Antonio M Quispe - Academia.edu (original) (raw)

Papers by Antonio M Quispe

Recent history suggests that malaria can be eliminated in low-endemic countries, and there is a g... more Recent history suggests that malaria can be eliminated in low-endemic countries, and there is a growing interest among key stakeholders from Peru to plan accordingly and achieve malaria elimination with a comprehensive programmatic goal. In support of this interest, this dissertation integrates a course of studies to inform and support such goal, by accounting for the two most important malaria transmission patterns that currently characterize Peru, the one affecting the Peruvian north coast and the other affecting the Peruvian Amazon basin. The first study will determine the impact of reactive case detection with focal mass drug administration (RCD/FMDA) as compared to passive case detection on reducing the regional annual parasite incidence in Tumbes, Peru (Paper 1). The second study will determine the impact of the malaria elimination program implemented in Tumbes on interrupting the transmission of malaria beyond the intervention area and along the Peruvian north coast (Paper 2). And the third study will determine whether further understanding the patterns of malaria incidence in Loreto, the main human malaria reservoir in Peru, may offer a variety of strategical targets for the malaria elimination program that was launched in Loreto, influencing as well the nearby regions at the Peruvian Amazon basin in 2017 (Paper 3). It has been observed that the malaria elimination program implemented in Tumbes, which was based on replacing passive case detection with RCD/FMDA strategy, had a significant effect on reducing the regional annual parasite incidence in Tumbes within the intervention areas (2/13 districts) during the first two years of the program (pilot project). When the strategy was scaled up across the entire Tumbes region, malaria transmission was halted with no endogenous cases for the following three years. Additionally, data suggest that the Tumbes intervention indirectly helped to interrupt malaria transmission in the nearby region of Piura. During the intervention in

medRxiv (Cold Spring Harbor Laboratory), Jan 20, 2021

doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by pee... more doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

DOAJ (DOAJ: Directory of Open Access Journals), Mar 1, 2010

Journal of Infection in Developing Countries, Nov 30, 2020

Introduction: This study aimed to assess the association between multidrug resistance (MDR) and l... more Introduction: This study aimed to assess the association between multidrug resistance (MDR) and late-onset sepsis (LOS) among newborns with bloodstream infection (BSI). Methodology: In this cross-sectional study, we routinely tested every newborn with a presumptive diagnosis of sepsis admitted to the largest reference maternity hospital in Lima, Peru for BSI over an 18-month period. We tested every isolate for MDR by using the disk-diffusion method and assessed its associated factors by using a robust Poisson regression analysis with a particular focus on its association with LOS (vs. early-onset sepsis, EOS). Results: We analyzed a total of 489 subjects, including 340 (69%) newborns with LOS, and estimated an MDR rate of 80% (95% confidence interval, CI: 76%-83%), which was significantly higher (p-value < 0.001) among LOS (85%; 95% CI: 81%-89%) than EOS cases (67%; 95% CI: 59%-75%). The primary isolate was coagulase-negative Staphylococci (CoNS) (60%), which exhibited a limited subset of antibiotic MDR patterns, most of which were characterized by their resistance to cefoxitin, gentamicin, and clindamycin and levofloxacin. Overall, the prevalence of MDR was higher among LOS compared to EOS cases (adjusted prevalence ratio [aPR] = 1.28; 95% CI: 1.14-1.45), and among BSI due to CoNS compared to other bacteria (Apr = 1.10; 95% CI: 1.01-1.20). Conclusions: MDR among newborns with sepsis is exceptionally high, being even higher among those with LOS than newborns with EOS, and among those infected with CoNS compared to other bacteria. Furthermore, CoNS exhibited a limited subset of MDR patterns, which could be used to guide therapeutic decisions.

