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PubMed2005

Virus evolution during a severe dengue epidemic in Cuba, 1997.

Full-length genomic sequences from six DENV-2 isolates sampled at different times during a dengue outbreak that occurred in Cuba in 1997 were determined. Phylogenetic analysis indicated that these isolates fall into the "American/Asian" genotype. Genome analysis revealed strong conservation of the structural proteins and the non-coding regions (5' NCR and 3' NCR). Nucleotide substitutions were observed in non-structural genes and most notably in the NS5 gene. There was a clear pattern of virus evolution during the epidemic; the earliest isolates sampled differed from those sampled later by amino acid replacements in the NS1 and NS5 proteins, although there was no evidence that these represented escape mutants. Further studies are therefore required to define the functional role of amino acid replacements observed and their possible relation to disease severity.

Aedes↗

PubMed2005

Assessment of heavy metal levels in Almendares River sediments--Havana City, Cuba.

The Almendares River watershed covers a large portion of Havana, Cuba and is centrally important to both recreational and other activities in the region. In order to assess current water quality conditions prior to planned remediation efforts, the spatial distribution of six heavy metals and other compounds were determined in river sediments at fifteen sampling stations in the watershed. Metal concentrations in sediments ranged from 86.1 to 708.8 for Zn, 39.3 to 189.0 for Pb, 71.6 to 420.8 for Cu, 84.4 to 209.7 Cr, 1.5 to 23.4 for Co, and 1.0 to 4.3 for Cd microg/g dry weight sediment. Calculated enrichment factors (EF; measured metal versus background mineral conditions) were almost always greater than 1.0, suggesting significant anthropogenic impact on metal levels in the river. The highest EF values were seen immediately below Cotorro (EF>10 for Pb, Cu, and Cd), a suburban town that has an active secondary smelter, and below the largest municipal landfill in Havana (EF>10 for Pb, Cu, Cd, and Zn). Further, three sampling stations had multiple metals at concentrations higher than probable effects concentrations (PEC), implying possible local ecotoxicological impacts. Finally, sequential extractions of the sediments indicated that heavy metals were largely associated with the organic fraction, and it was estimated that up to 62% of metals in the sediments would be susceptible to release back into the water column if hydraulic or other changes occurred in the river. These data are being used to prioritize decisions related to the remediation of the river system.

Cuba↗

PubMed1998

Genetic evidence of two species in the Biomphalaria havanensis complex (Gastropoda. Planorbidae) from Cuba.

In Cuba, several species of freshwater gastropods belonging to the genus Biomphalaria have been described according to morphological characters. However, the taxonomy of this group remains unclear and a number of synonyms are often cited in the literature. This is the case for B. havanensis whose taxonomical status is not well established. Multilocus enzyme electrophoresis at 18 loci was carried out on adult snails of B. havanensis from the type locality in Havana and from several other sites harbouring a morphologically slightly different form, referred to here as Biomphalaria sp. Another local distinct species B. helophila was used as an outgroup. Allelic distribution showed the presence of nine and 12 diagnostic loci between B. havanensis and Biomphalaria sp. and B. helophila, respectively. We detected eight fixed alleles between Biomphalaria sp. and B. helophila. The genetic divergence estimated by absolute genetic distances strongly supports the assumption that Biomphalaria sp. is quite different from the sympatric B. havanensis, morphologically the closest species.

Alleles↗

PubMed1997

Safety, efficacy, and acceptability of medical abortion in China, Cuba, and India: a comparative trial of mifepristone-misoprostol versus surgical abortion.

OBJECTIVE: We investigated safety, efficacy, and acceptability of an oral regimen of medical abortion compared with surgical abortion in three developing countries. STUDY DESIGN: Women (n = 1373) with amenorrhea < or = 56 days chose either surgical abortion (as provided routinely) or 600 mg of mifepristone followed after 48 hours by 400 micrograms of misoprostol. This is the appropriate design for studying safety, efficacy, and acceptability among women selecting medical abortion over available surgical services. RESULTS: The medical regimen had more side effects, particularly bleeding, than did surgical abortion but very few serious side effects. Failure rates for medical abortion, although low, exceeded those for surgical abortion: 8.6% versus 0.4% (China), 16.0% versus 4.0% (Cuba), and 5.2% versus 0% (India). Nearly half of failures among medical clients were not true drug failures, however, but surgical interventions not medically necessary (acceptability failures or misdiagnoses). Women were satisfied with either method, but more preferred medical abortion. CONCLUSION: Medical abortion can be safe, efficacious, and acceptable in developing countries.

