13. Otros

Klasen, E., Miranda, J., Khatry, S., Menya, D., Gilman, R., Tielsch, J., Kennedy, C., Dreibelbis, R., Naithani, N., Kimaiyo, S., Chiang, M., Carter, E., Sherman, Ch., Breysse, P., Checkley, W., Huaman, A., Levano, M., Haustein, D., Rhodes, E., Grajeda, L., Levy, S., LeClerq, S., Wise, R., Mosol, P., Ogaro, F., Apaka, C., Baliddawa, J.

https://doi.org/10.1186/1745-6215-14-327

Abstract

Background

Exposure to biomass fuel smoke is one of the leading risk factors for disease burden worldwide. International campaigns are currently promoting the widespread adoption of improved cookstoves in resource-limited settings, yet little is known about the cultural and social barriers to successful improved cookstove adoption and how these barriers affect environmental exposures and health outcomes.

Design

We plan to conduct a one-year crossover, feasibility intervention trial in three resource-limited settings (Kenya, Nepal and Peru). We will enroll 40 to 46 female primary cooks aged 20 to 49 years in each site (total 120 to 138).

Methods

At baseline, we will collect information on sociodemographic characteristics and cooking practices, and measure respiratory health and blood pressure for all participating women. An initial observational period of four months while households use their traditional, open-fire design cookstoves will take place prior to randomization. All participants will then be randomized to receive one of two types of improved, ventilated cookstoves with a chimney: a commercially-constructed cookstove (Envirofit G3300/G3355) or a locally-constructed cookstove. After four months of observation, participants will crossover and receive the other improved cookstove design and be followed for another four months. During each of the three four-month study periods, we will collect monthly information on self-reported respiratory symptoms, cooking practices, compliance with cookstove use (intervention periods only), and measure peak expiratory flow, forced expiratory volume at 1 second, exhaled carbon monoxide and blood pressure. We will also measure pulmonary function testing in the women participants and 24-hour kitchen particulate matter and carbon monoxide levels at least once per period.

Discussion

Findings from this study will help us better understand the behavioral, biological, and environmental changes that occur with a cookstove intervention. If this trial indicates that reducing indoor air pollution is feasible and effective in resource-limited settings like Peru, Kenya and Nepal, trials and programs to modify the open burning of biomass fuels by installation of low-cost ventilated cookstoves could significantly reduce the burden of illness and death worldwide.

Keywords

Adoption, Behavior change, Biomass fuel, DLCO, Improved cookstove, Indoor air pollution, Spirometry, Ventilated cookstove.

Kosek, M., Yori, P., Gilman, R., Vela, H., Olortegui, M., Chavez, C., Calderon, M., Bao, J., Hall, E., Maves, R., Burga, R., Sanchez, G.

Am J Trop Med Hyg. 2012 Jun;86(6)

Abstract

To evaluate the performance of enterobacterial repetitive intergenic sequence-based polymerase chain reaction (ERIC-PCR) typing versus the current standard for the typing of Shigella pulsed gel electrophoresis (PFGE), we typed 116 Shigella isolates from a village in an endemic setting over a 20-month period using both methods. PFGE identified 37 pulse types and had a discrimination index of 0.925 (95% confidence interval = 0.830-1.00), whereas ERIC-PCR identified 42 types and had a discrimination index of 0.961 (95% confidence interval = 0.886-1.00). PFGE and ERIC-PCR showed a 90.4% correlation in the designation of isolates as clonal or non-clonal in pairwise comparisons. Both systems were highly reproducible and provided highly similar and supplementary data compared with serotyping regarding the transmission dynamics of shigellosis in this community. ERIC-PCR is considerably more rapid and inexpensive than PFGE and may have a complementary role to PFGE for initial investigations of hypothesized outbreaks in resource-limited settings.

Eisen, S., Pealing, L., Aldridge, R., Siedner, M., Necochea, A., Leybell, I., Valencia, T., Herrera, B., Wiles, S., Friedland, J., Gilman, R., and Evans, C.,

Pai, M., Editor

PLoS One. 2013; 8(9): e74220

Abstract

Background

Tuberculosis infection, disease and mortality are all less common at high than low altitude and ascent to high altitude was historically recommended for treatment. The immunological and mycobacterial mechanisms underlying the association between altitude and tuberculosis are unclear. We studied the effects of altitude on mycobacteria and antimycobacterial immunity.