Gates open research, Jul 1, 2022

Background: Coronavirus disease 2019 (COVID-19) impact varies substantially due to various factor... more Background: Coronavirus disease 2019 (COVID-19) impact varies substantially due to various factors, so it is critical to characterize its main differences to inform decision-makers about where to focus their interventions and differentiate mitigation strategies. Up to this date, little is known about the patterns and regional clustering of COVID-19 waves worldwide. Methods: We assessed the patterns and regional clustering of COVID-19 waves in Peru by using the weekly mortality rates for each of the 25 regions as an outcome of interest. We obtained the death counts from the National Informatics System of Deaths and population estimates from the National Registry of Identification and Civil Status. In addition, we characterized each wave according to its duration, peak, and mortality rates by age group and gender. Additionally, we used polynomial regression models to compare them graphically and performed a cluster analysis to identify regional patterns. Results: We estimated the average mortality rate at the first, second, and third wave at 13.01, 14.12, and 9.82 per 100,000 inhabitants, respectively, with higher mortality rates among elders and men. The patterns of each wave varied substantially in terms of duration, peak, impact, and wave shapes. Based on our clustering analysis, during the first wave caused by the index virus, the 25 regions of Peru presented six different wave patterns. However, the regions were clustered in two different wave patterns during the second and third, caused by alpha/lambda/delta and omicron. Conclusions: The propagation of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) variants behaved in Peru with varying wave patterns and regional clustering. During the COVID-19 pandemic, the weekly mortality rates followed different Open Peer Review Approval Status AWAITING PEER REVIEW Any reports and responses or comments on the article can be found at the end of the article.

Revista del cuerpo médico del HNAAA, Jun 9, 2021

Introducción: La revisión sistemática es la evaluación comprehensiva, reproducible, crítica y exp... more Introducción: La revisión sistemática es la evaluación comprehensiva, reproducible, crítica y explícita de la mejor evidencia disponible en respuesta a una pregunta de investigación específica. Para conseguir ello las revisiones sistemáticas deben cubrir como mínimo los siguientes siete pasos: i) una pregunta de investigación específica y estructurada usando la técnica PICO; ii) criterios de elegibilidad de las evidencias; iii) una estrategia de búsqueda clara y reproducible; iv) selección de las evidencias y extracción de datos; v) análisis de sesgos; vi) síntesis de resultados; y, vii) publicación. Si los datos son suficientes y homogéneos es factible incluir en las síntesis de resultados el metanálisis de los mismos. De esta manera las revisiones sistemáticas y metanálisis pueden generar conocimiento nuevo y fundamental para la toma de decisiones en el área clínica y en otras áreas

Journal of Evidence-based Medicine, Jun 18, 2019

Aim: This study analyzes the quantitative and qualitative evolution of the Peruvian Clinical Tria... more Aim: This study analyzes the quantitative and qualitative evolution of the Peruvian Clinical Trial Registry during the last 22 years. Methods: Following a cross-sectional design, we reviewed all clinical trials registered at the Peruvian Clinical Trial Registry during 1995-2017. We downloaded and extracted all registries on 31 March 2018. We summarized qualitative variables and quantitative variables. Also, we performed trends analysis of the records by year, clinical phase, institutional review board, and children's participation. Results: The Peruvian Clinical Trial Registry recorded 1748 clinical trials during 1995-2017. Considering World Health Organization 20-standard descriptors as the standard, the registry suitably recorded four of them in 1995 and 19 since 2013. There was a meaningful change in the trend of the registries, showing a significant upward registry trend until 2008 and a significant downward registry trend since then. This trend could be influenced by new regulation in clinical trials registry. Several trials had incomplete entries for different studied variables. Most of the clinical trials (82%) included male and female participants, and only 14% included children. Oncological disorders were the diseases most frequently investigated (20%). Most of clinical trials were registered by pharmaceutical companies. A few institutional review boards evaluated most of the clinical trials. Conclusion: The registration of clinical trials in Peru has improved quantitatively and qualitatively since it started, but its quantitative grow stopped in 2008. Since then, the number of registries has declined steadily. There is an influence of pharmaceutical companies in clinical trial registration.

