Defining a standard set of health outcomes for patients with relapsing-remitting multiple sclerosis.

BACKGROUND: Standardizing health outcomes is challenging in clinical management, but it also holds the potential for creating a healthcare system that is both more effective and efficient. The aim of the present study is to define a standardized set of health outcomes for managing Relapsing-Remitting Multiple Sclerosis (RRMS). METHODS: The project was led and coordinated by a multidisciplinary scientific committee (SC), which included a literature review, a patient-focused group, three nominal group meetings, and two SC meetings. RESULTS: 36 outcome variables were included in the standard set: 24 clinical (including weight, smoking habit, comorbidities, disability, mobility, diagnosis of secondary progressive multiple sclerosis, relapsed-related variables, radiological variables, cognitive status and disease-related symptoms), nine treatment-related (pharmacological and non-pharmacological information), and 3 related to the impact of RRMS on the patient's life (quality of life, pregnancy desire, work-related difficulties). In addition, experts also agreed to collect 10 case-mix variables that may affect but cannot be controlled as part of the management of the condition: 4 sociodemographic (age, sex, race, and employment status) and 6 clinical (height, date of diagnosis and first episode, serological status, early symptoms, and number of relapses pre-diagnosis). CONCLUSION: The information provided through the present standard set of outcome variables can improve the management of RRMS and promote patient-centred quality care.

The Perspective of Patients and Health Professionals on the Prioritization of Assisted Reproductive Techniques. The PRIOFER Study.

Purpose: To determine the perspective of patients and professionals in Assisted Reproduction Units (ARU) on the importance of assisted reproductive techniques (ART) compared to other elective procedures, to highlight the relevance of ART as an elective procedure and the impact of delayed interventions on patients. Design Patients and Methods: An observational, descriptive, cross-sectional, online survey-based study was conducted in infertility patients and partners (n=98) and ARU healthcare professionals (n=83). The survey included a best-worst scaling (BWS) experiment and an ad-hoc questionnaire to analyze the pandemic impact on ART management and infertility patients in Spain. In the BWS, each respondent established priorities choosing which patient profile should be rated as the highest and lowest priority profile on a waiting list. To understand the importance that they give to assisted reproduction compared to other procedures, three very common elective procedures involving different patient profiles were selected: cataract surgery, knee arthroplasty, and varicose vein surgery. For each procedure, three hypothetical patient profiles corresponding to three different degrees of severity on a waiting list were designed. Results: Patients attributed greater importance to ART profiles (BWS score: patients 0.14 vs professionals -0.05; p<0.01) whereas professionals prioritized cataract surgery (patients 0.06 vs professionals 0.23; p<0.01). Concerning the profile severity, more severe profiles were prioritized in all procedures by both groups. Patients' and professionals' perspectives on the impact of the pandemic were similar, with exceptions: information received for resuming ART; health care provision in crisis situations; and reduction of parenting options. The pandemic affected patients' ability to conceive a child (70.4% of those surveyed), their psychological well-being (75.5%), and partner, social, and work relationships (69.4%). Conclusion: Preference studies involving patients and professionals can provide important information to define framework criteria for the management of waiting lists for elective procedures, and to prioritize interventions during pandemic periods. The pandemic impact on infertility patients highlights the relevance of developing measures and strategies to cope with similar future situations in the most appropriate way.

Cancer-Related Pain Management in Suitable Intrathecal Therapy Candidates: A Spanish Multidisciplinary Expert Consensus.

