Medico, Tropicalista, dedicado a la investigación en Malaria y otras enfermedades Metaxénicas, Actualmente en el Ministerio de Salud del Perú en el equipo del control de la COVID-19
Objectives: Vector control is the method of prevention and control of dengue outbreaks used in Pe... more Objectives: Vector control is the method of prevention and control of dengue outbreaks used in Peru. With the objective of calculating the costs incurred in vector control, an estimation of the costs of Aedes aegypti control of the Regional Health Directorate of Loreto, during the execution of the regional plan for surveillance and control of A. aegypti was carried out. Materials and methods: Documentation was reviewed, and interviews were conducted with stakeholders about the costs of A. aegypti control interventions in
Transactions of The Royal Society of Tropical Medicine and Hygiene
Background Anaemia is a public health problem in Peru. In the Loreto region of the Amazon, ≥50% o... more Background Anaemia is a public health problem in Peru. In the Loreto region of the Amazon, ≥50% of children may be anaemic, although insufficient information exists for rural villages. Methods To generate more data about childhood anaemia in the Peruvian Amazon, haemoglobin was measured as part of a trachoma survey in 21 randomly selected villages. All children 1–9 y of age from 30 randomly selected households per village were recruited. Anaemia was classified according to the World Health Organization guidelines and a socio-economic status (SES) index was created for each household using principal component analysis. Spatial autocorrelation was determined using Moran's I and Ripley's K function. Results Of 678 children with complete haemoglobin data, 25.4% (95% confidence interval [CI] 21.2 to 30.1) had mild-or-worse anaemia and 22.1% (95% CI 15.6 to 30.3) had moderate-or-worse anaemia. Mild-or-worse anaemia was more common among children whose primary source of drinking wa...
Objective To determine the relationship between socioeconomic status (SES) and visual impairment ... more Objective To determine the relationship between socioeconomic status (SES) and visual impairment (VI) or blindness in the rural Peruvian Amazon, hypothesizing that higher SES would have a protective effect on the odds of VI or blindness. Methods In this cross-sectional study of 16 rural communities in the Peruvian Amazon, consenting adults aged ≥ 50 years were recruited from ~30 randomly selected households per village. Each household was administered a questionnaire and had a SES score constructed using principal components analysis. Blindness and VI were determined using a ministry of health 3-meter visual acuity card. Results Overall, 207 adults aged ≥ 50 were eligible; 146 (70.5%) completed visual acuity screening and answered the questionnaire. Of those 146 participants who completed presenting visual acuity screening, 57 (39.0%, 95% CI 30.2–47.1) were classified as visually impaired and 6 (4.1%, 95% CI 0.9–7.3) as blind. Belonging to the highest SES tercile had a protective ef...
Sr. Editor, Hemos leído atentamente los comentarios al artículo titulado “Frecuencia elevada de d... more Sr. Editor, Hemos leído atentamente los comentarios al artículo titulado “Frecuencia elevada de dengue grave durante la epidemia por el Linaje II del DENV-2 americano/asiático en el Perú” (1), publicados en su prestigiosa revista. Agradecemos el interés por el mismo y hacemos algunas precisiones.
Background A major concern in malaria vaccine development is genetic polymorphisms typically obse... more Background A major concern in malaria vaccine development is genetic polymorphisms typically observed among Plasmodium isolates in different geographical areas across the world. Highly polymorphic regions have been observed in Plasmodium falciparum and Plasmodium vivax antigenic surface proteins such as Circumsporozoite protein (CSP), Duffy-binding protein (DBP), Merozoite surface protein-1 (MSP-1), Apical membrane antigen-1 (AMA-1) and Thrombospondin related anonymous protein (TRAP). Methods Genetic variability was assessed in important polymorphic regions of various vaccine candidate antigens in P. vivax among 106 isolates from the Amazon Region of Loreto, Peru. In addition, genetic diversity determined in Peruvian isolates was compared to population studies from various geographical locations worldwide. Results The structured diversity found in P. vivax populations did not show a geographic pattern and haplotypes from all gene candidates were distributed worldwide. In addition, e...
Introducción. El ingreso del linaje II del DENV-2 americano/asiático en la región Loreto de la Am... more Introducción. El ingreso del linaje II del DENV-2 americano/asiático en la región Loreto de la Amazonia Peruana, coincidió con un incremento súbito de los casos de dengue con necesidad de hospitalización. Sin embargo, las estadísticas oficiales reportaron pocos casos graves. Se postula, que existió una subnotificación de los casos graves en los reportes oficiales del Ministerio de Salud. Objetivos. Conocer la frecuencia de pacientes con signos de gravedad entre los pacientes hospitalizados por dengue probable durante el brote del 2011 en el Hospital Iquitos, Perú. Métodos. Se realizó un estudio longitudinal, aplicando una lista de chequeo diaria, sobre la presencia de signos de gravedad durante la estancia hospitalaria, a un grupo de pacientes hospitalizados en la unidad de dengue del Hospital Iquitos. Resultados. De 178 pacientes evaluados 66 (37%, IC: 29,9 – 44,6%) presentaron algún signo de gravedad, la mayor parte por shock (75,7%). Este resultado contrasta con el número de paci...
