INTRODUCTION Age-related cognitive disorders, including Alzheimer disease, are among the main causes of disability and dependence in older adults worldwide. High blood homocysteine levels (hyperhomocysteinemia) are a risk factor for diseases whose metabolism involves different B vitamins. Antioxidant vitamins provide a protective effect by mitigating oxidative stress generated by these diseases. Epidemiological studies have presented varying results on the relationships between blood levels of these vitamins and such cognitive disorders.
OBJECTIVE Evaluate the association of vitamin and homocysteine levels with mild cognitive impairment and Alzheimer disease in a group of Cuban older adults.
METHODS A cross-sectional study was conducted in Havana, Cuba, of 424 persons aged ≥65 years: 43 with Alzheimer disease, 131 with mild cognitive impairment, and 250 with no signs of cognitive impairment. Dementia was diagnosed using criteria of the International 10/66 Dementia Research Group and Diagnostic and Statistical Manual of Mental Disorders (DSM IV), and mild cognitive impairment was diagnosed using Petersen’s criteria. Blood levels of vitamins (thiamine, B-2, folate, B-12, C and A) and homocysteine were measured by standard procedures. Analysis of variance for continuous variables and percentage comparison tests for dichotomous variables were used to compare groups.
RESULTS Persons with Alzheimer disease presented significantly lower levels of vitamins B-2, C and A than healthy participants (p <0.05). Homocysteine levels were significantly higher in those with Alzheimer disease and mild cognitive impairment than in participants with no cognitive impairment (p <0.05). Statistically, levels of thiamine, folic acid, and vitamin B-12 were not significantly different across groups. Compared with those without cognitive impairment, prevalence rates (PR) in the Alzheimer group were significantly higher for hyperhomocysteinemia (PR = 3.26; 1.84–5.80) and deficiency of all B vitamins: thiamine (PR = 1.89; 1.04–3.43), B-2 (PR = 2.85; 1.54–5.26), folate (PR = 3.02; 1.53–5.95), B-12 (PR = 2.21; 1.17–4.19), vitamin C (PR = 3.88; 2.12–7.10) and A (PR = 5.47; 3.26–9.17). In mild cognitive impairment, prevalence rates were significantly higher for hyperhomocysteinemia (PR = 1.42; 1.08–1.87), vitamin B-2 deficiency (PR = 1.70; 1.24–2.32) and vitamin A deficiency (PR =1.88; 1.05–3.38).
CONCLUSIONS Hyperhomocysteinemia and various vitamin deficiencies are related to Alzheimer disease and mild cognitive impairment. Longitudinal studies are needed to further elucidate the relationship between different nutritional biomarkers and dementia. A better understanding of this relationship could provide a basis for therapeutic and preventive strategies.
KEYWORDS Vitamins, homocysteine, geriatrics, Alzheimer disease, cognitive impairment, Cuba
If all physicians are detectives, using their skills to track down what ails body and mind, then epidemiologists are medicine’s social detectives, using their training to understand the great calamities of population health. For over 30 years, Dr José Moya has worked in the field since his initial position as head of epidemiology in Ayacucho, […]
INTRODUCTION Cirrhosis of the liver is a chronic disease that is widespread and irreversible. It represents the final stage of numerous diseases that affect the liver. By the end of 2017, it was the 11th most common cause of death, with a loss of 41.4 million years of disability-adjusted life years, which represent 2.1% of the total years of life lost in the global mortality burden. In Cuba, cirrhosis and other chronic liver diseases have been among the top 10 causes of death for several decades, their rates consistently increasing, from 576 deaths in 1970 (6.7 per 100,000 population) to 1738 in 2017 (15.5 per 100,000 population), with a risk of death that is 4.6 times higher in men.
OBJECTIVE Characterize deaths from cirrhosis of the liver in Cuba from 1987 to 2017.
