ORIGINAL ARTICLE 09 REVISTA PERUANA DE INVESTIGACIÓN EN SALUD Novel Coronavirus in Wuhan, China

08 EDITORIAL ORIGINAL ARTICLE 09 REVISTA PERUANA DE INVESTIGACIÓN EN SALUD http://revistas.unheval.edu.pe/index.php/repis/ novel coronavirus in Wuhan, China. The Lancet [Internet]. el 24 de enero de 2020 [citado el 28 de https://doi.org/10.35839/repis.4.1.478 enero de 2020]; Disponible en: Clinical- epidemiological characteristics and knowledge about American Tegumentary http://www.sciencedirect.com/science/article/pii/S0140673620301835 Leishmaniasis in a population of Carabobo state. Venezuela 3. Lu H, Stratton CW, Tang Y-W. Outbreak of Pneumonia of Unknown Etiology in Wuhan China: the Mystery and the Miracle. J Med Virol. el 16 de enero de 2020; Características clínicas-epidemiológicas y conocimiento sobre la leishmaniosis 4. Wuhan seafood market pneumonia virus isolate Wuhan-Hu-1, complete genome. el 23 de enero de tegumentaria americana en una población de Carabobo. Venezuela 2020 [citado el 28 de enero de 2020]; Disponible en: http://www.ncbi.nlm.nih.gov/nuccore/MN908947.3 Karim Abdel1, Daniela Hernández1, Oniel Hidalgo1, Sol Hidalgo1, Fernando Hung1, Cristina Lorenzo2, Gilberto Bastidas2,*

5. Chan JF-W, Kok K-H, Zhu Z, Chu H, To KK-W, Yuan S, et al. Genomic characterization of the 2019 1School of Medicine, Faculty of Health novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Abstract Sciences, University of Carabobo, Venezuela. Wuhan. Emerg Microbes Infect. el 1 de enero de 2020;9(1):221–36. Every year 1.5 million new cases of American tegumentary Leishmaniasis are registered in the world, this 2Department of Public Health, Faculty of pathology is present in 88 countries, this makes it occupy the sixth place among the major diseases of the world and Health Sciences, University of the second among parasitic diseases only behind malaria, but in Latin America there are few works about Carabobo, Venezuela. Correspondencia a: [email protected] knowledge of American tegumentary Leishmaniasis as a support for health control programs. The objective was to determine the clinical, epidemiological characteristics and knowledge about American tegumentary Leishmaniasis ORCID: in the population of the state of Carabobo, Venezuela. The research was descriptive with documentary and ﬁeld *https://orcid.org/0000-0002-5805-6926 research design, based on the review of the epidemiological record and application of a questionnaire. The majorities of those affected are young adults (20-59 years) (66.3%) of the male gender, workers (27.4%) with upper Corresponding author: limb injuries (40.5%), generally unique (53.4%) and treated (86.3%). In the analyzed sample 80% know the Gilberto Bastidas disease, 83% the transmitter and 38% the pharmacological treatment. It was concluded that those affected with parasitism are mainly men, in economically productive age, workers and farmers, with educational levels not Postal Address: Department of Public exceeding the high school, in relative poverty, with unique skin lesions in exposed regions of the body and treated Health, University of Carabobo, Campus pharmacologically; that the population knows the natural history of the disease and the transmitter, but ignores Bárbula, Naguanagua, Carabobo state, aspects of the biology of the insect; and who prefer the pharmacological treatment of the public health service. Venezuela.

Keywords: Leishmaniasis, signs and symptoms, epidemiology, parasitism, skin (font: DeCS BIREME). Email: [email protected]

Resumen Reception date: 13 of september of 2019 Approval date: 09 of december of 2019 De leishmaniosis tegumentaria americana se registran en el mundo 1,5 millones de nuevos casos por año, está presente en 88 países, esto hace que ocupe el sexto lugar entre las enfermedades importantes del mundo y el Cite as: Abdel K, Hernández D, Hidalgo segundo entre las enfermedades parasitarias únicamente detrás del paludismo, pero en América Latina son O, Hidalgo S, Lorenzo C, Hung F, escasos los trabajos sobre conocimientos de leishmaniosis tegumentaria americana como sustento de los Bastidas G. Características clínicas- programas sanitarios de control. El objetivo fue determinar las características clínicas, epidemiológicas y el epidemiológicas y conocimiento sobre la conocimiento sobre tegumentaria americana en la población del estado de Carabobo, Venezuela. El estudio fue leishmaniosis tegumentaria americana 3descriptivo con diseño de investigación documental y de campo, basado en la revisión del registro epidemiológico en una población de Carabobo. y aplicación de un cuestionario. La mayoría de los afectados son adultos jóvenes (20-59 años) (66,3%) del género Venezuela. Rev Peru Investig Salud masculino, obreros (27,4%) con lesiones en miembro superior (40,5%), generalmente únicas (53,4%) y tratadas [ I n t e r n e t ] ; 4 ( 1 ) . Av a i l a b l e f r o m : (86,3%). En la muestra analizada 80% conoce la enfermedad, 83% al transmisor y 38% el tratamiento http://revistas.unheval.edu.pe/index.ph farmacológico. Se concluye que los afectados con la parasitosis son principalmente hombres, en edad p/repis/article/view/478. 09-16 económicamente productiva, obreros y agricultores, con niveles educativos no superiores a medio diversiﬁcado, en pobreza relativa, con lesiones de piel únicas en regiones expuestas del cuerpo y tratadas farmacológicamente; que la población conoce la historia natural de la enfermedad y el transmisor, pero ignoran aspectos de la biología del insecto; y que preﬁeren el tratamiento farmacológico del servicio sanitario público. 2616-6097/©2020. Peruvian Journal of Health Research. This is an Open Access article under the CC-BY license Palabras clave: Leishmaniosis, signos y síntomas, epidemiología, parasitosis, piel (fuente: DeCS BIREME). (https://creativecommons.org/licenses/by/4.0). It allows copying and redistributing the material in any medium or format. You must give credit appropriately, provide a link to the license, and indicate if changes have been made.

