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From April to September 2000, an epidemic of aseptic meningitis spread throughout Cuba, with 16,943 reported cases. Virologic studies identified echovirus 16 as the cause of this epidemic. This is the first reported isolate of echovirus 16 from patients with viral meningitis in Cuba.
A surveillance system to detect West Nile virus (WNV) was established in Cuba in 2002. WNV infection was confirmed by serologic assays in 4 asymptomatic horses and 3 humans with encephalitis in 2003 and 2004. These results are the first reported evidence of WNV activity in Cuba.
OBJECTIVES: We present an update of specific treatment for multiple sclerosis (MS), especially the form with a clinical course of exacerbation-remission (ER), in which we consider the benefits of beta interferons, copolymer 1 and intravenous immunoglobulin. We discuss the properties of alpha interferon and its modes of action which are very similar to those of beta interferon. The main clinical trials in which various subtypes of alpha interferons were used are summarized. PATIENTS AND METHODS: We establish the elements which justify interest in studying this substance and present the main trials carried out in Cuba. These consist in an initial trial in 9 patients, with encouraging results in the clinical course ER-MS and following this, the findings of a preliminary study of the first 17 patients of a randomized, double-blind National Clinical Trial, in which a placebo was used for control. CONCLUSIONS: In view of these results we recommend that the study being carried out in Cuba to confirm the efficacy of alpha interferon in the ER-MS form be continued.
The eradication of poliomyelitis in Cuba, for which effective vaccines had to be acquired, is reviewed in this article. The strategy for eradication was based on mass immunization campaigns for the annual delivery of two doses of trivalent Sabin oral poliovirus vaccine (OPV). Except during the first campaign in 1962, the ages of the children for immunization were determined through national serological surveys of the entire country, including rural and urban areas. The interruption of wild virus transmission had been suspected since 1967 in Cuba, and since 1970 no studies have detected any wild virus. The important role of political and social organizations in the success of the programme and in the execution of the mass immunization campaigns is underscored. Countries that have successfully interrupted poliovirus circulation should maintain high immunization coverage for as long as there are other countries in the world where poliovirus still exists.
INTRODUCTION: Neurocysticercosis is one of the main causes of epilepsy in the tropics, particularly in Central and South America. OBJECTIVES: To report the only five patients diagnosed in a tertiary care institution as having neurocysticercosis and its relation to epilepsy. PATIENTS AND METHODS: We made a retrospective study, reviewing the clinical histories of patients admitted to the Instituto de Neurologia y Neurocirugia of La Habana, Cuba, over 25 years up to 1989, to determine those with neurocysticercosis. RESULTS: We found only five patients, representing a frequency of 0.01% of all admissions. We discuss the origin of these cases and their possible place of infection, showing that this is almost non-existent in Cuba since three of the cases were of foreigners and there was evidence that the two Cubans had acquired the disease abroad. The correlation between neurocysticercosis and epilepsy (4 of 5 cases) was assessed. The main symptoms were analyzed: the three most important, in order, were tonic-clonic convulsions, headache and motor deficit respectively. The epileptic seizures were classified as secondary generalized partial seizures (symptomatic partial epilepsy secondary to cysticercosis). The clinical form, when the site is considered, was inactive, with intraparenchymatous and meningeal (mixed) calcifications in one case. CONCLUSION: We assess the elements which permit diagnosis, the efficacy of anti-helminth treatment and the drugs used to treat epilepsy and cerebral oedema, the prognosis as a function of the diagnosis and the treatment.
OBJECTIVE AND DEVELOPMENT: We present a synopsis of some of the main achievements of the Cuban Public Health Service in the past 39 years. We emphasize the importance of cerebrovascular disease as a cause of mortality, both in Cuba and in certain selected provinces, together with its relationship with some parameters such as age group. In the second part, we show the main results of a longitudinal or cohort study carried out in the town of Cienfuegos in Cuba. In this the importance of age as a statistically significant risk marker for the development of cerebrovascular disease is clearly seen. We also present the rate of incidence depending on exposure to risk markers, and the estimated number of new cases annually of cerebrovascular disease according to age group and gender in the town of Cienfuegos. We emphasize the need for our Public Health System to continue to deal with this disorder in an integrated manner.
