Barriers to early diagnosis and management of oral cancer in Latin America and the Caribbean.

OBJECTIVE: This study aimed to explore perceived barriers to early diagnosis and management of oral cancer, as well as potential pathways for improvement in Latin America and the Caribbean (LAC). METHODS: This cross-sectional study used a self-administered online questionnaire created via the Research Electronic Data Capture platform. The survey was distributed to health professionals trained in Oral Medicine, Oral Pathology, Oral and Maxillofacial Surgery, and Dentists with clinical and academic expertise in oral potentially malignant disorder (OPMD) and oral cancer. Data obtained were systematically organized and analyzed descriptively using Microsoft Excel. RESULTS: Twenty-three professionals from 21 LAC countries participated. Major barriers included the limited implementation of OPMD and oral cancer control plans (17.4%), low compulsory reporting for OPMD (8.7%) and oral cancer (34.8%), unclear referral pathways for OPMD (34.8%) and oral cancer (43.5%), and a shortage of trained professionals (8.7%). Participants endorsed the utility of online education (100%) and telemedicine (91.3%). CONCLUSION: The survey highlights major perceived barriers to early diagnosis and management of OPMD and oral cancer in LAC, as well as potential avenues for improvement.

Implementation of HPV-testing for cervical cancer screening in programmatic contexts: The Jujuy demonstration project in Argentina.

The aim of this article is to present results of programmatic introduction of HPV testing with cytologic triage among women 30 years and older in the province of Jujuy, Argentina, including description of the planning phase and results of program performance during the first year. We describe the project implementation process, and calculate key performance indicators using SITAM, the national screening information system. We also compare disease detection rates of HPV testing in 2012 with cytology as performed during the previous year. HPV testing with cytology triage was introduced through a consensus-building process. Key activities included establishment of algorithms and guidelines, creating the HPV laboratory, training of health professionals, information campaigns for women and designing the referral network. By the end of 2012, 100% (n = 270) of public health care centers were offering HPV testing and 22,834 women had been HPV tested, 98.5% (n = 22,515) were 30+. HPV positivity among women over 30 was 12.7%, 807 women were HPV+ and had abnormal cytology, and 281 CIN2+ were identified. CIN2+ detection rates was 1.25 in 2012 and 0.62 in 2011 when the program was cytology based (p = 0.0002). This project showed that effective introduction of HPV testing in programmatic contexts of low-middle income settings is feasible and detects more disease than cytology.

Hantavirus pulmonary syndrome in northwestern Argentina: circulation of Laguna Negra virus associated with Calomys callosus.

The purpose of this study was to characterize the hantaviruses circulating in northwestern Argentina. Human and rodent studies were conducted in Yuto, where most cases of hantavirus pulmonary syndrome (HPS) occur. Partial virus genome sequences were obtained from the blood of 12 cases of HPS, and from the lungs of 4 Calomys callosus and 1 Akodon simulator. Phylogenetic analysis showed that three genotypes associated with HPS circulate in Yuto. Laguna Negra (LN) virus, associated with C. laucha in Paraguay, was identified for the first time in Argentina; it was recovered from human cases and from C. callosus samples. The high sequence identity between human and rodent samples implicated C. callosus as the primary rodent reservoir for LN virus in Yuto. The genetic analysis showed that the Argentinian LN virus variant differed 16.8% at the nucleotide level and 2.9% at the protein level relative to the Paraguayan LN virus. The other two hantavirus lineages identified were the previously known Bermejo and Oran viruses.

Hantavirus infection in humans and rodents, northwestern Argentina.

We initiated a study to elucidate the ecology and epidemiology of hantavirus infections in northern Argentina. The northwestern hantavirus pulmonary syndrome (HPS)-endemic area of Argentina comprises Salta and Jujuy Provinces. Between 1997 and 2000, 30 HPS cases were diagnosed in Jujuy Province (population 512,329). Most patients had a mild clinical course, and the death rate (13.3%) was low. We performed a serologic and epidemiologic survey in residents of the area, in conjunction with a serologic study in rodents. The prevalence of hantavirus antibodies in the general human population was 6.5%, one of the highest reported in the literature. No evidence of interhuman transmission was found, and the high prevalence of hantavirus antibody seemed to be associated with the high infestation of rodents detected in domestic and peridomestic habitats.

Meningitis y sordera en niños: estudio retrospectivo / Meningitis and deafness in children: retrospective study

La sordera adquirida es una disfunción que afecta a uno de cada 1,000 niños. Las causas de esta alteración son múltiples y del 2 al 25 por ciento de los niños con hipoacusia neurosensorial tienen el antecedente de haber cursado con meningitis. Con objeto de conocer la frecuencia de esta complicación, se revisaron los expedientes clínicos de un período de 5 años, de niños que padecieron meningitis. Se encontraron 790 pacientes que tuvieron meningitis, de los cuales 138 (18 por ciento) desarrollaron sordera. Sesenta por ciento de los pacientes eran hombres y 40 por ciento mujeres, la edad prevalente de los niños fue el primer año de vida. El 73 por ciento de los casos tuvo sordera neurosensorial que en la mayoría fue de grado medio y bilateral. No se encontró asociación entre el grado de la sordera y el tiempo de evolución previo al inicio del manejo médico. El 66 por ciento de los pacientes se recuperó totalmente de la infección meníngea y 34 por ciento desarrolló secuelas neurológicas, algunas de ellas muy incapacitantes, sin mostrar relación con el grado de pérdida auditiva. Al 73 por ciento de los niños se les administró antibióticos conocidos como ototóxicos como parte integral de su esquema de manejo, pero su administración tampoco mostró relación con la sordera. A 76 niños (55 por ciento) de les realizaron estudios audiológicos un mes después de la fase aguda de la enfermedad; 35 normalizaron su audición, 31 presentaron mejoría, 18 permanecieron con el mismo grado de sordera y dos empeoraron. 27 pacientes desarrollaron otra enfermedad concomitante del oído medio cuya evolución y participación en la pérdida auditiva se comenta en forma especial