A consensus is needed among healthcare professionals involved in easing oncological pain in patients who are suitable candidates for intrathecal therapy. A Delphi consultation was conducted, guided by a multidisciplinary scientific committee. The 18-item study questionnaire was designed based on a literature review together with a discussion group. The first-round questionnaire assessed experts' opinion of the current general practice, as well as their recommendation and treatment feasibility in the near future (2-3-year period) using a 9-point Likert scale. Items for which consensus was not achieved were included in a second round. Consensus was defined as ≥75% agreement (1-3 or 7-9). A total of 67 panelists (response rate: 63.2%) and 62 (92.5%) answered the first and second Delphi rounds, respectively. The participants were healthcare professionals from multiple medical disciplines who had an average of 17.6 (7.8) years of professional experience. A consensus was achieved on the recommendations (100%). The actions considered feasible to implement in the short term included effective multidisciplinary coordination, improvement in communication among the parties, and an assessment of patient satisfaction. Efforts should focus on overcoming the barriers identified, eventually leading to the provision of more comprehensive care and consideration of the patient's perspective.

Nutritional management of cancer patients in clinical practice in Spain: patients' and multidisciplinary health care professionals' perceptions.

BACKGROUND/OBJECTIVES: Malnutrition is a prevalent problem in patients with cancer and is associated with poor prognosis. The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends the provision of nutritional support and evaluation. This study aims to describe the nutritional management of patients with cancer, including assessment of adherence, from the perspective of both patients and healthcare professionals (HCPs). SUBJECTS/METHODS: A cross-sectional descriptive observational study was carried out through two surveys addressed to patients and HCPs. RESULTS: A total of 230 cancer patients and 461 HCPs completed the questionnaire. The survey found 55.0% of patients experienced eating problems during treatment and 64.0% reported sequelae affecting nourishment. However, 60.1% of patients and 42.6% of HCPs indicated that nutritional status is not generally assessed. While 86.6% of HCPs stated that nutritional information is provided to patients, only 33.5% of patients reported having received it. Regarding nutritional adherence, 87.4% of HCPs stated that it is assessed whereas only 49.2% of patients receiving nutritional supplements confirmed this. General discomfort or gastrointestinal problems were the main issues hampering correct adherence perceived by both patients (41.8%) and HCPs (95.4%). CONCLUSIONS: Our study demonstrate that different perceptions exist between patients and HCPs about nutritional management in cancer and suggests that in Spain nutritional approach is suboptimal in terms of screening/assessment of malnutrition, nutritional information provided to the patient, nutritional intervention and assessment of adherence to nutritional support. Therefore, measure should be taken to foster the adoption of ESPEN recommendations in clinical practice and to promote nutritional education of HCPs.

Defining a Standard Set of Patient-Reported Outcomes for Patients With Advanced Ovarian Cancer.

Purpose: Advanced ovarian cancer (AOC) and its treatment cause several symptoms and impact on patients' health-related quality of life (HRQoL). We aim to reach a consensus on the most relevant patient-reported outcome (PROs), the corresponding measures (PROMs), and measurement frequency during AOC patients' follow-up from patients' and healthcare professionals' (HCP) perspective. Methods: The project comprised five steps: 1) a literature review, 2) a focus group with patients, 3) a nominal group with HCP, 4) two round-Delphi consultations with patients and HCP, and 5) a final meeting with HCP. Delphi questionnaire was elaborated based on literature review, focus group (n=5 patients), and nominal group (n=16 HCP). The relevance of each PRO and the appropriateness (A) and feasibility (F) of the proposed PROM were assessed (Likert scale 1=strongly agree; 9=strongly disagree). The consensus was reached when at least 75% of the panelists rated it as 'relevant', 'appropriate', or 'feasible' (score 7-9). Results: A total of 56 HCP [51.8% Hospital Pharmacy; 41.1% Oncology; 3.6% Nursing; and 3.6% Psycho-oncology; mean time in specialty 12.5 (8.0) years] and 10 AOC patients [mean time diagnosis 5.4 (3.0) years] participated in the 1st round. All PROs achieved consensus regarding their relevance, except dry skin (58.0%). Agreement was reached for PRO-CTCAE to be used to assess fatigue (A:84.9%; F:75.8%), neuropathy (A:92.4%; F:77.3%), diarrhea (A:87.9%; F:88.7%), constipation (A:86.4%; F:75.8%), nausea (A:89.4%; F:75.8%), insomnia (A:81.8%; F:88.7%), abdominal bloating (A:82.2%; F:82.2%) and sexuality (A:78.8%; F:88.6%); EQ-5D to determine patients' HRQoL (A:87.9%; F:80.3%), pain (A:87.9%; F:75.8%) and mood (A:77.7%; F:85.5%); to assess treatment adherence the Morisky-Green (A:90.9%; F:84.9%) and the dispensing register (A:80.3%; F:80.3%) were chosen. It was agreed to note in the medical record whether the patient's treatment preferences had been considered during decision-making (A:78.8%; F:78.8%) and to use a 5-point Likert scale to assess treatment satisfaction (A:86.4%; F:86.4%). Panelists agreed (A:92.4%; F: 77.3%) to collect these PROs (1) at the time of diagnosis/relapse; (2) one month after starting treatment/change therapeutic strategy; (3) every three months during the 1st-year of treatment; and later (4) every six months until treatment completion/change. Conclusions: The consensus reached represents the first step towards including the patient's perspective in AOC follow-up. The standardized collection of PROs in clinical practice may contribute to optimizing the follow-up of these patients and thus improving the quality of care.