METHODS An ecological time-series study was conducted for 1987 to 2017 using information obtained from the mortality database of the Medical Records and Health Statistics Bureau of Cuba’s Ministry of Public Health. The study universe consisted of all deceased persons in the country whose underlying cause of death was cirrhosis of the liver. Both general mortality rates and specific mortality were calculated by age group, sex and etiological classification using adjusted and crude rates. Rates were age-adjusted using the direct method, and the population from the 2002 Census of Population and Housing was considered as the standard population. Percentages and means were also calculated according to selected variables and the relative risk of death due to the disease according to sex, age group and etiological classification. The trend and forecast for mortality rates were estimated for this disease.
RESULTS The crude mortality rate from cirrhosis of the liver was 9.0 per 100,000 population for the period. Those aged ≥75 years had the highest risk of death (48.3 per 100,000 population). The crude and adjusted mortality rates were almost double for men (12.4 vs. 5.6 and 11.7 vs. 5.6 per 100,000 population, respectively), as was the total relative risk of death, which was 2.2 times higher. Nonalcoholic cirrhosis accounted for 71.6% of deaths. By the end of 2017, risk of death from cirrhosis had climbed to 14.8 per 100,000 population (adjusted rate: 10.6 per 100,000 population), a signal that mortality had progressively increased over the 31 years analyzed. In addition, forecasts predict that death rates will continue their gradual increase, reaching 19.2 per 100,000 population in 2025.
CONCLUSIONS Deaths from cirrhosis of the liver constitute a substantial health burden in Cuba. The upward trend and forecast, in addition to increased risk of mortality in men and older adults, are similar to those reported internationally. The finding that most of these deaths result from nonalcoholic cirrhosis should be further studied, as formulation of effective public health strategies depends largely on attaining a better understanding of the etiology, progression and social determinants of the disease.
KEYWORDS Liver cirrhosis, alcoholic liver cirrhosis, fatty liver, mortality, Cuba
INTRODUCTION Double-negative T lymphocytes act as immunomodulators in immune response. This subpopulation is rare in blood but important in the immunopathogenesis of autoimmune diseases, viral infections, cancer and transplant rejection. These disorders have been studied in Cuba using flow cytometry, but normal values of these cells have not yet been established.
OBJECTIVE Estimate preliminary reference values for double-negative T lymphocytes according to sex and age in Cuban adults.
METHODS A cross-sectional study was carried out in a population of 182 healthy adult residents of Havana: 93 women and 89 men aged 18–80 years with no chronic diseases, toxic habits (smoking, excessive alcohol or caffeine intake) or medications that might alter quantity or functioning of immune-system cells. Peripheral blood was drawn to determine immunophenotype with monoclonal antibodies. The phenotype of double-negative T lymphocytes was quantified as CD45+/CD3+/CD4–/CD8–/CD56–using a Gallios flow cytometer (Beckman-Coulter, France). Medians and ranges (to the 5th and 95th percentiles) were calculated for sex and age, for both percentages and absolute values. To evaluate the effects of sex and age, both variables as well as their interaction were included in a linear model.
RESULTS Respective median and range values were total percentage values 3.4 (1.6–7.4) and total absolute values (cells/μL) 57.5 (23.0–157.0). The effect of age on lymphocyte values (percentage and absolute) was significant, with lower numbers in the 51–80 years’ age group (p <0.001). Percentage values according to age group were: 18–25 years, 3.8 (2.2–7.4); 26–50 years, 3.7 (1.7–8.7); and 51–80 years 2.6 (1.3–6.6). Absolute values by age group were: 18–25 years, 90 (32.6–163.7); 26–50 years, 65 (28.8–184.0); and 51–80 years 38.5 (17.9–90.1). Desegregating data by sex and age: percentage of women aged 18–25 years 5.2 (2.1–7.8), 26–50 years 4.0 (1.8–7.7), and 51–80 years 2.5 (1.3–5.8); percentage of men aged 18–25 years 3.4 (2.3–7.3), 26–50 years 3.8 (1.5–8.7), and 51–80 years 2.6 (1.2–7.3). Absolute values: women aged 18–25 years 112.0 (40.0–153.1), 26–50 years 67.0 (26.7–138.3), and 51–80 years 40 (18.6–92.0); and men aged 18–25 years 71.5 (32.1–166.7), 26–50 years 61.5 (29.9–188.7), and 51–80 years 36 (13.5–81.7). The low sex*age interaction confirms these differences occur in both men and women. Values decrease with age, with a more abrupt fall starting at 50 years.