Introduction at risk of contracting it, and every year there are 2 million new cases. Of these, 200,000 to 400,000 new cases of visceral Leishmaniasis Leishmaniasis is a parasitic disease native to are reported, with high endemicity in the Indian the rainforests of America, also present in Asia subcontinent and East Africa, with the most and Africa. Leishmaniasis represents a group affected countries being Brazil, Ethiopia, of diseases caused by more than 20 different Somalia, Sudan and South Sudan [4,5]. species of parasitic protozoa of the gender Leishmania spp., which by their clinical Of American Tegumentary Leishmaniasis characteristics are divided into superficial and (ATL) 1.5 million new cases are registered and deep Leishmaniasis. The first mainly affects it is present in 88 countries, this makes the ATL skin and mucous membranes, while the occupy the sixth place among the world's major second damages internal organs (liver, spleen diseases and the second among parasitic and bone marrow), that can be deadly if it is not diseases only behind malaria. Likewise, the treated [1-3]. ATL has a morbidity burden of 2 090 000 years of life adjusted according to disability, which for According to the World Health Organization the men is 1 250 000 and for women 840 000. The Leishmaniasis predominantly affects at the high morbidity rate of the ATL, despite the very poor, especially in developing countries. It obvious sub registration is the main factor that is considered that there are 350 million people motivates research in this field [6].

ISSN 2616 - 6097, Rev Peru Investig Salud. 2020; 4(1), january - march 2020, 09-16 ISSN 2616 - 6097, Rev Peru Investig Salud. 2020; 4(1), enero - marzo 2020, 07-08 Abdel K, Hernández D, Hidalgo O, Hidalgo S, Hung F, Lorenzo C, Bastidas G. Clinical- epidemiological characteristics and knowledge about American Tegumentary 10 Leishmaniasis in a population of Carabobo state. Venezuela 11 In Latin America, ATL is probably known since state, Venezuela, zone with important are in the final stage of cognitive development Table 1 Epidemiological and clinical the pre-Colombian period. For this area casuistry and without previous studies on that enables them to master their mental characteristics of the American between 2001 and 2011, more than 600,000 these variables, which are indispensable as representations and achieve reasoning Tegumentary Leishmaniasis in the cases of ATL were registered, with an average theoretical inputs for the redesign of programs Hypothetical-deductive essential to overcome Trincheras community, Naguanagua incidence of 15.9 cases per 100,000 habitants, to endemic diseases control [13]. the different situations that arise in your daily municipality, Carabobo state, Venezuela. in addition this parasitism is endemic in 15 life. The survey was done individually and 2013-2017. Latin American countries: Argentina, Brazil, Methods confidentially. Informed consent was obtained Epidemiology Frequency % Bolivia, Colombia, Costa Rica, El Salvador, after explaining the objectives of the research. Age group* Ecuador, Guatemala, Guyana, Honduras, This work was approved by the Research Children (0-11 years) 5 6.8 Adolescents (12-19 years) 11 15.1 Nicaragua, Panama, Paraguay, Peru and This study was descriptive and with research Commission of the Department of Public Young adult (20-59 years) 48 65.8 Venezuela. In Venezuela it has been registered designs of documentary and field type. The Health attached to the Faculty of Health Older Adults (?60 years) 9 12.3 in 292 Municipalities, distributed in 22 of the 23 research was distributed in two stages: in the Sciences of the University of Carabobo. Gender** political-territorial entities [7-10]. The first stage the clinical-epidemiological Male 49 67.1 distribution of endemic focus of Leishmaniasis characteristics of the ATL were registered Statistical analysis: the data was recorded and Female 24 32.9 in Venezuela is located in the valleys of the using the archives of the Health Dermatology analyzed using the statistical program Epi Info Occupation mountainous system of the coast, the Yaracuy service of the Carabobo state, Venezuela. In 5.0. In addition to descriptive statistics, the j- Worker 20 27.4 depression, some regions of the lowland the second stage, through the application of a square test (X2), applied to 2X2 contingency Farmer 15 20.5 areas, the southern Orinoco, the mountainous questionnaire, the population's knowledge tables, was used. Student 15 20.5 Household Chores 15 20.5 and forested area of Táchira, Mérida, Trujillo, about ATL was determined. Employee 5 6.8 Lara, Miranda and Sucre, in addition to the Results Others 3 4.2 Carabobo and Aragua states [7-10]. The instrument used was the Bastidas's *** The Trincheras sector questionnaire previously validated [14], which The María 27 37 It should be noted that in the first quarter of consists of 2 sections. In the first one, the The majority of those affected with ATL are The Union 22 30.1 2015 (period until which official records are identity and affiliation data are registered, such young adults (20-59 years) (66.3%) and male The Salto 7 9.6 The Tres Marias 7 9.6 available) the Venezuelan Ministry of Health as; age, gender, occupation and degree of (66.3%), workers (26.3%) and mainly residing The Belen 5 6.9 reports 6 007 cases of Leishmaniasis, figures instruction of the respondent. In the second in the Marías sectors (37 % [27/73]) and the The Coina 4 5.5 that place their morbidity below expectations section, we explore through open and closed Union (30.1% [22/73]) (Table 1). The Ceiba 1 1.4 without being able to discern between a questions about the individual's knowledge Clinical characteristics decrease in casuistry or sub registration, in a about ATL. Finally, their socioeconomic The lesions were mainly located in the upper Location of lesions context in which the tendency is to increase the characteristics were asked by family with the (40.5%) and lower (32%) limbs. The skin Superior limbs 3. 