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Toolboxes
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1
El pediatra es el médico de cabecera de los niños pequeños y es el primero en ser consultado por las familias. Los padres esperan que el pediatra no solo sea un experto en atender al niño durante una enfermedad, sino que también lo sea en temas
vinculados al desarrollo. Las alteraciones del d
...
esarrollo son motivo frecuente de consulta en el ámbito pediátrico. La identificación temprana, el diagnóstico y el seguimiento de estos pacientes constituyen un verdadero desafío para los
médicos pediatras.Esta guía ofrece recomendaciones para la vigilancia del desarrollo, la pesquisa, la evaluación y el seguimiento de pacientes con
retrasos y discapacidades del desarrollo.
more
Los Marcos de Referencia para la Formación en Residencias Médicas constituyen una herramienta central del proceso de armonización de la formación en residencias en tanto establecen los componentes mínimos que tienen que estar presentes en la formación.
Acta Med Peru. 2017;34(3):203-7
En el Perú, la elaboración de guías de práctica clínica tiene exigencia normativa desde el año
2005; sin embargo, su desarrollo ha ténido poco énfasis en la calidad metodológica de las mismas, prefiriendo el tipo narrativo. Desde hace varios años se realiz
...
an esfuerzos dispersos para mejorar la calidad metodológica, principalmente que su elaboaración esté basada en evidencias científicas. Actualmente se cuenta con una nueva normativa que pone mayor enfasis en esta exigencia y algunas instituciones ya trabajan para adecuarse a estandares internacionales y poder generar impactos positivos en nuestro sistema de salud a través del adecuado desarrollo de guias de practica clínica en nuestro pais
more
Peru − Progress in health and sciences in 200 years of independence
Carrillo-Larco; R.M.; Guzman-Vilca, W. C.; Leon-Velarde, F.; et al.
The Lancet Regional Health - Americas
(2021)
CC
Peru celebrates 200 years of independence in 2021. Over this period of independent life, and despite the turbulent socio-political scenarios, from internal armed conflict to economic crisis to political instability over the last 40 years, Peru has experienced major changes on its epidemiological and
...
population health profile. Major advancements in maternal and child health as well as in communicable diseases have been achieved in recent decades, and today
Peru faces an increasing burden of non-communicable diseases including mental health conditions. In terms of the configuration of the public health system, Peru has also strived to secure country-wide optimal health care, struggling in particular to improve primary health care and intercultural services.
more
As climate change increasingly contributes to migration and displacement in many parts of the world, there is a pressing need for measures that build resilience and prevent displacement as well as those that help climate-affected people move to safety and support receiving communities. Multilateral
...
development banks (MDBs) are critical, if sometimes overlooked, players because of their ability to invest in large-scale projects that contribute to sustainable development, primarily in low- and middle-income countries.
This report explores the unique role of MDBs in the climate finance landscape and highlights opportunities for migration, humanitarian, and other key actors to partner with them on projects that effectively target climate-related migration and displacement. After reviewing the evidence on the complex linkages between climate and mobility, the report examines MDBs’ climate-related work to date, challenges they face to scaling up these efforts, and strategies to begin to address hurdles. These recommendations include learning from past MDB investments that have touched on climate migration, funding data collection or sharing to strengthen understanding of climate migration trends, and developing partnerships to support policy and project development, financing, and implementation.
more
Chapter 6 contents
Malaria
Human African trypanosomiasis (sleeping sickness)
American trypanosomiasis (Chagas disease)
Leishmaniases
Intestinal protozoan infections (parasitic diarrhoea)
Flukes
Schistosomiases
Cestodes
Nematode infections
Filariasis
...
Onchocerciasis (river blindness)
Loiasis.
Lymphatic filariasis (LF)
more
The year 2020 is the target date for the elimination of blinding trachoma as a public health problem. There has been great progress, and there is unprecedented funding available – particularly from DFID, the Queen Elizabeth Diamond Jubilee Trust, and USAID. There is also reason for optimism that,
...
over the next five years, further success will be seen in many endemic countries. In order to achieve elimination,
more
Rev. Panam Salud Publica. 2017;41:e153. doi: 10.26633/RPSP.2017.153
Worldwide, over 6 million people are infected with Trypanosoma cruzi, the pathogen that causes Chagas disease (CD). In the Americas, CD creates the greatest burden in disability-adjusted life years of any parasitic infection. In Co
...
lombia, 437 000 people are infected with T. cruzi, of whom 131 000 suffer from cardiomyopathy. Colombia’s annual costs for treating patients with advanced CD reach US$ 175 016 000. Although timely etiological treatment can significantly delay or prevent development of cardiomyopathy—and costs just US$ 30 per patient—fewer than 1% of people with CD in Colombia and elsewhere receive it.
more
This is a summary of the following peer-reviewed, scientific article:
Comparative Evaluation of Immunoassays to Improve Access to Diagnosis for Chagas Disease in Colombia.
