RESUMO
PURPOSE: This study aims to asses a cancer fast-track programme (CFP) to shorten the time since a patient with suspicion of cancer is referred by the primary care (PC) physician to the specialized medical team. METHODS: Guidelines for main suspected tumours were designed to help PC physicians to detect and rapidly refer cases to the CFP oncology coordinator, who sent them to the appropriate department to accelerate diagnosis, staging and therapy. All patients analysed in this report were referred from June 2009 to July 2012. RESULTS: A total of 897 suspected cancer cases were submitted and finally 705 were studied. In 205 (29 %) a cancer diagnosis was confirmed within 23 days (median). Therapy was initiated within 46 days after referral (median). Early diagnoses with a potential curative approach were made in 166 (82 %). CONCLUSIONS: This CFP decreased the waiting time for cancer diagnosis, by improving communication between PC physician and specialized care teams. Most patients included in this program could get therapy with curative intent.
Assuntos
Implementação de Plano de Saúde , Neoplasias/diagnóstico , Neoplasias/terapia , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde , Avaliação de Programas e Projetos de Saúde , Gerenciamento do Tempo/organização & administração , Atenção à Saúde/métodos , Atenção à Saúde/organização & administração , Humanos , Comunicação Interdisciplinar , Planejamento de Assistência ao Paciente/organização & administração , Planejamento de Assistência ao Paciente/normas , Encaminhamento e Consulta , Listas de EsperaRESUMO
From April to September 2000, an epidemic of aseptic meningitis spread throughout Cuba, with 16,943 reported cases. Virologic studies identified echovirus 16 as the cause of this epidemic. This is the first reported isolate of echovirus 16 from patients with viral meningitis in Cuba.
Assuntos
Surtos de Doenças , Infecções por Echovirus/epidemiologia , Enterovirus Humano B/isolamento & purificação , Meningite Asséptica/epidemiologia , Meningite Viral/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Líquido Cefalorraquidiano/virologia , Criança , Pré-Escolar , Cuba/epidemiologia , Infecções por Echovirus/diagnóstico , Infecções por Echovirus/virologia , Enterovirus Humano B/classificação , Enterovirus Humano B/genética , Fezes/virologia , Humanos , Incidência , Lactente , Meningite Asséptica/diagnóstico , Meningite Asséptica/virologia , Meningite Viral/diagnóstico , Meningite Viral/virologia , Pessoa de Meia-Idade , RNA Viral/análise , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
The erradication of poliomyelitis in the world is a goal that requires the adoption of effective and safe strategies for its attainment. Knowing how long the strains of poliovirus derived from the oral attenuated virus vaccine may circulate and remain in the environment was essential to define the measures to be taken and was also the objective of our paper. Specimens of stools and sewage water, which were weekly obtained at the end of the National Polio Vaccination Campaign, in 1998, were analyzed. Viruses were isolated and identified by culture and neutralization tests for the identification of poliovirus. In the particular case of the sewage water, it was also used the polymerase chain reaction. The curves of elimination in both media were drawn and it was concluded that the permanence of viruses in the environment did not exceed the 12 weeks after the immunization with the oral attenuated virus vaccine.
Assuntos
Fezes/virologia , Vacinas contra Poliovirus , Esgotos/virologia , Pré-Escolar , Humanos , Lactente , Fatores de TempoRESUMO
AIMS/HYPOTHESIS: To determine the association between exposure to enteroviruses and Type 1 diabetes. METHODS: We measured neutralizing antibodies to the following enteroviruses: Coxsackievirus CA9, CB1, CB2, CB3, CB4, CB5, CB6, and Echovirus E4, E6, E9, E11 in the sera of (1) Type 1 diabetic patients at diagnosis (n = 33), (2) healthy offspring of parents with Type 1 diabetes without islet cell antibodies (ICA) (n = 43) and (3) normal controls (n = 57). All subjects were less than 20 years old. We performed the neutralization test determining the cytopathogenic effect on Vero cells. HLA DR serotyping was also performed in Group 2. RESULTS: Type 1 diabetic patients showed a higher frequency (21.2%, p < 0.01) of neutralizing antibodies to E4 in relation to controls (1.8%), although there were no differences comparing with offspring of Type 1 diabetic patients (20.9%). Healthy offspring carrying Type 1 diabetes HLA DR susceptibility genes were also exposed to E4 (15.0%). High frequencies of neutralizing antibodies to most enteroviruses were found in the control group. CONCLUSION: This study shows the association between Type 1 diabetes and the presence of neutralizing antibodies to Echovirus 4, suggesting the possible participation of this virus as an environmental trigger of this autoimmune disease. Interestingly, our population displays high frequencies of exposure to enterovirus (including CB4) although the incidence for Type 1 diabetes is low (2.9 per 100,000 inhabitants).