4 40.5 number of affected [7-10]. The increase in the modified Graffar´s method that is based on the lesions were unique in 53.4% (54/80) of those Lower limbs 32 38.1 Abdomen 8 9.5 number of cases of ATL in many areas of Latin measurement of the variables: profession of affected and multiple in 45.2% of them, and Neck 4 4.8 America is due, among other factors, to the the head of the family, level of instruction of the about 90% of those affected with ATL complied Head 3 3.6 disease in which the subject is immersed, mother, main source of family income and the prescribed treatment with methylglumine Chest 3 3.6 especially those related to their knowledge of housing conditions that , result in five social antimoniate (Glucantime®) (Table 1). Number of injuries **** the pathologies that afflict them. Although it is strata namely: I (high quality of life) the score of Only 39 53.4 clear that many of the differences in people's the items is between 4-6, II (moderate quality of Most of the interviewees were between 20 and Multiple 33 45.2 health status are not predetermined, since life) values between 7-9, III (low quality of life) 59 years old (76%), belonged to the male Not registered 1 1.4 there are differences emanating from the values between 10-12, IV (relative poverty) gender (53%), were workers (31%) or were Type of injury Ulcerative 72 98.6 environment in which they live and from the values between 13-16 and V (critical poverty) engaged in household chores (25%), had the Not registered 1 1.4 knowledge and practices that society has values between 17-20 [15]. degree of instruction the incomplete high Treatment about the disease. Another relevant aspect for school (23%) and belonged to the socio- Complied 63 86.3 the management of ATL is the clinical - Population and sample: The population of the economic stratum IV (critical poverty) (73%) Not Complied 10 13.7 epidemiological behavior, because this can Trincheras corresponds to 9,600 habitants (Table 2). v a r y s i g n i fi c a n t l y b e t w e e n d i ff e r e n t according to local census and the “n” sample Source: Record of the Sanitary Dermatology Service to geographical regions [11, 12]. was 100 individuals, based on the expected More than 80% of respondents without gender the Carabobo state. frequency of ATL (2% taken as a reference of distinction (p = 0.27) know the disease, 63% In Venezuela, specifically in the Carabobo studies conducted in the Carabobo state) and ( [ 6 3 / 1 0 0 ] , p = 0 . 3 7 ) r e c o g n i z e t h e In the sample studied 61% know that the state, efforts have been made to incorporate population size. The sampling was of the symptomatology, and 62% know that this disease is related to insects and 83% knows the population into health actions and probabilistic type. A standard error of 5% and a disease is not transmitted by direct contact the transmitter of ATL, however, only 8.0% programs, but many of these programs do not confidence level of 95% were accepted for this between affected and healthy (p = 0.28), understand how insects are infected (p <0.05). measure the knowledge that people have investigation. however, only 37% know that the disease can However, respondents know in proportions about this disease. Therefore, the objective of be prevented and 38% know that animals can that they do not exceed 50% of what insects the present research is, firstly, to describe the On average the survey lasted 20 minutes per get sick (p <0.01) (Table 3). feed and at what time, as well as what attracts epidemiological clinical characteristics of the individual. It was applied to all persons over 11 them and where they hide (Table 4). ATL and then to determine the knowledge that years of age who were present at the time of the population of the Trincheras of the the survey, since they are mature enough to Naguanagua municipality of the Carabobo adequately answer the questionnaire as they

ISSN 2616 - 6097, Rev Peru Investig Salud. 2020; 4(1), january - march 2020, 09-16 ISSN 2616 - 6097, Rev Peru Investig Salud. 2020; 4(1), january - march 2020, 09-16 Abdel K, Hernández D, Hidalgo O, Hidalgo S, Hung F, Lorenzo C, Bastidas G. Clinical- epidemiological characteristics and knowledge about American Tegumentary 10 Leishmaniasis in a population of Carabobo state. Venezuela 11 In Latin America, ATL is probably known since state, Venezuela, zone with important are in the final stage of cognitive development Table 1 Epidemiological and clinical the pre-Colombian period. For this area casuistry and without previous studies on that enables them to master their mental characteristics of the American between 2001 and 2011, more than 600,000 these variables, which are indispensable as representations and achieve reasoning Tegumentary Leishmaniasis in the cases of ATL were registered, with an average theoretical inputs for the redesign of programs Hypothetical-deductive essential to overcome Trincheras community, Naguanagua incidence of 15.9 cases per 100,000 habitants, to endemic diseases control [13]. the different situations that arise in your daily municipality, Carabobo state, Venezuela. in addition this parasitism is endemic in 15 life. The survey was done individually and 2013-2017. Latin American countries: Argentina, Brazil, Methods confidentially. Informed consent was obtained Epidemiology Frequency % Bolivia, Colombia, Costa Rica, El Salvador, after explaining the objectives of the research. Age group* Ecuador, Guatemala, Guyana, Honduras, This work was approved by the Research Children (0-11 years) 5 6.8 Adolescents (12-19 years) 11 15.1 Nicaragua, Panama, Paraguay, Peru and This study was descriptive and with research Commission of the Department of Public Young adult (20-59 years) 48 65.8 Venezuela. In Venezuela it has been