Patient and retina specialists' preferences in neovascular age-related macular degeneration treatment. A discrete choice experiment.

INTRODUCTION AND OBJECTIVE: Neovascular age-related macular degeneration (nAMD) leads to severe and permanent visual impairment, significantly impacting patients' quality of life and functional independence. Although treatment with anti- vascular endothelial growth factor (VEGF) prevents and, in some cases, reverses visual damage, the need for frequent monitoring visits and intravitreal injections represents a significant burden on patients, caregivers and retina specialists. OBJECTIVE: To elicit preferences for nAMD treatment characteristics from the perspectives of patients and retina specialists. METHOD: A discrete choice experiment was conducted. Participants (patients > 50 years with nAMD receiving anti-VEGF drugs for at least 2 years and without previous experience with anti-VEGF and retina specialists working in the Spanish National Healthcare System) were asked to select one of two hypothetical treatments resulting from the combination of five attributes (effects on visual function, effects on retinal fluid, treatment regimen, monitoring frequency, and cost); their levels were identified by reviewing the literature and two focus groups. The relative importance (RI) given to each attribute was estimated using a mixed logit model. The marginal rates of substitution (MRS) were calculated taking cost as the risk attribute. RESULTS: A total of 110 patients (P) [aged 79.0 (SD:7.4) years; 57.3% women; 2.3 (SD:0.7) years with nAMD; 2.1 years (SD:0.1) in treatment] and 66 retina specialists (RS) participated in the study. Participants gave greater RI to improvements in their visual function [60.0% (P); 52.7% (RS)], lower monitoring frequency [20.2% (P); 27.1% (RS)] and reduction in retinal fluid [9.8% (P); 13.0%(RS)]. Patients and retina specialists would agree to an increase in cost by 65.0% and 56.5%, respectively, in exchange for improvements of visual function; and 25.5% and 43.3% on delaying monitoring frequency by one month. CONCLUSIONS: Efficacy of treatment, in terms of visual function improvements, is the main driver for treatment election for both patients and retina specialists. Treatment monitoring requirements are also considered, mainly from the retina specialist's perspective. These results suggest that the use of more efficacious anti-VEGF agents with a longer duration of action may contribute to aligning treatment characteristics with patients/specialists' preferences. A better alignment would facilitate better disease management, fulfilling the unmet needs of patients and retina specialists.

Additional Value of Patient-Reported Symptom Monitoring in Cancer Care: A Systematic Review of the Literature.