Assuntos
Diabetes Mellitus Tipo 1/virologia , Enterovirus Humano B/isolamento & purificação , Adolescente , Adulto , Anticorpos Antivirais/sangue , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/etiologia , Diabetes Mellitus Tipo 1/imunologia , Feminino , Antígenos HLA-DR/genética , Humanos , Lactente , MasculinoRESUMO
Perceptions of health risks were surveyed in the inner city of Centro Habana, Cuba. A questionnaire developed by community leaders and experts was administered to 348 residents to determine the level of perceived risk for each of 41 risk items. Ecologic-level data on morbidity, mortality, and environmental indicators were also gathered. Using factor analysis to reduce the dimensionality of the data, five factor groupings accounted for 60% of the variance, as follows: social environment (40.8%); infectious agents and other health-risk factors of immediate concern (6.1%); lifestyle risks (4. 9%); environmental sanitation (4.1%); and living conditions (3.3%). A relationship between the perception of risk and the ecologic data was found, with inconsistencies largely attributable to factors known to influence risk perception. The greatest concern identified throughout the municipality was housing conditions, highest in the neighborhood that had already begun to address this problem. The analysis was useful in planning targeted health promotion campaigns and prioritizing further interventions. Repeat evaluation of risk perception will be conducted following the completion of interventions.
Assuntos
Serviços de Saúde Comunitária , Saúde Ambiental , Adolescente , Adulto , Criança , Intervalos de Confiança , Cuba , Interpretação Estatística de Dados , Feminino , Promoção da Saúde , Habitação , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Estilo de Vida , Masculino , Mortalidade , Gravidez , Fatores de Risco , Meio Social , Inquéritos e Questionários , População UrbanaRESUMO
OBJECTIVE: To investigate the possibility of a viral agent in the central nervous system of patients with epidemic neuropathy. DESIGN: Virus isolation attempts, in cell cultures and suckling mice, from cerebrospinal fluid (CSF) of neuropathy patients and controls undergoing lumbar puncture for unrelated reasons. Serologic studies in patients, contacts, and controls. SETTING: An epidemic of optic and peripheral neuropathy affected more than 50,000 people in Cuba in 1991 through 1993. Illness was associated with dietary limitations and increased physical demands accompanying the shortages of food and fuel experienced in Cuba since 1989. Most patients responded to parenteral vitamin therapy, and the epidemic began to subside when oral vitamin supplementation was begun for the entire Cuban population. RESULTS: Coxsackievirus A9 (five isolates) and a similar, less cytopathic virus (100 isolates) were recovered from 105 (84%) of 125 CSF specimens from neuropathy patients. The strains with light cytopathic effect were antigenically related to Coxsackieviruses A9 and B4 by cross-neutralization and immunoblotting assays. Virus persisted in CSF of some patients for 1 to 12 months. Cerebrospinal fluid from patients and both types of virus from cell culture produced illness, including complete posterior flaccid paralysis, in newborn mice, and virus was reisolated from the mice. Mouse tissues and sural nerve biopsy specimens from patients were stained by immunoperoxidase and colloidal gold techniques using hyperimmune rabbit antisera against the virus with light cytopathic effect. CONCLUSIONS: Coxsackievirus A9 or an antigenically related agent with a light cytopathic effect was present in CSF of 84% of 125 patients with epidemic neuropathy. The role of these agents, probably in combination with nutritional factors, in the pathophysiology of the disease requires further investigation.
