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Pyrethroid insecticide-resistant strain of Aedes aegypti from Cuba induced by deltamethrin selection.

A sample of Aedes aegypti L. from Santiago de Cuba with a high level of deltamethrin resistance (113.7 x at the 50% lethal concentration [LC50]), was subjected to deltamethrin selection to determine the capacity of this population to evolve higher resistance under intensive laboratory selection pressure, to characterize that resistance, to attempt to identify some of the mechanisms involved, and to use it as a reference strain for future molecular research. High resistance developed after 12 generations of selection (1,425 x). After selection for 12 generations with deltamethrin, the Santiago de Cuba colony (SAN-F12) showed little or no cross-resistance to the organophosphates evaluated, but high cross-resistance was observed for all the pyrethroids in larvae from this strain: lambdacyhalothrin (197.5 x), cypermethrin (45 x), and cyfluthrin (41.2 x). Adult bioassays reveal that a SAN-F12 strain was resistant to the pyrethroid and the organochlorine dichlorodiphenyltrichloroethane (DDT). Synergism tests implicated detoxifying esterase or glutathione S-transferase (GST) and monooxygenase in pyrethroid resistance. Biochemical tests reveal that acetylcholinesterase was not involved in deltamethrin resistance. The frequency of GST enzyme increased from 0.43 in Santiago de Cuba to 0.88 in SAN-F12. Esterase frequency increased from 0.12 in Santiago de Cuba to 0.63 in SAN-F6 and it diminished to 0.38 in SAN-F12. The polyacrylamide gel electrophoresis and inhibition study suggests the presence of elevated esterase activity not associated with pyrethroid resistance. The presence of both DDT and pyrethroid resistance in the SAN-F12 strain suggests the presence of a knockdown (Kdr)-type resistance mechanism, although the frequency of this mechanism was low. Resistance to deltamethrin could be associated with esterase or GST mechanisms, and more investigation is required. This information contributes to the improvement of resistance management strategies in the Cuban Ae. aegypti control program.

Aedes↗

[Exogenous factors in the aetiology of multiple sclerosis in Cuba. A study of cases and controls].

INTRODUCTION: Descriptive epidemiological studies indicate that the prevalence of multiple sclerosis (MS) in Cuba is in the mid range of risk. It is not known what exogenous factors may be related to the aetiology of MS. OBJECTIVE: To study the exogenous factors possibly related to the aetiology of MS in the central provinces of Cuba. PATIENTS AND METHODS: We studied all the patients with definite clinical MS (Poser et al) with positive MR who came from the provinces of Cienfuegos, Villa Clara and Sancti Spiritus. The protocol was approved by the Medical Ethics Committees of each of the three institutions and reviewed by two international authorities on the subject. Each of the patients (cases) and one member of their family (control), after written consent, when they fulfilled the criteria for inclusion in the study, were personally interviewed by trained persons and the questionnaire for studying cases and controls of Boiko et al was completed. The questionnaire had been adapted for use in Cuba. The main data obtained were: demographic data, history of occupation and residence, personal medical history, exposure to possibly toxic substances, diet and nutrition, contact with animals and life style. For measurement of risk we used the risk of the results of the crossed products odds ratio (OR) with its confidence interval (CI), always insisting on precision of 95%. RESULTS: High educational level (OR= 2.293; 95% CI= 0.9 5.4), two or more children (OR= 2.84; 95% CI= 1.22 6.59), four or more pregnancies (OR= 3.60; 95% CI= 0.69 18.7), three or more deliveries (OR= 1.939, 95% CI= 0.44 8.4); previous measles infection (OR= 2.042; 95% CI= 0.76 5.47), a history of migraine (OR= 2.538; 95% CI= 0.81 7.94); stress (OR= 3.768; 95% CI= 1.64 8.62) and insomnia (OR= 2.95; 95% CI= 1.14 7.14) were the factors related to MS. CONCLUSIONS: This study confirmed the existence of exogenous factors in the aetiology of patients with clinically defined MS and positive MR findings who lived in the provinces studied in Cuba. The exogenous factors found in this population of patients with MS were: high educational level, two or more children, four or more pregnancies, three or more deliveries, previous measles, a history of migraine, stress and insomnia.