BACKGROUND: To describe the benefit of patient-reported symptom monitoring on clinical, other patient-reported, and economic outcomes. METHODS: We conducted a systematic literature review using Medline/PubMed, limited to original articles published between 2011 and 2021 in English and Spanish, and focused on the benefit of patient-reported symptom monitoring on cancer patients. RESULTS: We identified 16 reports that deal with the benefit of patient-reported symptom monitoring (collected mostly electronically) on different outcomes. Five studies showed that patient-reported symptom surveillance led to significantly improved survival compared with usual care-mainly through better symptom control, early detection of tumor recurrence, and extended chemotherapy use. Additionally, three evaluations demonstrated an improvement in Health-Related Quality of Life (HRQoL) associated with this monitoring strategy, specifically by reducing symptom severity. Additionally, six studies observed that this monitoring approach prevented unplanned emergency room visits and hospital readmissions, leading to a substantial decrease in healthcare usage. CONCLUSIONS: There is consistent evidence across the studies that patient-reported symptom monitoring might entail a substantial survival benefit for cancer patients, better HRQoL, and a considerable decrease in healthcare usage. Nonetheless, more studies should be conducted to demonstrate their effectiveness in addition to their cost-effectiveness in clinical practice.

Defining a Standard Set of Health Outcomes for Patients With Squamous Cell Carcinoma of the Head and Neck in Spain.

PURPOSE: A systematic, standardized collection of health outcomes during patient treatment and follow-up, relevant from the perspective of all stakeholders, is a crucial step toward effective and efficient disease management. This project aimed to define a standard set of health outcomes for patients with squamous cell carcinoma of the head and neck (SCCHN). METHODS: The project was led and coordinated by a scientific committee (SC). It comprised: (1) a literature review (to identify variables used during SCCHN management); (2) 1st-SC meeting (to select the variables for presentation during nominal groups-NG); (3) five NG (n=42 experts) and four interviews with patients (to reach consensus on the variables for inclusion); and (4) final-SC meeting (to review the results of NG ensuring consensus on the variables where consensus was not reached). RESULTS: Experts agreed to include the following variables in the standard set: treatment-related (treatment intent and type, response to treatment, treatment toxicity/complication, treatment completion), degree of health (performance status, patient-reported health status, pain, dysphonia, feeding and speech limitations, body image alteration, tracheotomy), survival (overall and progression-free survival, cause of death), nutritional (weight, nutritional intervention), other variables (smoking status, alcohol consumption, patient satisfaction with aftermath care, employment status), and case-mix variables (demographic, tumor-related, clinical and nutritional factors). CONCLUSIONS: This project may pave the way to standardizing the collection of health outcomes in SCCHN and promote the incorporation of patients' perspective in its management. The information provided through the systematic compilation of this standard set may define strategies to achieve high-quality, patient-centered care.

Standardizing Health Outcomes for Lung Cancer. Adaptation of the International Consortium for Health Outcomes Measurement Set to the Spanish Setting.

Purpose: Lung cancer (LC) and its treatment impose a significant burden on patients' life. However, patient-centered outcomes are rarely collected during patient follow-up. Filling this gap, the International Consortium for Health Outcomes Measurement (ICHOM) developed a standard set of variables for newly diagnosed LC patients. In order to facilitate the use of this standard set, the project aims to adapt it to the Spanish setting. Methods: The variables (instrument and periodicity) to be included in Spanish standard set were selected through consensus during 4 nominal groups (13 oncologists, 14 hospital pharmacists, 4 hospital managers and 3 LC patients), under the supervision of a Scientific Committee (1 oncologist, 3 hospital pharmacists, 2 LC patients advocates). Results: The variables agreed upon included: (1) case-mix: demographic [age, sex, education and social-family support], clinical [weight loss, smoking status, comorbidities (Charlson index), pulmonary function (FEV-1)], tumor [histology, clinical, and pathological stage (TNM), EGFR, ALK, ROS-1, PD-L1] and treatment factors [intent and completion] and (2) outcomes: degree of health [performance status (ECOG) and quality-of-life (EQ-5D, LCSS)], survival [overall survival and cause of death], quality of death [place of death, end-of-life care and palliative care, death aligned with living will], treatment complications, and others [date of diagnosis and treatment initiation, productivity loss (sick leave)]. Conclusion: The adaptation of ICHOM standard set to the Spanish setting pave the way to standardize the collection of variables in LC.