INTRODUCTION: This century, the greatest epidemic affecting the nervous system was notified in Cuba seven years ago. At the present time the epidemic continues although to a lesser extent. The clinical findings of the illness were mainly bilateral optic neuropathy sometimes accompanied by other symptoms and peripheral neuropathy. The similarity of the optic form of the illness with Leber's hereditary optic neuropathy, and their common risk factors, were obvious from the beginning. PATIENTS AND METHODS: Statistics from the national reference department of neuro-ophthalmology of the Instituto de Neurologia de Cuba were reviewed. From these it was evident that the number of cases of Leber's hereditary optic neuropathy had increased in recent years, coinciding with the period of epidemic and endemic Cuban neuropathy. Many of these patients had previously been diagnosed as having epidemic optic neuropathy. RESULTS: We describe the characteristics of a group of these patients and discuss the differences and possible relationship between the two conditions. In the case of epidemic optic neuropathy, there is strikingly simultaneous loss of vision, less visual changes with much smaller cecocentral scotomas, loss of ganglion fibres of the retina around the papillomacular bundle, a good response to multivitamin treatment, and increased frequency of association with peripheral sensory neuropathy. CONCLUSION: This analysis reinforces the hypothesis that many patients with Leber's hereditary optic neuropathy, which started at the time of the epidemic, were incorrectly classified as suffering from this, and also perhaps their condition worsened due to the toxic nutritional features common to both conditions.
INTRODUCTION: The authors describes the past eight years, since an epidemic started in Cuba which mainly affected the nervous system, particularly the optic nerve and the peripheral nerves. It is thought to have been the biggest epidemic involving the nervous system this century, although there may be over-diagnosis. The cause is controversial but is probably nutritional imbalance with additional toxic elements also in some cases. At the present time the continuous, low, notification of new cases means that it is endemic. DEVELOPMENT: In this paper we consider the clinical and electrophysiological aspects characteristic of the disorder, the degree of involvement, evolution, incidence and annual follow-up of cases from 1992 to date and their differential diagnosis. We describe the national programme of healthcare for control of the disease in Cuba, the measures designed to reduce the number of patients, most of the results of clinical and epidemiological studies and the possible causes. We also discuss the most likely physiopathological hypotheses.
BACKGROUND: The province of Havana City, the capital and most densely populated city in Cuba, totals around 27% of the new cases of tuberculosis. This article is for the purpose of describing the distribution and trend of the tuberculosis cases rates from 1986 to 1998, by municipalities and age groups in this province. METHOD: A calculation was made of the rates and of the total percentage of deviation of these rates, in addition to the annual average deviation both throughout two time periods and between the two (1986-1993 and 1994-1998). The trends were calculated by simple linear regression. RESULTS: Throughout the 1986-1993 period, the case rate for this province underwent a 6% increase. Throughout the 1994-1998 period, it dropped by 7.3%. The three most densely-populated cities showed a higher rate increase. Of the 15 municipalities, only La Lisa showed a drop in the rates throughout the entire period in question. The rates by ages were similar throughout all of the municipalities, being higher for individuals > 65 years of age. Six tenths (0.6%) of the cases reported involved people under 15 years of age. The infantile tuberculosis rates were very low for the time period under analysis. CONCLUSIONS: The differences among the municipalities in question make it necessary for different measures to be taken to achieve a greater impact and repercussion in Cuba. The drop in the rates detected over the last three years is indicative of the epidemic being brought under control and the national tuberculosis control program being reinstated.
A general overview of hypertension as a major health problem in Cuba in the last 25 years are presented. In the first period, 1974-1990 was created a National Hypertension High Commission by the Minister of Public and the First national program for prevention and Control of Hypertension in Cuba was launched. To define high blood pressure in adults 15 years and older the cut-off point was set at 160/95 mmHg. The prevalence found was 15% in urban areas and 7-8% in rural areas. The second period, 1991-1998 the original National program was re-evaluated in 1990 and 1995. The new blood pressure cut-off point was set at 140/90 mmHg. The prevalence increased to 30.6% in urban areas and 15% in rural areas and incidence of 2.5% annual. A total of 862,303 hypertensive patients were registry at the end of 1997 which represents less than 40% of the total number of possible hypertensive patients. A National Campaign was launched in 1998. In 9 months the preliminary reports were: 25% increase in prevalence, registry and follow-up of hypertensive patients 15 years old and older (8.5% to 12.5%); 92.9% of primary care doctors and 89.5% of primary care nurses received training; improvement in public education and social support; improvement in risk factor awareness in general public and improvement of hypotensive drugs availability and splygmomanometers supplies.