Assuntos
Infecções por Coxsackievirus/etiologia , Surtos de Doenças , Enterovirus/isolamento & purificação , Neurite Óptica/virologia , Doenças do Sistema Nervoso Periférico/virologia , Adulto , Animais , Animais Lactentes/virologia , Anticorpos Antivirais/análise , Antígenos Virais/análise , Técnicas de Cultura de Células , Líquido Cefalorraquidiano/virologia , Chlorocebus aethiops , Infecções por Coxsackievirus/líquido cefalorraquidiano , Infecções por Coxsackievirus/epidemiologia , Infecções por Coxsackievirus/patologia , Cuba/epidemiologia , Efeito Citopatogênico Viral , Enterovirus/imunologia , Enterovirus/patogenicidade , Feminino , Humanos , Imuno-Histoquímica , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Pessoa de Meia-Idade , Neurite Óptica/líquido cefalorraquidiano , Neurite Óptica/epidemiologia , Neurite Óptica/patologia , Sistema Nervoso Periférico/patologia , Sistema Nervoso Periférico/virologia , Doenças do Sistema Nervoso Periférico/líquido cefalorraquidiano , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/patologia , Coelhos , Células Vero/virologiaRESUMO
The immune response of a group of patients with epidemical neuropathy and of controls was studied by the immunoblotting technique against proteins of the Coxsackie virus and the proteins of slow effect isolated in our laboratory. 13 sera of patients with epidemical neuropathy and 9 sera of controls were studied. Of the 13 sera studied, 8 (61.5%) recognized protein VPI and 2 sera (15.3%) protein VP0 of the strain 47.93. Of the 9 controls studied, 4 (44.4%) recognized protein VPI and 3 (33.3%) protein VP0 only. With the antigen prepared from the slow effect strain it was obtained a specific signal in 5 (38.5%) sera of patients and in 2 sera (22.5%) of controls. It should be stressed that in this last case the protein observed had a molecular weight of 41,300 D, and that its size was smaller than that of the preceding protein detected against the strain 47.93 was of 45,000 D.
Assuntos
Anticorpos Antivirais/sangue , Infecções por Coxsackievirus/imunologia , Surtos de Doenças , Enterovirus/imunologia , Doenças do Nervo Óptico/imunologia , Doenças do Sistema Nervoso Periférico/imunologia , Proteínas Virais/imunologia , Animais , Especificidade de Anticorpos , Western Blotting , Chlorocebus aethiops , Infecções por Coxsackievirus/epidemiologia , Infecções por Coxsackievirus/virologia , Cuba/epidemiologia , Enterovirus/classificação , Enterovirus/isolamento & purificação , Humanos , Peso Molecular , Doenças do Nervo Óptico/sangue , Doenças do Nervo Óptico/epidemiologia , Doenças do Nervo Óptico/virologia , Doenças do Sistema Nervoso Periférico/sangue , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/virologia , Coelhos , Estudos Soroepidemiológicos , Células Vero , Proteínas Virais/químicaRESUMO
Using as a reference the strain 44/93 isolated during the neuropathy epidemic in 1991 and characterized as a producer of a light cytopathic effect (L-CPE), it was possible the standardization of an ELISA for the fast identification of other strains with similar effect. The assay consisted in a sandwich-type ELISA where the conditions selected for each reactive (10 micrograms/mL for the coating antibody, 1 mg/mL for the antigen, and dilution 1/2,000 for the conjugate) allowed to have an adequate discrimination between the antigen and the antigen control for the reference strain used. The evaluation of a panel of reference viral strains and of other L-CPE producing strains showed a 100% of coincidence between this method and the isolation in cellular culture. The results obtained permit us to recommend the use of this assay as a more precise alternative to identify these agents.
