Prospective, comprehensive, and effective viral monitoring in Cuban children undergoing solid organ transplantation.

PURPOSE: In Cuba, viral monitoring in the post-transplant period was not routinely performed. The aim of this research is to identify the most frequent viruses that affect transplanted Cuban children, by implementing a viral follow-up during the post-transplant period. METHODS: The study population included all Cuban pediatric patients who underwent solid organ transplantation (SOT) between November 2009 and December 2012. A total of 34 transplanted pediatric patients of kidney (n = 11) and liver (n = 23) were prospectively monitored during a 34-week period for viral DNAemia and DNAuria by simultaneous detection of cytomegalovirus (CMV), Epstein-Barr virus, herpes simplex virus type 1 and 2, varicella zoster virus, human herpesvirus 6, human adenovirus, and polyomaviruses (BKV and JCV) using quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: Viral genome of at least one virus was detected in 21 of 34 recipients, 18 patients excreted virus in urine while 12 presented DNAemia. CMV (41.2%) and BKV (35.3%) were the most frequent viruses detected during the follow-up. CMV was the virus mainly associated with clinical symptoms and DNAemia. Its excretion in urine (with cut off value of 219 copies/mL) was associated with detection in plasma (p < 0.001); furthermore, CMV viruria was predictive of CMV viremia (OR:8.4, CI:2.4-29.1, p = 0.001). There was no association between high viral load and clinical complications, due to the prompt initiation of preemptive ganciclovir. CONCLUSION: This comprehensive viral monitoring program effectively prevents the development of critical viral disease, thus urge the implementation of qRT-PCR as routine for viral monitoring of transplanted Cuban organ recipients.

Assessment of infection with polyomaviruses BKV, JCV and SV40 in different groups of Cuban individuals.

We investigated the frequency of BKV, JCV and SV40 reactivation in three groups of Cuban patients by multiplex nested PCR assay of 40 paraffin-embedded colorectal neoplasm tissues, 113 urine samples, and 125 plasma samples from 27 transplant recipients, and cerebrospinal fluid (CSF) from 67 HIV-1-infected individuals with central nervous system (CNS) disorders. None of these polyomaviruses were detected in colorectal neoplasms. JCV DNA was detected in 2 of 67 patients (2.9%) with CNS disorders, but neither BKV nor SV40 was identified. BKV was found in urine from 38.5% and 28.6% of adult and pediatric transplant recipients, respectively. In adult renal transplant recipients, excretion of BKV in urine was significantly associated with episodes of acute rejection (p=0.012) and with excretion of HCMV in urine (p= 0.008). In Cuba, the polyomaviruses studied here could not be related to colorectal neoplasms, and JCV was rarely detected in CSFs of HIV-1-infected individuals, whilst BKV reactivation was found to occur frequently in organ transplant recipients.

Metodología para la evaluación de la calidad en instituciones de atención primaria de salud / Methodology for the assessement of quality in primary health care institutions

Se propone una metodología que permite evaluar la calidad, utilización para ello la selección de actividades y/o problemas de salud que puedan ser consederados como "trazadores" para el proceso y métodos participativos para la selección de criterios, indicadores y estándares a utilizar en la evaluación, en los que interviene el propio personal de la institución objeto de la misma, y se refieren no sólo a los resultados de la atención, sino también a la estructura y el proceso. Se incluye la opinión de los usuarios del servicio. La aplicación de esta metodología permite un mayor compromiso de los proveedores de los servicios con los resultados del proceso y con las medidas correctoras que de él se deriven, por lo que se hacen más factibles las soluciones a los problemas que se detecten. Se demuestra cómo su aplicación práctica en una institución de atención primaria de salud, permitió conocer la calidad de la atención a pacientes hipertensos, mediante la evaluación de 2 importantes dimensiones de la calidad: calidad cientificotécnica de la atención y satisfactión del usuario. Se utiliza esta metodología también para la evaluación de la calidad de la atención a la madre y al niño y se diseña un proyecto para la evaluación de la calidad de los servicios de Higiene y Epidemiología de un sistema local de salud (AU)