Systematic review of nonpharmacological analgesic interventions for common needle­related procedure in newborn infants and development of evidence­based clinical guidelines

The aim of this literature review was to develop clinical guidelines for the prevention and control of needle-related pain in newborn infants. The guidelines were developed by the Italian Society of Neonatology, using the Grading of Recommendations, Assessment, Development and Evaluation approach, based on the assessment of 232 papers published between 1986 and 2015. The quality of the evidence was high or moderate for some behavioural and nonpharmacological interventions. CONCLUSION: There was sufficient evidence to strongly support the use of nonpharmacological interventions for common needle-related procedures in newborn infants. Combined interventions seemed to be more effective in relieving procedural pain

Effects of crude hydroalcoholic extract of Syzygium cumini (L.) Skeels leaves and continuous aerobic training in rats with diabetes induced by a high-fat diet and low doses of streptozotocin.

ETHNOPHARMACOLOGICAL RELEVANCE: The leaves of Syzygium cumini (L.) or Skeels (Myrtaceae) are widely used in Brazilian folk medicine to treat diabetes. AIM OF THE STUDY: The present study evaluated the functional capacity, biochemical parameters, oxidative stress and DNA damage from eight weeks of intervention with a crude hydroalcoholic extract of S. cumini leaves (EBH) and continuous aerobic training (TAC) in diabetic (D) rats. MATERIALS AND METHODS: A hydroalcoholic (50%) extract was prepared by ultrasound and phytochemical parameters (total phenols, total tannins and myricetin content) were analyzed. Thirty-seven male Wistar rats were divided into five groups: normoglycemic controls (CONT), diabetic controls (D-CONT), diabetics treated with extract (D+EBH), trained diabetic (D+TAC) and diabetics treated with extract and trained (D+EBH+TAC). Functional capacity was assessed with a maximum exercise capacity test; biochemical parameters with enzymatic kits; oxidative stress by superoxide dismutase (SOD), catalase (CAT), thiobarbituric acid reactive substances (TBARS) and oxidized dichlorofluorescein (DCF), and the DNA damage by the comet assay. RESULTS: The D+TAC and D+EBH+TAC groups showed better functional capacity at the end of interventions. The D+EBH group showed glucose and triglyceride reduction, lowest DNA damage index in the blood, liver, kidney, heart, lung and gastrocnemius muscle, improved SOD levels in the liver, kidney and lung, improved CAT levels in the kidney and lower lipid peroxidation in all tissues studied, compared to the D-CONT group. The exercise (D+TAC) was effective in reducing triglycerides, improving SOD levels in the lung, reducing lipid peroxidation in all tissues studied and reducing the DCF oxidation in the kidney, in addition to protecting against DNA damage in the blood and heart. However, the additive effect of the intervention protocols when combined (EBH+TAC) was observed only in improving the gastrocnemius SOD levels. The phytochemical analyses showed a high content of phenols and the presence of myricetin glycosides. CONCLUSION: The findings in this study suggest a crude hydroalcoholic extract of S. cumini leaves has potential hypoglycemic, hypolipidemic and protective properties acting against oxidative stress and against DNA damage, probably due to its phenols and myricetin glycoside content and the antioxidant properties of these constituents. Moreover, exercise was suggested to have beneficial effects on diabetes, improving functional capacity, ameliorating blood triglyceride control and decreasing lipid peroxidation, but with no effects on ameliorating blood glucose levels. The association of intervention protocols presented an additive effect on the antioxidant SOD activity in the muscle cells of diabetic rats.

Chronic electroacupuncture of the ST36 point improves baroreflex function and haemodynamic parameters in heart failure rats.