OBJECTIVE: This review has been designed to describe the main clinical, epidemiological, electrophysiological, molecular and quantitative neurological characteristics in SCA2. DEVELOPMENT: The prevalence rate of patients with ataxia in Holguin province is 43 per 100,000 inhabitants. The prevalence of family members at risk of having this disorder is 159.33 per 100 thousand in this province. The main neurophysiological abnormality observed was reduction in the amplitudes of sensory potentials. These alterations are the expression of a predominantly axonal peripheral lesion with signs of myelin damage. Techniques of quantitative neurology were developed for evaluation of the main disorders of coordination such as asymmetry and adiadochokinesis. In Cuba 125 families have hereditary ataxia, 772 patients and 8 to 10,000 family members are at risk of developing this condition. Seventy percent of the patients with ataxia are concentrated in Holguin province. The most severely affected towns are Báguanos (a rate of 129.20 per 100,000 inhabitants), Holguin (71.85 per 100,000) and Cacocúm (69.83 per 100,000). These are the highest rates in the world. CONCLUSIONS: The commonest molecular form in Cuba is the SCA2, observed in 120 families. Clinically it is characterized by a cerebellar syndrome associated with disorders of eye movements and osteotendinous reflexes.
UNLABELLED: The Epidemic Optic Neuropathy (EON) that occurred in Cuba in 1993 affected more than 50,000 people. With the purpose of characterizing it from the clinical and neurophysiological points of view, and of determining the etiology of this illness, we studied 85 of this patients who were treated in the Ophthalmology Department of the Hermanos Ameijeiras Clinical Surgical Hospital, located in Centro Havana, Havana city. Cuba. METHODS: We examined 8 cases at the beginning of the epidemic, 27 in the middle period and 50 at the end. RESULTS: The bilateral and symmetrical affectation of the optic nerve was the most remarkable clinical feature in all cases studied. This affectation was more severe in the first group of studied patients with a very extended evolution of the illness. The amplitude and latency values of visual evoked potentials were affected in the first and second group of patients. CONCLUSIONS: This neuropathy is of a toxic-nutritional-metabolic type and the severity of the clinical-neurophysiological picture is determined by the time of evolution of the symptoms, before the diagnosis of the illness.
The number of children born to HIV/AIDS-seropositive mothers in Cuba is small due to the implementation of the program for the prevention of maternal-infant transmission of HIV/AIDS in Cuba. During the studied period (January 1st, 1985, to December 31st, 1999) 64 children were born, 9 were infected with HIV, 7 of them have developed AIDS (3 have died due to this cause and 4 are under treatment with antiviral agents and proteases inhibitors) and 2 are asymptomatic HIV seropositive. Of the 48 children that concluded the study, 39 (81.25%) are sound and 9 (18.75%) are HIV/AIDS-seropositive children, which is a low figure of maternal-infant transmission compared with that of the developed countries. Since 1997, when AZT began to be administered to mothers and children, none of the 8 children that finished the study have been infected. Up to now, 10 HIV/AIDS-seropositive children, 9 by perinatal route and 1 by blood transfusion, already dead, have been reported in the country.
The insect visitors of flowers in nine weeds species were studied in the Botanical Garden of Santiago de Cuba, Eastern Cuba, during 1993 (March-June, spring season) and 1994 (January-March, end of winter and beginning of spring season). About 50 hours of collecting efforts were made at three times (0900-0930 hr in 1993; 0900-0930 hr, 1200-1230 hr and 1500-1530 hr in 1994). More than 140 species of at least 37 families were found; Hymenoptera dominated (with more than a half of specimens), followed by Diptera, Coleoptera and Lepidoptera. Among Hymenoptera, bees (Apoidea) were the largest group, especially Apis mellifera L; followed by wasps (Vespidae, Pompilidae, Sphecidae) and ichneumon flies (Ichneumonidae); Microhymenopterans were not sampled. Hymenopterans of each weed were compared for diversity, similarity, dominant and subdominant species, visitation time, sampling efficiency, etc. Each plant species had a particular Hymenoptera complex, almost one third of which were natural enemies of agricultural pests, and most are believed to be potential pollinators. Closely related species showed similar patterns of daily activity, with a peak at 0900-0930 hr for all plant species. Second grade polynomial equations were the best fitted models to describe the relationships between number of species and number of specimens, and between total number of species and number of samples (R2 = 0.9734 and R2 = 0.9573, p < 0.01). The role of weeds in the biodiversity of the agroecosystems is analyzed; as well as the effectiveness of this collection method to study Hymenoptera.
