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César Ramal Asayag

César Ramal Asayag
Hospital Regional de Loreto · Loreto, Peru

PhD

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41
Publications
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Publications

Publications (41)
Article
Background There is a need to evaluate antibiotic use, duration of therapy and stewardship in low- and middle-income countries to guide the development of appropriate stewardship programs that are global in scope and effectively decrease unnecessary antibiotic use. Methods We prospectively collected information on illness occurrence and antibiotic...
Article
Full-text available
Background: Diagnosis of toxoplasmic encephalitis (TE) is challenging under the best clinical circumstances. The poor clinical sensitivity of quantitative polymerase chain reaction (qPCR) for Toxoplasma in blood and CSF and the limited availability of molecular diagnostics and imaging technology leaves clinicians in resource-limited settings with...
Preprint
Full-text available
Background Diagnosis of toxoplasmic encephalitis (TE) is challenging under the best clinical circumstances. The poor sensitivity of quantitative polymerase chain reaction (qPCR) for Toxoplasma in blood and CSF and the limited availability of molecular diagnostics and imaging technology leaves clinicians in resource-limited settings with few options...
Article
Se presentan dos casos de pacientes, naturales de Requena, ciudad a 160 Km al suroeste de Iquitos, departamento de Loreto, selva baja, con síntomas moderados de COVID-19, quienes fueron inyectados con ivermectina de uso veterinario por vía subcutánea en el hombro, como parte de un tratamiento que pudiera tener cierto efecto benéfico sobre la enferm...
Article
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Background: HIV-related incidence and mortality is increasing across Peru, with highest mortality rates recorded in the Amazonian region of Loreto. This epidemic is concentrated in men who have sex with men, a population with 14% HIV treatment adherence despite free national provision. This study investigates barriers and facilitators to following...
Preprint
Full-text available
Background HIV-related incidence and mortality is increasing across Peru, with highest mortality rates recorded in Amazonian region of Loreto. This epidemic is concentrated in men who have sex with men, a population with 14% HIV treatment adherence despite free national provision. This study investigates barriers and facilitators to following healt...
Preprint
Full-text available
Background HIV-related incidence and mortality is increasing across Peru, with highest mortality rates recorded in Amazonian Loreto. This epidemic is concentrated in MSM, a population with 14% HIV treatment adherence despite free national provision. This study investigates barriers and facilitators to following healthcare advice through experiences...
Preprint
Full-text available
Background HIV-related incidence and mortality is increasing across Peru, with highest mortality rates recorded in Amazonian Loreto. This epidemic is concentrated in men who have sex with men, a population with 14% HIV treatment adherence despite free national provision. This study investigates barriers and facilitators to following healthcare advi...
Article
Full-text available
Background Transmission of dengue virus (DENV) from humans to mosquitoes represents a critical component of dengue epidemiology. Examinations of this process have generally been hampered by a lack of methods that adequately represent natural acquisition of DENV by mosquitoes from humans. In this study, we assessed artificial and natural blood feedi...
Data
Data summary of mosquito blood feeding experiments on 58 human participants. DoI = Day of illness; Viremia (log 10) expressed in FFU/ml, IR = infection rate (PCR+ bodies/total tested); DR = Dissemination rate (PCR+heads/PCR+bodies), SC = Disease Severity category (1 = mild, 4 = hospitalized, 2–3 = intermediate scores (see methods), and EXP = expose...
Data
Description of final data cleanup for statistical analysis. Explains participants from S1 Table that were excluded from statistical analysis. (DOCX)
Article
Here we report the first incidence of New Delhi metallo-β-lactamase (NDM-1)-producing Acinetobacter baumannii in Peru, identified via a strain-based nosocomial surveillance project carried out in Lima and Iquitos. The blaNDM-1 gene was detected by multiplex polymerase chain reaction (PCR) and confirmed by loci sequencing. Acinetobacter baumannii is...
Article
Probiotics are increasingly used for diarrhea, but studies under FDA IND are few. We conducted a phase-one placebo-controlled study of Lactobacillus reuteri DSM 17938 under IND in 60 children 2-5 years of age (41 L. reuteri, 19 placebo) in a resource constrained community in Peru. No differences in objective data on adverse events were noted, altho...
