Summary This review on snake bites, seek to update the clinical epidemiology and therapy of frequent pathology in the Peruvian jungle and coast. Among the venomous snakes, the accident caused by the genus Bothrops stands out, in Peru the species B. atrox (jungle jar) is the cause in more than 90% of cases.

Resumen Esta revisión sobre mordedura de serpiente (ofidismo), buscar actualizar la epidemiologia clínica y terapia de la patología frecuente en la selva y costa peruana. Entre las serpientes venenosas destaca el accidente producido por el género Bothrops, en el Perú la especie B. atrox (Jergón de la selva) es el causante en más del 90% de los casos.

Gastrointestinal tuberculosis is a rare and fatal complication in patients with HIV infection. It occurs in 3%-16% of extra pulmonary forms. The main location in 90% of cases is the ileocecal valve and colon. The most unusual presentation of gastrointestinal tuberculosis is massive bleeding with the presence of one or multiple ulcers in the colon. The diagnosis can be confirmed by biopsy and by culture of intestinal tissue. Surgical resection is the treatment of choice. We report a case of a HIV-infected patient, who did not receive antiretrovirals, and who developed disseminated tuberculosis with intestinal perforation, presenting a fatal massive intestinal bleeding.

Resumen La tuberculosis (TBC) gastrointestinal es una complicación infrecuente y fatal en pacientes con infección por VIH. Se presenta en 3-16% de las formas extrapulmonares y su principal localización es la válvula ileocecal y colon. La hemorragia digestiva baja con presencia de una o múltiples úlceras en colon es una presentación muy inusual de TBC intestinal. El diagnóstico se confirma por biopsia y cultivo del tejido intestinal. La cirugía en caso de perforación intestinal sigue siendo el tratamiento de elección. Se presenta el caso de un paciente con infección por VIH, sin tratamiento anti-retroviral, quien desarrolló una TBC diseminada con perforación intestinal y hemorragia digestiva masiva de curso fatal.

In order to describe the incidence of nosocomial infections associated to invasive devices in intensive care units (UCI) of the National Hospital Cayetano Heredia, a retrospective observational study was conducted using the data from the Office of Epidemiology and Environmental Health from 2010 to 2012. A total number of 222 nosocomial infections were reported; the general medicine UCI reported the highest incidence of pneumonia cases associated to a mechanical ventilator in 1000 days of use of the device (28.6); infection of the blood stream associated to central venous catheter (11.9), and infection of the urinary tract associated to a catheter (8,1). The main infectious agents isolated were Pseudomona sp. (32.3%) in the emergency UCI, negative Staphylococcus coagulasa (36%) in the general medicine UCI and Candida sp (69.2%) in the Surgery UCI. The rates of infections associated to invasive devices were high as in other national hospitals with limited resources and infrastructure

Con el objetivo de describir la incidencia de infecciones intrahospitalarias asociadas a dispositivos invasivos en unidades de cuidados intensivos (UCI) del Hospital Nacional Cayetano Heredia se realizó un estudio observacional retrospectivo utilizando datos de la Oficina de Epidemiología y Salud Ambiental durante los años 2010 al 2012. Se notificó un total de 222 infecciones intrahospitalarias, la UCI de Medicina tuvo la incidencia por 1000 días de uso del dispositivo más alta para neumonía asociada a ventilador mecánico (28,6); infección del torrente sanguíneo asociado a catéter venoso central (11,9), e infección del tracto urinario asociado a catéter (8,1). Los principales agentes infecciosos aislados fueron Pseudomona sp. (32,3%) en la UCI de emergencia, Staphylococcus coagulasa negativo(36%) en la UCI de medicina y Candida sp (69,2%) en la UCI de cirugía. Las tasas de infecciones asociadas a dispositivos invasivos se reportaron altas semejantes a otros hospitales nacionales con limitados recursos e infraestructura

In order to describe the incidence of nosocomial infections associated to invasive devices in intensive care units (UCI) of the National Hospital Cayetano Heredia, a retrospective observational study was conducted using the data from the Office of Epidemiology and Environmental Health from 2010 to 2012. A total number of 222 nosocomial infections were reported; the general medicine UCI reported the highest incidence of pneumonia cases associated to a mechanical ventilator in 1000 days of use of the device (28.6); infection of the blood stream associated to central venous catheter (11.9), and infection of the urinary tract associated to a catheter (8,1). The main infectious agents isolated were Pseudomona sp. (32.3%) in the emergency UCI, negative Staphylococcus coagulasa (36%) in the general medicine UCI and Candida sp (69.2%) in the Surgery UCI. The rates of infections associated to invasive devices were high as in other national hospitals with limited resources and infrastructure

Con el objetivo de describir la incidencia de infecciones intrahospitalarias asociadas a dispositivos invasivos en unidades de cuidados intensivos (UCI) del Hospital Nacional Cayetano Heredia se realizó un estudio observacional retrospectivo utilizando datos de la Oficina de Epidemiología y Salud Ambiental durante los años 2010 al 2012. Se notificó un total de 222 infecciones intrahospitalarias, la UCI de Medicina tuvo la incidencia por 1000 días de uso del dispositivo más alta para neumonía asociada a ventilador mecánico (28,6); infección del torrente sanguíneo asociado a catéter venoso central (11,9), e infección del tracto urinario asociado a catéter (8,1). Los principales agentes infecciosos aislados fueron Pseudomona sp. (32,3%) en la UCI de emergencia, Staphylococcus coagulasa negativo(36%) en la UCI de medicina y Candida sp (69,2%) en la UCI de cirugía. Las tasas de infecciones asociadas a dispositivos invasivos se reportaron altas semejantes a otros hospitales nacionales con limitados recursos e infraestructura

