Tesis – Maestría en Biología de las Enfermedades Infecciosas (Sin Restricción)
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Effect of Bono de Desarrollo Humano (Conditional Cash Transfer 1 Programme) on childhood mortality: a nationwide analysis of 2 Ecuadorian counties(PUCE - Quito, 2018) Granizo Mena, Guillermo Vinicio; Moncayo Benalcázar, Ana LucíaBackground: The mortality rate in children under five years old (U5MR) has decreased 24 considerably in Ecuador; however, thousands of children continue to die from causes 25 related to poverty. A social program known as Bono de Desarrollo Humano (BDH) was 26 created to guarantee a minimum level of consumption for families and to reduce chronic 27 malnutrition and preventable and preventable childhood diseases. 28 Objective: To evaluate the effect of the Bono de Desarrollo Humano programme on 29 mortality of children younger than 5 years, particularly from malnutrition, diarrheal 30 diseases, and lower respiratory tract infections. 31 Methods: Mortality rates and the BDH coverage from 2009 to 2014 was evaluated from 32 the 144 (of 222) Ecuadorian counties with intermediate and adequate quality of vital 33 information. A multivariable regression analyses for panel data was conducted by using 34 a negative binomial regression model with fixed effects, adjusted for relevant 35 demographic and socioeconomic covariates. 36 Results: For each 1% increase in BDH coverage, calculated from the county population 37 (CP) or the eligible population (EP), there would be a decrease in U5MR of 3% (RR 38 0.971, 95% CI 0.953-0.999) and 1.5% (RR 0.985, CI 0.973-0.998), respectively. A 39 lower effect of BDH on mortality resulting from respiratory infections was observed 40 (BDH-CP coverage: reduction of 0.8%, 95% CI 0.984-0.999 and BDH-PE coverage: 41 reduction of 0.5%, 95% CI 0.989-0.999). The BDH also reduced hospital discharge 42 rates in children younger than 5 years, resulting from all causes and for diarrhea. 43 Conclusion: 44 A conditional cash transfer program such as Bono de Desarrollo Humano could 45 contribute to the reduction of mortality due to causes related to poverty, such as 46 malnutrition and respiratory infections. Ecuador, being a country that has recently 47 3 increased the amount of the BDH, requires making a careful monitoring and evaluation 48 of the impact of the program to ensure that truly reduce inequities and improves health.Item Open Access Genetic diversity of the Trypanosoma cruzi and Trypanosoma rangeli mini-exon gene in two localities of Southern Ecuador(PUCE - Quito, 2018) Maiguashca Sánchez, Jalil; Costales Cordero, Jaime AlfredoTrypanosoma cruzi, causative agent of Chagas Disease, and Trypanosoma 25 rangeli, are both protozoan parasites endemic to Latin America, including Ecuador. 26 T. cruzi shows high molecular and morphological heterogeneity and six lineages or 27 DTU’s are currently recognized. In Ecuador, TcI predominates while zymodeme III, 28 corresponding to what is currently TcIV, was previously reported by a single study. 29 T. rangeli, although nonpathogenic to humans, is a species of interest due to its 30 sympatric distribution with T. cruzi and confounding effect in Chagas Disease 31 diagnosis. In the present study, we isolated DNA of intestinal contents of triatomines 32 belonging to two communities of Southern Ecuador. Infection status determined by 33 kinetoplast-minicircle PCR was contrasted with results yielded by PCR amplification 34 of the non-transcribed region of the mini-exon gene. For disambiguation of the 35 results obtained, amplified fragments from the non-transcribed region of the mini-36 exon gene were sequenced using an Illumina MiSeq platform. We evaluated genetic 37 variability in terms of richness and diversity at a population level for both parasites 38 using Operational Taxonomic Units. T. cruzi genetic diversity was found to be 39 significantly larger in adult female vectors as compared to the nymphal stages. 40 Additionally, NGS revealed 21 mixed infections between TcI and T. rangeli, and the 41 presence of DTU TcIV in 7 samples, (a novel record in Southern Ecuador), which 42 the PCR-based methods were not able to detect. This suggests that the PCR-based 43 methods are not reliable as molecular tools for identification of mixed infections. 44 Furthermore, parasite populations present in only one of the two studied localities 45 were not found, suggesting active parasite dispersal over the study area. Our results highlight the value of NGS methodologies to clarify the population dynamics of 47 triatomines and inform control strategies.Item Open Access Knowledge, attitudes and practices on influenza vaccine 1 during pregnancy in Quito, Ecuador.(PUCE - Quito, 2018) Erazo Verdugo, Carlos Espartaco; Moncayo Benalcázar, Ana LucíaBackground: Vaccination is the most effective way to prevent infection and severe 27 outcomes caused by influenza viruses in pregnant women and their children. In 28 Ecuador, the coverage of seasonal influenza vaccination in pregnant women is low. 29 Objective: The aim of this study was to assess the knowledge, attitudes, practices, and 30 factors associated with the uptake of the influenza vaccination in women in Quito-31 Ecuador during pregnancy. 