Front Chem. 2021; 9: 622286.
Published online 2021 Mar 12. doi: 10.3389/fchem.2021.622286
Geographical, landscape and host associations of Trypanosoma cruzi DTUs and lineages
Izeta-Alberdi, A.; Ibarra-Cerdena, C.; Moo-llanes, D.; Ramsey,J.
BMC Part of Springer Nature
(2016)
CC
Trypanosoma cruzi is the etiological agent of Chagas disease (CD), considered one of the most important parasitic infections in Latin America. Between 25 and 90 million humans are at infection risk via at least one of multiple infection mechanisms. Under natural conditions, the principal transmissio
...
n modes are transplacental or via one of more than 140 hematophagous triatomine bugs (Reduviidae: Triatominae). Triatomines acquire the parasite from mammal reservoirs due to their obligate blood-feeding (albeit triatomines can also feed on non-reservoir vertebrates such as birds and reptiles). The disease burden for CD in the Latin America and Caribbean region, based on disability-adjusted life-years (DALYs), is at least five times greater than that of malaria, and is approximately one-fifth that of HIV/AIDS. In recent decades, CD has extended to other continents outside natural reservoir or vector distributions due to human migration, with a minimum estimated 10 million individuals infected worldwide.
more
Discrete typing units of Trypanosoma cruzi: Geographical and biological distribution in the Americas
Chagas disease caused by Trypanosoma cruzi is a public health issue in Latin America. This highly diverse parasite is divided into at least seven discrete typing units (DTUs) TcI-TcVI and Tcbat. Some DTUs have been associated with geographical distribution in epidemiological scenarios and clinical m
...
anifestations, but these aspects remain poorly understood. Many studies have focused on studying the parasite and its vectors/hosts, using a wide variety of genetic markers and methods. Here, we performed a systematic review of the literature for the last 20 years to present an update of DTUs distribution in the Americas, collecting ecoepidemiological information. We found that the DTUs are widespread across the continent and that there is a whole gamma of genetic markers used for the identification and genotyping of the parasite. The data obtained in this descriptor could improve the molecular epidemiology studies of Chagas disease in endemic regions.
more
Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 117: e200460, 2022
Integrating the multiple dimensions of the problem into a coherent approach adapted to field realities and needs represents an immense challenge, but the payoff is more effective and sustainable experiences, with higher social awareness
...
, increased case detection and follow-up, improved adherence to care, and integrated participation of various actors from multiple action levels. Information, Education, and Communication (IEC) initiatives have great potential for impact in the implementation of multidimensional programs of prevention and control successfully customised to the diverse and complex contexts where Chagas disease persists.
more
Comparison of the Influence of Different Nucleic Acid Extraction Assays on the Sensitivity of Trypanosoma cruzi-Specific Real-Time PCR
Kann, S.; Zabala-Monterroza, W.; García, C.
Multidisciplinary Digital Publishing Institute MDPI
(2022)
CC
For the molecular diagnosis of Chagas disease by real-time PCR (polymerase chain reaction), optimization of diagnostic accuracy is desirable. The detection limit of real-time PCR assays for the diagnosis of Trypanosoma cruzi in human serum is affected by various influences including the choice of th
...
e nucleic acid extraction assay. In this study, three nucleic acid extraction assays were compared regarding their influence on the sensitivity of a T. cruzi-specific real-time PCR with 62 reference sera containing T. cruzi target DNA (deoxyribonucleotide acid). More than 95% of the positive sera were correctly identified after all three nucleic acid extraction strategies with a detection rate ranging from 96.8% (60/62) for the worst assay to 100% (62/62) for the best one. A matched pairs analysis for the comparison of the cycle threshold (Ct) values obtained with the 59 reference samples with positive real-time PCR results after all three nucleic acid extraction schemes indicated differences in a range of about 3 Ct steps. Summarized, all three compared nucleic acid extraction schemes were basically suitable for T. cruzi-specific PCR from serum with some minor differences. However, in the case of low quantities of circulating parasite DNA in the serum of a patient with Chagas disease, even minor effects can make a difference in the individual diagnosis.
more
Front. Immunol. 12:620657. doi: 10.3389/fimmu.2021.620657.
