroplasia in arteries. The reverse direction, fibroplasia somehow accelerating hyalinization, seems unreasonable, because the presumed consequence, Hy, fails to increase notably with age after 40 years, whereas the presumed causes, R(r) and R(c), rise unremittingly into old age. The etiologies of the population differences are of great consequence to public health but remain unknown.

Adolescent↗

Intestinal worm burden and serum cholesterol or lipid concentration in a Shipibo population (Peru).

Paired samples of stool and serum of 32 members of the Shipibo tribe resident in the rain forest of the Peruvian lowlands were tested for worm egg count and serum lipid parameters, respectively. 90% of the stool samples tested were found to contain eggs or larvae of several worm species, most commonly 3 or 4 different species. Serum lipid levels were found to be relatively low, most probably due to a low proportion of dietary fat ranging from 16-31%. Statistical analysis showed a significant inverse correlation between worm egg excretion and HDL levels which was true for hookworm, strongyloides and trichuris, but not for ascaris. The mechanisms underlying the observed association between intestinal worm load and HDL reduction are not completely understood and may include reduced HDL synthesis in the gut wall due to inflammatory and/or toxic irritation.

Cholesterol↗

Psychosocial assessment for victims of violence in Peru: the importance of local participation.

This paper describes a pilot study assessing the psychosocial impact of political violence in the Peruvian Andes, utilizing a collaborative approach with local professionals and communities. The study team prioritized dialogue and information exchange with the local professional community and villagers participating in the assessment in order to raise awareness of psychosocial issues and provide education and support. Participation in the pilot study had positive therapeutic effects for villagers, and inspired ongoing discussion groups to address psychosocial problems in communities. This paper also describes a psychosocial assessment strategy utilizing qualitative methods and an adaptation of the Harvard Trauma Questionnaire in collaboration with Andean villagers. Usefulness and limitations of the data will be reviewed, in terms of cultural and context relevance, usefulness for informing interventions, and comparisons with ethnographic methodologies and other survey instruments.

Female↗

Vibrio furnissii isolated from humans in Peru: a possible human pathogen?

During a cholera surveillance programme, Vibrio furnissii was isolated in late January and early February 1994 from stool samples collected from 14 persons of whom six had diarrhoea. The remaining eight persons were healthy family members or neighbours to cholera cases. No common source of infection was found. Strains isolated from stool samples each showed typical biochemical reactions of V. furnissii including gas production. Each isolate, except one, agglutinated O-antisera yielding a total of eight different serotypes. Most isolates were sensitive to 10 antibiotics tested, except to ampicillin and the vibriostatic agent O/129 (10 micrograms). Eight of 14 (57%) strains carried plasmids in the size range 2.6-88 kb, however, no correlation was found between antibiotic susceptibility patterns and plasmid content. Altogether, seven closely related HindIII ribotypes were observed among the 14 V. furnissii isolates studied. V. furnissii strains isolated from family members and other persons living close together often showed different ribotypes suggesting that the isolation was not associated with neighbourhood. Serotyping, plasmid profiling and ribotyping revealed a high strain diversity within V. furnissii, however, the importance of V. furnissii as an enteric pathogen remains to be elucidated.

Adolescent↗

Anthrone and oxanthrone C-glycosides from Picramnia latifolia collected in Peru.

Cytotoxicity-based, bioassay-guided fractionation of the chloroform-soluble extracts of both the roots and leaves of Picramnia latifolia led to the isolation of two new anthrone C-glycosides, picramniosides G (1) and H (2), two new oxanthrone C-glycosides, mayosides D (3) and E (4), and a new benzanthrone natural product, 6,8-dihydroxy-10-methyl-7H-benz[de]anthracen-7-one (5), together with 10 known compounds, 6,8-dihydroxy-4-methyl-7H-benz[de]anthracen-7-one (6), nataloe-emodin (7), chrysophanein, chrysophanol, 1,5-dihydroxy-7-methoxy-3-methylanthraquinone, pulmatin, 7-hydroxycoumarin, 7-hydroxy-6-methoxycoumarin, beta-sitosterol, and beta-sitosterol glucoside. The structures of 1-5 were established by spectroscopic methods, including 1D and 2D NMR, HRMS, and CD data interpretation. The cytotoxic activity of all isolates was evaluated in a small panel of human cancer cell lines. Compound 7 exhibited significant in vitro cytotoxic activity in the tested cell lines, but no significant activity was observed with an in vivo hollow fiber model at doses of 6.25, 12.5, 25, and 50 mg/kg/injection.

Anthracenes↗

Early maize agriculture and interzonal interaction in southern Peru.

Over the past decade, increasing attention to the recovery and identification of plant microfossil remains from archaeological sites located in lowland South America has significantly increased knowledge of pre-Columbian plant domestication and crop plant dispersals in tropical forests and other regions. Along the Andean mountain chain, however, the chronology and trajectory of plant domestication are still poorly understood for both important indigenous staple crops such as the potato (Solanum sp.) and others exogenous to the region, for example, maize (Zea mays). Here we report the analyses of plant microremains from a late preceramic house (3,431 +/- 45 to 3,745 +/- 65 14C bp or approximately 3,600 to 4,000 calibrated years bp) in the highland southern Peruvian site of Waynuna. Our results extend the record of maize by at least a millennium in the southern Andes, show on-site processing of maize into flour, provide direct evidence for the deliberate movement of plant foods by humans from the tropical forest to the highlands, and confirm the potential of plant microfossil analysis in understanding ancient plant use and migration in this region.

Agriculture↗

Randomized clinical study of nitazoxanide compared to metronidazole in the treatment of symptomatic giardiasis in children from Northern Peru.

BACKGROUND: Enteric infection by Giardia intestinalis is a common cause of diarrhoea world-wide and a significant cause of morbidity in children. AIM: To compare the efficacy and safety of nitazoxanide and metronidazole in the treatment of diarrhoea caused by G. intestinalis in children. METHODS: A total of 110 children presenting with diarrhoea caused by G. intestinalis were randomized to treatment with either a 3-day course of nitazoxanide (100 mg b.d., age range 2-3 years; 200 mg b.d., age range 4-11 years) or a 5-day course of metronidazole (125 mg b.d., age range 2-5 years; 250 mg b.d., age range 6-11 years). The patients were followed-up for a determination of clinical response 7 days after the initiation of treatment, and two subsequent stool samples were collected for parasitological examination. RESULTS: Diarrhoea had resolved in 47 children out of 55 (85%) in the nitazoxanide treatment group before the day 7 follow-up visit, compared to 44 out of 55 (80%) for metronidazole. Diarrhoea resolved within 4 days in most cases. Only mild, transient adverse events were reported. CONCLUSIONS: A 3-day course of nitazoxanide suspension is as efficacious as a standard 5-day course of metronidazole suspension in treating giardiasis in children.

Anti-Infective Agents↗