Cesar Ugarte-Gil

Cesar Ugarte-Gil
Universidad Peruana Cayetano Heredia | UPCH · Instituto de Medicina Tropical Alexander von Humboldt

MD, MSc, PhD

About

111
Publications
23,470
Reads
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1,834
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Introduction
Physician and Epidemiologist, with training in Peru, UK and USA and collaborative work in topics on Infectious Diseases, focused on Tuberculosis, HIV and Tropical Diseases. Special interest in clinical research, diagnostic trials, systematic reviews/meta-analysis and randomized controlled trials. Other interest are Medical training, Ethical issues and Human Rights and Health
Additional affiliations
September 2015 - present
Universidad Peruana Cayetano Heredia
Position
  • Member
June 2015 - present
London School of Hygiene and Tropical Medicine
Position
  • Honorary Lecturer
May 2013 - present
Universidad Peruana Cayetano Heredia
Position
  • Lecturer
Education
August 2011 - December 2016
Johns Hopkins Bloomberg School of Public Health
Field of study
  • International Health
August 2008 - August 2009
March 1996 - December 2004

Publications

Publications (111)
Article
Full-text available
Multidrug resistant tuberculosis refers to tuberculosis with resistance to at least rifampicin and isoniazidMultidrug resistant tuberculosis is increasingly common; however, there is a large shortfall between the estimated total number of cases and the numbers diagnosed and treatedDiagnosis is hampered by lack of access to quality assured diagnosti...
Article
Diabetes triples the risk for active tuberculosis, thus the increasing burden of type 2 diabetes will help to sustain the present tuberculosis epidemic. Recommendations have been made for bidirectional screening, but evidence is scarce about the performance of specific tuberculosis tests in individuals with diabetes, specific diabetes tests in pati...
Article
Full-text available
Tuberculosis (TB) destroys lung tissues and this immunopathology is mediated in part by Matrix Metalloproteinases (MMPs). There are no data on the relationship between local tissue MMPs concentrations, anti-tuberculosis therapy and sputum conversion. Induced sputum was collected from 68 TB patients and 69 controls in a cross-sectional study. MMPs c...
Article
Full-text available
Tuberculosis (TB) remains a global health pandemic. Infection is spread by the aerosol route and Mycobacterium tuberculosis must drive lung destruction to be transmitted to new hosts. Such inflammatory tissue damage is responsible for morbidity and mortality in patients. The underlying mechanisms of matrix destruction in TB remain poorly understood...
Article
Full-text available
Mycobacterium tuberculosis can cause lung tissue damage to spread, but the mechanisms driving this immunopathology are poorly understood. The breakdown of lung matrix involves MMPs, which have a unique ability to degrade fibrillar collagens at neutral pH. To determine whether MMPs play a role in the immunopathology of tuberculosis (TB), we profiled...
Article
Full-text available
Cough assessment is central to the clinical management of respiratory diseases, including tuberculosis (TB), but strategies to objectively and unobtrusively measure cough are lacking. Acoustic epidemiology is an emerging field that uses technology to detect cough sounds and analyze cough patterns to improve health outcomes among people with respira...
Preprint
Background Host innate immune cells have been identified as key players in the early eradication of Mycobacterium tuberculosis and in the maintenance of an anti-mycobacterial immune memory, which we and others have shown are induced through epigenetic reprogramming. Studies on human tuberculosis immunity are dominated by those using peripheral bloo...
Article
Full-text available
Background: In Peru, 32,970 people were diagnosed with tuberculosis (TB) in 2019. Although TB treatment is effective, 3.4%-13% is associated with significant adverse drug reactions (ADR), considering drug-induced liver injury (DILI) as the most prevalent. Among the first-line anti-TB drugs, isoniazid (INH) is primarily responsible for the occurren...
Article
Tuberculosis is one of the leading causes of death worldwide, primarily affecting low- and middle income countries and individuals with limited-resources within fractured health care systems. Unfortunately, the COVID-19 pandemic has only served to aggravate the already existing diagnostic gap, decreasing the number of people who get diagnosed and t...
Article
Full-text available
Worldwide, nations have struggled during the COVID‐19 pandemic. However, Latin America and the Caribbean faced an unmatched catastrophic toll. As of March 2022, the region has reported approximately 15% of cases and 28% of deaths worldwide. Considering the relative late arrival of SARS‐CoV‐2, several factors in the region were determinant to the hu...
Article
Peru celebrates 200 years of independence in 2021. Over this period of independent life, and despite the turbulent socio-political scenarios, from internal armed conflict to economic crisis to political instability over the last 40 years, Peru has experienced major changes on its epidemiological and population health profile. Major advancements in...