Revista Peruana de Medicina Experimental y Salud Pública, 2004
Objetivos: Como respuesta a la emergencia de la resistencia del P. falciparum a los antimaláricos... more Objetivos: Como respuesta a la emergencia de la resistencia del P. falciparum a los antimaláricos, el Ministerio de Salud del Perú decidió adoptar los esquemas de tratamiento para malaria combinados recomendados por la OMS: MQ-AS y SP-AS, pero el costo de la nueva terapia es significativamente superior a los anteriores esquemas; SP y quinina + tetraciclina, sin embargo tendría como ventaja una mayor eficacia y probablemente la capacidad de disminuir la transmisión. Por estos motivos se evaluó de manera prospectiva el costo efectividad del cambio en los esquemas de tratamiento para malaria. Materiales y métodos: Se uso el método de análisis de decisiones y de riesgos, se construyó un modelo probabilística que estableció las relaciones formales entre diversos factores que van a modificar el número de casos, muertes, los años de vida ajustados por discapacidad (AVAD) y los costos del programa en un periodo de cinco años. Resultados: Se halló que si bien el costo unitario por tratamient...
Outdoor malaria transmission hinders malaria elimination efforts in the Amazon region and novel v... more Outdoor malaria transmission hinders malaria elimination efforts in the Amazon region and novel vector control tools are needed. Ivermectin mass drug administration (MDA) to humans kills wild Anopheles, targets outdoor-feeding vectors, and can suppress malaria parasite transmission. Laboratory investigations were performed to determine ivermectin susceptibility, sporontocidal effect and inhibition of time to re-feed for the primary Amazonian malaria vector, Anopheles darlingi. To assess ivermectin susceptibility, various concentrations of ivermectin were mixed in human blood and fed to An. darlingi. Mosquito survival was monitored daily for 7 days and a non-linear mixed effects model with Probit analysis was used to calculate lethal concentrations of ivermectin that killed 50% (LC50), 25% (LC25) and 5% (LC5) of mosquitoes. To examine ivermectin sporonticidal effect, Plasmodium vivax blood samples were collected from malaria patients and offered to mosquitoes without or with ivermect...
Objectives: Vector control is the method of prevention and control of dengue outbreaks used in Pe... more Objectives: Vector control is the method of prevention and control of dengue outbreaks used in Peru. With the objective of calculating the costs incurred in vector control, an estimation of the costs of Aedes aegypti control of the Regional Health Directorate of Loreto, during the execution of the regional plan for surveillance and control of A. aegypti was carried out. Materials and methods: Documentation was reviewed, and interviews were conducted with stakeholders about the costs of A. aegypti control interventions in
Transactions of The Royal Society of Tropical Medicine and Hygiene
Background Anaemia is a public health problem in Peru. In the Loreto region of the Amazon, ≥50% o... more Background Anaemia is a public health problem in Peru. In the Loreto region of the Amazon, ≥50% of children may be anaemic, although insufficient information exists for rural villages. Methods To generate more data about childhood anaemia in the Peruvian Amazon, haemoglobin was measured as part of a trachoma survey in 21 randomly selected villages. All children 1–9 y of age from 30 randomly selected households per village were recruited. Anaemia was classified according to the World Health Organization guidelines and a socio-economic status (SES) index was created for each household using principal component analysis. Spatial autocorrelation was determined using Moran's I and Ripley's K function. Results Of 678 children with complete haemoglobin data, 25.4% (95% confidence interval [CI] 21.2 to 30.1) had mild-or-worse anaemia and 22.1% (95% CI 15.6 to 30.3) had moderate-or-worse anaemia. Mild-or-worse anaemia was more common among children whose primary source of drinking wa...
Objective To determine the relationship between socioeconomic status (SES) and visual impairment ... more Objective To determine the relationship between socioeconomic status (SES) and visual impairment (VI) or blindness in the rural Peruvian Amazon, hypothesizing that higher SES would have a protective effect on the odds of VI or blindness. Methods In this cross-sectional study of 16 rural communities in the Peruvian Amazon, consenting adults aged ≥ 50 years were recruited from ~30 randomly selected households per village. Each household was administered a questionnaire and had a SES score constructed using principal components analysis. Blindness and VI were determined using a ministry of health 3-meter visual acuity card. Results Overall, 207 adults aged ≥ 50 were eligible; 146 (70.5%) completed visual acuity screening and answered the questionnaire. Of those 146 participants who completed presenting visual acuity screening, 57 (39.0%, 95% CI 30.2–47.1) were classified as visually impaired and 6 (4.1%, 95% CI 0.9–7.3) as blind. Belonging to the highest SES tercile had a protective ef...