F1000Research, Dec 27, 2019

Abdominal obesity represents an accurate predictor of Background overall morbidity and mortality,... more Abdominal obesity represents an accurate predictor of Background overall morbidity and mortality, which is worrisome because it is also continuously increasing across Andean countries. However, its relationship with altitude remains unclear. The objective of this study was to assess the association between altitude and abdominal obesity in Peru, and how sociodemographic variables impact this association. : We estimated the prevalence of abdominal obesity in Peru and Methods analyzed its association with altitude using the data from the 2012-2013 National Household Survey (ENAHO). During this survey, a representative sample of Peruvians was screened for abdominal obesity, using waist circumference as a proxy, and the Adult Treatment Panel III guidelines cutoffs. : Data were analyzed from a sample of 20 489 Peruvians (51% Results male). The prevalence of abdominal obesity was estimated at 33.6% (95% CI: 32.5 to 34.6%). In Peru, altitude was significantly and inversely associated with abdominal obesity, decreasing with higher altitudes: 1500-2999 meters above mean sea level (MAMSL) vs <1500 MAMSL, adjusted prevalence rate [aPR]= 0.90 (95% CI: 0.84 to 0.96); ≥3000 MAMSL vs <1500 MAMSL, aPR= 0.78 (95% CI: 0.72 to 0.84), when adjusting by age, gender and residence area (rural/urban). However, this association was significantly modified by age and gender (< 0.001). p : Abdominal obesity is highly prevalent in Peru and decreases Conclusion significantly with altitude, but age and gender modify this association. Thus, abdominal obesity appears to affect older women from low altitudes more than younger men from high altitudes.

Revista Peruana de Medicina Experimental y Salud Pública, Mar 1, 2010

(DISA) V Lima-Ciudad desde el año 2001 al 2008, y determinar los patrones característicos. Materi... more (DISA) V Lima-Ciudad desde el año 2001 al 2008, y determinar los patrones característicos. Material y métodos. Estudio de tipo ecológico en el que se revisaron los reportes mensuales de todos los hospitales que prestan atención de partos en la DISA V Lima-Ciudad y se analizó la tendencia de la razón mensual de cesáreas o TC mensual (TCM = total de partos cesáreas atendidos en un mes * 100 / total de recién nacidos en el mismo mes) con el objeto de identificar sus patrones característicos.

Pathogens and Global Health, Jan 2, 2021

Disinfectants play an essential role in controlling the dissemination of bacteria in health care ... more Disinfectants play an essential role in controlling the dissemination of bacteria in health care settings, but it may also contribute to the selection of antibiotic resistance bacteria. This study looked at Klebsiella pneumoniae isolates collected from three hospitals in Lima, Peru, in order to evaluate: their susceptibility to chlorhexidine [CHG] and isopropanol [ISP]), and their association with antimicrobial susceptibility. We analyzed 59 K. pneumoniae isolates and assessed their CHG and ISP susceptibility by minimum inhibitory concentrations (MICs). Additionally, we performed a regression analysis to assess the association between disinfectant tolerance and antibiotic resistance (measured by the disc diffusion method), colistin resistance (by microdilution), carbapenemases presence (by polymerase chain reaction [PCR]), and clonal relationships (by pulsed-field gel electrophoresis [PFGE]). Eleven K. pneumoniae strains were isolated from fomites, and 48 strains from clinical samples. The MIC range of these isolates was 8-128 µg/ml for CHG and 16-256 mg/ml for ISP. We found that resistance to trimethoprim/sulfamethoxazole (TMP/SMX) was the main factor associated with CHG log 2 MIC (ß = 0.65; 95%CI: 0.03, 1.27; R 2 = 0.07). In the case of ISP, the log 2 (MIC) was associated with the institution of origin, showing lower ISP log 2 (MIC) in fomites compared to clinical samples(ß = −0.77; 95%CI: −1.54, −0.01; R 2 = 0.08). Resistance to CHG and ISP among K. pneumoniae isolates found in Peruvian hospitals seems to be elevated and highly variable. Further studies are needed to confirm our results and implement actionable interventions if necessary.