registered designs of documentary and field type. The Health attached to the Faculty of Health Older Adults (?60 years) 9 12.3 in 292 Municipalities, distributed in 22 of the 23 research was distributed in two stages: in the Sciences of the University of Carabobo. Gender** political-territorial entities [7-10]. The first stage the clinical-epidemiological Male 49 67.1 distribution of endemic focus of Leishmaniasis characteristics of the ATL were registered Statistical analysis: the data was recorded and Female 24 32.9 in Venezuela is located in the valleys of the using the archives of the Health Dermatology analyzed using the statistical program Epi Info Occupation mountainous system of the coast, the Yaracuy service of the Carabobo state, Venezuela. In 5.0. In addition to descriptive statistics, the j- Worker 20 27.4 depression, some regions of the lowland the second stage, through the application of a square test (X2), applied to 2X2 contingency Farmer 15 20.5 areas, the southern Orinoco, the mountainous questionnaire, the population's knowledge tables, was used. Student 15 20.5 Household Chores 15 20.5 and forested area of Táchira, Mérida, Trujillo, about ATL was determined. Employee 5 6.8 Lara, Miranda and Sucre, in addition to the Results Others 3 4.2 Carabobo and Aragua states [7-10]. The instrument used was the Bastidas's *** The Trincheras sector questionnaire previously validated [14], which The María 27 37 It should be noted that in the first quarter of consists of 2 sections. In the first one, the The majority of those affected with ATL are The Union 22 30.1 2015 (period until which official records are identity and affiliation data are registered, such young adults (20-59 years) (66.3%) and male The Salto 7 9.6 The Tres Marias 7 9.6 available) the Venezuelan Ministry of Health as; age, gender, occupation and degree of (66.3%), workers (26.3%) and mainly residing The Belen 5 6.9 reports 6 007 cases of Leishmaniasis, figures instruction of the respondent. In the second in the Marías sectors (37 % [27/73]) and the The Coina 4 5.5 that place their morbidity below expectations section, we explore through open and closed Union (30.1% [22/73]) (Table 1). The Ceiba 1 1.4 without being able to discern between a questions about the individual's knowledge Clinical characteristics decrease in casuistry or sub registration, in a about ATL. Finally, their socioeconomic The lesions were mainly located in the upper Location of lesions context in which the tendency is to increase the characteristics were asked by family with the (40.5%) and lower (32%) limbs. The skin Superior limbs 3. 4 40.5 number of affected [7-10]. The increase in the modified Graffar´s method that is based on the lesions were unique in 53.4% (54/80) of those Lower limbs 32 38.1 Abdomen 8 9.5 number of cases of ATL in many areas of Latin measurement of the variables: profession of affected and multiple in 45.2% of them, and Neck 4 4.8 America is due, among other factors, to the the head of the family, level of instruction of the about 90% of those affected with ATL complied Head 3 3.6 disease in which the subject is immersed, mother, main source of family income and the prescribed treatment with methylglumine Chest 3 3.6 especially those related to their knowledge of housing conditions that , result in five social antimoniate (Glucantime®) (Table 1). Number of injuries **** the pathologies that afflict them. Although it is strata namely: I (high quality of life) the score of Only 39 53.4 clear that many of the differences in people's the items is between 4-6, II (moderate quality of Most of the interviewees were between 20 and Multiple 33 45.2 health status are not predetermined, since life) values between 7-9, III (low quality of life) 59 years old (76%), belonged to the male Not registered 1 1.4 there are differences emanating from the values between 10-12, IV (relative poverty) gender (53%), were workers (31%) or were Type of injury Ulcerative 72 98.6 environment in which they live and from the values between 13-16 and V (critical poverty) engaged in household chores (25%), had the Not registered 1 1.4 knowledge and practices that society has values between 17-20 [15]. degree of instruction the incomplete high Treatment about the disease. Another relevant aspect for school (23%) and belonged to the socio- Complied 63 86.3 the management of ATL is the clinical - Population and sample: The population of the economic stratum IV (critical poverty) (73%) Not Complied 10 13.7 epidemiological behavior, because this can Trincheras corresponds to 9,600 habitants (Table 2). v a r y s i g n i fi c a n t l y b e t w e e n d i ff e r e n t according to local census and the “n” sample Source: Record of the Sanitary Dermatology Service to geographical regions [11, 12]. was 100 individuals, based on the expected More than 80% of respondents without gender the Carabobo state. frequency of ATL (2% taken as a reference of distinction (p = 0.27) know the disease, 63% In Venezuela, specifically in the Carabobo studies conducted in the Carabobo state) and ( [ 6 3 / 1 0 0 ] , p = 0 . 3 7 ) r e c o g n i z e t h e In the sample studied 61% know that the state, efforts have been made to incorporate population size. The sampling was of the symptomatology, and 62% know that this disease is related to insects and 83% knows the population into health actions and probabilistic type. A standard error of 5% and a disease is not transmitted by direct contact the transmitter of ATL, however, only 8.0% programs, but many of these programs do not confidence level of 95% were accepted for this between affected and healthy (p = 0.28), understand how insects are infected (p <0.05). measure the knowledge that people have investigation. however, only 37% know that the disease can However, respondents know in proportions about this disease. Therefore, the objective of be prevented and 38% know that animals can that they do not exceed 50% of what insects the present research is, firstly, to describe the On average the survey lasted 20 minutes per get sick (p <0.01) (Table 3). feed and at what time, as well as what attracts epidemiological clinical characteristics of the individual. It was applied to all persons over 11 them and where they hide (Table 4). ATL and then to determine the knowledge that years of age who were present at the time of the population of the Trincheras of the the survey, since they are mature enough to Naguanagua municipality of the Carabobo adequately answer the questionnaire as they