CONCLUSIONS Estimated reference values were determined for absolute values and relative proportions of double-negative T lymphocytes in healthy Cuban adults according to sex and age. Age was found to have a significant effect.
KEYWORDS Reference values, T lymphocytes, flow cytometry, immunology, Cuba
Cuban participation in and contributions to education, medical care and research on diabetes and pregnancy in Latin America dates back to the 1970s when the Latin American Diabetes Association was founded. The Cuban health system and its professionals recognized early the problems presented by diabetes during pregnancy for the health of an expectant mother and her children and assimilated and disseminated important lessons that became influential in the region. These included: importance of adopting a program within primary health care that offers national coverage for diabetic pregnant women, with a special focus on pre-conception monitoring of diabetic women; benefits of defining a specific range for application of a fasting glucose test to identify risk of gestational diabetes through selective screening for the disease; using insulin to treat gestational diabetes; controlling excessive weight at the beginning and during pregnancy; and underscoring the importance of interdisciplinary treatment of diabetes in pregnancy. The goal was to improve care and research in reproductive health for diabetic pregnant women and their children in Cuba.
KEYWORDS: Gestational diabetes, pregnancy, Latin America, Cuba
The COVID-19 pandemic exhibits different characteristics in each country, related to the extent of SARS-CoV-2 local transmission, as well as the speed and effectiveness of epidemic response implemented by authorities. This study presents a descriptive epidemiological analysis of the daily and cumulative incidence of confirmed cases and deaths in Cuba from COVID-19 in the first 110 days after first-case confirmation on March 11, 2020. During this period, 2340 cases (20.7 x 100,000 population) were confirmed, of which 86 patients died (case fatality 3.67%; 52 men and 34 women). Mean age of the deceased was 73.6 years (with a minimum of 35 years and a maximum of 101), with the average age of men lower than that of women. More than 70% of all deceased had associated noncommunicable diseases. The incidence curve ascended for five weeks and then descended steadily. The average number of confirmed cases and deaths for the last week included (June 23–28, 2020) were 25 and 1 respectively; the curve always moved within the most favorable forecast zone of available mathematical models and the effective reproductive number fell below 1 after the fifth week following the onset of the epidemic.
We present the prevention and control measures implemented during this period—some unique to Cuba—and assess their effectiveness using two analytical tools: comparison of observed deaths and confirmed cases with those predicted by mathematical models; and estimation of the effective reproductive rate of SARS-CoV-2. Some distinctive features of this strategy include nationwide door-to-door active screening for individuals with fever and/or symptoms of respiratory distress, isolation of cases and quarantine of contacts of confirmed cases and of persons suspected of having the virus. During this period, Cuba’s response to the epidemic was successful in flattening the curve and limiting transmission, resulting in fewer cases and a lower number of subsequent deaths.