Adolescent↗

Cuba shows jump in HIV positives.

Cuba experienced a substantial increase in the number of HIV cases in 1996 due primarily to a growth of foreign tourism and an increase in prostitution, health officials said. The Juventud Rebelde newspaper said that since HIV/AIDS testing began in 1985, government-run hospitals and clinics have detected 1609 HIV-positive cases. In 1995 the total was reported at 1196, meaning that 413 new cases were detected in 1996. This compared with only 97 new cases reported during 1995. HIV infection among the island's 11 million inhabitants has remained relatively low due to a massive testing program and a public health infrastructure that provides universal and free medical treatment. Cuba was a pioneer in the use of interferon on those testing HIV-positive. Cuba produces its own interferon, which prolongs the life expectancy of patients, and also reagents for AIDS testing. There are special sanitariums for AIDS patients in most of Cuba's 12 provinces. Cuban adults who test HIV-positive are required to enter the sanitarium in a policy reminiscent of the way tuberculosis patients were tested in the US earlier in this century. Officials said the isolation of patients in sanitariums has been somewhat relaxed over past years by introducing greater flexibility in allowing persons who are considered reliable to live at home or make prolonged visits.

Americas↗

An educator's perspective on the emerging Cuba and multiculturalism.

Plagued by many years of frequent leadership changes, and influences from power brokers whose policies and politics were oftentimes detrimental to Cuba's emerging as an industrialized and diverse economy nation, Cuba is now attempting to move beyond the survival mode. After the symbiotic relationship between the Soviet Union was dismantled in the 90s, Cuba is now undergoing metamorphoses of growth and change, socially, politically and culturally, while still remaining a mixture of worlds both rural and urban. This narrative article describes the multicultural experiences that an American university professor recently experienced while visiting Cuba.

Cuba↗

[Characteristics of the ecology of the eastern equine encephalomyelitis virus in the Republic of Cuba].

Virologic and serological surveys of wild vertebrates carried out in various provinces of Cuba demonstrated definitely that birds were the main hosts of eastern equine encephalomyelitis (EEE) virus in this territory. Fifteen strains of this virus were isolated from 8 species of birds belonging to 5 orders. Isolation of EEE virus from the blood of the endemic genus of iguanas indicates a certain role of cold-blooded animals in the ecology of this agent. Active EEE virus foci have been found in 4 provinces of the Republic of Cuba: Pinar del Rio, Havana, Matanzas and Las Villas. Isolation of a number of EEE virus strains from sick horses during an epizootic in the latter province confirmed the importance role of this agent in the infectious pathology of domestic animals in Cuba. The experimental results suggest that in Cuba there occur at least two types of foci of this infection: forest and water-littoral (fresh-water swamps and lakes, and sea coast with mangrove forests).

Animals↗

Breast-feeding trends in Cuba and the Americas.

In order to analyze breast-feeding trends in the Region of the Americas vis-à-vis trends observed in Cuba, information was culled from a selection of national surveys on the prevalence and duration of breast-feeding conducted in the 1970s and compared with the results of a national survey carried out in Cuba in 1973. Similarly, information from PAHO Document HPN/92.7, which contains reports from countries of the Americas for the period 1986-1991, was compared with the results of the National Survey carried out in Cuba in 1990. A cessation index (CI) was calculated with a view to comparing the relative extent to which the cessation of breast-feeding occurred at different ages in the two time periods. The study revealed a consistent pattern: typically, a relatively high percentage of newborns were initially breast-fed, but the prevalence of exclusive breast-feeding was low and the percentage of breast-fed infants declined quickly. However, the more recent data showed improvements in most of the countries involved with respect to both the prevalence and duration of breast-feeding. Cuba was found to have intermediate values relative to the other countries. Although a slight decline in the initial prevalence of breast-feeding was observed in 1990 (as compared to 1973), notably higher percentages of infants were being breast-fed at 30, 60, 90, and 120 days, and the CI values for the corresponding intervals up to 90 days were lower. These results suggest that positive changes have taken place in factors promoting a longer duration of breast-feeding.