HIV-1 infection disproportionately affects women in sub-Saharan Africa, where areas of high HIV-1 prevalence and Schistosoma haematobium endemicity largely overlap. Female genital schistosomiasis (FGS), caused most frequently by S. haemato
...
bium egg deposition in the genital tract, has been associated with prevalent HIV-1 infection in cross-sectional studies. The presence of S. haematobium eggs in genital tissue is also associated with vascularization and the accumulation of CD4+ lymphocytes and macrophages, making the granuloma-associated environment a potential contributor to HIV-1 vulnerability. In addition to modulation of the local cervicovaginal environment, FGS has also been associated with a higher frequency of systemic CD4 T-cells expressing the chemokine receptor CCR5. Tissue-entrapped eggs are also associated with clinically visible FGS-associated manifestations in the cervicovaginal mucosa. FGS lesions may breach the intact cervicovaginal immune barrier and are hypothesized to provide an entry point for HIV-1 infection. However, the underlying mechanism for potential HIV-1 vulnerability in FGS has not been fully characterized and requires further investigation.
more
After 100 years of chemotherapy with impractical and toxic drugs, an oral cure for human African trypanosomiasis (HAT) is available: Fexinidazole. In this case, we review the history of drug discovery for HAT with special emphasis on the discovery, pre-clinical development, and operational challenge
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s of the clinical trials of fexinidazole. The screening of the Drugs for Neglected Diseases initiative (DNDi) HAT-library by the Swiss TPH had singled out fexinidazole, originally developed by Hoechst (now Sanofi), as the most promising of a series of over 800 nitroimidazoles and related molecules. In cell culture, fexinidazole has an IC50 of around 1 µM against Trypanosoma brucei and is more than 100-fold less toxic to mammalian cells. In the mouse model, fexinidazole cures both the first, haemolymphatic, and the second, meningoencephalitic stage of the infection, the latter at 100 mg/kg twice daily for 5 days. In patients, the clinical trials managed by DNDi and supported by Swiss TPH mainly conducted in the Democratic Republic of the Congo demonstrated that oral fexinidazole is safe and effective for use against first- and early second-stage sleeping sickness. Based on the positive opinion issued by the European Medicines Agency in 2018, the WHO has released new interim guidelines for the treatment of HAT including fexinidazole as the new therapy for first-stage and non-severe second-stage sleeping sickness caused by Trypanosoma brucei gambiense (gHAT). This greatly facilitates the diagnosis and treatment algorithm for gHAT, increasing the attainable coverage and paving the way towards the envisaged goal of zero transmission by 2030.
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This was a Phase 3, multi-center, randomized, open-label, parallel-group, active control study where 273 male and female patients with first stage Trypanosoma brucei gambiense HAT were treated at six sites: one trypanosomiasis reference center in Angola, one hospital in South Sudan, and four hospita
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ls in the Democratic Republic of the Congo between August 2005 and September 2009 to support the registration of pafuramidine for treatment of first stage HAT in collaboration with the United States Food and Drug Administration. Patients were treated with either 100 mg of pafuramidine orally twice a day for 10 days or 4 mg/kg pentamidine intramuscularly once daily for 7 days to assess the efficacy and safety of pafuramidine versus pentamidine. Pregnant and lactating women as well as adolescents were included.
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Schistosomiases are acute or chronic visceral parasitic diseases due to 5 species of trematodes (schistosomes). The three main species infecting humans are Schistosoma haematobium, Schistosoma mansoni and Schistosoma japonicum. Schistosoma mekongi and Schistosoma intercalatum have a more limited dis
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tribution.
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Human African Trypanosomiasis (HAT, sleeping sickness) and Animal African Trypanosomiasis (AAT) are neglected tropical diseases generally caused by the same etiological agent, Trypanosoma brucei. Despite important advances in the reduction or disappearance of HAT cases, AAT represents a risky reserv
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oir of the infections. There is a strong need to control AAT, as is claimed by the European Commission in a recent document on the reservation of antimicrobials for human use. Control of AAT is considered part of the One Health approach established by the FAO program against African Trypanosomiasis. Under the umbrella of the One Health concepts, in this work, by analyzing the pharmacological properties of the therapeutic options against Trypanosoma brucei spp., we underline the need for clearer and more defined guidelines in the employment of drugs designed for HAT and AAT. Essential requirements are addressed to meet the challenge of drug use and drug resistance development. This approach shall avoid inter-species cross-resistance phenomena and retain drugs therapeutic activity.
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The major neglected tropical diseases, Taenia solium taeniosis/cysticercosis and schistosomiasis caused by Schistosoma mansoni or S. haematobium are presumed to be widely distributed in Africa. Taenia solium taeniosis/ cysticercosis has been reported as an emerging disease in different regions of Af
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rica [1, 2], but currently the exact distribution remains unclear. Reported prevalences of T. solium taeniosis and cysticercosis in African countries are not extensive and are further complicated by the lack of ‘gold standard’ tests for diagnosis.
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