KEYWORDS COVID-19, SARS-CoV-2, epidemiology, pandemic, emerging infectious disease, contact tracing, patient isolation, Cuba
Virologist Dr María Guadalupe Guzmán is recognized as a global leader in dengue research and heads the Pedro Kourí Tropical Medicine Institute’s work as a WHO/PAHO Collaborating Center for the Study of Dengue and Its Vector. The Institute (IPK) was founded in 1937 and is now Cuba’s national reference center for the diagnosis, treatment, control […]
Lower-extremity diabetic ulcers are responsible for 80% of annual worldwide nontraumatic amputations. Epidermal growth factor (EGF) reduction is one of the molecular pillars of diabetic ulcer chronicity, thus EGF administration may be considered a type of replacement therapy. Topical EGF administration to improve and speed wound healing began in 1989 on burn patients as part of an acute-healing therapy. Further clinical studies based on topically administering EGF to different chronic wounds resulted in disappointing outcomes. An analysis of the literature on unsuccessful clinical trials identified a lack of knowledge concerning: (I) molecular and cellular foundations of wound chronicity and (II) the pharmacodynamic requisites governing EGF interaction with its receptor to promote cell response. Yet, EGF intra- and perilesional infiltration were shown to circumvent the pharmacodynamic limitations of topical application. Since the first studies, the following decades of basic and clinical research on EGF therapy for problem wounds have shed light on potential uses of growth factors in regenerative medicine. EGF’s molecular and biochemical effects at both local and systemic levels are diverse: (1) downregulation of genes encoding inflammation mediators and increased expression of genes involved in cell proliferation, angiogenesis and matrix secretion; (2) EGF intervention positively impacts both mesenchymal and epithelial cells, reducing inflammation and stimulating the recruitment of precursor circulating cells that promote the formation of new blood vessels; (3) at the subcellular level, upregulation of the EGF receptor with subsequent intracellular trafficking, including mitochondrial allocation along with restored morphology of multiple organelles; and (4) local EGF infiltration resulting in a systemic, organismal repercussion, thus contributing to attenuation of circulating inflammatory and catabolic reactants, restored reduction-oxidation balance, and decreased toxic glycation products and soluble apoptogenic effectors. It is likely that EGF treatment may rearrange critical epigenetic drivers of diabetic metabolic memory.
KEYWORDS Epidermal Growth Factor, diabetes, diabetes complications, wound healing, diabetic foot, amputation, ulcer, Cuba
INTRODUCTION On March 11, 2020, WHO declared COVID-19 a pandemic and called on governments to impose drastic measures to fight it. It is vitally important for government health authorities and leaders to have reliable estimates of infected cases and deaths in order to apply the necessary measures with the resources at their disposal.
OBJECTIVE Test the validity of the logistic regression and Gompertz curve to forecast peaks of confirmed cases and deaths in Cuba, as well as total number of cases.
METHODS An inferential, predictive study was conducted using logistic and Gompertz growth curves, adjusted with the least squares method and informatics tools for analysis and prediction of growth in COVID-19 cases and deaths. Italy and Spain—countries that have passed the initial peak of infection rates—were studied, and it was inferred from the results of these countries that their models were applicable to Cuba. This hypothesis was tested by applying goodness-of-fit and significance tests on its parameters.
RESULTS Both models showed good fit, low mean square errors, and all parameters were highly significant.
CONCLUSIONS The validity of models was confirmed based on logistic regression and the Gompertz curve to forecast the dates of peak infections and deaths, as well as total number of cases in Cuba.
KEYWORDS COVID-19, SARS-CoV-2, logistic models, pandemic, mortality, Cuba
ABSTRACT INTRODUCTION Antimicrobial drug resistance constitutes a health risk of increasing concern worldwide. One of the most common avenues for the acquisition of clinically-relevant antimicrobial resistance can be traced back to the food supply, where resistance is acquired through the ingestion of antimicrobial resistant microorganisms present in food. Antimicrobial resistance constitutes a health risk, leading to production losses and negative consequences for livelihood and food safety.
OBJECTIVE Determine whether resistant bacteria are present in foods in Cuba.
METHODS A descriptive observational study was conducted in the Microbiology Laboratory of Cuba’s National Institute of Hygiene, Epidemiology and Microbiology from September 2004 through December 2018. Researchers analyzed 1178 bacterial isolates from food samples. The isolates were identified as Escherichia coli, Salmonella, Vibrio cholerae and coagulase-positive Staphylococcus. The antimicrobial susceptibility study was performed using the Bauer-Kirby disk diffusion method, following procedures outlined by the Clinical and Laboratory Standards Institute. The data were analyzed using WHONET version 5.6.