ISSN 2616 - 6097, Rev Peru Investig Salud. 2020; 4(1), january - march 2020, 09-16 ISSN 2616 - 6097, Rev Peru Investig Salud. 2020; 4(1), january - march 2020, 09-16 Abdel K, Hernández D, Hidalgo O, Hidalgo S, Hung F, Lorenzo C, Bastidas G. Clinical- epidemiological characteristics and knowledge about American Tegumentary 12 Leishmaniasis in a population of Carabobo state. Venezuela 13 Table 2 Socio-demographic of pathologies that affect the population) (p Table 4 Knowledge about the American Tegumentary Leishmaniasis transmitter of characteristics of habitants to the <0.01) (Table 5). residents of the Trincheras, Naguanagua municipality, Carabobo state, Venezuela. 2013- Trincheras, Naguanagua municipality, 2017 Carabobo state, Venezuela. 2013-2017 Discussion Female Male Transmitter Cutaneous Leishmaniasis frequency % frequency % Characteristics Frequency % Age group* Know that the disease is related to insects 31 66 30 56.6 39 83 44 83 Adolescents (12-19 years) 7 7 Due to the biological, clinical, epidemiological Know that insect transmits ATL 6 12.8 2 3.8 Young adult (20-59 years) 76 76 and social complexity, the ATL remains an Know how insects are infected * Older Adults (?60 years) 17 17 Know what insects feed on 15 31.9 21 39.6 important public health problem that mainly Know what time the insects feed 22 46.8 24 45.3 Gender Know what attracts insects 15 31.9 17 32.1 Male 53 53 affects poor populations, particularly of 18 38.3 22 41.5 Female 47 47 countries with low and medium economic Know where insects hide χ2: * With significant difference between women and men who they know how insects become infected (p <0.01). Occupation resources, those that seek their development, Worker 31 31 that is why individual and collective efforts are Household Chores 25 25 made to find the epidemiological behavior of Table 5 Knowledge about the treatment of the American Tegumentary Leishmaniasis of Merchant 15 15 this parasitic first and in second place the residents of Las Trincheras, Naguanagua municipality, Carabobo state, Venezuela. 2013- Student 9 9 2017 Farmer 7 7 people know about it, with the firm purpose of Female Male Professional 5 5 adapting socio-sanitary schemes and Healing Retired and (o) pensioners 4 4 programs to ensure the control of this endemic frequency % frequency % Employee 3 3 Know the Treatment * Military 1 1 disease, because there are differences that Pharmacological treatment indicated by the doctor 18 38.3 20 37.7 arise from the environment in which one lives, Traditional or homemade methods 6 12.8 7 13.2 Degree of instruction from knowledge and social practices towards Incomplete Primary 5 5 Health system you go to in search of cure for Complete Primary 10 10 the disease. ATL ** Complete Secondary 19 19 Medical - Scientific 43 91.5 51 96.2 Incomplete Secondary 7 7 Traditional 3 6.4 2 3.8 Complete High School 22 22 Since there is a large number of cases of ATL, it None 1 2.1 0 0 Incomplete High School 2. 3 23 is understandable why the socio-sanitary Complete Technical Education. 3 3 projects and programs for the control of ATL Healing service used to treat ATL *** Incomplete Technical Education. 2 2 have proved insufficient in coverage, Public 43 91.5 41 77.4 Incomplete Higher Education. 2 2 Private 4 8.5 12 22.6 Complete Higher Education. 7 7 permanence in time and social participation, because many of them ignore the local and χ2: * With significant difference between drug and traditional treatment (p <0.01). Socioeconomic** ** With significant difference between health system medical - science and traditional p <0.01). Stratum II (moderate quality of life) 3 3 specific cultural realities, the knowledge that *** With significant difference between public and private service healing (p <0.01). Stratum III (low quality of life) 2. 3 23 communities have about specific parasitism, Stratum IV (relative poverty) 73 73 so in Venezuela it has been tried to incorporate For this reason, this research was proposed area, is due to multiple common factors to the Stratum V (extreme poverty) 1 1 to the community into health programs under w h o s e fi n d i n g s r e g a r d i n g c l i n i c a l - life cycle of this parasite, among which are Of the respondents 51% know about the the tutelage of institutions related to health epidemiological behavior and knowledge of the mentioned the ecological characteristics treatment of ATL, 28% mention the administration and the implementation of population about ATL will contribute decisively c o n d u c i v e t o t h e d e v e l o p m e n t a n d pharmacological treatment as indicated and various strategies, among which are in the control of this parasitism as a public preservation of the vector and reservoir, the 13% show a preference for traditional or mentioned health education, committees for health problem, in this sense it is reported in possibility of contact between parasite and homemade treatment (p <0.01). With respect the participation with work force in works of this paper who are finding in economically susceptible host; rapid and disorganized to the health system to which to go in search of collective benefit, groups of volunteers to carry productive age they were mainly infected and urbanization; and the purely vertical official a cure for the ATL 94% prefer