American Journal of Tropical Medicine and Hygiene, Jun 3, 2015

Much debate exists regarding the need, acceptability, and value of humanitarian medical assistanc... more Much debate exists regarding the need, acceptability, and value of humanitarian medical assistance. We conducted a cross-sectional study on 457 children under 5 years from four remote riverine communities in the Peruvian Amazon and collected anthropometric measures, blood samples (1-4 years), and stool samples. Focus groups and key informant interviews assessed perspectives regarding medical aid delivered by foreigners. The prevalence of stunting, anemia, and intestinal parasites was 20%, 37%, and 62%, respectively. Infection with multiple parasites, usually geohelminths, was detected in 41% of children. The prevalence of intestinal parasites both individual and polyparasitism increased with age. Participants from smaller communities less exposed to foreigners expressed lack of trust and fear of them. However, participants from all communities were positive about foreigners visiting to provide health support. Prevalent health needs such as parasitic infections and anemia may be addressed by short-term medical interventions. There is a perceived openness to and acceptability of medical assistance delivered by foreign personnel.

Gates open research, Aug 8, 2022

Background: Gender-based violence (GBV) is an increasing social problem worldwide, but it has bee... more Background: Gender-based violence (GBV) is an increasing social problem worldwide, but it has been neglected despite its high relevance to women's health. In this study, we aim to assess the coronavirus disease 2019 (COVID-19) pandemic impact on GBV incidence in Peruvian, determine the physical violence prevalence and its associated factors among GBV victims. Methods: We assessed the impact of the COVID-19 pandemic on the GBV weekly incidence by fitting an autoregressive integrated moving average model. Additionally, we assessed the physical violence prevalence and its associated factors by fitting a multivariate Poisson regression model with a link log and robust variance. Results: We analyzed 588,587 cases of women victims of GBV and calculated an annual GBV incidence of 518, 714, 958, 596, and 846 cases per 100,000 women during the years 2017-2021, respectively. During the COVID-19 pandemic, the observed GBV weekly incidence went significantly below the forecasted GBV weekly incidence since 2021. Overall, most GBV cases were of middle to high-risk (76%), regular (75%), and verbal (82%) violence. Most victims were single (81%), rural (75%), mothers with children (60%), who did not complete high school (54%). Most aggressors were men (81%), paid workers (77%), had completed high school education (63%), and partner of their victims (58%). Around 44% of the victims suffered physical violence and its main associated factors were aggressor's school education (adjusted prevalence ratio = 0.

International Journal of Tuberculosis and Lung Disease, Jun 1, 2020

Chronic tuberculous granulomatous mastitis (CTGM) is a rare form of tuberculosis (TB) treated pri... more Chronic tuberculous granulomatous mastitis (CTGM) is a rare form of tuberculosis (TB) treated primarily with anti-TB drugs. Oncoplastic surgery (OS) has been proposed as adjuvant therapy for CTGM. M E T H O D : We followed for 1 year every CTGM patients and assessed the efficacy (defined as non-recurrence and no need for corticosteroids) and safety attributable to the standard anti-TB drugs therapy with and without OS. R E S U LT S : We analysed 128 CTGM cases, including 78 (61%) treated with OS plus anti-TB drugs and 50 (39%) with anti-TB drugs only. We observed a significantly higher efficacy among those exposed vs. unexposed to OS (100% vs. 92%; prevalence ratio [PR] 1.09, 95% CI