Adult↗

[Breast-feeding trends in Cuba and the Americas].

To determine breast-feeding trends in the Region of the Americas and compare them with those observed in Cuba in the last decade, information was complied from a select group of national surveys conducted in the 1970s on the prevalence and duration of breast-feeding and then compared with information from a survey carried out in Cuba in 1973. In addition, data were taken from document HPN/92.7 of the Pan American Health Organization, which contains reports corresponding to the period 1986-1991, and these were compared to the results of the national study carried out in Cuba in 1990. The discontinuation rate (DR) was also calculated. The study found a sustained pattern of initial breast-feeding of a relatively high proportion of babies, with rapid declines in subsequent days and low prevalence of exclusive breast-feeding. In most countries, prevalence and duration showed a tendency to increase. In Cuba intermediate values were observed with a discrete decline in initial prevalence, increases up to 180 days, and lower DR values up to 90 days in 1990 as compared to 1973. This suggests that there have been favorable changes in the factors that help to prolong the duration of breast-feeding. Calculation and analysis of the DR at various intervals proved useful for comparing the trends observed in the different countries.

Adult↗

Molecular epidemiology of tuberculosis in Cuba outside of Havana, July 1994-June 1995: utility of spoligotyping versus IS6110 restriction fragment length polymorphism.

SETTING: Molecular typing has become an important tool for examining the extent of active transmission of tuberculosis. OBJECTIVES: To examine transmission of tuberculosis in Cuba using IS6110 restriction fragment length polymorphism (RFLP) typing and to evaluate the utility of spoligotyping. DESIGN: One hundred and sixty Mycobacterium tuberculosis strains isolated over a one year period in Cuba were subjected to RFLP and spoligotyping. RESULTS: Forty-eight percent of the isolates were found in 19 clusters of strains with identical RFLP patterns. In general, cluster sizes were limited, except for two large institutional outbreaks. Age was strongly inversely correlated to clustering. Most streptomycin-resistant isolates were found in clusters. Fifteen spoligotype clusters comprised 78% of the isolates. Significantly different IS6110 RFLP types subdivided 11 spoligotype clusters, whereas none of the IS6110 clusters were subdivided by spoligotyping. CONCLUSIONS: Considering the short study period, 48% clustering is high, indicating that recent transmission plays an important role in Cuba. Although resistance is still a minor problem, transmission of streptomycin-resistant strains occurs. The high polymorphism observed with IS6110 RFLP indicates that this marker is useful for future molecular epidemiological studies in Cuba. Spoligotyping appeared less suitable for population-based studies.

Cluster Analysis↗

Epidemic optic neuropathy in Cuba. Eye findings.

OBJECTIVE: To characterize and establish a clinical definition of the optic neuropathy that appeared in epidemic form in Cuba in 1992 and 1993. METHODS: At the invitation of the Cuban Ministry of Health, Havana, members of ORBIS International and the Pan American Health Organization, assembled teams that traveled to Cuba in May 1993. We were initially briefed by Cuban national experts in the areas of virology, nutrition, toxicology, ophthalmology, neurology, and public health. We then examined 20 patients on our own. Thirteen of these patients underwent a comprehensive neuro-ophthalmologic examination, including neurologic examination, ophthalmologic examination, visual fields, optic nerve function studies, contrast sensitivity studies, and funduscopy. We returned 4 months later to perform an additional 12 comprehensive neuro-ophthalmologic and follow-up examinations. RESULTS: Only seven of the 13 patients who were alleged to have the optic form of the epidemic and who were rigorously and systematically examined on the first visit demonstrated a bilateral optic neuropathy. These seven patients had several features that included decreased visual acuity, poor color vision, central scotomas, decreased contrast sensitivity, saccadic eye movements, and most prominent and distinctive of all, nerve fiber layer wedge defects of the papillomacular bundle. Our clinical definition was then implemented by the Cuban ophthalmologists and epidemiologists. On returning 4 months later, we found that all newly presented patients were correctly diagnosed to have the epidemic disease. With the new case definition and the application of a few simple psychophysical tests, the false-positive rate of diagnosis became much lower. After vitamin therapy, we reexamined the patients seen on our initial visit, and all showed marked improvement. CONCLUSIONS: The Cuban epidemic was characterized by an optic neuropathy with features that were similar to those of tobacco/alcohol amblyopia and Leber's optic atrophy. Recent political, economic, and social changes in Cuba may have contributed to the nutritional and/or toxic compromise of mitochondrial function of an acquired nature, which led to selective retinal ganglion cell damage. We have termed this condition Cuban epidemic optic neuropathy.