Electroacupuncture (EA) has been used to treat many diseases, including heart failure (HF). This study aimed to evaluate the effects of chronic stimulation in the ST36 acupuncture point on haemodynamic parameters and baroreflex function in rats with HF. Cardiovascular parameters assessed were heart rate (HR), blood pressure (BP), and the reflex cardiovascular response of HR triggered by stimulation of baroreceptors in animals with HF subsequent to acute myocardial infarction (AMI). Male Wistar rats were divided into three groups: Sham Control - animals without HF and without EA; HF Control group - animals with HF and without EA; and HF EA group - animals with HF that received the EA protocol. Six weeks after surgical induction of AMI, the EA protocol (8 weeks, 5 times a week) was performed. The protocol was applied with EA at the ST36 point, frequency of 2 Hz, pulse of 0.3 ms and intensity of 1-3 mA for 30 min. Haemodynamic parameters and baroreceptor function were assessed. There was no difference between groups in the variables HR, systolic blood pressure (SBP) and diastolic blood pressure (DBP), which were evaluated with awake animals (p>0.05). There was an increase in the mean arterial pressure (MAP) in the HF EA group compared to the HF Control group (p<0.05). The maximum gain of the baroreflex heart rate response (Gain) was higher in the HF EA group than the HF Control and Sham Control groups. Chronic EA in the ST36 point increased the MAP and baroreflex sensitivity in rats with HF.

Neuropeptides in the posterodorsal medial amygdala modulate central cardiovascular reflex responses in awake male rats

The rat posterodorsal medial amygdala (MePD) links emotionally charged sensory stimuli to social behavior, and is part of the supramedullary control of the cardiovascular system. We studied the effects of microinjections of neuroactive peptides markedly found in the MePD, namely oxytocin (OT, 10 ng and 25 pg; n=6/group), somatostatin (SST, 1 and 0.05 μM; n=8 and 5, respectively), and angiotensin II (Ang II, 50 pmol and 50 fmol; n=7/group), on basal cardiovascular activity and on baroreflex- and chemoreflex-mediated responses in awake adult male rats. Power spectral and symbolic analyses were applied to pulse interval and systolic arterial pressure series to identify centrally mediated sympathetic/parasympathetic components in the heart rate variability (HRV) and arterial pressure variability (APV). No microinjected substance affected basal parameters. On the other hand, compared with the control data (saline, 0.3 µL; n=7), OT (10 ng) decreased mean AP (MAP50) after baroreflex stimulation and increased both the mean AP response after chemoreflex activation and the high-frequency component of the HRV. OT (25 pg) increased overall HRV but did not affect any parameter of the symbolic analysis. SST (1 μM) decreased MAP50, and SST (0.05 μM) enhanced the sympathovagal cardiac index. Both doses of SST increased HRV and its low-frequency component. Ang II (50 pmol) increased HRV and reduced the two unlike variations pattern of the symbolic analysis (P<0.05 in all cases). These results demonstrate neuropeptidergic actions in the MePD for both the increase in the range of the cardiovascular reflex responses and the involvement of the central sympathetic and parasympathetic systems on HRV and APV.

Neuropeptides in the posterodorsal medial amygdala modulate central cardiovascular reflex responses in awake male rats.

The rat posterodorsal medial amygdala (MePD) links emotionally charged sensory stimuli to social behavior, and is part of the supramedullary control of the cardiovascular system. We studied the effects of microinjections of neuroactive peptides markedly found in the MePD, namely oxytocin (OT, 10 ng and 25 pg; n=6/group), somatostatin (SST, 1 and 0.05 µM; n=8 and 5, respectively), and angiotensin II (Ang II, 50 pmol and 50 fmol; n=7/group), on basal cardiovascular activity and on baroreflex- and chemoreflex-mediated responses in awake adult male rats. Power spectral and symbolic analyses were applied to pulse interval and systolic arterial pressure series to identify centrally mediated sympathetic/parasympathetic components in the heart rate variability (HRV) and arterial pressure variability (APV). No microinjected substance affected basal parameters. On the other hand, compared with the control data (saline, 0.3 µL; n=7), OT (10 ng) decreased mean AP (MAP50) after baroreflex stimulation and increased both the mean AP response after chemoreflex activation and the high-frequency component of the HRV. OT (25 pg) increased overall HRV but did not affect any parameter of the symbolic analysis. SST (1 µM) decreased MAP50, and SST (0.05 µM) enhanced the sympathovagal cardiac index. Both doses of SST increased HRV and its low-frequency component. Ang II (50 pmol) increased HRV and reduced the two unlike variations pattern of the symbolic analysis (P<0.05 in all cases). These results demonstrate neuropeptidergic actions in the MePD for both the increase in the range of the cardiovascular reflex responses and the involvement of the central sympathetic and parasympathetic systems on HRV and APV.