Article
Full-text available
Quantitative polymerase chain reaction (qPCR) for Toxoplasma gondii multicopy genes has emerged as a promising strategy for sensitive detection of parasite DNA. Quantitative polymerase chain reaction can be performed from blood samples, which are minimally invasive to collect. However, there is no consensus about what type of blood specimen yields...
Article
Full-text available
Background: Delays in receiving adequate care for children suffering from pneumonia can be life threatening and have been described associated with parents' limited education and their difficulties in recognizing the severity of the illness. The "three delays" was a model originally proposed to describe the most common determinants of maternal mor...
Article
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Diffuse multibacillary leprosy of Lucio and Latapí is mainly reported in Mexico and Central America. We report a case in a 65-year-old man in Peru. He also had Lucio’s phenomenon, characterized by vascular thrombosis and invasion of blood vessel walls by leprosy bacilli, causing extensive skin ulcers. © 2017, Centers for Disease Control and Prevent...
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Early childhood enteric infections have adverse impacts on child growth and can inhibit normal mucosal responses to oral vaccines, two critical components of environmental enteropathy. To evaluate the role of indoleamine 2,3-dioxygenase 1 (IDO1) activity and its relationship with these outcomes, we measured tryptophan and the kynurenine-tryptophan...
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Mayaro virus (MAYV), an alphavirus similar to chikungunya virus (CHIKV), causes an acute debilitating disease which results in the development of long-term arthralgia in more than 50% of infected individuals. Currently, the immune response and its role in the development of MAYV-induced persistent arthralgia remain unknown. In this study, we evalua...
Article
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El dengue ha afectado a Iquitos desde 1990 causando varios brotes de gran impacto en la salud pública y por el que se desplegaron grandes esfuerzos para su control temporal. Actualmente, ante la expansión del virus chikungunya en las Américas y la amenaza de la emergencia del virus en Iquitos, reflexionamos a modo de lecciones aprendidas las activi...
Article
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Dengue has affected Iquitos since 1990 causing outbreaks of major impact on public health and for this reason great efforts have been made for its temporal control. Currently, with the expansion of the chikungunya virus in the Americas and the threat of the emergence of the virus in Iquitos, we reflect on lessons learned by way of the activities un...
Article
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The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study communities in Peru are located in Loreto province, in a rural area 15 km from the city of Iquitos. This riverine population of approximately 5000 individuals is fairly representative of Lore...
Article
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Introduction Long-term disease surveillance data provide a basis for studying drivers of pathogen transmission dynamics. Dengue is a mosquito-borne disease caused by four distinct, but related, viruses (DENV-1-4) that potentially affect over half the world's population. Dengue incidence varies seasonally and on longer time scales, presumably driven...
Article
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During 2010-2013, we recruited 16 persons with confirmed Mayaro virus infection in the Peruvian Amazon to prospectively follow clinical symptoms and serologic response over a 12-month period. Mayaro virus infection caused long-term arthralgia in more than half, similar to reports of other arthritogenic alphaviruses.
Data
Full-text available
Signs and symptoms in patients with Mayaro virus infection at the acute-phase visit and each follow-up visit, Amazon Basin region, Peru, 2010–2013.
Article
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Dengue fever is the world's most important arboviral disease, presenting a wide clinical spectrum. We report for the first time in Peru, a case caused by dengue virus serotype 4 with significant gastrointestinal involvement (acute acalculous cholecystitis and acute hepatitis). In addition we carried out a review of the literature atypical presentat...
Article
Full-text available
El dengue es la arbovirosis más importante del mundo y causa un amplio espectro clínico. Presentamos el primer caso de dengue causado por el serotipo 4 (DENV-4) en Perú con compromiso gastrointestinal (colecistitis aguda alitiásica y hepatitis aguda moderada). Se presenta una revisión de la literatura médica sobre este tipo de presentación, enfatiz...
