Caracterización de las complicaciones de los pacientes diagnosticados con cólera en el Hospital Pediátrico de Centro Habana, 2013-2017 / Characterization of the complications of patients diagnosed with cholera in the Pediatric Hospital of Centro Habana, 2013-2017

Introducción: La séptima pandemia del cólera llegó a las Américas en 1991. En Cuba hacía más de 130 años no se registraba ningún caso. Objetivos: Identificar y caracterizar las complicaciones por cólera y su relación con características clínicas y de tratamiento. Métodos Se realizó un estudio descriptivo y prospectivo desde el año 2013-2017 a los pacientes a los que se les confirmó el V. cholerae como causa exclusiva de enfermedad diarreica aguda. Las variables cualitativas se describieron estadísticamente mediante frecuencias absolutas y relativas y para las variables cuantitativas se utilizó la media, la mediana, la desviación estándar y el rango intercuartílico como medidas de dispersión. Resultados: El 36,5 por ciento de los enfermos presentó complicaciones donde la deshidratación fue la más frecuente. El valor de la mediana del tiempo que medió entre la aparición de los síntomas y la atención en el centro fue menor en los pacientes con complicaciones comparado con el observado en los no complicados, pero la diferencia no fue significativa: (24 horas [RI: 24,0-72,0 horas] vs. 48 horas [RI: 24,0-72,0 horas], p= 0,355). Conclusiones: La mayoría de los enfermos no presentaron complicaciones y la más frecuente es la deshidratación ligera(AU)

Introduction: The seventh cholera pandemic arrived to the Americas in 1991. In Cuba for more than 130 years there were no case reports. Objectives: To identify and characterize the complications by cholera and its relation with clinical characteristics and treatment. Methods: A descriptive and prospective study was conducted from 2013 to 2017 to the patients who had been confirmed with V. cholerae as exclusive cause of acute diarrheal disease. The qualitative variables were described statistically using absolute and relative frequencies, and for the quantitative variables were used the average, medium, and standard deviation and the interquartile range as dispersion measures. Results: 36.5 percent of the patients presented complications where dehydration was the most frequent. The value of the median time between the onset of symptoms and attention in the center was lower in patients with complications in comparison with the observed in non-complicated patients, but the difference was not significant (24.0 h [RI: 24,0-72,0 h] vs. 48,0 h [RI: 24,0-72,0 h], p= 0.355). Conclusions: Most of the patients did not present complications and the most frequent is the slight dehydration (AU)

Burden of typhoid fever and cholera: similarities and differences. Prevention strategies for European travelers to endemic/epidemic areas.

The burden of diarrheal diseases is very high, accounting for 1.7 to 5 billion cases per year worldwide. Typhoid fever (TF) and cholera are potentially life-threatening infectious diseases, and are mainly transmitted through the consumption of food, drink or water that have been contaminated by the feces or urine of subjects excreting the pathogen. TF is mainly caused by Salmonella typhi, whereas cholera is caused by intestinal infection by the toxin-producing bacterium Vibrio cholerae. These diseases typically affect low- and middle-income countries where housing is overcrowded and water and sanitation are poor, or where conflicts or natural disasters have led to the collapse of the water, sanitation and healthcare systems. Mortality is higher in children under 5 years of age. Regarding their geographical distribution, TF has a high incidence in sub-Saharan Africa, India and south-east Asia, while cholera has a high incidence in a few African countries, particularly in the Horn of Africa and the Arabian Peninsula. In the fight against these diseases, preventive measures are fundamental. With modern air travel, transmissible diseases can spread across continents and oceans in a few days, constituting a threat to global public health. Nowadays, people travel for many reasons, such as tourism and business. Several surveys have shown that a high proportion of travelers lack adequate information on safety issues, such as timely vaccination and prophylactic medications. The main objective of this overview is to provide information to help European travelers to stay healthy while abroad, and thus also to reduce the potential importation of these diseases and their consequent implications for public health and society. The preventive measures to be implemented in the case of travel to countries where these diseases are still endemic are well known: the adoption of safe practices and vaccinations. It is important to stress that an effective preventive strategy should be based both on vaccinations and on hygiene travel guidelines. Furthermore, the emergence of multidrug-resistant strains is becoming a serious problem in the clinical treatment of these diseases. For this reason, vaccination is the main solution.

An elusive adenylate cyclase complicit in cholera is exposed.

The intestinal consequences of cholera enterotoxin are caused by activation of the cystic fibrosis transmembrane conductance regulator (CFTR) anion channel through the actions of an as-yet-unknown adenylate cyclase. A new study hunts down this elusive enzyme, showing that mouse and human intestinal epithelium functionally and structurally pair adenylate cyclase isoform 6 (AC6) with CFTR. These findings provide important insights into the molecular mechanisms underlying the robust pathological activation of CFTR activity and promise new opportunities to treat cholera.