Article
Integrated testing for TB and COVID-19 may help find those TB patients who are not accessing care in the context of the COVID-19 pandemic., Some molecular platforms with assays for both diseases are already commercially available; however, integrated testing approaches need to be systematically evaluated to ensure their appropriate implementation.
Article
Introducción: Este artículo resume la guía de práctica clínica (GPC) para el manejo de cáncer de cuello uterino estadios tempranos (IA1, IA2, IB1, IB2 o IIA1) en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el manejo de cáncer de cuello uterino estadios tempranos en EsSalud. Materiales...
Article
Introducción: Las complicaciones por diabetes tipo 2 (DT2) están incrementando la demanda de servicios especializados en la Seguridad Social Peruana por lo que se torna necesario determinar la magnitud y factores asociados a complicación crónica por DT2 en esta población. Material y Métodos: Estudio transversal-analítico basado en 7875 registros d...
Article
Full-text available
Objectives The primary objective is to determine the effect of a daily dose of ivermectin administered in three consecutive days to non-severe COVID-19 patients with no more than 96 hours of symptoms, on the detection of SARS-CoV-2 RNA by PCR from nasopharyngeal swabs at day seven post-treatment initiation. The secondary objectives are: To assess t...
Article
Full-text available
Tuberculosis (TB), caused by Mycobacterium tuberculosis, spreads via aerosols and the first encounter with the immune system is with the pulmonary-resident immune cells. The role of epigenetic regulations in the immune cells is emerging and we have previously shown that macrophages capacity to kill M. tuberculosis is reflected in the DNA methylome....
Article
Full-text available
Background Bartonella bacilliformis is the aetiological agent of Carrión's disease, a biphasic and highly lethal illness formerly restricted to the South American Andes that is now spreading to adjacent areas. Reliable serodiagnostic approaches and vaccines are urgently needed. In this study, we aimed to identify immunodominant proteins of B bacill...
Article
Full-text available
Background: Type 2 diabetes mellitus (T2DM) has been associated with infectious diseases; however, whether T2DM is associated with bacterial-resistant infections has not been thoroughly studied. We ascertained whether people with T2DM were more likely to experience resistant infections in comparison to T2DM-free individuals. Methods: Systematic...
Article
Full-text available
Objetivo: Describir las características de los pacientes adultos con tuberculosis (TB) y diabetes mellitus (DM) en el Perú, y explorar la asociación de la DM y la mortalidad en personas con TB. Materiales y métodos: Se realizó un análisis secundario de la base de datos del Sistema de Información Gerencial de Tuberculosis de la Dirección de Prevenci...
Article
Full-text available
Background Bringing reliable and accurate tuberculosis (TB) diagnosis closer to patients is a key priority for global TB control. Molbio Diagnostics have developed the Truenat point-of-care molecular assays for detection of TB and rifampicin (RIF) resistance. Methods We conducted a prospective multicentre diagnostic accuracy study at 19 primary he...
Article
Full-text available
Host immune responses at the site of Mycobacterium tuberculosis infection can mediate pathogenesis of tuberculosis (TB) and onward transmission of infection. We hypothesized that pathological immune responses would be enriched at the site of host-pathogen interactions modeled by a standardized tuberculin skin test (TST) challenge in patients with a...
Article
Full-text available
Host immune responses at the site of Mycobacterium tuberculosis infection can mediate pathogenesis of tuberculosis (TB) and onward transmission of infection. We hypothesized that pathological immune responses would be enriched at the site of host-pathogen interactions modeled by a standardized tuberculin skin test (TST) challenge in patients with a...
Article
Background Vancomycin serum trough concentrations are monitored to reduce nephrotoxicity and optimize therapeutic efficacy. Vancomycin pharmacokinetics and trough levels used in pediatric patients are extrapolated from the adult population. The pediatric dosing strategies are empirical and there is limited evidence to suggest that these doses resul...
Preprint
Host innate immune cells, including alveolar macrophages, have been identified as key players in the early eradication of Mycobacterium tuberculosis and in the maintenance of an anti-mycobacterial immune memory, which is believed to be induced through epigenetic changes. The aim of the study was to elucidate whether exposure to M. tuberculosis indu...
Preprint
Tuberculosis (TB), caused by Mycobacterium tuberculosis, spreads via aerosols and the first encounter with the immune system is with the pulmonary resident immune cells. The role of epigenetic regulations through DNA methylation in the immune cells is emerging. We have previously shown that capacity to kill M. tuberculosis is reflected in the DNA m...
Preprint
Full-text available
Objectives: The primary objective is to determine the effect of a daily dose of ivermectin administered in three consecutive days to non-severe COVID-19 patients with no more than 96 hours of symptoms, on the detection of SARS-CoV-2 RNA by PCR from nasopharyngeal swabs at day seven post-treatment initiation. The secondary objectives are: 1. To asse...
