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¿Qué papel desempeña el cultivo micobacteriano en el diagnóstico y la definición de casos?
No full textPCR-RFLP/Hsp70 para identificar y tipificar Leishmania de la región neotropical
No full textSe realizó la estandarización de las condiciones de amplificación del gen que codifica para la proteína de choque térmico de 70 kDa (Hsp70) de Leishmania mediante la reacción en cadena de la polimerasa (PCR-Hsp70), así como el análisis posterior de la longitud de los fragmentos de restricción (RFLP) del producto amplificado, utilizando como molde ADN puro de una cepa de referencia de Leishmania mexicana. Se estudió la sensibilidad y especificidad analíticas de la PCR, así como la reproducibilidad, utilizando ADN de L. mexicana, L. amazonensis, L. guyanensis y L. lainsoni. Se obtuvo una banda de 1,3 Kpb, demostrándose la amplificación del gen que codifica para la Hsp70. Los patrones de bandas obtenidos tras la digestión enzimática, utilizando la enzima Hae III, permitieron establecer diferencias entre las especies estudiadas: L. guyanensis y L. lainsoni se diferencian entre sí y estas a su vez de L. mexicana y L. amazonensis, que mostraron un patrón de bandas común. La sensibilidad y especificidad analíticas de la técnica fueron adecuadas. Se demostró la factibilidad de identificar y tipificar especies del continente americano mediante la PCR-RFLP/Hsp70, y de utilizar la restricción enzimática del producto amplificado para distinguir entre Leishmania spp. y Trypanosoma cruzi, dándose un primer paso en el establecimiento de estos métodos moleculares en el laboratorio de referencia del instituto
Collaboration between private pharmacies and national tuberculosis programme: an intervention in Bolivia
No full textThe definitive version is available at www3.interscience.wiley.comBackgroundPublic–private partnerships are felt to be necessary for tuberculosis (TB) control in some developing countries.
ObjectivesTo evaluate the potential of a collaboration between the National TB Programme (NTP) and private pharmacies in Bolivia, the country with the highest TB incidence in Latin America.
MethodsWe contacted the local Pharmacists' Association in the city of Cochabamba, and designed a two phase intervention. The objectives of the first phase were to decrease the availability of TB drugs in private pharmacies on a voluntary basis, and to improve referral of clients seeking TB drugs to the NTP. A survey of all pharmacies allowed for a before–after comparison with a baseline survey. The objectives of the second phase were to obtain referral of pharmacy clients with chronic cough for TB screening in the NTP. This phase was started in 70 pharmacies and evaluated after 2 months using the referral slips issued by the pharmacists.
ResultsThe proportion of pharmacies selling TB drugs decreased (rifampicin: 23–11.5%; isoniazid: 16–3.1%; P < 0.001) and the proportion of pharmacies referring to the NTP clients seeking TB drugs increased (22–58%; P < 0.0001). In the second phase, 26 of 70 pharmacies (38%) referred a total of 41 clients for screening in the NTP (i.e. an average of 0.29 clients per pharmacy and per month); 11 of 41 (27%) were screened and three of 11 (27%) diagnosed with smear-positive TB.
ConclusionThe first phase of the intervention proved effective in reducing the availability of the main TB drugs in pharmacies, and in improving referral of clients seeking TB drugs. Key factors in this success were not specific to Bolivia, and collaboration between private pharmacies and public services appears possible in that respect. However, collaboration with pharmacies does not seem an efficient way to increase the number of patients screened for TB, and to shorten delays to TB diagnosis and treatment
Intersectoral coordination in Aedes aegypti control; a pilot project in Havana City, Cuba
No full textThe definitive version is available at www3.interscience.wiley.comBackground The 55th World Health Assembly declared dengue prevention and control a priority and urged Member States to develop sustainable intersectoral strategies to this end. To provide evidence for the reorientation of the dengue prevention policy in Cuba, we launched an intervention study to document the effectiveness of a local-level intersectoral approach.
Methods We used a quasi-experimental design. Social scientists introduced participatory methods to facilitate dialogue in the biweekly meetings of the intersectoral Health Council of the intervention area. This council subsequently developed an intersectoral plan for dengue prevention, of which the core objective was to design and implement activities for communication and social mobilization. In the control area, routine dengue control activities continued without additional input. Knowledge, attitudes and perceptions of dengue, and entomological indices were compared inside and between the areas before and after the 1-year intervention period.
Results In the intervention area the Health Council elaborated an intersectoral plan for dengue prevention focused on source reduction. The Aedes aegypti control methods consisted in eliminating useless containers in the houses and surroundings, covering tanks, and cleaning public and inhabited areas. It was implemented through communication and social mobilization. The Health Council in the control area occasionally discussed dengue issues but did not develop a coordinated action plan. Good knowledge about breeding sites and disease symptoms increased significantly (by 49.7% and 17.1% respectively) in the intervention area as well as the proportion of respondents eliminating containers in and around their houses (by 44%). No changes were observed in the control area. The House Index in the intervention area was 3.72% at baseline and decreased to 0.61% after 1 year. In the control area it remained stable throughout the study period (1.31% and 1.65% respectively).
Conclusion The introduction of a participatory approach by social scientists promotes changes in intersectoral management. This facilitates social mobilization which, in its turn, leads to significant changes in knowledge, attitudes and dengue-related practices in the population and eventually to more effective control of Ae. aegypti
Quality standards for health care delivery and management in publicly oriented health services
No full textReprinted from: Int J Health Plann Manag, 2003;18: S79-S8
Replicative fitness of historical and recent HIV-1 isolates suggests HIV-1 attenuation over time
No full textNot the final published versionBACKGROUND: Changes in virulence during an epidemic are common among pathogens, but still unexplored in the case of HIV-1. Here we used primary human cells to study the replicative fitness of primary HIV-1 isolates from untreated patients, comparing historical (1986-1989) and recent samples (2002-2003). METHODS: Head-to-head dual virus infection/competition assays were performed in both peripheral blood mononuclear cells and human dendritic cell/T-cell co-cultures with pairs of 12 carefully matched historical and recent HIV-1 isolates from untreated patients. Sensitivity to inhibition by lamivudine (3TC) and TAK-779 of historical and recent R5 HIV-1 isolates was measured in a subset of samples. RESULTS: Overall, the historical HIV-1 out-competed the recent HIV-1 isolates in 176 of 238 competitions and in 9 of 12 competitions carefully matched for CD4 cell count. The mean relative replicative fitness (W) of all historical HIV-1 strains was significantly greater than that of recent HIV-1 isolates (W(1986-1989) = 1.395 and W(2002-2003) = 0.545, P 1) from 1986-1989 appeared less sensitive to TAK-779 and 3TC than did the less fit (mean W < 1) 2002-2003 viruses. CONCLUSIONS: These findings suggest that HIV-1 replicative fitness may have decreased in the human population since the start of the pandemic. This 'attenuation' could be the consequence of serial bottlenecks during transmission and result in adaptation of HIV-1 to the human host