Assuntos
Enterovirus Humano B/isolamento & purificação , Enterovirus/isolamento & purificação , Ensaio de Imunoadsorção Enzimática/métodos , Cuba/epidemiologia , Efeito Citopatogênico Viral , Humanos , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/virologiaAssuntos
Anticorpos Antivirais/sangue , Enterovirus/imunologia , Doenças do Nervo Óptico/imunologia , Doenças do Sistema Nervoso Periférico/imunologia , Adulto , Cuba/epidemiologia , Surtos de Doenças , Feminino , Humanos , Masculino , Doenças do Nervo Óptico/epidemiologia , Doenças do Nervo Óptico/virologia , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/virologiaRESUMO
This paper reports on the physical and chemical characteristics of agents isolated from serum samples of patients presenting with epidemic neuropathy. The behaviour of isolated enteroviruses was as described for such viruses. Mild cytopathogenic effects-producing agents behaved in a variable form regarding sensitivity to chloroform; on the other hand they were neither sensitive to phosphonoacetic acid (PAA) nor to guanidine hydrochloride (GHC1) and grew in cells previously treated with bromodeoxyuridine (BDUR). These results suggest the presence of agents resembling enteroviruses and enveloped viruses. Further studies for the characterization of such agents need to be performed.
Assuntos
Surtos de Doenças , Enterovirus/química , Neurite Óptica/virologia , Doenças do Sistema Nervoso Periférico/virologia , Aciclovir/farmacologia , Antivirais/farmacologia , Bromodesoxiuridina/farmacologia , Fenômenos Químicos , Físico-Química , Cuba/epidemiologia , Enterovirus/efeitos dos fármacos , Enterovirus/isolamento & purificação , Guanidina/farmacologia , Humanos , Concentração de Íons de Hidrogênio , Neurite Óptica/epidemiologia , Doenças do Sistema Nervoso Periférico/epidemiologia , Ácido Fosfonoacéticos/farmacologia , TemperaturaRESUMO
The presence of 2 agents such as a Cox A9 strain and another mild cytopathogenic effect-producing strain, both isolated from patients presenting with epidemic neuropathy is reported in this paper. A mild cutopathogenic effect which was propagated in successive dilutions was developed in the dilution 10(-4) by means of the neutralization test of a Coxsackie A9 virus with its homologous hyperimmune serum. A gradient in saccharose was performed in a mild cytopathogenic effect-producing strain and a typical cytopathogenic effect of an Enterovirus developed from one of the fractions passed in tissular cultures in the presence phosphonoacetic acid (PAA). The possible pathogenic role of these viruses are discussed.
Assuntos
Enterovirus/química , Neurite Óptica/virologia , Doenças do Sistema Nervoso Periférico/virologia , Animais , Fenômenos Químicos , Físico-Química , Chlorocebus aethiops , Cuba/epidemiologia , Efeito Citopatogênico Viral , Enterovirus/efeitos dos fármacos , Enterovirus/isolamento & purificação , Enterovirus/patogenicidade , Humanos , Neurite Óptica/epidemiologia , Doenças do Sistema Nervoso Periférico/epidemiologia , Inoculações Seriadas , Células VeroRESUMO
A number of 213 monosera from patients presenting with epidemic neuropathy and their contacts was studied by indirect immunofluorescence and neutralization tests with the aim of demonstrating the presence of serum IgM and neutralizing antibodies against the strain 47/93 IPK identified as a Coxsackie A9 virus. The mean age of the patients ranged from 20 to 59 years and positivity to both techniques was not found to be predominant for one or another sex. No significant difference was observed with respect to results obtained between patients and contacts with the techniques used for the study.
Assuntos
Anticorpos Antivirais/sangue , Enterovirus/imunologia , Imunoglobulina M/sangue , Neurite Óptica/imunologia , Doenças do Sistema Nervoso Periférico/imunologia , Adulto , Cuba/epidemiologia , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Neutralização , Neurite Óptica/epidemiologia , Doenças do Sistema Nervoso Periférico/epidemiologiaRESUMO
Certain factors influencing upon the growth of the agent producer of mild cytopathogenic effect and isolated from the cerebrospinal fluid of patients presenting with epidemic neuropathy are described in this paper. It was demonstrated that a concentration of NaHCO3 was essential for the occurrence of the cytopathogenic effect. Determined concentrations of MnCl2 allowed for the visualization of the cytopathogenic effect and increased viral yields.