Sr. Editor, Hemos leído atentamente los comentarios al artículo titulado “Frecuencia elevada de d... more Sr. Editor, Hemos leído atentamente los comentarios al artículo titulado “Frecuencia elevada de dengue grave durante la epidemia por el Linaje II del DENV-2 americano/asiático en el Perú” (1), publicados en su prestigiosa revista. Agradecemos el interés por el mismo y hacemos algunas precisiones.
Background A major concern in malaria vaccine development is genetic polymorphisms typically obse... more Background A major concern in malaria vaccine development is genetic polymorphisms typically observed among Plasmodium isolates in different geographical areas across the world. Highly polymorphic regions have been observed in Plasmodium falciparum and Plasmodium vivax antigenic surface proteins such as Circumsporozoite protein (CSP), Duffy-binding protein (DBP), Merozoite surface protein-1 (MSP-1), Apical membrane antigen-1 (AMA-1) and Thrombospondin related anonymous protein (TRAP). Methods Genetic variability was assessed in important polymorphic regions of various vaccine candidate antigens in P. vivax among 106 isolates from the Amazon Region of Loreto, Peru. In addition, genetic diversity determined in Peruvian isolates was compared to population studies from various geographical locations worldwide. Results The structured diversity found in P. vivax populations did not show a geographic pattern and haplotypes from all gene candidates were distributed worldwide. In addition, e...
Introducción. El ingreso del linaje II del DENV-2 americano/asiático en la región Loreto de la Am... more Introducción. El ingreso del linaje II del DENV-2 americano/asiático en la región Loreto de la Amazonia Peruana, coincidió con un incremento súbito de los casos de dengue con necesidad de hospitalización. Sin embargo, las estadísticas oficiales reportaron pocos casos graves. Se postula, que existió una subnotificación de los casos graves en los reportes oficiales del Ministerio de Salud. Objetivos. Conocer la frecuencia de pacientes con signos de gravedad entre los pacientes hospitalizados por dengue probable durante el brote del 2011 en el Hospital Iquitos, Perú. Métodos. Se realizó un estudio longitudinal, aplicando una lista de chequeo diaria, sobre la presencia de signos de gravedad durante la estancia hospitalaria, a un grupo de pacientes hospitalizados en la unidad de dengue del Hospital Iquitos. Resultados. De 178 pacientes evaluados 66 (37%, IC: 29,9 – 44,6%) presentaron algún signo de gravedad, la mayor parte por shock (75,7%). Este resultado contrasta con el número de paci...
Revista Peruana de Medicina Experimental y Salud Pública, 2004
Objetivos: Como respuesta a la emergencia de la resistencia del P. falciparum a los antimaláricos... more Objetivos: Como respuesta a la emergencia de la resistencia del P. falciparum a los antimaláricos, el Ministerio de Salud del Perú decidió adoptar los esquemas de tratamiento para malaria combinados recomendados por la OMS: MQ-AS y SP-AS, pero el costo de la nueva terapia es significativamente superior a los anteriores esquemas; SP y quinina + tetraciclina, sin embargo tendría como ventaja una mayor eficacia y probablemente la capacidad de disminuir la transmisión. Por estos motivos se evaluó de manera prospectiva el costo efectividad del cambio en los esquemas de tratamiento para malaria. Materiales y métodos: Se uso el método de análisis de decisiones y de riesgos, se construyó un modelo probabilística que estableció las relaciones formales entre diversos factores que van a modificar el número de casos, muertes, los años de vida ajustados por discapacidad (AVAD) y los costos del programa en un periodo de cinco años. Resultados: Se halló que si bien el costo unitario por tratamient...
Outdoor malaria transmission hinders malaria elimination efforts in the Amazon region and novel v... more Outdoor malaria transmission hinders malaria elimination efforts in the Amazon region and novel vector control tools are needed. Ivermectin mass drug administration (MDA) to humans kills wild Anopheles, targets outdoor-feeding vectors, and can suppress malaria parasite transmission. Laboratory investigations were performed to determine ivermectin susceptibility, sporontocidal effect and inhibition of time to re-feed for the primary Amazonian malaria vector, Anopheles darlingi. To assess ivermectin susceptibility, various concentrations of ivermectin were mixed in human blood and fed to An. darlingi. Mosquito survival was monitored daily for 7 days and a non-linear mixed effects model with Probit analysis was used to calculate lethal concentrations of ivermectin that killed 50% (LC50), 25% (LC25) and 5% (LC5) of mosquitoes. To examine ivermectin sporonticidal effect, Plasmodium vivax blood samples were collected from malaria patients and offered to mosquitoes without or with ivermect...
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