An estimate of infant and child mortality in the eastern provinces of Cuba is presented using the Brass method as adapted by Trussell. "Estimations by urban and rural zones are also performed within the provinces studied, and results are compared with those possible to obtain by continuous statistics. Results obtained show that in the eastern [part] of the country Holguin and Guantanamo are the provinces with highest infantile mortality rates, and the lowest rates correspond to Granma, followed by Santiago de Cuba." (SUMMARY IN ENG AND FRE)
AIMS: In this paper we report on Public Health Resolution 90, which regulates the determination and certification of death in Cuba. METHOD: Public Health Resolution 90 is of great social importance in our country since it allows the determination and certification of death to be lawfully regulated throughout the whole territory. It is the fruit of over ten years work by a national commission which was set up for that purpose. This resolution includes a series of features that are unprecedented on an international level. By legalising all the aspects linked with the determination and certification of death by means of a ministerial resolution (Ministry of Public Health), and not through a law passed by Parliament, no obstacles are created to prevent it from being reassessed and changed in the future in order to keep up with scientific and technical progress. Unlike most legislation throughout the world, this resolution does not regulate the determination of death, or brain death, linked with organ transplants. In fact, the word transplants does not appear anywhere in the resolution. The clinical and instrumental criteria for determining death were grouped under the heading of the well known true signs of death , but included a true sign based on the irreversible loss of brain functions . Although the irreversible absence of respiratory and circulatory functions, together with the presence of post mortem changes, were included as true signs, the national commission concluded that the death of an individual can only be defined in terms of the irreversible loss of brain functions . The clinical and instrumental criteria for determining death are included in two annexes to the resolution, which must be reviewed from time to time by the National Commission for the Determination of Death, as and when scientific and technical progress makes it necessary to do so. Among the instrumental tests used as a diagnostic aid for the irreversible loss of brain functions and, for perhaps the first time in the world, a battery of tests made up of multimodal evoked potentials and electroretinography has been included. CONCLUSIONS: Public Health Resolution 90 offers the legal framework for regulating the determination and certification of death in Cuba.
During the 17th, 18th and 19th centuries, yellow fever has been an ordinary scourge in American cities. In the early part of the 20th century, a main discovery has been achieved in Havana city, Cuba, leading to direct consequences for tropical medicine, public health and virology. There, the U.S. Army yellow fever commission headed by Walter Reed proved that yellow fever was a viral disease transmitted by a specific mosquito, Stegomyia fasciata, in fact Aedes aegypti L. The idea that vomito negro would be spread by mosquito bites was not a new one. It has already been postulated, since 1881, by Carlos Finlay, a Cuban physician, who has attempted to prove experimentally his hypothesis in human beings, but without real success. The U.S. Army commission quickly demonstrated two essential facts ignored by C. Finlay, which explained his failure. To be able to transmit yellow fever, Ae. aegypti had to bite a patient during the first three days of the disease (viraemia), and then, a delay of about 12 days was necessary before the mosquito would be ready to transmit the disease to a non immune human (the virus replication time inside the insect). Since the role of mosquito in spreading yellow fever was established, an efficient means to fight the scourge was available, i.e., the mosquito extermination. This concept was quickly applied leading to the complete clean up of Cuba (1901) and the Panama isthmus (1907).
The results of a two-year study on swine stephanuriasis in Cuba indicate the high economic importance of this parasitosis in view of its pattern of local distribution and pathological changes occurring during the endogeneous phase of its life cycle. Under the present conditions of pig breeding in Cuba, it appears to be most economic to base control measures on a strict observance of general zoohygienic rules and on several specific measures suggested in the paper. The administration of expensive drugs is uneconomic because none of them is universally effective in any phase of the life cycle of S. dentatus. It is suggested to direct research work to suitable preventive measures and the choice of drugs to be administered during the most critical period in the spread of infection covering the time from birth to weaning.