32 Methods: A cross-sectional study enrolled 842 women who delivered at three main 33 public gynecological-obstetric units of the Metropolitan District of Quito. A 34 questionnaire regarding demographics, antenatal care, risk conditions and knowledge, 35 attitudes and practices related to influenza vaccination was administered. We examined 36 factors associated with vaccination using log-binomial regression models. 37 Results: A low vaccination rate (36.6%) against influenza was observed among 38 pregnant women. The factors associated with vaccination included the 39 recommendations from health providers (adjusted PR: 15.84; CI 95% 9.62-26.10), 40 belief in the security of the influenza vaccine (adjusted PR: 1.53; CI 95% 1.03-2.37) and 41 antenatal care (adjusted PR: 1.21; CI 95% 1.01-1.47). The most common reasons for not 42 vaccinating included the lack of recommendation from health care providers (73.9%) 43 and lack of access to vaccine (9.0%). 44 Conclusions: Our results show that recommendations by a health provider and 45 antenatal care affected vaccination coverage, reflecting their importance for vaccination 46 campaign success. Therefore, health educational programs aimed to pregnant women 47 and antenatal care providers have the most potential to increase influenza vaccination 48 rates. It is necessary develop further studies to understand the barriers for health care 49 providers regarding influenza vaccination in Ecuador.Item Open Access Genotypes and phenotypes of resistance in ecuadorian Plasmodium falciparum(PUCE - Quito, 2018) Valenzuela Sánchez, Gabriela Paola; Sáenz Calderón, Fabián ErnestoIntroducción: La malaria continúa siendo endémica en la costa y Amazonia de Ecuador. Determinar la situación actual de resistencia de P. falciparum a medicamentos en el país contribuirá con la eliminación de la enfermedad. En este estudio P. falciparum ecuatorianos fueron analizados para determinar su fegotipo y genotipo de resistencia. Métodos: Se realizaron análisis moleculares para determinar mutaciones en los genes pfcrt, pfdhfr, pfdhps, pfmdr1 y k13. El número de copias del gen Pfmdr1 se determinó a través de PCR en tiempo real. El transporte de Fluo 4 fue usado para determinar la actividad transportadora de la proteína PFMDR1. Ensayos in vitro se usaron para determinar la susceptibilidad de los parásitos a cloroquina, quinina, lumefantrina, mefloquina, dihydroartemisinina y artemeter. Resultados: La mayoría de muestras presentaron el genotipo CVMNT en el gen pfcrt (72-26), mutaciones (NEDF SDFD) en el gen pfmdr1 y los genotipos salvajes en los genes pfdhfr, pfdhps y k13. La cepa ESM-2013 presentó resistencia in vitro a la cloroquina, pero susceptibilidad a quinina, lumefantrina, mefloquina, dihydroartermisinina y artemeter. Además, ESM-2013 presentó inhibición en el transporte de Fluo 4 AM, desde el citosol hacia la vacuola digestiva. Todas las muestras analizadas presentaron solo una copia del gen Pfmdr1. Conclusión: Este estudio nos indica que los parásitos ecuatorianos presentan el genotipo y fenotipo de resistencia a cloroquina, pero de sensibilidad a sulfadoxina – pirimetamina, artemeter – lumefantrina, quinina, mefloquina y dihydroartemisinina. Los resultados de este estudio sugieren que el actual tratamiento está siendo efectivo. Este estudio pretende clarificar la situación actual de resistencia a los antimaláricos en Ecuador y de esta manera contribuir con la eliminación de malaria causada por P. falciparum.Item Open Access Distinct proteomic profiles are associated with Trypanosoma cruzi I strains displaying high/low infectivity towards mammalian cells in vitro(PUCE - Quito, 2018) Rodríguez Riglos, Camila Cilveti; Costales Cordero, Jaime AlfredoCausative agent of Chagas disease, Trypanosoma cruzi, has a digenetic life cycle, 24 comprising life stages in invertebrate and mammalian hosts. In mammalian hosts, the 25 parasites multiply intracellularly; therefore, the process of cellular invasion is required for 26 life cycle completion. T. cruzi is a genetically diverse species and six different genetic 27 lineages are currently recognized (TCI-TCVI), TCI being the most widespread and 28 genetically variable. TcI strains present significant differences in their ability to invade 29 mammalian cells in vitro, which may be rooted both in genetic differences as well as in 30 protein expression levels. We report the identification of sets over and underexpressed of 31 2-DE spots statiscally associated with high and low infectivity strains. Proteins associated 32 with high infectivity strains identified through mass spectrometry showed a major 33 presence of proteins related to the cytoskeleton and motility of the parasite, which 34 suggests that the more infective strains could be more motile than the less infective ones. 35 Additionally, high infective strain proteins associated with antioxidant activity were also 36 present, which may be related to more aggressive invasive patterns. Ultimately, 37 identification of specific proteins and pathways associated to the ability of 38 trypomastigotes to infect mammalian cells will open up the possibility of functional 39 confirmation through overexpression and knockout experiments and may unveil potential 40 drug and vaccine targets.