Interleukin-10 and interferon-gamma patterns during tuberculosis treatment: possible association with recurrence.

Interleukin (IL) 10 and interferon-gamma (IFN-) levels in induced sputum supernatants of 21 tuberculosis (TB) patients at diagnosis and during chemotherapy were correlated to recurrence rates. IL-10 decreased until day 60 of treatment (T60), and between T60 and T180 it increased again in 7 cases (Pattern 1) and further decreased in 14 cases (Pattern 2). Follow-up of 69 months was performed in 20/21 cases; 6 had recurrence of TB, of which 5/7 (71%) had Pattern 1 and 1/13 (7.7%) Pattern 2 (OR 30.0, 95%CI 2.19411.3, P 0.0072). This was not observed for IFN-. High IL-10 levels at the end of treatment may function as a risk factor for TB recurrence.

Acciones tomadas durante El Morir en las UTI's del Cono Sur (Brasil, Argentina y Uruguay) / Actions taken during Dying in the UTIs of the Southern Cone (Brazil, Argentina and Uruguay)

La discusión respecto de la actitud con pacientes críticos terminales, está en aumento. Opciones sobre el límite de esfuerzo terapéutico (LET) han sido una creciente necesidad del intensivista. Objetivo. Diagnosticar y comparar las conductas tomadas durante el morir en las UTIs de los países del Cono Sur (Brasil, Argentina y Uruguay) Método. Corte transversal realizado por las AMIB, SATI y SUMI. Los miembros del grupo de estudio del final de la vida de ésas sociedades elaboraron un cuestionario donde constataban evaluaciones demográficas de los participantes y de las instituciones en que ellos trabajaban, así como las decisiones sobre el LET. El cuestionario fue respondido durante eventos científicos de UTI de los 3 países y vía on line, en un tiempo previamente estipulado. Participaron del estudio los miembros del equipo multiprofesional pertenecientes a las sociedades involucradas. Se compararon las respuestas obtenidas entre los miembros de las sociedades de los 3 países. Las variables fueron analizadas a través de los test de chi-cuadrado (χ2 ) ANOVA/Bonferroni. Se consideró significativo el valor de p <0,05. Resultados. En el estudio participaron 420 profesionales (217 de Brasil, 141 de Argentina y 62 de Uruguay). Se constata que el 29% se declara agnóstico,siendo la mayoría médicos. En Uruguay predominó el sexo masculino. En Brasil las UTI's tenían mas camas, fue mas excepcional las visitas irrestrictas, los profesionales eran mas jóvenes y hacía menos tiempo que trabajaban en las UTI's y había mas participación de personal no-médico. El número de visitas más frecuente en los tres países era de 3 por día. Los factores que más influyen en las decisiones de LET son: el pronóstico de la enfermedad, las comorbilidades y la futilidad terapéutica. Hubo diferencias significativas en las decisiones entre los 3 países, donde más del 90% ya había optado por LET. El equipo médico fue el principal responsable de las decisiones de LET, principalmente en Brasil y Argentina. Reanimación cardiorrespiratoria, administración de drogas vaso activas, métodos dialíticos y nutrición parenteral fueron las terapias más suspendidas/rechazadas en los 3 países, habiendo diferencias puntuales entre los mismos. Hubo una diferencia significativa respecto a la suspensión de la ventilación mecánica, más frecuente en Argentina, luego en Uruguay. Las terapias menos suspendidas entre los 3 países fueron la analgesia seguida de la sedación. Definiciones legales y éticas fueron señaladas como las principales barreras para la toma de decisiones. Conclusión. A pesar de que existan diferencias regionales y culturales entre los profesionales, el LET es común en los 3 países. Existe una tendencia de que sea más de forma pro-activa entre los argentinos y de que haya una mayor equidad en la distribución de las decisiones entre los uruguayos. Esta diferencia puede estar vinculada a la edad, experiencia, profesión y sexo de los participantes.(AR)