Abortifacient Agents↗

PubMed1999

Side effects of mifepristone-misoprostol abortion versus surgical abortion. Data from a trial in China, Cuba, and India.

Although serious adverse events of early abortion have been studied, little attention has been paid to the more common side effects experienced by early medical or surgical abortion clients. Using data from a multicenter comparative trial of women < or = 56 days' gestation in China, Cuba, and India (n = 1373), side effects experienced by mifepristone-misoprostol medical abortion and surgical abortion clients were analyzed at the different stages of their abortions. Data on side effects came from women's reports at each clinic visit, providers' observations during the clinic visits, and symptom diaries maintained during the study period. Medical abortion clients at all sites experienced more side effects than their surgical counterparts. The disparity between the two groups was particularly pronounced for bleeding and pain. Despite more reports of side effects among medical abortion clients, however, assessments of well-being and reports of satisfaction at the exit interview were similar in both treatment groups.

Abortifacient Agents↗

PubMed1998

Blood loss with mifepristone--misoprostol abortion: measures from a trial in China, Cuba and India.

OBJECTIVE: We compared bleeding patterns following early mifepristone-misoprostol abortion with those following early surgical abortions ( < or = 56 days gestation LMP). We analyzed women's reports of their bleeding and clinical measures of blood loss, and modeled the relationships between different bleeding measures and indicators of success and satisfaction. METHOD: Using data from a multicenter trial held in China, Cuba and India, we fit bivariate and multivariate models to analyze bleeding patterns, controlling for a range of demographic, experiential and medical factors (n = 1373). RESULT: Medical abortion patients perceived their bleeding to be heavier than did the surgical patients; however, there were few statistically significant differences in clinical measures of blood loss between the two groups, and blood loss rarely represented a medical problem. Nationality, far more than actual levels of bleeding, influenced women's impressions about blood loss. Although medical abortion patients saw their bleeding as heavier than did the surgical patients, their perceptions of heavier bleeding did not prevent them from having higher satisfaction levels. One exception was that if bleeding exceeded prior expectations, women with the medical method were more likely to be dissatisfied. Pain and cramps, which often accompanied bleeding, were an independently significant factor in predicting satisfaction with the method. CONCLUSION: In order for women to know what to expect with medical abortion, they must be informed beforehand about the level of bleeding that generally accompanies the procedure vs. excessive bleeding that would signal a clinical problem.

Abortifacient Agents↗

PubMedDate not supplied

Epidemic optic and peripheral neuropathy in Cuba: a unique geopolitical public health problem.

During 1992 and 1993 an epidemic of optic and peripheral neuropathy affected over 50,000 Cubans. This occurred in the unique setting of a communist country which had a widespread health care network and wherein sudden changes in the economy affected most of the population. Although nutritional factors appeared to play a key role in the pathogenesis of the epidemic neuropathy, viral, toxic, and genetic factors were investigated by Cuban and North American scientists. The authors, representing different disciplines and different groups that visited Cuba during the epidemic, review and reflect on the clinical and laboratory findings which became available through their own experience and through reviewing the literature. The recent Cuban epidemic is compared to similar outbreaks of optic and peripheral neuropathy which have occurred in the past.

Alcohol Drinking↗

PubMed2004

Fish assemblages on fringe coral reefs of the northern coast of Cuba near Havana Harbor.

It is difficult to separate effects on fish community assemblages due to anthropogenic stressors from natural factors. We examined small-bodied-fish communities along the northern coast of Cuba near Havana Harbor during the dry (February/March of 2000) and wet (June 2000) seasons. Over 35,000 individual fish were visually counted at 15 sites along the coast in three areas located 0-2.4, 2.4-6.1, and 6.1-10.3 km from the entrance to Havana Harbor. Fish communities in four substrate biotopes did not vary significantly between wet and dry seasons, but did vary with water depth. Proximity to Havana Harbor was the second most important factor affecting fish assemblages, and sites closest to the harbor had reduced populations of the bluehead wrasse (Thalassoma bifasciatum) and an increased abundance of slippery dick (Halichoeres bivittatus). More studies are required at the population and individual levels to link stressors (e.g., contaminants, siltation) directly to observed effects.