Methods

Antimycobacterial immunity was assayed in 15 healthy adults residing at low altitude before and after they ascended to 3400 meters; and in 47 long-term high-altitude residents. Antimycobacterial immunity was assessed as the extent to which participants’ whole blood supported or restricted growth of genetically modified luminescent Bacille Calmette-Guérin (BCG) mycobacteria during 96 hours incubation. We developed a simplified whole blood assay that could be used by a technician in a low-technology setting. We used this to compare mycobacterial growth in participants’ whole blood versus positive-control culture broth and versus negative-control plasma.

Results

Measurements of mycobacterial luminescence predicted the number of mycobacterial colonies cultured six weeks later. At low altitude, mycobacteria grew in blood at similar rates to positive-control culture broth whereas ascent to high altitude was associated with restriction (p≤0.002) of mycobacterial growth to be 4-times less than in culture broth. At low altitude, mycobacteria grew in blood 25-times more than negative-control plasma whereas ascent to high altitude was associated with restriction (p≤0.01) of mycobacterial growth to be only 6-times more than in plasma. There was no evidence of differences in antimycobacterial immunity at high altitude between people who had recently ascended to high altitude versus long-term high-altitude residents.

Conclusions

An assay of luminescent mycobacterial growth in whole blood was adapted and found to be feasible in low-resource settings. This demonstrated that ascent to or residence at high altitude was associated with decreased mycobacterial growth in whole blood relative to controls, consistent with altitude-related augmentation of antimycobacterial cellular immunity.

Castro-Sesquen YE, Gilman RH, Paico H, Yauri V, Angulo N, Ccopa F, Bern C.

PLoS Negl Trop Dis. 2013;7(2):e1996.

We studied cell death by apoptosis and necrosis in cardiac remodeling produced by Trypanosoma cruzi infection. Eight infected and two uninfected guinea pigs were necropsied at seven time points up to one year post-infection. Cell death by necrosis and apoptosis was determined by histopathological observation and terminal deoxynucleotidyl transferase dUTP nick end labeling, respectively. Cardiac cell death by necrosis predominated over apoptosis during the acute phase; during the chronic phase, both apoptosis and necrosis were observed in cardiac cells. Apoptosis was also observed in lymphocytes, endothelial cells and epicardial adipose tissue, especially in the chronic phase.

Bernabe-Ortiz A, Benziger CP, Gilman RH, Smeeth L, Miranda JJ.

PLoS One. 2012;7(4):e35127.

Although men and women have similar risk factors for cardiovascular disease, many social behaviors in developing countries differ by sex. Rural-to-urban migrants have different cardiovascular risk profiles than rural or urban dwellers. The objective of this study was to evaluate the sex differences with specific cardiovascular risk factors in rural-to-urban migrants.

Our results suggest that interventions for CVD in Peru should be sex-specific and address the unique health needs of migrant populations living in urban shantytowns since the risk factors for obesity and metabolic syndrome differ between males and females.

Miranda, J., Bernabé-Ortiz, A., Diez-Canseco, F., Málaga, G., Cárdenas, M., Carrillo-Larco, R., Lazo-Porras, M., Moscoso-Porras, M., Pesantes, M., Ponce, V., Araya, R., Beran, D., Busse, P., Boggio, O., Checkley, W., García, P., Huicho, L., León-Velarde, F., Lescano, A., Mohr, D., Pan, W., Peiris, D., Perel, P., Rabadán-Diehl, C., Rivera-Chira, M., Sacksteder, K., Smeeth, L., Trujillo, A., Wells, J., Yan, L., García, H., and Gilman R.

Global Health. 2016; 12: 29

Human capital requires opportunities to develop and capacity to overcome challenges, together with an enabling environment that fosters critical and disruptive innovation. Exploring such features is necessary to establish the foundation of solid long-term partnerships. In this paper we describe the experience of the CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Herediain Lima, Peru, as a case study for fostering meaningful and sustainable partnerships for international collaborative research.