Should clinically meaningful outcomes in cancer be based on individual survival rather than median overall survival?

AIM: To assess whether the use of median overall survival to define clinically meaningful outcomes in the area of oncology could yield different decisions compared with those obtained with a more realistic measure such as individual survival. METHODS: Two scenarios that offered equivalent health gains/money spent were presented: 'median overall survival' scenario (new treatment provided small clinical benefits for the average population) and 'individual survival'scenario (new treatment provided substantial clinical benefits for a small percentage of the patients and no benefits for the rest). Responses from both scenarios were compared. RESULTS: Responses between the two scenarios were different for oncologists, healthcare policy makers and patients (p < 0.05). 'Individual survival' scenario obtained higher percentage of positive answers compared with 'median overall survival'. CONCLUSION: Expressing the benefits of new oncologic treatments in terms of 'individual survival' may yield to different healthcare decisions compared with the widely used median overall survival.

Perceptions of Oncologists, Healthcare Policy Makers, Patients and the General Population on the Value of Pharmaceutical Treatments in Oncology.

INTRODUCTION: The purpose of this study was to explore the main factors explaining the relative weight of the different attributes that determine the value of oncologic treatments from the different perspectives of healthcare policy makers (HCPM), oncologists, patients and the general population in Spain. METHODS: Structured interviews were conducted to assess: (1) the importance of the attributes on treatment choice when comparing a new cancer drug with a standard cancer treatment; (2) the importance of survival, quality of life (QoL), costs and innovation in cancer; and (3) the most worrying side effects related to cancer drugs. RESULTS: A total of 188 individuals participated in the study. For all participants, when choosing treatments, the best rated characteristics were greater efficacy, greater safety, treatment adaptation to patients' individual requirements and the rapid reincorporation of patients to their daily activities. There were important differences among participants in their opinion about survival, QoL and cost. In general, oncologists, patients, and the general population gave greater value to gains in QoL than healthcare policy makers. Compared to other participants healthcare policy makers gave greater importance to the economic impact related to oncology treatments. CONCLUSIONS: Gains in QoL, survival, safety, cost and innovation are perceived differently by different groups of stakeholders. It is recommended to consider the perspective of different stakeholders in the assessment of a new cancer drugs to obtain more informed decisions when deciding on the most appropriate treatment to use. FUNDING: Eli Lilly & Co, Madrid (Spain).

Diarrea por rotavirus y lactancia materna: estudio de 66 pacientes / Diarrhea by rotaviruses and maternal lactation: study of 66 patients

Mundialmente es conocida la protección que ejerce la leche materna contra las enfermedades bacterianas y virales del lactante. Basado en estos elementos se procedió a estudiar 66 pacientes con diarreas por Rotavirus, cuyo diagnóstico fue realizado por el método de Contrainmunoelectroforesis en gel de Agarosa, con la finalidad de ver el comportamiento de la lactancia materna en lactantes con diarreas. Primeramente se comprobó que el 71,2% de las madres de estos niños eran trabajadoras manuales e intelectuales; el 54,5% de las madres eran menores de 25 años; el 59,1% de los pacientes recibió lactancia materna dentro de las primeras 12 horas de su nacimiento en la Maternidad. La duración de la lactancia se comportó de la siguiente manera: 10,6% lactó al niño durante 15 días; 42,4% lo hizo hasta cumplir un mes; 19,7% le dio el pecho hasta los 2 meses y sólo un 3,0% alcanzó 6 meses de lactancia materna. El 27,3% de los pacientes con Rotavirus recibía más de un litro de leche de vaca diario, lo cual incrementaba aún más la sintomatología. En relación con la causa de suspensión de la lactancia materna, el 39,4% de las madres de niños con diarrea por Rotavirus contestó que no tenían leche; un 16,7% señaló que el niño rechazaba el pecho; el 19,1% la achacaron a enfermedad de la madre o del niño y el 6,1% suspendió la lactancia materna por prescripción facultativa. Al final hacen algunas consideraçöes acerca de la lactancia materna en la protección contra los Rotavirus