the doctor- out specific actions, training of the population among these men they are the most affected, intervention, through the design of essentially scientist (p <0.01), finally more than 80% of the for the self-care of their health, among others, subjects mainly dedicated to agriculture that curative control programs that ignore the respondents refer preference for the public however, all have been insufficient for the force them to be in greater contact with the community's knowledge and practices about curative service (network of institutions for the control of the ATL [14]. ecological niche of natural transmission of the the disease [21-23]. diagnosis and free pharmacological treatment ATL. Likewise, the characteristic of a mountain range and foothills with humid forest and lush Regarding knowledge about the ATL, the vegetation that is typical of the Trincheras population studied recognizes the symptoms, Table 3 Knowledge about the natural history of the American Tegumentary Leishmaniasis surely defines the casuistry of ATL found in this the form of transmission and prevention, in this to the people from the Trincheras, Naguanagua municipality, Carabobo state, Venezuela. area, since it constitutes the ecosystem that research we finding similarity with a research 2013-2017 usually characterizes ATL outbreaks in realized in the community of the Cojedes state Venezuela and in the world, with more [15], but with differences to that found in Female Male Natural history of disease frequency % Frequency % accentuated vegetation in the María and Unión studies conducted in other Venezuelan Know the Disease 38 80.9 Four. Five 84.9 sectors where most of the registered ATL cases regions, among those mentioned in the Andes Know the symptoms that people present 29 61.7 3. 4 64.2 in the area are located [15, 17-19]. mountain range, because it detected a low Know that it is not transmitted by direct contact level of global knowledge about ATL. Also in 28 59.6 3. 4 64.2 between people As expected, the ATL because of its high countries such as Brazil and Colombia with Know that the disease can be prevented 21 44.7 16 30.2 incidence has a great impact on the population, populations exposed to the ATL, the Know that animals can become infected * 15 31.9 2. 3 43.4 in rural areas such as the Trincheras [20]. The information deficit is common, to the detriment χ2: * With significant gender difference (p <0.01). maintenance of the ATL endemic, in the studied of the fundamental role that these aspects

ISSN 2616 - 6097, Rev Peru Investig Salud. 2020; 4(1), january - march 2020, 09-16 ISSN 2616 - 6097, Rev Peru Investig Salud. 2020; 4(1), january - march 2020, 09-16 Abdel K, Hernández D, Hidalgo O, Hidalgo S, Hung F, Lorenzo C, Bastidas G. Clinical- epidemiological characteristics and knowledge about American Tegumentary 14 Leishmaniasis in a population of Carabobo state. Venezuela 15 have in the conformation of the socio-sanitary biological control of vectors, study of Asamblea Mundial de la Salud. Control de Oliveria M. Factores socio-económicos e programs destined to combat it, hence the reservoirs, seroprevalence in endemic areas, la leishmaniasis. Informe de la Secretaria; atitudes em relacao a prevencao domiciliar importance of carrying out interventions and p h a r m a c o l o g i c a l t r e a t m e n t a n d Resolución N° A60/10; Ginebra, Suiza. da Leishmaniose Tegumentar Americana, constant evaluations of the local clinical immunotherapy, therefore, the information 2007. Citado mayo 2018. Disponible en: em uma area endémica do Sul da Bahia, epidemiological characteristics and the provided here will be very useful [31]. apps.who.int/gb/ebwha/pdf_files/...WHA60 Brasil. Cad Saude Publica. 2000; knowledge that the habitants of endemic areas -Rec1/.../WHASS1_WHA60REC1-sp.pdf. 16(3):701-708. have on ATL in order to reformulate them in It is concluded that those affected with ATL are 7. Scorza J. Protocolo para la investigación 18.García B. Aporte de la etnografía en el order to achieve control of these parasitism in mainly men, in economically productive age, epidemiológica de Leishmaniasis c o n o c i m i e n t o d e l o s c ó d i g o s these areas [24-26]. workers and farmers, with educational levels tegumentaria en Venezuela. Bol Mal Salud socioculturales de la leishmaniasis cutánea not exceeding the high school environment, Amb. 1988; 28:83-90. localizada en un programa de educación The knowledge of the investigated population located in relative poverty as a socio-economic 8. Ortega J, Zerpa O, Sosa A, Rodríguez N, para la salud, en Venezuela. Cad Saude about ATL in terms of natural history is very stratum, with unique skin lesions in exposed A r a n z a z u N . E s t u d i o C l í n i c o , Publica. 2007; 23(Supl.1):S75-S83. interesting in comparison with the findings by regions of the body and pharmacologically Epidemiológico y Caracterización 19.Teles G, Fonseca F, Gonçalves M. Isaza [27] in Colombia who describes that 94% treated; the population knows the natural Taxonómica de Leishmaniasis Cutánea en American Tegumentary Leishmaniasis in of the sample only recognized ATL as a skin history of the disease and the transmitter, but el Estado Vargas, Venezuela. Dermatol the Brazilian Amazon from 2010 to 2014. disease, without more details. Now it is they are unknown of aspects of the biology of Venez. 2004; 42(4):10-16. Rev Inst Med Trop Sao Paulo. 2019; important to highlight that what was found in the insect; and that they prefer the medical- 9. De Lima H, Borges R, Escobar J, Convit J. 6 1 : e 2 2 . ( d o i : 1 0 . 