Animals↗

PubMedDate not supplied

[Perspectives on the application of automated systems to epidemiologic surveillance in Cuba].

A few considerations on the development of the applied automatization of epidemiologic surveillance systems in Cuba are exposed. Reference is made to aspects of the national strategy, to the lines of development of the National Health Systems, to the projections of the subsystems of epidemiologic surveillance, and to the future integrated intercommunication.

Computer Communication Networks↗

PubMed2002

137Cs and 210Po dose assessment from marine food in Cienfuegos Bay (Cuba).

One part of Radiological Monitoring Programme in central Cuba (1991-1995) was dedicated to study the background levels of natural and anthropogenic radioactivity in Cienfuegos Bay in the vicinity of the first Cuban nuclear power station under construction. 210Po and 137Cs concentrations in fish, molluscs and crustaceans collected in Cienfuegos Bay were determined and the committed effective doses (CED) were calculated for two population groups inhabiting this region. The highest values of 210Po concentrations were found in crustaceans, but significant accumulation was also observed in fish and molluscs. The mean 137Cs concentrations in organisms are several times lower with respect to 210Po, a situation that characterises the regions affected by the global fallout only. Values of CED from the consumption of crustaceans and molluscs are very low both from 210Po and 137Cs. The mean individual dose from 210Po in the seafood consumed varies from 39 microSv for general populations to 2802 microSv for the "critical group" consuming 320 kg of fish per year. The dose from 137Cs is negligible.

Animals↗

PubMed1999

Fatal dengue hemorrhagic fever in Cuba, 1997.

OBJECTIVES: After more than 15 years without dengue activity, a dengue II epidemic was reported in Cuba in 1997. Three thousand and twelve serologically confirmed cases were reported, with 205 dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) cases and 12 fatalities. This report presents the clinical, serologic, and virologic findings in the 12 fatal DHF/DSS cases. METHODS: Serum and necropsy samples were studied by viral isolation in C636 cell line and polymerase chain reaction. Serum samples were tested by IgM capture enzyme-linked immunoassay (ELISA) and ELISA inhibition method (EIM). RESULTS: All 12 cases were classified as DHF/DSS according to the Pan American Health Organization Guidelines for Control and Prevention of Dengue and Dengue Hemorrhagic Fever in the Americas. All patients were older than 15 years. Women were more frequently affected. The symptoms and signs presented by these patients were similar to those previously described in DHF/DSS cases. Clinical deterioration occurred on average at day 3.75. Abdominal pain and persistent vomiting were the earliest and most frequent warning signs. Dengue infection was confirmed in all cases. IgM antibodies were detected in 11 of 12 cases, all of them with a secondary infection. Dengue II virus was detected by viral isolation in 12 samples and by polymerase chain reaction in 17. Virus or RNA was detected in various tissues, including kidney, heart, lung, and brain. CONCLUSION: The clinical, pathologic, and laboratory features of 12 cases of fatal dengue hemorrhagic fever were reviewed. The results obtained demonstrate that adults with a primary dengue infection are at risk of developing the severe disease (DHF) if they are infected with a different serotype.

Adolescent↗

PubMed2000

Hepatitis E virus in Cuba.

The hepatitis E virus (HEV) has a global distribution and is known to have caused large waterborne epidemics of icteric hepatitis. The transmission is primarily fecal-oral. Some reports have suggested parenteral transmission of HEV from its association to hepatitis B or hepatitis C infection, or due to the development of hepatitis E after blood transfusion. Though most of the developing countries in Asia and Africa have been shown to be endemic for HEV infection, studies in the Latin American countries have been limited to Mexico, Brazil and Venezuela. We have developed an enzyme immunoassay (EIA) for IgM and IgG antibodies to a recombinant protein containing antigenic epitopes of the ORF3 region of the HEV. This system, as well as a commercial kit that includes ORF2 and ORF3 antigenic epitopes, were used to study the prevalence of anti-HEV antibodies in a sample of Cuban blood donors, acute hepatitis cases and individuals subjected to plasmapheresis. The incidence of anti-HEV IgM was compared with other viral hepatitis markers. Our findings suggest that infections due to HEV are an important viral cause of sporadic hepatitis in Cuba, and that HEV is endemic to this region of the world.