Enfermedad diarreica aguda por rotavirus: estudio de 66 pacientes / Acute diarrheic disease by rotavirus: study of 66 patients

Se estudiaron 176 pacientes con enfermedad diarreica aguda, de los cuales 66 fueron egresados con el diagnóstico cusal de rotavirus, lo cual representó una positividad del 37,5 %. El diagnóstico de rotavirus se realizó por el método de contrainmunoelectroforesis en placa de agarosa. De los casos positivos, el 7 % procedía del área urbana; el 86,4 % era menor de 1 año de edad, en el 72,7 % la madre tenía un nivel de escolaridad de secundaria y preuniversitario; en el 54,5 % la madre tenía menos de 25 años de edad; el 87,9 % vivía en casa o apartamento con condiciones adecuadas de higiene; el 92,4 % recibía agua del acueducto por tuberías; el 92 % tenía servicios sanitarios en el interior de la casa; el 21,2 % mantenía animales en el domicilio; el 33,3 % se encontraba en instituciones infantiles; el 57,6 % nació con un peso superior a los 3 000 g y el 13,5 % presentó menos de 2 500 g; el 83,3 % nació con 37 semanas o más de embarazo; el 45,5 % de los pacientes presentó de 1 a 3 episodios de diarrea antes de su ingreso; y el 60,6 % presentó su primer episodio de diarrea antes de cumplir 3 meses de edad; el 59,1 % nunca antes había ingresado por dirreas. El 53,1 % de los pacientes tuvo como motivo de ingreso la diarrea aislada, el 16,7 % ingresó por diarreas y vómitos y el 12,1 % por diarreas, vómitos y fiebre; los vómitos aislados y las manifestaciones respiratorias spolo en el 3,0 % cada uno. El 74,2 % presentó diarreas de menos de 6 días de duración antes del ingreso y el 94 % de los pacientes presentó una diarrea líquida o semilíquida. En ninguno de los pacientes se detectó sangre en las depósiciones

Diagnóstico por microscopia electrónica y prueba de latex de la enfermedad diarreica aguda por rotavirus / Diagnosis by electronic microscope and latex test of acute diarrheic disease due to rotavirus

Durante el periodo de cotubre a diciembre de 1986 se procedió a realizar estudios virológicos por microscopia electrónica y con látex (ROLATEX) a 64 pacientes ingresados en el Servicio de Enfermedades Diarréicas Agudas del Hospital Pediátrico Docente de Centro Habana. Se procedió a recoger las heces de los pacientes y un número de ellas (37) se envió al Centro de Investigaciones Biológicas (CIB) para su estudio por microscopia y 27 se procesaron en el Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM); se utilizó TOTALEX de la firma Orion de Finlandia. Los resultados encontrados fueron los siguientes: el 48,6% de las muestras de heces examinadas por microscopia electrónica y el 52,0% de las que fueron estudiadas con ROLATEX fueron positivas a rotavirus. Hubo 4 muestras repetidas que se estudiaron por ambos métodos, y se encontró el 50,0% de positividad. El 56,2% de los pacientes con diarreas por rotavirus presentó infecciones mixtas asociadas con bacterias y parásitos; el 25,0% se asoció con Giardia lamblia y el 12,5% se asoció con varios serotipos de E. Coli enteropatógena. Todos los pacientes estudiados procedian de los distintos municipios de Ciudad de La Habana. El 52,2% de los pacientes era menor de 7 meses y de éstos, el 25,0% era menor de 3 meses. El 62,5% correspondía al sexo masculino. El 18,8% de los padres de los pacientes era menor de 20 años y el 93,8% de ellos tenía un nivel educacional por encima del noveno grado. La diarrea se presentó en el 100% de los pacientes positivos a rotavirus, como único síntoma en el 37,5%; y asociada con vómitos y fiebre en el 31,2% . Se destaca la alta positividad de los rotavirus como agente causal de diarrea, lo cual debe ser un elemento que oriente al pediatra para no prescribir antimicrobianos en el tratamiento de las diarreas, hasta no demostrar la presencia de otro tipo de infección en el paciente