Low expression of antigen-presenting and costimulatory molecules by lung cells from tuberculosis patients

Costimulatory and antigen-presenting molecules are essential to the initiation of T cell immunity to mycobacteria. The present study analyzed by immunocytochemistry, using monoclonal antibodies and alkaline phosphatase-anti-alkaline phosphatase method, the frequency of costimulatory (CD86, CD40, CD40L, CD28, and CD152) and antigen-presenting (MHC class II and CD1) molecules expression on human lung cells recovered by sputum induction from tuberculosis (TB) patients (N = 22) and non-TB controls (N = 17). TB cases showed a statistically significant lower percentage of HLA-DR+ cells than control subjects (21.9 ± 4.2 vs 50.0 ± 7.2 percent, P < 0.001), even though similar proportions of TB cases (18/22) and control subjects (16/17, P = 0.36) had HLA-DR-positive-stained cells. In addition, fewer TB cases (10/22) compared to control subjects (16/17) possessed CD86-expressing cells (P = 0.04; OR: 0.05; 95 percentCI = 0.00-0.51), and TB cases expressed a lower percentage of CD86+ cells (P = 0.04). Moreover, TB patients with clinically limited disease (£1 lobe) on chest X-ray exhibited a lower percentage of CD86-bearing cells compared to patients with more extensive lung disease (>1 lobe) (P = 0.02). The lower expression by lung cells from TB patients of HLA-DR and CD86, molecules involved in antigen presentation and activation of T cells, may minimize T cell recognition of Mycobacterium tuberculosis, fostering an immune dysfunctional state and active TB.

Low expression of antigen-presenting and costimulatory molecules by lung cells from tuberculosis patients.

Costimulatory and antigen-presenting molecules are essential to the initiation of T cell immunity to mycobacteria. The present study analyzed by immunocytochemistry, using monoclonal antibodies and alkaline phosphatase-anti-alkaline phosphatase method, the frequency of costimulatory (CD86, CD40, CD40L, CD28, and CD152) and antigen-presenting (MHC class II and CD1) molecules expression on human lung cells recovered by sputum induction from tuberculosis (TB) patients (N = 22) and non-TB controls (N = 17). TB cases showed a statistically significant lower percentage of HLA-DR+ cells than control subjects (21.9 +/- 4.2 vs 50.0 +/- 7.2%, P < 0.001), even though similar proportions of TB cases (18/22) and control subjects (16/17, P = 0.36) had HLA-DR-positive-stained cells. In addition, fewer TB cases (10/22) compared to control subjects (16/17) possessed CD86-expressing cells (P = 0.04; OR: 0.05; 95%CI = 0.00-0.51), and TB cases expressed a lower percentage of CD86+ cells (P = 0.04). Moreover, TB patients with clinically limited disease ( pound1 lobe) on chest X-ray exhibited a lower percentage of CD86-bearing cells compared to patients with more extensive lung disease (>1 lobe) (P = 0.02). The lower expression by lung cells from TB patients of HLA-DR and CD86, molecules involved in antigen presentation and activation of T cells, may minimize T cell recognition of Mycobacterium tuberculosis, fostering an immune dysfunctional state and active TB.

Bronchial hyperresponsiveness and analysis of induced sputum cells in Crohn's disease.