1 5 9 0 / S 1 6 7 8 - the Trincheras is similar to that reported by pharmacological treatment of the medical- Leishmaniasis cutánea americana en 9946201961022). Nieves [28] in populations of the Venezuelan scientific system and the public curative V e n e z u e l a : u n a n á l i s i s c l í n i c o 20.Vasconcelos-Dos-Santos T, Chaves R, Andean mountain range, who also points out service. epidemiológico a nivel nacional y por Prévot G, Silveira F, Póvoa M, Rangel E. that knowledge about ATL is restricted to those entidad federal, 1988-2007. Bol Mal Salud Binational burden of american cutaneous who have suffered the disease, to family Referencia bibliográficas Amb. 2010; 50(2):283-299. leishmaniasis in Oiapoque, Amapá State, members or neighbors, a phenomenon 10.Ministerio Poder Popular para la Salud. Brazil, bordering French Guiana. Rev Soc similarly observed in the Trincheras a small Boletín epidemiológico semana 52. Citado Bras Med Trop. 2019; 52:e20180256. (doi: community in population terms. 1. Organización Mundial de la Salud. Centro de agosto 2018. Disponible en: http: 10.1590/0037-8682-0256-2018). prensa Nota descriptiva. Citado agosto www.mpps.gob.ve. 2015. 21.Manotas-Berdugo H, Toro-Maldonado J, With respect to the ATL transmitter, more than 2018. Disponible en: 11.Buttigieg S. Innovation Strategies and Rodríguez-Rodríguez J, Salgado-García D. 80% of the respondents know the vector, but http://www.who.int/mediacentre/factsheets Health System Guiding Principles to Urban outbreak of leishmaniasis in mostly they do not know many of the aspects of /fs375/es/ 2016. Address Equity and Sustainability in Colombia. Rev Salud Publica (Bogota). insect biology, however, the situation in terms 2. Chavy A, Ferreira Dales Nava A, Luz S, Responsible Innovation in Health Comment 2 0 1 8 ; 2 0 ( 1 ) : 8 9 - 9 3 . ( d o i : of knowledge is better than that reported in Ramírez J, Herrera G, Vasconcelos Dos on "What Health System Challenges 10.15446/rsap.V20n1.47135). populations of the Venezuelan Andean Santos T, Ginouves M, Demar M, Prévot G, Should Responsible Innovation in Health 22.Cohnstaedt L, Alfonso-Parra C. Highlights mountain range and Miranda state where 35 Guégan J, de Thoisy B. Ecological niche Address? Insights From an International of Mosquito and Vector Biology and Control and 45%, respectively, relate the disease with modelling for predicting the risk of Scoping Review". Int J Health Policy in Latin America. J Am Mosq Control Assoc. insect bites [15, 28]. It is probable that the cutaneous leishmaniasis in the Neotropical Manag. 2019; 8(9):570-572. (doi: 2019; 35(1):40-46. (doi: 10.2987/18- knowledge found about the transmitter of the moist forest biome. PLoS Negl Trop Dis. 10.15171/ijhpm.2019.50). 6769.1). ATL, although partial, is due to the continuous 2 0 1 9 ; 1 3 ( 8 ) : e 0 0 0 7 6 2 9 . ( d o i : 12.Mokni M. Cutaneous leishmaniasis. Ann 23.Detoni M, Lima D, Silva T, Machado L, interventions of the health sector, and also of 10.1371/journal.pntd.0007629). Dermatol Venereol. 2019; 146(3):232-246. Tomiotto-Pellissier F, Costa I, Pavanelli W, the university, that transmit information about 3. Uribe-Restrepo A, Cossio A, Desai M, (doi: 10.1016/j.annder.2019.02.002). Oliveira FA, Custódio L, Conchon-Costa I, it, although vertically, but that have positively Dávalos D, Castro M. Interventions to treat 13.Clifford J. Parcial truths: introduction. In: On Melanda F . Temporal and spatial influenced the knowledge that the population cutaneous leishmaniasis in children: A Writing Culture: The Poetics and Politics of distribution of American tegumentary owns [29]. systematic review. PLoS Negl Trop Dis. Ethnography (J. Clifford & G. Marcus, ed), leishmaniasis in north Paraná: 2010-2015. 2 0 1 8 ; 1 2 ( 1 2 ) : e 0 0 0 6 9 8 6 . ( d o i : pp.1-26, Berkeley: University of California R e v S o c B r a s M e d T r o p . 2 0 1 9 ; The people who reported to know the treatment 10.1371/journal.pntd.0006986). Press.1986. 52:e20180119. (doi: 10.1590/0037-8682- of ATL, indicated that the pharmacological 4. Feliciangeli M. Leishmaniosis en Venezuela: 14.Testa M. Extensión de cobertura con 0119-2018). treatment of the medical health system and the Situación actual, acciones y perspectivas atención médica primaria. Venezuela. 24.Sunyoto T, Boelaert M, Meheus F. public curative service is the indicated one, this para el control vectorial en el marco de un Documentos CENDES-UCU, No. 14. 1981. Understanding the economic impact of despite being bureaucratic and apathetic programa de control multisectorial, 2014. 15.Bastidas G, Díaz B. Prácticas y leishmaniasis on households in endemic institutions, according to the interviewees. It is Bol Mal Salud Amb. 2014; 54(1):1-5. c o n o c i m i e n t o s p o p u l a r e s s o b r e countries: a systematic review. Expert Rev common to find out about access to health 5. Organización Mundial de la Salud. Informe leishmaniasis tegumentaria americana Anti Infect Ther. 2019; 17(1):57-69. (doi: services because these are central elements de una reunión del Comité de Expertos de la (LTA) en un área endémica de Cojedes, 10.1080/14787210.2019.1555471). for the production of satisfactory results in OMS sobre el control de las leishmaniasis, Venezuela. Hacia el desarrollo de 25.dos Reis D, Gazzinelli A, Silva C, Gazzinelli terms of disease control [15, 30]. In Latin Ginebra, 22-26 Mar 2010. Ser Inf Técn. estrategias educativas alternativas de M. Educação em saúde e representações America, and of specifically in Venezuela, 949.2010. Citado marzo 2018. Disponible control. Fermentum. 2008; 18(53):634-655. sociais: uma experiencia no controle da there are few researches carried out to en: 16.Méndez C, López B, Landaeta J, Gónzales leishmaniose tegumentar em área research the knowledge associated with the www.who.int/iris/bitstream/10665/82766/1/ T. Estudio transversal de Caracas. Arch. endémica de Minas Gerais, Brasil. Cad fact of contracting LTA, most of the researches WHO_TRS_949_spa.pdf. Venez. Pueric. Pediatr. 1983; 49:111-155. Saude Publica. 2006; 22:2301-2310. focuses on aspects such as: chemical and 6. Organización Mundial de la Salud. 60ª 17.Barberino S, Lauand L, Santos G, De 26.Bernardes Filho F, Queiroz RM, Nery B.