Article
Full-text available
Introduction International conferences on tuberculosis (TB) have been held since the 19th century. In Peru, the TB Scientific Conferences have been held annually in Lima since 2013 as a means of developing a national TB research network and setting the stage for researchers and institutions to present and share new findings from studies conducted i...
Article
Full-text available
Growing evidence suggests pollution and other environmental factors have a role in the development of tuberculosis (TB), however, such studies have never been conducted in Peru. Considering the association between air pollution and specific geographic areas, our objective was to determine the spatial distribution and clustering of TB incident cases...
Article
Introducción. Las complicaciones crónicas por diabetes mellitus tipo 2 (DMT2) elevan la mortalidad y carga de enfermedad en Perú, siendo necesario evaluar su prevalencia y factores asociados. Métodos. Estudio transversal, analítico, en registros de 212 pacientes adultos con DMT2 atendidos por consulta externa en un hospital general del Seguro Soci...
Article
Background Diabetes mellitus (DM) patients are three times more likely to develop tuberculosis (TB) than the general population. Active TB screening in people with DM is part of a bidirectional approach. The aim of this study was to conduct pragmatic active TB screening among DM patients in four countries to inform policy. Methods DM patients were...
Article
Full-text available
Lung ultrasound (LUS) is highly portable and has excellent diagnostic accuracy for pneumonia compared with conventional radiography, but the literature on its use in pulmonary tuberculosis (PTB) is limited. This study characterized lesions using LUS in patients with PTB and compared them with chest X-ray (CXR). Adult patients in Lima, Peru, with PT...
Article
Full-text available
BACKGROUND Tuberculosis (TB) kills more people than any other infection, and new diagnostic tests to identify active cases are required. We aimed to discover and verify novel markers for TB in nondepleted plasma.METHODS We applied an optimized quantitative proteomics discovery methodology based on multidimensional and orthogonal liquid chromatograp...
Article
Full-text available
A major challenge of tuberculosis diagnosis is the lack of universal accessibility to bacteriological confirmation. Computer-aided diagnostic interventions have been developed to address this gap and their successful implementation depends on many health systems factors. A socio-technical system to implement a computer-aided diagnostic tuberculosis...
Poster
In 2018, Tuberculosis (TB) was the leading cause of mortality due to an infectious disease, with an estimated 10 million new cases and 1.5 million deaths. Despite having a low HIV prevalence and a successful TB control program, Peru still has the second-highest estimated TB rates in the Americas and reported 29% of all multidrug-resistant (MDR) cas...
Article
Full-text available
Background People with diabetes have an increased risk of developing active tuberculosis (TB) and are more likely to have poor TB-treatment outcomes, which may impact on control of TB as the prevalence of diabetes is increasing worldwide. Blood transcriptomes are altered in patients with active TB relative to healthy individuals. The effects of dia...
Preprint
Pediatric tuberculosis is a neglected disease that is receiving more attention lately. Some studies found that serum levels of first line antituberculosis drugs do not reach reference concentrations in children. However, these reference ranges were validated in an adult sample. Thus, we do not know if subtherapeutic concentrations of antitubercular...
Article
Full-text available
Background: Tuberculosis (TB) transmission has long been recognized as an important occupational hazard for healthcare workers (HCWs). HCWs have a 5.8% annual risk of exposure and three times greater risk of developing active TB than the general population. Methods: We conducted an observational cross-sectional study between September 2014 and M...
Preprint
Full-text available
Background Tuberculosis (TB) transmission has long been recognized as an important occupational hazard for healthcare workers (HCWs). HCWs possess a 5.8% annual risk of exposure and three times greater risk of developing active TB than the general population. Methods We conducted an observational cross-sectional study between September 2014 and Mar...
Preprint
Full-text available
Background: Tuberculosis (TB) transmission has long been recognized as an important occupational hazard for healthcare workers (HCWs). HCWs possess a 5.8% annual risk of exposure and three times greater risk of developing active TB than the general population. Methods: We conducted an observational cross-sectional study between September 2014 and M...
Preprint
Full-text available
Background: Tuberculosis (TB) transmission has long been recognized as an important occupational hazard for healthcare workers (HCWs). HCWs have a 5.8% annual risk of exposure and three times greater risk of developing active TB than the general population. Methods: We conducted an observational cross-sectional study between September 2014 and Marc...
Article
Full-text available
Background: Diabetes mellitus (DM) increases active tuberculosis (TB) risk and worsens TB outcomes, jeopardizing TB control especially in TB-endemic countries with rising DM prevalence rates. We assessed DM status and clinical correlates in TB patients across settings in Indonesia, Peru, Romania, and South Africa. Methods: Age-adjusted DM preval...