Adult↗

Evaluation of patients with retinitis pigmentosa receiving electric stimulation, ozonated blood, and ocular surgery in Cuba.

OBJECTIVE: To evaluate the effect of intervention with electric stimulation, autotransfused ozonated blood, and ocular surgery, performed in Cuba, on the course of the common forms of retinitis pigmentosa. DESIGN: Ocular evaluations over 6 to 8 months before and after intervention in Cuba. SETTING: Evaluations performed at a US clinical research facility. PATIENTS: Ten adult patients aged 25 to 67 years with retinitis pigmentosa. MAIN OUTCOME MEASURES: Visual acuity, visual field area, and electroretinogram (ERG) amplitude. RESULTS: No significant change in visual acuity or visual field area was observed on average between preintervention and postintervention values over a 6- to 8-month interval. Mean 30-Hz cone ERG amplitude declined by 15.5% between preintervention and postintervention values (P = .006). When data on change in visual field area from 1 statistically significant outlier were excluded from the analysis, a significant decline of 12.9% in mean visual field area was observed (P = .025). CONCLUSIONS: These data support the conclusion that the intervention offered in Cuba provides no benefit to patients with retinitis pigmentosa as measured by visual acuity, visual field area, and ERG. The magnitudes of the mean declines observed in ERG amplitude and visual field area over a 6- to 8-month interval, relative to those reported in previous studies, raise the possibility that this intervention may worsen the course of the disease.

Adult↗

Epidemiological assessment of levodopa use in Cuba: 1993-1998.

PURPOSE: The purpose of this study is to describe and evaluate the use of levodopa in Cuba in order to provide a basis for intervention aimed at improving pharmacological treatment of individuals presenting with Parkinson's disease (PD). METHODS: We studied the amount of levodopa, both plain and combined, distributed by the central laboratory to hospital and community pharmacies in Cuba in the period 1993-1998. An internationally established drug-classification system and a reported method for epidemiological assessment of levodopa sales were applied. Sweden in 1994 served as the reference population. RESULTS: National crude rates of levodopa use basically remained stable since 1994, and in 1998 stood at 0.11 defined daily dose (DDD) per 1000 inhabitants/day, approximately 15 times lower than the corresponding figure for the reference population. Annual provincial use of levodopa showed considerable geographical variation, with the lowest rates in the eastern provinces and the highest rates in Havana City (Ciudad de La Habana). Adjustment for age reduced such differences by approximately 50%. CONCLUSIONS: Levodopa use in Cuba is low and consistent with the reported low prevalence of the diagnosis of PD. Results suggest that the diagnosis and treatment of PD can be improved, with emphasis on better detection of PD.

Cuba↗

Maternal serum alpha-fetoprotein screening for neural tube defects and other disorders using an ultramicro-ELISA. Collaborative study in Cuba and in the German Democratic Republic.

In Cuba and in the German Democratic Republic (GDR) a total of 24,412 pregnant women were tested for maternal serum alpha-fetoprotein (MSAFP) at the 16th to 20th week of gestation. An inexpensive and partly automated ultramicroliter enzyme immunoassay (ELISA) with final volumes of 10 microliter was used to analyze simultaneously 50 samples. The intraassay coefficient of variation (CV) of 5-8% and day/day CVs of 6-10.5% were obtained with a test frequency of 320 assays/day. A cut-off level of twice the median value (MoM) was chosen. An amniocentesis was done in a total of 0.5% (in the GDR) and 0.7% (in Cuba) of the screened women. The prevalence of open neural tube defects (ONTD) was calculated from the present study and was 1.43% in Cuba and 1.34% in the GDR. Through MSAFP screening 88.2% ONTD were detected. There was no therapeutic abortion of a normal fetus. The approximate cost for this program was about 2.36 marks-GDR per patient screened, or about 2,048 marks per ONTD detected.