Adult↗

PubMed2002

Isolation and quantitative analysis of phenolic antioxidants, free sugars, and polyols from mango (Mangifera indica L.) stem bark aqueous decoction used in Cuba as a nutritional supplement.

An aqueous decoction of mango (Mangifera indica L.) stem bark has been developed in Cuba on an industrial scale to be used as a nutritional supplement, cosmetic, and phytomedicine. Previously we reported its antioxidant activity, and we concluded that the product could be useful to prevent the production of reactive oxygen species and oxidative tissue damage in vivo. A phytochemical investigation of mango stem bark extract has led to the isolation of seven phenolic constituents: gallic acid, 3,4-dihydroxy benzoic acid, gallic acid methyl ester, gallic acid propyl ester, mangiferin, (+)-catechin, (-)-epicatechin, and benzoic acid and benzoic acid propyl ester. All structures were elucidated by ES-MS and NMR spectroscopic methods. Quantitative analysis of the compounds has been performed by HPLC, and mangiferin was found to be the predominant component. Total polyphenols were assayed also by the Folin-Ciocalteu method. The free sugars and polyols content was also determined by GC-MS.

Antioxidants↗

PubMed1999

Trends in survival rates of cancer in Cuba.

Reports of population-based survival rates of cancer from developing countries are infrequent. In Latin America, only the Cancer Registry of Puerto Rico has published population-based survival data. The National Cancer Registry of Cuba has achieved three survival studies with cases incident in 1976, 1982 and 1988-1989. This article deals with the global observed and relative survival rates estimated in the latter study. Survival time trends are analysed. In the period 1988-1989, 12,985 primary cancer cases were included from the most common cancer sites, with the exclusion of cancer in situ cases and 8900 cases reported by 'death certificate only' (DCO) (35.8%). The vital status of cases was checked up to 31 December 1994 using a mixed follow-up system with the exclusion of 2900 cases lost to follow-up (11.2%). DCO proportions are shown for the major sites and compared to those of 1982. Observed survival rates were estimated by Kaplan-Meier method using the SPSS Statistical Software. The relative rates were estimated by the Hakulinen's Computer Program Package for Cancer Survival Studies (1988) using life tables from Cuban population. Statistical comparisons of survival curves by year of diagnosis were achieved by using the Log-Rank and Pearson statistic tests. Global results are shown by year of follow-up and a comparative analysis is done in time and with internationals values. Survival rates decreased in the period 1982/1988-1989 for colon, prostate and lung cancer. Prostate cancer shows a low five years relative survival rate when compared with the USA, but its observed rate is comparable with Puerto Rico's. Figures for mouth and lung cancer were comparable with the corresponding figures of the USA and Europe. Breast and cervix cancers rates are comparable with the European mean and the blacks in USA.

Breast Neoplasms↗

PubMed2002

Structural organization of the estalpha3(1) gene in a Colombian strain of Culex quinquefasciatus differs from that in Cuba.

In Culex mosquitoes (Diptera: Culicidae), the most common mechanism for resistance to organophosphorus (OP) insecticides involves amplification of one or more esterases. Two esterase loci are often involved, with different allelic forms co-amplified. Estalpha3(1) is co-amplified with estbeta1 in a Colombian (COL) strain of Culex quinquefasciatus Say. These two alleles co-migrate on acrylamide gels, often leading to misscoring of the phenotype as elevation of a single estbeta enzyme. By sequencing COL genomic DNA, we determined the estalpha3(1) gene length is 1623 nucleotides. The open reading frame of estalpha3(1) encodes a 540 amino acid protein, as for estalpha2(1) in strain Pel RR from Sri Lanka. The intron/exon boundaries of estalpha3(1) are identical to those of estalpha2(1), suggesting that they are alleles of the same locus. The COL estalpha3(1) gene differs from estaalpha3(2) in strain MRES from Cuba, although they have equivalent electrophoretic mobility, showing that these two strains contain distinct resistance-associated amplicons. Twenty nucleotide differences were scored between the MRES partial 495 bp sequence and that in the COL strain, with two amino acid changes, demonstrating distinct estalpha enzymes. Our sequencing data show 95% identity between the three estalpha genes (each has six introns and seven exons) in OP-resistant Cx. quinquefasciatus. Amplified estalpha3(1) and estbeta1 are at least 10kb apart in temephos-selected COL and 2.7kb apart in Pel RR, whereas these non-amplified genes are only 1.7kb apart in the nonselected parental COL stock, as in Pel SS (susceptible Sri Lankan strain), demonstrating that this region of the genome is susceptible to expansion and contraction.

