Clinical Epidemiological Characterization of Patients with Suspected Human Leptospirosis

Introducción: la leptospirosis es considerada históricamente la zoonosis de mayor difusión internacional.Objetivo: caracterizar clínica y epidemiológicamente los pacientes con leptospirosis humana sospechada en el Policlínico Universitario Hermanos Cruz de Pinar del Río, durante el periodo 2019- 2021.Métodos: se realizó un estudio observacional, descriptivo y transversal. El universo estuvo constituido por 182 pacientes notificados por los consultorios, el cuerpo de guardia del policlínico y los hospitales. Para seleccionar la muestra se aplicó un muestreo aleatorio simple, la muestra quedó conformada por 162 pacientes. Desde el punto de vista ético esta investigación respetó los fundamentos de la ética que aparecen en la Declaración de Helsinki.Resultado: en la investigación predominó el grupo  de edad de 40 - 49,  en  71  pacientes (43,83 %), prevaleció en hombres (76,46 %). Son los campesinos los que aportan mayor frecuencia, con 89 casos (54,94 %). Las manifestaciones clínicas presentes están la fiebre elevada, mialgias y artralgias en el 100 %. Como riesgo epidemiológico fue el cultivo de arroz el que predominó, con 86 casos (53,09 %).Conclusiones: ante la prevalencia de pacientes con leptospirosis humana sospechada en la muestra estudiada, se debe fortalecer las normas y procedimientos para el mejor control preventivo de estos pacientes desde la atención primaria de salud, lo que conllevaría a una mejor vinculación policlínico hospital y por ende, redundaría en una mejor atención y una mejor calidad de vida tanto para el paciente como para la familia.Introduction: leptospirosis, historically considered the zoonosis of greater international diffusion.Objective: to characterize clinically and epidemiologically the patients with suspected human leptospirosis in the Hermanos Cruz academic Polyclinic of Pinar del Río during the period 2019- 2021. Methods: an observational, descriptive and transversal study was carried out. The universe consisted of 182 patients notified by the clinics, the on-call department of the polyclinic and the hospitals. The sample was selected by simple random sampling and consisted of 162 patients. From the ethical point of view, this research complied with the ethical principles contained in the Declaration of Helsinki.Results: in the research, the age group 40-49 predominated in 71 patients (43,83 %), with a predominance of men (76,46 %). Peasants were the most frequent with 89 cases (54,94 %).  The clinical manifestations present were high fever, myalgias and arthralgias in 100 %. As epidemiological risk, rice cultivation predominated with 86 cases (53,09 %).Conclusions: given the prevalence of patients with suspected human leptospirosis in the sample studied, the norms and procedures for better preventive control of these patients should be strengthened in primary health care, which would lead to a better polyclinic-hospital linkage and thus result in better care and a better quality of life for both the patient and the family

Safety and effectiveness of CIMAvax-EGF administered in community polyclinics

In spite of the advances in immunotherapy and targeted therapies, lung cancer continues to be the leading cause of cancer-related death. The epidermal growth factor receptor is an established target for non-small cell lung cancer (NSCLC), and its overactivation by the ligands can induce accelerated proliferation, angiogenesis, and metastasis as well as proinflammatory or immunosuppressive signals. CIMAvax-EGF is an epidermal growth factor (EGF)-depleting immunotherapy that is approved for the treatment of NSCLC patients in Cuba. The study was designed as a phase IV trial to characterize the safety and effectiveness of CIMAvax-EGF in advanced NSCLC patients treated in 119 community polyclinics and 24 hospitals. CIMAvax-EGF treatment consisted of four bi-weekly doses followed by monthly boosters. Overall, 741 NSCLC patients ineligible for further cancer-specific treatment were enrolled. CIMAvax-EGF was safe, and the most common adverse events consisted of mild-to-moderate injection site reactions, fever, chills, tremors, and headache. For patients completing the loading doses, the median survival was 9.9 months. For individuals achieving at least stable disease to the frontline and completing vaccination induction, the median survival was 12 months. Most of the functional activities and symptoms evaluated through the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire improved over time. In conclusion, this real-world trial demonstrated that CIMAvax-EGF was safe and effective in patients who were vaccinated in the maintenance scenario. A larger effect was seen in subjects with poor prognosis like those with squamous tumors and high EGF levels. Remarkably, this community-based intervention was very important because it demonstrated the feasibility of treating advanced lung cancer patients with active immunotherapy in primary care institutions. In addition to CIMAvax-EGF, patients received supportive care at the community clinic. Vaccine administration by the family doctors at the polyclinics reduced the patients’ burden on the medical oncology services that continued providing chemotherapy and other complex therapies. We conclude that community polyclinics constitute the optimal scenario for administering those cancer vaccines that are safe and require prolonged maintenance in patients with advanced cancer, despite the continuous deterioration of their general condition.Clinical trial registrationhttps://rpcec.sld.cu/trials/RPCEC00000205-En, identifier RPCEC00000205