Control de foco de un brote de Cólera. Matanzas 2014 / Control of Focus in front of a Bud of Cholera. Matanzas 2014

Se presenta un estudio de control de foco de un brote de cólera, mediante la técnica observacional del tipo serie de casos, en el mes de julio de 2014 en el Municipio Matanzas, donde se describe, según el método epidemiológico, la relación de los casos detectados con el caso índice; se analiza el problema detectado teniendo en cuenta el enfoque de riesgo del cólera. Se realiza una evolución clínico-epidemiológica de los casos detectados y se analizan las medidas de control de foco aplicadas. Se revisan tanto las historias clínicas individuales en el consultorio del médico de la familia, como las encuestas epidemiológicas y el expediente de control de foco en el departamento de Epidemiología (AU).

A study of control of focus of a bud of cholera is presented, by means of the observational technique of the type series of cases, in the month of July of 2014 in the Municipality Matanzas, where it is described, according to the epidemic method, the relationship of the cases detected with the index case; the detected problem is analyzed keeping in mind the focus of risk of the cholera. He/she is carried out a clinical-epidemic evolution of the detected cases and of the applied measures of focus control. They are revised the clinical histories so much in the clinic of the doctor of the family, as the epidemic surveys and the file of focus control in the department of epidemiology (AU).

Spontaneous bacterial empyema due to non-O1, non-O139 Vibrio cholerae in a cirrhotic patient with hepatocellular carcinoma.

Vibrio cholerae is known as a common etiology of epidemic diarrheal disease and rarely causes extra-intestinal infections. In this report, we described a cirrhotic patient with hepatocellular carcinoma who developed spontaneous bacterial empyema due to non-O1, non-O139 V. cholerae. The patient was successfully treated with antimicrobial agents and percutaneous drainage.

Cólera en Haití / Cholera in Haiti

La República de Haití con 9 millones de habitantes vive desde antaño una gran debilidad en varios frentes, pero en especial, en aspectos concernientes a la salud y a los servicios públicos que además de ser precarios solo alcanzan para una pequeña parte de la población. Terremotos, inundaciones y huracanes sumados a una eterna inestabilidad social y a una magra cobertura de salud llevan a panoramas ominosos como la actual epidemia de cólera del que solo se saldrá cuando se dejen de buscar culpables y se mancomunen el gobierno, ONGs y Naciones Unidas para controlar la epidemia y sentar bases sólidas de salubridad y protección social.

The Republic of Haiti, with 9 million inhabitants, has been living a great precariouness in several areas, specially in health and public services. These aspects are not only precarious but they can only reach a few people. Earthquakes, floods and hurricans added to a never ending social instability and a very poor health covering lead to ominous settings like the today colera epidemy. They will only get rid of this problem when they stop looking for guilty ones and the government start working together with ONG's and United Nations in order to control the epidemy and to stablish solid foundations of health and social protection.

[Cholera--once and nowadays].

HISTORY: Cholera is an acute intestinal infection which raged in India in the nineteenth century and it broke out in six great pandemics out in Europe. ETIOLOGY: Cholera is caused by bacteria Vibrio cholerae, which produce an enterotoxin causing massive diarrhoea. There are two biotypes--classic and El Tor. EPIDEMIOLOGY: The source of Vibrio cholerae is a man. Cholera is a typical faecally-oral infection. PATHOGENESIS: Ingested by contaminated water and food, Vibrio cholerae comes to the intestinal wall. The tightness is intermediated with toxin-coregulated pilus. There it produces enterotoxin and activates adenilate cyclase which accumulate intracellular cyclic adenosine monophosphate. The result is isotonic watery diarrhoea. CLINICAL FEATURES: Cholera can occur as asymptomatic infection, then enteritis and deathly classic cholera. Patients suffer from explosive, unremitting, watery diarrhoea (known as "rice water"). DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS: The diagnosis is based on clinical features, epidemiological data and laboratory diagnostic methods. The most important is to isolate Vibrion cholerae from the stool. THERAPY: The most important treatment for cholera is fluid containing minerals. The best antibiotics available are tetracycline. PREVENTION: The best preventive measures are water supply, sanitation, food safety and community awareness. The importance of vaccines comes second. CHOLERA NOWADAYS: Cholera has been known since ancient times, but it is present even nowadays. It has been developed as a biological weapon. CONCLUSION: Cholera is a dreadful intestinal disease with severe clinical features. One thing is known for certain: hygienic and sanitary measures are the main prevention.