Objective: To evalúate the frequency of intestinal parasites and risk factors associated with coccidian infection in patients cared for at a public hospital in Lima-Peru. Methods: A descriptive, cross-sectional study was conducted using reports of the parasitology laboratory. Patients included were >18 years, who gave at least one faecal sample for parasitologic evaluation. Logistic regression was used to calcúlate Odd Ratios (OR) and 95%) confidence intervals. Results: 2.056 patients were included in the analysis, 55.2%> of them were males and 334 (16.3%) were HlVpositive. Overall, Blostocystis hominis was the most frequent parasite (35.4%). The multivariate model adjusted for sex shows that HIV infection (OR = 4.53; 95%CI: 3.03-6.77), being hospitalized (OR = 2.42; 95%CI: 1.06-5.52), and age ≥ 40 years (OR = 0.57; 95%IC: 0.37-0.86) were associated with coccidian mfection. Conclusions: Blostocystis hominis was the most frequent parasite in HIV positive and negative patients. Being hospitalized and HIV infection were risk factors for coccidian infection, but age ≥ 40 years was a protective factor.

Objetivos: Evaluar la frecuencia de parásitos intestinales y factores asociados a la infección por coccidias en un hospital público de Lima-Perú. Métodos: Estudio descriptivo, transversal, realizado con los reportes del Laboratorio de Parasitología. Se incluyeron pacientes de > 18 años, ambulatorios u hospitalizados, que tuvieron al menos una muestra de heces evaluada. Usando regresión logística, se calcularon OR e IC al 95%. Resultados: Se incluyó 2.056 pacientes en el análisis; 55,2% fueron varones y 334 (16,3%) fueron seropositivos para VIH. La infección parasitaria más frecuente fue Blastocystis hominis (35,4%). El modelo multivariado ajustado por sexo mostró que la infección por VIH (OR = 4,53), estar hospitalizado (OR = 2,42) y la edad ≥ 40 (OR = 0,57) estuvieron asociados con infección por coccidias. Conclusiones: Blastocystis hominis se aisló frecuentemente en pacientes con y sin infección por VIH. Estar hospitalizado y ser seropositvo para VIH fueron factores de riesgo para infección por coccidias, mientras la edad ≥ 40 años fue un factor protector.

Several factors have been associated with HIV infection, but alcohol consumption has not been studied completely. The purpose of this study is to evaluate the association between alcohol consumption and HIV infection. A case-control study was undertaken with HIV-positive and HIV-negative patients, matched by sex and age (± 2 years). Latin-American Alcoholism Test (long version) was used to evaluate alcoholism diagnosis. A total of 198 cases were matched with 198 controls: 38.9% of cases were diagnosed as alcoholics, and only 22.7%> of controls (p < 0.001). The multivariate model showed that economic income (p < 0.001), sexual orientation (p < 0.001), and alcoholism diagnosis (p < 0.001) were associated with HIV infection. This study demonstrates an association between alcohol consumption, homosexual practices between men and economic income with the prevalence of HIV infection

Se conocen diversos factores asociados a la infección por VIH, siendo uno de los menos estudiados el consumo de alcohol. El propósito de este trabajo es evaluar la asociación entre el consumo de alcohol y la infección por VIH. Se realizó un estudio caso-control, pacientes con y sin infección por VIH, apareados por sexo y edad (± 2 años). Se utilizó la Prueba de Alcoholismo Latinoamericano Versión Larga para el diagnóstico de alcoholismo. Se evaluaron 198 casos y 198 controles: 38,9% de los casos fueron diagnosticados de alcoholismo y sólo 22,7% de los controles (p < 0,001). El modelo multivariado mostró que el ingreso económico (p < 0,001), la orientación sexual (p < 0,001), así como el diagnóstico de alcoholismo (p < 0,001) se asociaron a la infección. Este estudio demuestra una asociación entre el consumo de alcohol, las prácticas homosexuales entre hombres y el ingreso económico con la prevalencia de infección por VIH

Hydatidic illness is a frequent parasitic zoonosis in our country whose more frequent localization is the liver and the lungs. However other many sites have been described, depending their symptoms on the cyst’s size, localization and effect on next structures, being sometimes its evolution fatal. This is a 52 year-old female patient admitted at emergency room for dysfunction of sensory and neurological focalization. She had a previous history of surgery many years ago by abdominal tumor. We found a collateral circulation on right hemithorax and facial and arms edema at exam. The cerebral CT howed extensive left parietal parenchymal hemorrhage. Thoracoabdominal CT revealed multiple cystic masses of diverse sizes in the mediastinum, lungs, liver and other places. The patient’s evolution was torpid, the neurological compromise didn’t improve in spite of the treatment against the intracranial hypertension (EH), being also added a nosocomial pneumonia. The patient died after several days. Necropsy revealed presence of cystic lesions in mediastinum, heart’s great vessels, pericardium, lungs, liver, spleen and mentum, as well as intra and extraparenchymal hemorrhages of hypertensive cause in brain, not being cystic lesions in central nervous system. We concluded that it was disseminated hydatidic illness, cysts in the mediastinum caused compression of the heart’s great vessels, causing a superior cave vein syndrome. ( Rev Med Hered 2001; 12: 142-149 )