Assuntos
Enterovirus/crescimento & desenvolvimento , Neurite Óptica/virologia , Doenças do Sistema Nervoso Periférico/virologia , Animais , Cloretos/farmacologia , Chlorocebus aethiops , Efeito Citopatogênico Viral/efeitos dos fármacos , Relação Dose-Resposta a Droga , Enterovirus/efeitos dos fármacos , Enterovirus/isolamento & purificação , Enterovirus/patogenicidade , Humanos , Cloreto de Magnésio/farmacologia , Compostos de Manganês/farmacologia , Bicarbonato de Sódio/farmacologia , Temperatura , Células VeroRESUMO
This paper reports on the necessary conditions for plaque development in mild cutopathogenic effect-producing agents which were isolated from samples of the cerebrospinal fluid of patients presenting with epidemic neuropathy.
Assuntos
Neurite Óptica/virologia , Doenças do Sistema Nervoso Periférico/virologia , Ensaio de Placa Viral/normas , Animais , Chlorocebus aethiops , Cuba , Efeito Citopatogênico Viral , Humanos , Células Vero , Ensaio de Placa Viral/métodosRESUMO
La conjuntivitis hemorrágica epidémica es una infección viral muy contagiosa. Desde 1969 se ha reportado en Africa, la India, Inglaterra y países asiáticos. En el Hemisferio Occidental se reportó por primera vez en agosto de 1981. En Cuba se reportó en septiembre de 1981 producida por el Enterovirus 70. Se utilizó el interferón alfa semipurificado producido en el Centro de Investigaciones Biológicas en Ciudad de La Habana (actividad específica 1-1.5 . 106 U.I./mg de proteína). Un grupo de 150 casos se ingresó en las primeras 24 horas de la enfermedad en una unidad especial de oftalmología y se trató durante tres días. Se seleccionaron tres grupos de 50 casos para un estudio estrictamente al azar. Dos grupos recibieron colirios de interferón, 5 . 105 y 2.5 . 105 U.I. IFN/ml respectivamente (dos gotas en cada ojo cada 4 horas). El tercer grupo recibió una solución placebo. Fue posible encontrar mejoría significativa (p < 0,05) en el edema parpebral, inyección ciliar, blefaroespasmo, fotofobia y adenopatía preauricular en el grupo que recibió mayores dosis de interferón en comparación con el grupo de control
Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Conjuntivite Hemorrágica Aguda/terapia , Interferon Tipo I/uso terapêuticoRESUMO
Se determino el comportamiento ergometrico de 1269 pacientes divididos en 4 grupos:1) controles no diabeticos no hipertensos (375 pacientes); 2) hipertensos (232 vacientes); 3) diabeticos (362 pacientes), y 4) diabeticos-hipertensos (300 pacientes). Los resultados obtenidos demonstraron una baja prevalencia de estudios positivos en el grupo control, con buena tolerancia al ejercicio y un ARE (alto riesgo ergometrico) del 4.3%. La diabetes incrementa el nurero de estudios ergometricos positivos en hombres (34%) como asimismo disminuye la tolerancia al ejercicio a bajas cargas (24.7%) con un mayor ARE (14.4%). El comportamiento del EE de las mujeres diabeticas no se diferencio del grupo testigo. La hipertension arterial per se, aumenta la cantidad de estudios ergometricos positivos, los cuales no son de mayor severidad.La asociacion de hipertension y diabetes pareciera afectar significativamente el estudio ergometrico, elevando no solo el numero de positividades sino tambien la severidad de las pruebas y el ARE. La hipertension y diabetes cuando se presentan simultaneamente danan en forma sustencial al sexo feminino