Etiology of children's diarrhea in Montevideo, Uruguay: associated pathogens and unusual isolates.

We studied microorganisms associated with infant diarrhea in a group of 256 children admitted to a public pediatric hospital in Montevideo, Uruguay. Diagnostic procedures were updated to optimize detection of potential pathogens, which were found in 63.8% of cases, and to be able to define their characteristics down to molecular or antigenic type. Coinfection with two or more agents was detected in more than one-third of positive studies. Escherichia coli enteric virotypes, especially enteropathogenic E. coli (EPEC), were shown to be prevalent. Rotavirus, Cryptosporidium, Campylobacter (mainly Campylobacter jejuni), and Shigella flexneri were also often identified. Enterotoxigenic E. coli, Salmonella, and Giardia lamblia were sporadically recognized. Unusual findings included two enteroinvasive E. coli strains, one Shigella dysenteriae 2 isolate, and a non-O:1 Vibrio cholerae culture. EPEC bacteria and S. flexneri (but not Salmonella) showed unusually frequent antimicrobial resistance, especially towards beta-lactam antibiotics, which is the subject of ongoing work.

[Research in tropical medicine and primary health care in Peru]. / Investigación en medicina tropical y atención primaria a la salud en Perú.

Tropical medicine's fundamental task is to improve health in the tropics. By adopting primary health care strategies, it satisfies the real needs of the population while doing research, improving its effectiveness and social impact. We illustrate this with some examples drawn from our experience, where this potentiation is evident. A sanitary dermatology study, based on health auxiliaries and promoters, encompassed a whole jungle province, with 68,977 km2 and 103,681 inhabitants. It resulted in an excellent relationship with the populations, and findings of significance for early diagnosis and control of hanseniasis and other diseases. It also facilitated an extension of activities to include the entire Amazonian Region, with specific concentration on training of the health personnel. Clinico-epidemiological studies on leishmaniasis in Andean valleys incorporated activities of sanitary education, health care, aspects of community development, etc., and extended into other geographic areas. Migrant workers from high-altitude communities in Cusco who have been to the jungle and acquired cutaneous or mucocutaneous leishmaniasis formed Patient Associations. The latter now receive support for their health and development needs from health authorities and many institutions; our Institute contributes with improved therapeutic procedures and further epidemiologic studies to orient preventive and control measures.

PIP: Tropical medicine is characterized by its focus on targeted research, which has improved biomedical knowledge for application to diagnosis, treatment, and prevention of illness. The UN Development Program/World Bank/World Health Organization Special Program for Research and Training in Tropical Diseases is promoting research to improve application of the results of targeted research. Combining a primary health care strategy with tropical medicine can help ensure that the real needs of the population will be met while research continues, maximizing effectiveness and social impact. Three examples from Peru illustrate the efficacy of this combined approach. A sanitary dermatology study was conducted in Alto Amazonas, a province of the Department of Loreto with a 1980 population estimated at 103,681 living in 68.977 sq. km of jungle. An intensive training program was held for physicians, nurses, auxiliaries, and other health personnel as well as the prospective health promoters who would participate in the pilot program to diagnose and control Hansen's disease (leprosy). The training included preparation of specimens for serological and other studies and other diagnostic procedures. Two 4-member field teams covered the entire province in 18 months, during which they censused 57,927 persons and clinically examined 47,160. After diagnosis of Hansen's disease was confirmed, a project physician or nurse initiated treatment with the multidrug regimen recommended by the World Health Organization and instructed the patient in the procedures to be followed to avoid incapacity. The auxiliary in the nearest health post supervised treatment and referred the patient to a higher level if adverse reactions occurred. 45 patients with Hansen's disease were detected during the study, along with 784 with leishmaniasis, 290 with malaria, and 164 with tuberculosis. All patients diagnosed with these conditions received treatment. A clinical and epidemiological study of leishmaniasis in Andean valleys combined health education, treatment, community development, and other interventions. The incidence of leishmaniasis has been increasing in Peru, and 15,000 new cases are projected for 1992. Active collaboration with the populations involved was sought through the primary health care system. A number of different organizations participated in the work. Field studies conducted primarily in the Purisima Valley included a census, recruiting of promoters and other health workers to diagnose cases, surveillance of new cases, systematic study of leishmaniasis vectors in houses and outside, and observation of the activity patterns of the population that might increase risk of disease. Positive correlations were found with the concentration of vectors inside houses and with seasons of increased agricultural activity. The third example concerned migrant workers from the highlands who contracted leishmaniasis in the jungle. They formed associations to seek assistance from the health system.

Nuevo indicador de la carencia de hierro: relación hemoglobina y protoporfirina eritrocitaria

La protoporfirna es metabolismo indispensable en al síntesis del HEM, pues su presencia hace posible que el hierro en estado ferroso se incorpore en su interior mediante la acción catalítica de una enzima mitrocondrial denominada ferroquetalasa o hem sintetasa y finalmente formarse el Hem. Este hecho puede alterarse ya sea, por un estado deficitário en hierro en forma crónica o por acumulación anormal de plomo. El estudio se realiza en 199 personas de la zona rural de Sto. Domingo de los Colorados, integrado por 87 hombres (43.72%) y 112 mujeres (56.28%). Los resultados nos permiten inferir la existencia de un estado deficitario de este mineral son: niños en crecimiento rápido (lactantes, preescolares y escolares), mujeres en edad fértil y mujeres embarazadas (no consideradas en este trabajo). En este presente estudio aproximadamente el 90% de las personas pertencientes a estos grupos señalados presentan algún trastorno relacionado con el metabolismo del hierro, definido por una disminución en la concentración sanguínea de hemoglobina y un aumento en la concentración de protoporfirina eritrocitaria. Con el presente estudio pretendemos insistir en el uso de indicadores adecuados y técnicas de laboratório fáciles y fiables para determinar el estado de hierro en el organismo