Abortion, Spontaneous↗

Monogeneans on native and introduced freshwater fishes from Cuba with the description of a new species of Salsuginus Beverley-Burton, 1984 from Limia vittata (Poeciliidae).

During a parasitological survey carried out between March and September 2003 in Cuba, the following monogeneans were found on the gills of freshwater fishes: Salsuginus cubensis n. sp. on the Cuban molly Limia vittata Guichenot (Poeciliidae); Cichlidogyrus sclerosus Paperna & Thurston, 1969 and C. tilapiae Paperna, 1960 on the African cichlid Tilapia rendalli Boulenger (Cichlidae); Haplocleidus dispar Mueller, 1936 and Pterocleidus acer Mueller, 1936 (all Dactylogyridae) on the sunfish Lepomis macrochirus Rafinesque (Centrarchidae) (new geographical records); and Gyrodactylus sp. (Gyrodactylidae) on the biajaca Nandopsis tetracanthus Valenciennes (Cichlidae) (new host and geographical record). Salsuginus cubensis differs from all other species of the genus in the size and morphology of the copulatory complex. The occurrence of C. sclerosus, C. tilapiae, H. dispar and P. acer in their respective hosts is due to the introduction of these hosts to Cuba. A review of the species composition of the Monogenea in native and introduced freshwater fish from Cuba is presented and the zoogeographical distribution of the species found is briefly discussed.

Animals↗

The state of the provision of nutritional care to hospitalized patients--results from The Elan-Cuba Study.

Current nutritional care provision to 1905 patients hospitalized in 12 Cuban hospitals is presented in this article, diagnosed after conducting the Hospital Nutrition Survey (HNS), as part of the activities comprising the Cuban Study of Hospital Malnutrition (Elan-Cuba). The obtained HNS results were contrasted with standards regarding the nutritional assessment of hospitalized patient, the diagnosis of nutritional disorders occurring in the patient, and the identification of patients in need of nutritional intervention. The Elan-Cuba Study returned a 41.2% malnutrition rate [Barreto Penié J, Cuban Group for the Study of Hospital Malnutrition. State of malnutrition in Cuban hospitals. Nutrition 2005;21:487-97]. However, malnutrition was recorded as an independent diagnosis in only 0.4% of the surveyed clinical charts. It could not be shown that medical care teams were systematically applying any of the techniques and procedures recommended for the assessment of the nutritional status of hospitalized patients. In the best of the cases, only 40.6% of the surveyed patients had their height and weight recorded in their clinical charts at admission, 9.0% of those with more than 15 days of hospitalization had a prospective value of weight, and less than 20.0% of them had their serum albumin levels and/or their counts of Lymphocytes annotated on their clinical charts. Although 10.9% of the surveyed patients (median of the subcategories values; range: 3.5-41.2%) fulfilled an indication for nutritional intervention, support (enteral and/or parenteral) was only provided to less than 15.0% of them, with the exception made of patients on NPO, of whom 32.3% received either of the two modes of artificial nutrition listed above. It is to be noticed that none of the patients with chronic organic failure were on nutritional support at the time of the survey. The current nutritional care provision to the hospitalized patient might explain the increased rates of hospital malnutrition documented in the Elan-Cuba Study, and should lead to the design and urgent implementation of nutritional and metabolic intervention programs in the surveyed hospitals, given the deleterious effects of nutritional disorders upon the ultimate results of the medical and surgical actions, and the quality and costs of medical care.

Cuba↗

Herbal mixtures in the traditional medicine of eastern Cuba.