With the aim of investigating the presence of latent inflammatory process in the lungs of patients with Crohn's disease, 15 patients with Crohn's disease were evaluated by spirometry, the methacholine challenge test, induced sputum, and skin tests for inhaled antigens. Serum IgE, erythrocyte sedimentation rate and hematocrit were also determined. The patients were compared with 20 healthy controls by the Mann-Whitney and Fisher exact tests. Their respiratory physical examination was normal. None had a personal or family history of clinical atopy. None had a previous history of pulmonary disease, smoking or toxic bronchopulmonary exposure. None had sinusitis, migraine, diabetes mellitus, or cardiac failure. Four (26.6%) of the patients with Crohn's disease had a positive methacholine challenge test whereas none of the 20 controls had a positive methacholine test (P = 0.026, Fisher exact test). Patients with Crohn's disease had a higher level of lymphocytes in induced sputum than controls (mean 14.59%, range 3.2-50 vs 5.46%, 0-26.92%, respectively; P = 0.011, Mann-Whitney test). Patients with Crohn's disease and a positive methacholine challenge test had an even higher percentage of lymphocytes in induced sputum compared with patients with Crohn's disease and a negative methacholine test (mean 24.88%, range 12.87-50 vs 10.48%, 3.2-21.69%; P = 0.047, Mann-Whitney test). The simultaneous findings of bronchopulmonary lymphocytosis and bronchial hyperresponsiveness in patients with Crohn's disease were not reported up to now. These results suggest that patients with Crohn's disease present a subclinical inflammatory process despite the absence of pulmonary symptoms.

Bronchial hyperresponsiveness and analysis of induced sputum cells in Crohn's disease

With the aim of investigating the presence of latent inflammatory process in the lungs of patients with Crohn's disease, 15 patients with Crohn's disease were evaluated by spirometry, the methacholine challenge test, induced sputum, and skin tests for inhaled antigens. Serum IgE, erythrocyte sedimentation rate and hematocrit were also determined. The patients were compared with 20 healthy controls by the Mann-Whitney and Fisher exact tests. Their respiratory physical examination was normal. None had a personal or family history of clinical atopy. None had a previous history of pulmonary disease, smoking or toxic bronchopulmonary exposure. None had sinusitis, migraine, diabetes mellitus, or cardiac failure. Four (26.6 percent) of the patients with Crohn's disease had a positive methacholine challenge test whereas none of the 20 controls had a positive methacholine test (P = 0.026, Fisher exact test). Patients with Crohn's disease had a higher level of lymphocytes in induced sputum than controls (mean 14.59 percent, range 3.2-50 vs 5.46 percent, 0-26.92 percent, respectively; P = 0.011, Mann-Whitney test). Patients with Crohn's disease and a positive methacholine challenge test had an even higher percentage of lymphocytes in induced sputum compared with patients with Crohn's disease and a negative methacholine test (mean 24.88 percent, range 12.87-50 vs 10.48 percent, 3.2-21.69 percent; P = 0.047, Mann-Whitney test). The simultaneous findings of bronchopulmonary lymphocytosis and bronchial hyperresponsiveness in patients with Crohn's disease were not reported up to now. These results suggest that patients with Crohn's disease present a subclinical inflammatory process despite the absence of pulmonary symptoms.

[Genetic changes in strains of poliovirus type 2 isolated from patients with vaccine-associated paralytic poliomyelitis]. / Cambios geneticos en cepas de poliovirus tipo 2 aisladas de pacientes con poliomielitis paralitica asociada a la vacuna.

INTRODUCTION: Poliomyelitis is currently a rare disease in developed countries, where only vaccinal strains seem to be in circulation, which replace wild poliovirus. Nevertheless, it is still a serious disease for children in underdeveloped countries of Asia and Africa. PATIENTS AND METHODS: We analysed nine strains of poliovirus type 2 isolated from the faecal matter of patients with vaccine associated paralytic poliomyelitis (VAPP), from the beginning of anti polio vaccination campaigns in our country. These strains were submitted to sequencing of a fragment of 114 base pairs from the 5 NTR (non traductional region), where one of the main determinants of attenuation/reversion to the neurovirulence of poliovirus lies in the position of nucleotide 481. RESULTS: In this position it was observed how guanine had been replaced by adenine in all the strains that were sequenced, so that it coincided with the homologous sequence of the wild strain, as well as with that of strains obtained from healthy children immunised with the live vaccine. This presupposes that other changes must occur or that other factors must be involved for VAPP to occur or not, and we therefore suggest the sequencing of other regions of the genome in search of other possible differential changes in nucleotides.