Article
Full-text available
Dengue fever is the world's most important arboviral disease, presenting a wide clinical spectrum. We report for the first time in Peru, a case caused by dengue virus serotype 4 with significant gastrointestinal involvement (acute acalculous cholecystitis and acute hepatitis). In addition we carried out a review of the literature atypical presentat...
Article
Full-text available
Long-lasting insecticidal net (LLIN) use is a proven malaria prevention method. Mass distribution has greatly expanded LLIN access in sub-Saharan Africa, but a gap remains between LLIN ownership and use. Furthermore, LLINs wear out more quickly than anticipated. This paper suggests a participatory research strategy-trials of improved practices (TIP...
Article
Full-text available
Se describe el caso de un paciente varón, de 13 años de edad, procedente de la ciudad de Iquitos con cuadro clínico de Dengue y que cumplía con los criterios de dengue hemorrágico. La gravedad de este caso de dengue hemorrágico fue de grado II. El diagnóstico fue confirmado por serología. El serotipo encontrado fue el tres. Este es el primer caso d...
Article
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The study objective was to investigate an acute case of Chagas disease in the San Pedro de Shishita community, Pebas District, in the Peruvian Amazon basin, a non-endemic area. Both parents of the index case (acute case) were thoroughly interviewed, a seroepidemiological survey was carried out in the community, parasitological exams were carried ou...
Article
Objectives. To explore the relationship between climatic variables with the transmission of malaria in Loreto, in a period of 13 years. Material and methods. Ecological study was conducted with data from the monthly average temperature (° C), relative humidity (%), precipitation (mm) and the level of the Amazon River (meters), with cases of malaria...
Article
Full-text available
Objectives. To explore the relationship between climatic variables with the transmission of malaria in Loreto, in a period of 13 years. Material and methods. Ecological study was conducted with data from the monthly average temperature (º C), relative humidity (%), precipitation (mm) and the level of the Amazon River (meters), with cases of malaria...
Article
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An 8-year-old girl from the rural eastern Amazon depart- ment of Loreto presented to her local health post with a 1-week history of fever, headache, and poorly localized ab- dominal discomfort. At the health post, the child had a tem- perature of 39°C. A thick smear was obtained, and the patient was started on chloroquine after parasites were obser...
Article
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Introduction: Malaria is an endemic parasitic disease in northern Peru, both in the coast and in the jungle. There is still poor knowledge about the incidence of malaria in pregnant women, as well as about congenital malaria and some associated variables.Objective: To determine the cumulative incidence of malaria in pregnant women during a 15-month...
Article
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Introduction: Malaria is a parasitic disease caused by Plasmodium sporozoites. Peruvian National Regulations for Malaria and Severe Malaria state that active surveillance of febrile patients is the main activity to perform, since it allows early case detection. Objective: To determine the usefulness of fever as a clinical predictor for malaria in e...
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En: Rev Perú Med Exp Salud Pública 2005; 22 (1). El presente estudio busca evaluar la capacidad del Ministerio de Salud (MINSA) para el diagnóstico y tratamiento oportuno de la malaria en las comunidades periféricas de la ciudad de Iquitos. Para ello en el año 2001 se entrevistó a pacientes febriles atendidos por promotores de salud debido a la sos...
Article
Full-text available
Epidemic malaria has rapidly emerged in Loreto Department, in the Peruvian Amazon region. Peru reports the second highest number of malaria cases in South America (after Brazil), most from Loreto. From 1992 to 1997, malaria increased 50-fold in Loreto but only fourfold in Peru. Plasmodium falciparum infection, which has increased at a faster rate t...
Article
Epidemic malaria has rapidly emerged in Loreto Department, in the Peruvian Amazon region. Peru reports the second highest number of malaria cases in South America (after Brazil), most from Loreto. From 1992 to 1997, malaria increased 50-fold in Loreto but only fourfold in Peru. Plasmodium falciparum infection, which has increased at a faster rate t...
Article
Full-text available
Introduction: In February 2000 an outbreak of malaria ocurred in Nuevo Pevas, a town with ten years of establishment situated in the district of Pevas, Loreto. Objective: To describe the characteristics of the outbreak of malaria in the village of Nuevo Pevas and the actions developped for its control. Methods: Once the outbreak was reported and ve...