Revista del cuerpo médico del HNAAA, Oct 24, 2019

Objetivo: Analizar cuáles son los desenlaces neonatales adversos que con mayor frecuencia afectan... more Objetivo: Analizar cuáles son los desenlaces neonatales adversos que con mayor frecuencia afectan a los recién nacidos de gestantes diagnosticadas con preeclampsia severa y determinar cuáles son sus factores asociados. Material y métodos: Siguiendo un diseño de cohortes se analizaron retrospectivamente todos los casos de preeclampsia severa diagnosticados en el Instituto Nacional Materno Perinatal durante el periodo 2016-2017. Resultados: Se analizaron un total de 942 casos de preeclampsia severa (28,5 ± 7,6 años de edad). El 100% de los gestantes dio a luz a producto vivo con 36,2 ± 3,2 semanas de gestación (rango: 24-41). Los desenlaces neonatales adversos más frecuentes fueron parto pretérmino (incidencia [I]=48,7%; intervalo de confianza al 95% [IC 95%]: 45,4% a 51,9%), talla baja para edad gestacional (I=33,7%; IC 95%: 30,6% a 36,7%), pequeño para la edad gestacional (I=25,6%; IC 95%: 22,9% a 28,5%) y Apgar 1-5´ bajo al nacer (I=12,1%; IC 95%: 10,0% a 14,2%). Las gestantes adolescentes tuvieron un menor riesgo de parto prematuro (IRR =0,70; IC 95%: 0,57 a 0,85) y un puntaje Apgar 1-5´ bajo al nacer (IRR =0,39; IC 95%: 0,21 a 0,72) que las adultas. Conclusión: La incidencia de desenlaces neonatales adversos en gestantes diagnosticadas con preeclampsia severa es alta, siendo los más frecuentes prematuridad, talla baja para edad gestacional, pequeño para la edad gestacional y APGAR 1-5´ bajo al nacer. Adicionalmente, se encontró que el riesgo de parto prematuro y Apgar bajo al nacer era menor en gestantes adolescentes que en gestantes adultas.

The American Journal of Tropical Medicine and Hygiene

ABSTRACT. The COVID-19 pandemic affected the main Amazon cities dramatically, with Iquitos City r... more ABSTRACT. The COVID-19 pandemic affected the main Amazon cities dramatically, with Iquitos City reporting the highest seroprevalence of anti-SARS-CoV-2 antibodies during the first COVID-19 wave worldwide. This phenomenon raised many questions about the possibility of a co-circulation of dengue and COVID-19 and its consequences. We carried out a population-based cohort study in Iquitos, Peru. We obtained a venous blood sample from a subset of 326 adults from the Iquitos COVID-19 cohort (August 13–18, 2020) to estimate the seroprevalence of anti-dengue virus (DENV) and anti-SARS-CoV-2 antibodies. We tested each serum sample for anti-DENV IgG (serotypes 1, 2, 3, and 4) and SARS-CoV-2 antibodies anti-spike IgG and IgM by ELISA. We estimated an anti-SARS-CoV-2 seroprevalence of 78.0% (95% CI, 73.0–82.0) and an anti-DENV seroprevalence of 88.0% (95% CI, 84.0–91.6), signifying a high seroprevalence of both diseases during the first wave of COVID-19 transmission in the city. The San Juan Di...

Pathogens and Global Health

Peru started its COVID-19 Immunization Program after recording the highest mortality worldwide du... more Peru started its COVID-19 Immunization Program after recording the highest mortality worldwide during the first wave of the pandemic and halfway through its second wave. However, it became one of the fastest developing countries to cover 80% of its adult population with two COVID-19 vaccine doses. Overall, from the beginning of the Program in February 2021 up to March 2022, Peru delivered 66.2 million vaccine doses in a country with 32.8 million inhabitants. To do so, Peru successfully implemented a COVID-19 Immunization Program using an intersectoral and multidisciplinary approach. In addition, and more importantly, the Program included the participation of traditional and nontraditional health leaders. Peru's experience from previous immunization campaigns played a crucial role in its success. This experience allowed Peru to tackle challenges such as having over 80 original languages, a segmented and fragmented health system, and a vast territory with remote communities across...