Alopatia, arte oficial de curar: disputas em tempo de cólera no Grão-Pará / Allopathy, the official art of healing: disputes in times of cholera in Gran-Pará

Tendo em vista o incremento da epidemia de Cólera no Grão-Pará (1855-1856), focaliza a contenda acadêmica referente às instruções a serem seguidas em época de epidemia e do tratamento mais adequado à cólera. Surgiram, por meio da imprensa, instruções e guias médicos que, além de auxiliar no combate à epidemia, revelavam a capacidade pedagógica, persuasiva e autoritária dos profissionais de saúde em busca de dar continuidade ao projeto de elevar a alopatia à condição de medicina oficial, excluindo as demais artes de curar.

Sales de rehidratación oral: ¿es tiempo de cambiar la fórmula? / Rehydration solutions: is it time to change this formula?

En el presente artículo se exponen las razones fisipatológicas y las posibles ventajas de la utilización de sales de rehidrataciónoral de osmolaridad reducida para el tratamiento de las diarreas en relación a la solución estándar. Las mismas tienen lapropiedad de respetar la relación molar entre sodio y glucosa necesaria para un cotransporte eficiente, pero a su vez tienen laparticularidad de ofrecer una menor osmolaridad al tracto gastrointestinal que las SRO originales. Aunque no sin controversia,los ensayos clínicos en general demostraron menos vómitos, menores pérdidas fecales, menor duración de enfermedad y menornecesidad de suplementación intravenosa al utilizarlas. Se resumen también las nuevas recomendaciones vigentes de la OMSy UNICEF, que promueven el uso de las SRO de osmolaridad reducida y la mayor investigación de las mismas, especialmenteen los casos de cólera.

Doses infinitesimais contra a epidemia de cólera em 1855 / Infinitesimal doses against the epidemics of cholera in 1855

Discute a atuação dos homeopatas na epidemia de cólera no Rio de Janeiro, tendo como fundo a sociedade brasileira da segunda metade do século XIX, a institucionalização da pesquisa científica, as práticas terapêuticas e as representações das doenças.

As artes de curar nos tempos do cólera: Recife, 1856 / The arts of healing in times of cholera: Recife, 1856

Tem como objetivo indicar como uma conjuntura de crise epidêmica se caracterizou por um jogo de forças em que noções concorrentes de saúde e práticas terapêuticas disputaram legitimidade social e reconhecimento hegemônico.

Distance education with tutoring improves diarrhea case management in Guatemala.

OBJECTIVE: To evaluate the impact of distance education in diarrhea and cholera case management on the quality of physicians' and nurses' practice. DESIGN: The pre-post panel, program and control group design used trained physician observers to measure if doctors and nurses complied with case management standards. Extended observations and client exit interviews were used to analyze audience bias and the validity of counseling measurements. SETTING: Health care facilities in six districts of Guatemala. Ministries of Health in four Central American countries and the Institute of Nutrition for Central America and Panama implemented the course. STUDY PARTICIPANTS: The study panel consisted of 66 course graduates (program group) and 66 doctors and nurses who were interested in taking the course where the course was not offered (control group). RESULTS: The percentage of diarrhea cases assessed correctly and dehydration cases classified correctly increased by 25% more in the program group than in the control group, but post-course performance was still only approximately 60% in the program group. Rehydration treatment did not improve. Counseling improved insignificantly. Client exit interviews suggested that indicators for counseling may need to be re-examined for validity. No audience effect on health worker practice was found. Completion rates were high. The program cost 60 dollars US per enrollee. CONCLUSION: This is an effective, relatively low-cost program that substantially improved case management of diarrhea in Guatemala, in particular the quality of assessment and classification. However, many health workers who completed the course are still not performing to standard, so additional work is needed to resolve this problem.

A arte de curar dos profissionais de saúde popular em tempo de cólera: Gräo-Pará do século XIX / The curative art of specialists in folk medicine in times of cholera: 19th century Gräo-Pará

Durante a epidemia de cólera que assolou o Gräo-Pará, em 1855, pouco mais de uma dezena de anônimos profissionais de saúde popular inscreveram suas arte de curar nos anais da história. As terapias näo eram muitas, mas foram disseminadas nos jornais provinciais ou pela forte tradiçäo oral presente na Amazônia. Uma dessas terapias - o uso do sumo de limäo - chegou a ser avalizada pelos médicos da província como cientificamente correta. Os homens que "näo eram médicos, nem cirurgiöes" usavam ervas e frutos medicinais preparados em sumos, infusöes, banhos, emplastos e supositórios, rompendo as fronteiras estabelecidas pela arte oficial de curar, a medicina alopátia, que tentava estabelecer-se hegemonicamente. Descreve a trilha da cólera até o Gräo-Pará e analisa o contexto social da epidemia; os conhecimentos sobre a cólera; as possibilidades de socorro oferecidas à populaçäo e as práticas curativas entäo adotadas.