Article
Full-text available
Background: To evaluate the effectiveness and safety of the World Health Organization antibiotic regimen for the treatment of paucibacillary (PB) and multibacillary (MB) leprosy compared to other available regimens. Methods: We performed a search from 1982 to July 2018 without language restriction. We included randomized controlled trials, quasi...
Article
Full-text available
Background Depression is a common comorbidity of tuberculosis (TB) and is associated with poor adherence to treatment of multiple disorders. We conducted a systematic review to synthesize the existing evidence on the relationship between depression and negative outcomes of TB treatment. Methods We systematically reviewed studies that evaluated dep...
Article
Full-text available
Background: In Peru, tuberculosis (TB) is perceived as a nutritional disease. This perception, alongside factors including household food insecurity, may drive the food choices of people with TB and influence treatment outcomes. Objectives: The objective of this qualitative study was to explore drivers of food choice among adults recently diagno...
Article
Full-text available
Background: We conducted a systematic review to study the association between diabetes and malaria as well as malaria severity. Methods: The search was conducted in Embase, Global Health, MEDLINE, Scopus and Web of Science. Titles and abstracts were screened, full-text studied and information extracted for qualitative synthesis. Risk of bias was as...
Poster
Background: Peru has the highest multidrug-resistant tuberculosis (MDR TB) burden in the Americas, with more than 80% persons with MDR TB living in urban areas. Diabetes (DM) prevalence is increasing, particularly in urban areas and is associated with poor TB treatment outcomes. There is limited data on the characteristics of MDR TB in persons with...
Article
Background: We conducted a systematic review to study the association between diabetes and malaria as well as malaria severity. Methods: The search was conducted in Embase, Global Health, MEDLINE, Scopus and Web of Science. Titles and abstracts were screened, full-text studied and information extracted for qualitative synthesis. Risk of bias was as...
Preprint
Full-text available
Background: Depression is a common comorbidity of tuberculosis (TB) and is associated with poor adherence to treatment of multiple disorders. We conducted a systematic review to synthesize the existing evidence on the relationship between depression and negative outcomes of TB treatment. Methods: We systematically reviewed studies that evaluated de...
Article
Full-text available
Background: We conducted a systematic review to study the association between diabetes as a risk factor for malaria. Methods: The search was conducted in Embase, Global Health, MEDLINE, Scopus and Web of Science. Titles and abstracts were screened, full-text studied and information extracted for qualitative synthesis. Risk of bias was assessed with...
Article
Full-text available
Background: Cutaneous leishmaniasis is a prevalent communicable disease in low- and middle-income countries, where non-communicable diseases like skin cancer are on the rise. However, the study of multi-morbidity or co-morbidity between communicable and non-communicable diseases is limited, and even null for some tropical or neglected diseases. Nev...
Article
BACKGROUND: Previous evidence synthesis has suggested diabetes mellitus (DM) worsens tuberculosis (TB) treatment outcomes. However, these reviews are limited by the number, robustness and conflicting results among the studies included. We conducted a systematic review to update earlier analyses and explore heterogeneity among studies.METHODS: MEDLI...
Article
Full-text available
Background: In 2014 the World Health Organization (WHO) launched the "End TB Strategy", setting new ambitious goals for elimination of tuberculosis (TB). In contrast with previous efforts to control TB, the new strategy adopted the protection and promotion of human rights in TB prevention and care as a core pillar. This mandated the development of...
Article
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Background Leptospirosis is a worldwide prevalent zoonosis and chronic kidney disease (CKD) is a leading global disease burden. Because of pathophysiological changes in the kidney, it has been suggested that these conditions may be associated. However, the extent of this interaction has not been synthetized. We aimed to systematically review and cr...
Article
Full-text available
Objective: To evaluate the effectiveness of interventions aimed at the prevention of risk factors and incidence of type 2 diabetes in the workers population. Methods: Systematic review of interventions aimed at adult workers at risk of type 2 diabetes published in Medline, Embase, Web of Science, Central Cochrane Registry of Controlled Trials, a...
Article
Full-text available
Background: Diabetes mellitus (DM) is common among tuberculosis (TB) patients and often undiagnosed or poorly controlled. We compared point of care (POC) with laboratory glycated haemoglobin (HbA1c) testing among newly diagnosed TB patients to assess POC test accuracy, safety and acceptability in settings in which immediate access to DM services m...
Article
The prevalence of non-communicable diseases is increasing worldwide, which coincides with the persistence of infectious diseases including tuberculosis. These can synergistically affect individual and population health. Three non-communicable diseases that are relevant because of their associated morbidity, mortality and disability are type 2 diabe...