ISSN 2616 - 6097, Rev Peru Investig Salud. 2020; 4(1), january - march 2020, 09-16 ISSN 2616 - 6097, Rev Peru Investig Salud. 2020; 4(1), january - march 2020, 09-16 16 Abdel K, Hernández D, Hidalgo O, Hidalgo S, Hung F, Lorenzo C, Bastidas G. ORIGINAL ARTICLE 17 REVISTA PERUANA DE INVESTIGACIÓN EN SALUD http://revistas.unheval.edu.pe/index.php/repis/ American Tegumentary Leishmaniasis. J 29.Fajardo P, Monje C, Lozano G, Realpe O, https://doi.org/10.35839/repis.4.1.607 Emerg Med. 2018; 54(5):692-693. (doi: Hernández L. Nociones populares sobre Acne in medical students and their associated factors 10.1016/j.jemermed.2018.02.003). “Dengue” y “Rompehuesos”, dos modelos 27.Isaza D, Restrepo B, Arboleda M. La de la enfermedad en Colombia. Rev Panam Acné en alumnos de medicina humana y sus factores asociados leishmaniasis: conocimientos y prácticas Salud Publica. 2001; 10(3):161-168. en poblaciones de la costa del Pacífico de 30.Tabbabi A. Review of Leishmaniasis in the Cesar Flores-Rojas1,a, Syntia Cabello-Carlos1,a, Patricia K. Paucar-Lescano2,b Colombia. Rev Panam Salud Publica. 2000 Middle East and North Africa. Afri Health 1Sergio E. Bernales Hospital. Lima, Perú. 6(3):177-184. Sci. 2019; 19(1):1329-1337. (doi: Abstract 2EsSalud II Hospital. Huánuco, Perú. 28.Loiseau R, Nabet C, Simon S, Ginouves M, 10.4314/ahs.v19i1.4). Introduction: The Acne is a multifactorial chronic inflammatory disease to affect the pilosebaceous unit present in aGeneral physician Brousse P, Blanchet D, Demar M, Couppie 31.Garapati P, Pal B, Siddiqui NA, Bimal S, Das the face, back and chest. In this research we wanted to know what the frequency was and the factors associated bDermatologist P, Blaizot R. American cutaneous P, Murti K, Pandey K. Knowledge, stigma, with the presence of acne in medical students. Materials and Methods: A case-control study was carried out in students from 1st to 5th year of the Hermilio ORCID: leishmaniasis in French Guiana: an health seeking behaviour and its Valdizán National University School of Medicine. A 95% confidence interval with an alpha of 0.05 and a statistical *https://orcid.org/0000-0002-4449-6058 epidemiological update and study of determinants among patients with post power of 80% with a beta equal to 0.20 were considered. Results: The average age was 22.31 + 3.22 years. The fruit consumption obtained significance as a protective Corresponding author: environmental risk factors. Int J Dermatol. kalaazar dermal leishmaniasis, Bihar, India. factor (p = 0.04; OR = 6.09) . The anxiety was not significant (p = 0.59; OR = 1.34), as well as the nutritional status (p Cesar Flores Rojas = 0.57; OR = 1.14) and the consumption of B vitamin supplement (p = 0.35 ; OR = 0.56). Significance was found in 2 0 1 9 ; 5 8 ( 11 ) : 1 3 2 3 - 1 3 2 8 . ( d o i : PLoS One. 2018; 13(9):e0203407. (doi: biological inheritance (p = 0.01; OR = 3.74 with lower range = 10.61 and higher range = 1.31). Postal Address: A. universitaria 606, 10.1111/ijd.14625). 10.1371/journal.pone.0203407). Conclusions: The frequent consumption of fruits showed to act as a protective factor in the development of acne; Huánuco, Perú. additionally, it is also concluded that biological inheritance plays an important role in the acne occurrence. Email: cesarfl[email protected] Keywords: acne, diet, anxiety, body mass index, B vitamin, family medical history. Reception date: 26 of june of 2019 Resumen Approval date: 13 of dcember of 2019

Introducción: El acné es una enfermedad inflamatoria crónica de la unidad pilosebácea de origen multifactorial Cite as: Flores-Rojas C, Cabello-Carlos presente en cara, espalda y pecho. En este estudio quisimos conocer cuál era la frecuencia y los factores S, Paucar-Lescano P. Acné en alumnos asociados a la presencia de acné en los estudiantes de medicina. de medicina humana y sus factores Materiales y Métodos: Se realizó un estudio de casos y controles, en alumnos de 1° a 5° año de la escuela de asociados. Rev Peru Investig Salud Medicina de la Universidad Nacional Hermilio Valdizán. Se consideró un IC de 95% con un alfa de 0,05 y una [Internet]; 4(1). Recuperado de: potencia de 80% con una beta igual a 0,20. http://revistas.unheval.edu.pe/index.ph Resultados: La media de la edad fue de 22,31 + 3,22 años. El consumo de frutas obtuvo significancia (p=0,04; p/repis/article/view/607, 17-23 OR=6,09) como factor protector. La ansiedad no fue significativa (p=0,59; OR=1,34), asi como el estado nutricional (p=0,57; OR=1,14) y el consumo de suplemento vitamínico B (p=0,35; OR=0,56). Se encontró significancia en la 2616-6097/©2020. Peruvian Journal of Health Research. This is an Open Access article under the CC-BY license herencia biológica (p=0,01; OR=3,74 con rango inferior=10,61 y rango superior=1,31). (https://creativecommons.org/licenses/by/4.0). It allows Conclusiones: El consumo frecuente de frutas demostró actuar como factor protector en el desarrollo de acné; copying and redistributing the material in any medium or además, se concluye también que la herencia biológica juega un papel importante en el mismo. format. You must give credit appropriately, provide a link to the license, and indicate if changes have been made. Palabras clave: acné, dieta, ansiedad, índice de masa corporal, vitamina B, historia familiar.

Introduction with psychological and social deterioration (4). In our region, it represents 15.16% of the 50 The acne is a multifactorial chronic inflamma- most frequent dermatoses in the dermatology tory disease to affect the pilosebaceous unit service to the EsSalud II Huanuco Hospital present in the face (99%), back (60%) and until at the 3 years ago, being of greater chest (15%). It is one of the most frequent prevalence in adolescents and young adults dermatoses worldwide, it distinguishes several with a predominance by the female sex (5), clinical types that can leave serious scars and which is underestimated because it does not produce great psychological impact that can include the consultations that are made to the alter the moods, interpersonal relationships pediatrician or general practitioner both in the and produce a deficient job performance same center and in hospitals of the Ministry of causing economic losses (1). Health. That is why the exact statistics in our region are currently unknown. Currently affects 1 in 10 people worldwide and an estimated 80 to 90% of adolescents have It has been shown that certain foods or type of acne. In 2005 it was calculated that the global diets also influence the presence or act as expenses to treat it represented more than aggravating of acne. For example the milk 10% of the general expenses in the treatment products and their derivatives, especially skim of dermatosis. In 2016, it was estimated that milk, as well as all foods with high glycemic and the global acne market reached revenues of 3 lipid load (Western diet) have an important role billion dollars (2). in the pathogenesis of the acne that leads to an increase in body mass index (6). The Acne also In France, acne is considered to be one of the has a close relationship with the psychic three most frequent skin diseases as well as in component such as the anxiety. The 44% of England and the USA (3). Peru has a affected adolescents suffer from anxiety as is prevalence of 80-85% of adolescents between explaining by the president of the Sectional 13 and 18 years, being able to be associated Center of the Spanish Academy of Dermatolo-

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