Amino Acid Sequence↗

PubMed1998

Characterization of amplified esterase Estbeta1(2) associated with organophosphate resistance in a multi-resistant population of the mosquito Culex quinquefasciatus from Cuba.

Esterase amplification is the major organophosphorus (OP) insecticide resistance mechanism in Culex mosquitoes. The amplified Estalpha2(1)¿Estbeta2(1) esterases are found in > 90% of resistant populations worldwide, whereas amplified DNAs (amplicons) containing Estbeta1s are much rarer. Individuals with the Estbeta1 amplicons appear to be at a selective disadvantage in competition with those carrying the Estalpha2(1)¿Estbeta2(1) amplicons. To test the hypothesis that this is because Estbeta1 is less able to bind insecticide than the common amplified esterases, Estbeta1(2) was purified from the multi-resistant Habana strain of Culex quinquefasciatus, from Cuba. In its native form Estbeta1 is a monomeric enzyme of 66 kDa, with a pI of 4.8. The bimolecular rate constants for interaction of Estbeta1(2) with several OP insecticides were similar to those for the commonly elevated esterases Estalpha2(1) and Estbeta2(1), and much higher than for the electrophoretically identical non-elevated Estbeta1(3) and Estalpha3. Hence the apparent selective advantage of the Estalpha2(1)¿Estbeta2(1) amplicon is not due to its greater efficiency of insecticide binding, as OP insecticides are significantly better inhibitors of all the amplified esterases than of their non-amplified counterparts and therefore should be equally effective at conferring resistance.

Animals↗

PubMed2002

[Histoplasmosis group disease in bat researchers returning from Cuba].

CASE HISTORY: Four males (age 25 to 40 years) and one female (age 25) were admitted to our hospital almost simultaneously with symptoms of fever up to 38 degrees C, dry cough, thoracodynia, dyspnoea, myalgia and arthralgia. All patients belonged to a team of eight German bat researchers who had returned from Cuba 10 days before, where they had investigated bats in caves. Another member of the team had only mild histoplasmosis and was followed in our outpatient clinic. Two scientists who wore their breathing masks continuously during their work in the caves did not fall ill. EXAMINATIONS: Chest X-rays of all in-patients showed pulmonary infiltrates correlating with the severity of their illness. In all patients specific IgG antibodies against Histoplasma capsulatum-antigen were found in the Western Blot assay, confirming the diagnosis of histoplasmosis. TREATMENT: Treatment with oral itraconazole 200 mg b.d was given to four inpatients for 6 weeks, in the fifth patient itraconazole was discontinued because of an increase of liver transaminases. CONCLUSION: Antimycotic treatment of advancing histoplasmosis seems appropriate also in immunocompetent patients. The high number of patients within this group suggests high numbers of Histoplasma capsulatum in the caves. Wearing breathing masks throughout the work in the caves may prevent histoplasmosis even in case of high infectious doses. Pre-travel recommendations for cave researchers have to emphasize the continuous use of breathing masks and vaccination against tetanus and rabies.

Adult↗

PubMed2001

From quarantine to condoms: shifting policies and problems of HIV control in Cuba.

This study reviews HIV prevention in Cuba in light of (1) the liberalization of HIV quarantine, (2) the growth in tourism, and (3) the aggressive system of public health promotion. Sixty-two key informants, including Cubans who are HIV-positive, at risk, or working as health professionals, were interviewed during June and July of 1996. Findings include: (1) there is a common public perception that the government's national HIV screening and contact tracing system obviates the need for individual precaution; and (2) both commercial sex workers and men who have sex with men believe that legal and social forces hinder their indigenous HIV prevention efforts. A well developed system of preventive health care offers the potential for effective HIV prevention. The fact that Cuban officials use the success of their HIV/AIDS control program to promote national pride may retard appropriate changes in their response to currently rising levels of infection.

Anthropology, Cultural↗