Anales de la Facultad de Medicina

Introducción: La eliminación de la malaria es la solución definitiva para evitar que la creciente... more Introducción: La eliminación de la malaria es la solución definitiva para evitar que la creciente resistencia a los medicamentos e insecticidas amenace los avances alcanzados en la lucha contra la malaria desde comienzos del siglo XXI. Objetivo: Analizar las características espacio temporales de la trasmisión de la malaria en Loreto. Método: Se realizó un estudio de tipo series de tiempo y se analizó la incidencia semanal de malaria en Loreto en los últimos 20 años (2000-2019) utilizando los datos del Sistema de Vigilancia Epidemiológica del Ministerio de Salud. Con esta información se modeló la incidencia semanal de malaria reportada por las unidades de vigilancia epidemiológica de Loreto y se determinaron sus características espacio temporales a nivel macro y microregional. Adicionalmente se caracterizaron las zonas “calientes” así como su estabilidad en el tiempo. Resultados: Durante los últimos 20 años observamos que Loreto tuvo un patrón de trasmisión estacional de la malaria, ...

Hispanic Health Care International

Background. Femicides are an increasing social problem worldwide. In this study, we aim to descri... more Background. Femicides are an increasing social problem worldwide. In this study, we aim to describe the trend of femicides in the prepandemic decade and characterize the femicide victims and their perpetrators. Methods. We assessed the trend of femicides in Peru during 2010–2019 and performed a cross-sectional study to analyze the femicides reported in 2019 using open data. Results. We analyzed 166 femicides reported in 24/25 regions of Peru in 2019 and calculated a yearly incidence of 1.01 femicides per 100,000 women. This incidence level represents an increase of 38% compared to the mean annual incidence from 2010 to 2018 (0.74 femicides per 100,000 women). Most femicides occurred in urban areas (64%), through strangling/asphyxiation (25.9%), stabbing (23%), and shooting (16%). Most victims were mothers (61%) 30 years old or over (51%). Most perpetrators have had a partner history with their victims (69%), 30 years old or over (62%), employed (57%), and consumed enablers (51%). Ou...

medRxiv (Cold Spring Harbor Laboratory), Jan 20, 2021

DOAJ (DOAJ: Directory of Open Access Journals), Mar 1, 2010

Journal of Infection in Developing Countries, Nov 30, 2020

Gates open research, Jul 1, 2022

Revista del cuerpo médico del HNAAA, Jun 9, 2021

Journal of Evidence-based Medicine, Jun 18, 2019

F1000Research, Dec 27, 2019

Revista Peruana de Medicina Experimental y Salud Pública, Mar 1, 2010

Pathogens and Global Health, Jan 2, 2021

American Journal of Tropical Medicine and Hygiene, Jun 3, 2015

Gates open research, Aug 8, 2022

International Journal of Tuberculosis and Lung Disease, Jun 1, 2020

Revista del cuerpo médico del HNAAA, Oct 24, 2019

The American Journal of Tropical Medicine and Hygiene

Pathogens and Global Health

Anales de la Facultad de Medicina

Hispanic Health Care International

Current Topics in Giardiasis, 2017

Giardiasis is the intestinal infection caused by Giardia lamblia, in which pathogenicity was cast... more Giardiasis is the intestinal infection caused by Giardia lamblia, in which pathogenicity was cast doubted for decades but now is recognized as one of the most common causes of diarrheal disease worldwide. Originally described as waterborne transmitted, it has been broad described as of fecal-oral, person-to-person contact, and sexual transmission also. Although it is recognized as endemic throughout the world, most cases are reported from tropical countries with regular outbreaks commonly reported from developed countries. In humans, giardiasis normally produces a self-limited infection without symptoms, but some patients may present intestinal symptoms such as diarrhea and abdominal pain, and few show symptoms long after parasites clear up. Upon diagnosis, we may choose among several effective treatment alternatives, but not every patient responds to such therapies. Hence, having specific knowledge about the epidemiology of Giardia, it is critical for its prevention, which is the best strategy to protect us against such important disease.