Herbal mixtures in the traditional medicine of Eastern Cuba. Traditional herbal mixtures in Eastern Cuba are investigated through interviews with 130 knowledgeable people and traditional healers of the provinces of Santiago de Cuba and Guantánamo. One hundred seventy plant species and other products are used in 199 formulas, galones being the more complex. Cocos nucifera L. (Arecaceae), Bidens pilosa L. (Asteraceae), Cissus sicyoides L. (Vitaceae), Erythroxylum havanense Jacq. (Erythroxylaceae) and Stachytarpheta jamaicensis (L.) Vahl. (Verbenaceae) are the species most frequently cited. The ecological distribution of the taxa and cultural and anthropological aspects of mixtures are highlighted; particularly American and African influences that have shaped local knowledge about plant combinations are discussed.

Cuba↗

Drug-resistant tuberculosis in Cuba. Results of the three global projects.

SETTING: The spread of multidrug-resistant tuberculosis (MDR TB) in the world remains a major public health problem. Surveillance of anti-TB drug resistance is therefore an essential tool for monitoring the effectiveness of TB control program and, through policy development, for improving national and global TB control. OBJECTIVE: To determine the prevalence of anti-TB drug resistance in Cuba during the execution of the three global projects. DESIGN: Drug-resistance was determined using the proportion method in 1528 Mycobacterium tuberculosis strains to first line anti-TB drugs. RESULTS: Resistance in new cases was 8.3%, 4.6% and 5.0%; MDR was 0.7%, 0% and 0.3% in the first (1997), second (2000) and third (2004) global projects, respectively. In new cases, none showed resistance to the four drugs. There were among previously treated cases statistically significant decreases in the prevalence of resistance to at least one drug when comparing the results obtained in the three global projects. CONCLUSIONS: The contributed data through Cuba demonstrated that our country is relatively free of MDR strains, reflecting the good National Control Program and the possibility of TB elimination in Cuba.

Antitubercular Agents↗

Role of the virology diagnosis laboratory in the surveillance of rubella virus Cuba 1988/2000.

In Cuba, on the basis of Measles Elimination Program, the incidence of this disease decline, and was necessary to test rubella virus as a possible etiology agent that produce fever and rash illness. To reach this goal, Cuba developed rubella elimination strategies with integrated epidemiologic and laboratory surveillance. In the country, the vaccination program against rubella started in 1982 by vaccinating 12-14 years old females, with a special surveillance program with laboratory study of all suspected cases. Through 1988-2000, the Serology Diagnosis Laboratory in the Virology Branch of Pedro Kouri Institute had the responsibility to do the measles and rubella surveillance and play a key roll in the elimination strategies of these diseases. For confirmation of all suspected cases, 8566 serum samples with the suspected diagnosis of measles or rubella from different provinces in Cuba were studied in the laboratory using different techniques as haemagglutination inhibition test (HIA), ultra micro analytic assay (UMA); and in 1995 by the newly introduced IgM ELISA, which was used taken only one sample in the acute phase of the disease. These techniques allowed knowing that the annual number of reported rubella cases in the country decreased substantially after the implementation, in 1986, of the second vaccine policy, that of vaccinating women of childbearing age. However, in 1989, was detected an outbreak of rubella virus infection that had occurred in young adults male 15-19 age groups in Matanzas' province. The last three indigenous cases of this disease were confirmed by our laboratory in 1995, after national vaccine coverage over 95%.

Adolescent↗

Abortion among adolescents in Cuba.

PURPOSE: To understand which adolescents in Havana, Cuba, seek abortions and reasons for pregnancy termination. METHODS: The sample included all adolescents (n = 248) under the age of 20 years who sought pregnancy termination over a 1-month period in 1995. The participants completed a questionnaire exploring a range of issues including age of onset of sexual intercourse, pregnancy history, and reasons for pregnancy termination. RESULTS: There was no difference in age of onset of sexual intercourse between pregnant adolescents who did and did not seek an abortion. Three fourths of all adolescents who aborted a pregnancy were students, and interruption of studies was a major reason for pregnancy termination. Other reasons included being a single mother and poor socioeconomic conditions. More than half of those who sought to terminate their pregnancy did so at a clinic outside of the community in which they lived. CONCLUSION: As in other countries, in Cuba, concerns over education interruption remain the predominant reason for abortion. Likewise, while abortion has been legal and widely available in Cuba since 1969, there remains sufficient stigma so that over half of young women seek pregnancy termination outside their community of residence.

Abortion Applicants↗