Diarrea por rotavirus y lactancia materna / Diarrhea by rotavirus and maternal breast feeding

Se estudian 66 pacientes con diarreas por rotavirus, cuyo diagnóstico fue realizado por el método de contrainmunoelectróforesis en gel de agarosa, con la finalidad de observar el comportamiento de la lactancia materna en lactantes con diarreas. Se comprobó que el 71,2% de las madres de estos niños eran trabajadores manuales e intelectuales; el 54,5% de las madres eran menores de 25 años; el 59,1% de los pacientes recibió lactancia materna dentro de las primeras 12 horas de su nacimiento en el hospital ginecobstétrico. La duración de la lactancia materna se comprobó de la siguiente manera: el 10,6% lactó al niño durante 15 días; el 42,4% lo hizo hasta cumplir 1 mes; el 19,7% le dio el pecho hasta los 2 meses y sólo el 3,0% alcanzó 6 meses de lactancia materna. El 27,3% de los pacientes con rotavirus recibía de 1 litro de leche de vaca diario,lo cual incrementaba aún más la sintomatología. En relación con la causa de suspensión de lactancia materna, el 39,4% de las madres de niños con diarreas por rotavirus contestó que no tenía leche; el 16,7% señaló que el niño rechazaba el pecho; el 9,1% lo adjudicó a alguna enfermedad de la madre o del niño y el 6,1% suspendió la lactancia materna por prescripción facultativa. Se hacen algunas consideraciones acerca de la lactancia materna en la protección contra los rotavirus

Enfermedad diarreica aguda por rotavirus: diagnóstico por microscopia electronica y prueba de Latex / Acute diarrheic disease by rotaviruses: diagnosis by electronic microscopy and latex test

Durante el período de octubre a diciembre de 1986 se procedió a realizar estudios virológicos por microscopía electrónica y con latex (ROTALEX) a 64 pacientes ingresados en el Servicio de enfermedades Diarreicas Agudas del Hospital Pediátrico docente de Centro Habana. Se procedió a recoger las heces de los pacientes y un número de ellas se enviaron al Centro de Investigaciones Biológicas (CIB) para su estudio por microscopía electrónica y 27 se procesaron en el Instituto Nacional de Higiene, Epidemiología y Microbiologia (INHEM), utilizando ROTALEX de la ORION de Finlandia. Los resultados encontrados fueron los siguientes: el 48,6% de las muestras de heces examinadas por microscopía electrónica y el 52,0% de los que fueron estudiados con ROTALEX fueron positivas a Rotavirus. Hubo 4 muestras repetidas que se estudiaron por ambos métodos, encontrando un 20,0% de postividad. El 56,2% de los pacientes con diarreas por Rotavirus presentaron infecciones mixtas asociadas a bacterias y parásitos; el 25,0% se asoció a Giardia Lamblia y el 12,5% se asoció a varios serotipos de E. Coli enteropatógena. Todos los pacientes estudiados procedían de los distintos municipios de la ciudad de La Habana. El 56,2% de los pacientes eran menores de 7 meses y de estos el 25,0% eran menores de 3 meses. El 62,5% correspondian al sexo masculino. El 18,8% de los padres de los pacientes eran menores de 20 años y el 193,8% de ellos tenían un nivel educacional por encima del 9 no. grado. La diarrea se presentó en el 100% de los pacientes positivos a Rotavirus, como único síntoma en el 37,5%; y asociada a vómitos y fiebre en el 31,2%. Se destaca la alta positividad de los Rotavirus como agente causal de diarrea, lo cual debe ser un elemento que oriente al pediatra para no prescribir antimicrobianos en el tratamiento de las diarreas, hasta no demostrar la presencia de otro tipo de infección en el paciente