Modos de morrer na UTI pediátrica de um hospital terciário / Modes of death in PICU of a tertiary hospital

OBJETIVO: Determinar a prevalência dos diferentes modos de morrer e identificar limites terapêuticos em pacientes de uma Unidade de Tratamento Intensivo Pediátrica (UTIP) de hospital universitário. MÉTODOS: Estudo retrospectivo, baseado na revisäo de prontuários dos pacientes que morreram na UTIP do Hospital de Clínicas de Porto Alegre, no período de 1º julho de 1996 a 30 junho de 1997. Para modo de morrer, adotou-se critérios de: näo resposta às medidas de ressuscitaçäo cardiorrespiratória (NRRST), morte cerebral (MC), retirada/näo-adoçäo de medidas de suporte de vida (R/NASV) e decisäo de näo reanimar (DNR). Para causa de morte, adotou-se critério de falências de órgäos. RESULTADOS: Dos 61 óbitos ocorridos no período, entraram no estudo 44 pacientes, cuja mediana de idade foi 28 meses. Todos tiveram como causa de morte a falência de múltiplos órgäos. Vinte e seis pacientes (59 por cento) eram do grupo I (NRRST e MC), enquanto 18 (41 por cento) do grupo II (R/NASV e DNR). No grupo II, 83 por cento dos pacientes tinham doença crônica e/ou debilitante (p = 0,017; chi²). Os motivos de admissäo mais prevalentes foram necessidade de terapias de suporte (55 por cento), ventilatória e cardiocirculatória, sem diferença estatística entre os grupos. A mediana do tempo de permanência na UTI foi de 5 dias, e no hospital, de 11 dias, sem significância estatística entre os dois grupos. CONCLUSÖES: Observou-se alta prevalência de modos de morrer R/NASV e DNR nos pacientes de UTIP avaliados, sugerindo condutas de limitaçäo terapêutica para eles. Näo se conseguiu avaliar o nível de participaçäo da equipe e da família nesse processo de tomada de decisöes

Persistence of vaccine-derived poliovirus following a mass vaccination campaign in Cuba: implications for stopping polio vaccination after global eradication.

BACKGROUND: With substantial progress made toward polio eradication, developing the appropriate strategy for discontinuing global oral poliovirus vaccine (OPV) after global eradication becomes increasingly important. At issue is the theoretical risk of independent circulation of potentially virulent OPV-derived strains. Because Cuba uses OPV only in mass campaigns, it represents an ideal site to assess vaccine-derived poliovirus persistence. METHODS: Infants born after the 1997 biannual mass campaigns were evaluated for past (neutralizing antibody) or current (virus excretion) evidence of vaccine-derived poliovirus exposure. We obtained sera and/or stool specimens from 861 infants; a second serum from 218 infants. RESULTS: All stool specimens were poliovirus negative. Of 762 infants, 113 (14.8%) had initially detectable poliovirus type 1 antibody, 193 (25.3%) type 2, and 94 (12.3%) type 3. A precipitous antibody decline occurred in initially positive sera. CONCLUSIONS: Our results suggest that in a country with high population immunity, vaccine-derived virus is unlikely to establish ongoing circulation.

Mechanism of enterovirus involvement in epidemic neuropathy: hypothesis regarding pathophysiology.

During the epidemic of optic and peripheral neuropathy which occurred in Cuba in 1992-1993, viruses antigenically related to the Coxsackie viruses were isolated from cerebrospinal fluid of patients. Concurrently with the virologic studies, epidemiologic, toxicologic, nutritional, immunologic, and histopathologic investigations were also carried out. Although it was demonstrated that the illness was associated with toxic and nutritional risk factors, it has not been possible to identify a specific etiology for the symptoms observed. Taking into consideration the results obtained in all of the various investigations, we have formulated an integral, multifactorial hypothesis which attempts to explain a pathophysiologic mechanism by which the viruses isolated could participate in the pathogenesis of the illness. We propose that the viral agents produce a persistent infection, and the possibility that they may act as mediator of an autoimmune pathogenic process.

[Modes of death in the PICU of a tertiary care hospital]. / Modos de morrer na UTI pediátrica de um hospital terciário.

BACKGROUND: To determine the prevalence of different modes of death and to identify therapeutic limitations in patients admitted to the Pediatric Intensive Care Unit (PICU) at a teaching hospital. METHODS: A retrospective study was carried out. Information was collected from the medical records of patients who died at the PICU of Hospital de Clínicas de Porto Alegre between July 1st, 1996 and June 30th, 1997. Four modes of death were considered: patient not responding to cardiopulmonary resuscitation methods (NRCPR), brain death (BD), withdrawal / withhold life-support measures (W/WLS) and decision not to resuscitate (DNR). For cause of death we employed the criterion of organ failure. RESULTS: Out of 61 deaths occurred during the period under analysis, 44 patients were included in the study. Patient age median was 28 months. The cause of death for all patients was multiple organ failure. Twenty-six patients (59%) were classified in group I (NRCPR and BD) and 18 (41%) in group II (W/WLS and DNR). Among patients of group II, 83% had a chronic and/or debilitating disease (p = 0.017; chi(2)). The prevalent reason for patient admission was the need for organ support (55%), both respiratory and cardiovascular. The median for duration of patient stay at the PICU was 5 days and at the hospital was 11 days. There was no statistically significant difference between the two groups in terms of reason for patient admission or duration of PICU/hospital stay. CONCLUSIONS: There was a high prevalence of W/WLS and DNR deaths among ICU patients, thus suggesting therapeutic limitation for them. We were unable to evaluate the level of participation by the medical team and by the family in this decision making process.

[Rapid detection of Enterovirus by a direct method of polymerase chain reaction]. / Detección rápida de Enterovirus mediante un método directo de reacción en cadena de la polimerasa.

For the detection of Enterovirus, we devised a direct economical method of polymerase chain reaction which does not require a previous extraction of ribonucleic acid and uses infected cell culture supernatants. The system was developed on the basis of universal primers of Enterovirus and specific primers of vaccinal strain Sabin 1. The achieved results proved that the non-existence of methods of RNA extraction and purification prior to the reaction does not affect the susceptibility and specificity of the system, in the rapid detection of Enterovirus genomes and identification of vaccinal strains of poliovirus.

Eradication of poliomyelitis in Cuba: a historical perspective.

The eradication of poliomyelitis in Cuba, for which effective vaccines had to be acquired, is reviewed in this article. The strategy for eradication was based on mass immunization campaigns for the annual delivery of two doses of trivalent Sabin oral poliovirus vaccine (OPV). Except during the first campaign in 1962, the ages of the children for immunization were determined through national serological surveys of the entire country, including rural and urban areas. The interruption of wild virus transmission had been suspected since 1967 in Cuba, and since 1970 no studies have detected any wild virus. The important role of political and social organizations in the success of the programme and in the execution of the mass immunization campaigns is underscored. Countries that have successfully interrupted poliovirus circulation should maintain high immunization coverage for as long as there are other countries in the world where poliovirus still exists.

[Evaluation of a new technology for the detection of enterovirus in sewage]. / Valoración de una novedosa tecnología para la detección de enterovirus en aguas negras.

This paper reported the appraisal of a novel technology for the detection of enterovirus in sewage based on a viral recovery method using polyethylenglycol as a concentrating agent and on the combined use of viral isolation and polymerase chain reaction as viral detection and identification techniques. It was also confirmed that the viral recovery method is highly efficient since it allows to recover all viruses present in sewage and to preserve their infective capacity. It was proved that the polymerase chain reaction (PCR) is less sensitive than cell culture for detecting enteroviruses in sewage. It is also possible to use guadinine isothiocyanate, whose components can be prepared in the lab, as an alternative method for taking out and purifying nucleic acids instead of using the conventional TRIZOL method which is the one recommended in these cases by the World Health Organization.