RESULTS Of the total isolates, 62.1% were resistant to at least one antibiotic. Within each group, >50% of isolates showed some type of resistance. E. coli and V. cholerae exceeded 50% resistance to tetracycline and ampicillin, respectively. Staphylococcus showed the highest resistance to penicillin, and Salmonella to tetracycline, nalidixic acid and ampicillin. The highest percentages of non-susceptible microorganisms were identified in meats and meat products.
CONCLUSIONS These results serve as an alert to the dangers of acquiring antibiotic-resistant bacteria from food and demonstrate the need to establish a surveillance system and institute measures bacterial control in food products.
KEYWORDS Microbial drug resistance, bacteria, food, foodborne disease, Cuba
INTRODUCTION The scales available to predict death and complications after acute coronary syndrome include angiographic studies and serum biomarkers that are not within reach of services with limited resources. Such services need specific and sensitive instruments to evaluate risk using accessible resources and information.
OBJECTIVE Develop a scale to estimate and stratify the risk of intrahospital death in patients with acute ST-segment elevation myocardial infarction.
METHODS An analytical observational study was conducted in a universe of 769 patients with acute ST-segment elevation myocardial infarction who were admitted consecutively to the Camilo Cienfuegos Provincial Hospital in Sancti Spíritus Province, Cuba, from January 2013 to March 2018. The fi nal study cohort included 667 patients, excluding 102 due to branch blocks, atrial fibrillation, drugs that prolong the QT interval, low life expectancy or history of myocardial infarction. The demographic variables of age, sex, skin color, classic cardiovascular risk factors, blood pressure, heart rate, blood glucose level, in addition to duration and dispersion of the QT interval with and without correction, left ventricular ejection fraction, and glomerular filtration rate were included in the analysis. Patients were categorized according to the Killip-Kimball Classification for degree of heart failure. A risk scale was constructed, the predictive ability of which was evaluated using the detectability index associated with an receiver-operator curve.
RESULTS Seventy-seven patients died (11.5%). Mean blood glucose levels were higher among the deceased, while their systolic and diastolic blood pressure, left ventricular ejection fraction, and glomerular filtration rate were lower than those participants discharged alive. Relevant variables included in the scale were systolic blood pressure, Killip-Kimball class, cardiorespiratory arrest, glomerular filtration rate, corrected QT interval dispersion rate, left ventricular ejection fraction, and blood glucose levels. The variable with the best predictive ability was cardiorespiratory arrest, followed by a blood glucose level higher than 11.1 mmol/L. The scale demonstrated a great predictive ability with a detectability index of 0.92.
CONCLUSIONS The numeric scale we designed estimates and stratifies risk of death during hospitalization for patients with ST-segment elevation myocardial infarction and has good metric properties for predictive ability and calibration.
KEYWORDS ST-segment elevation myocardial infarction, mortality, risk assessment, Cuba
Dr Pastor Castell-Florit’s career in public health spans work at local, national and international levels. In 2016, he received PAHO’s Award for Health Administration in the Americas, for “outstanding leadership and valuable contributions to the management and administration of the Cuban National Health System.” He serves as president of Cuba’s National Council of Scientific […]
Excerpted and translated from the Spanish (Letras de Género, CUBADEBATE) and reprinted with the author’s permission. Original available at: http://www.cubadebate.cu/especiales/2020/01/23/roles-de-genero-y-si-no-basta-con-salir-de-la-cocina/#.XioBOSO23IU The scene: a family doctor-and-nurse office. After the usual well-baby visit for the eight-month-old, the physician poses a question to the young mother that sounds more like a statement: “I suppose you won’t be going […]
INTRODUCTION Human papillomaviruses and Chlamydia trachomatis are the most frequent causes of sexually transmitted infections. Although the association between some human papillomavirus genotypes and cervical cancer has been demonstrated and Chlamydia trachomatis infection is the most common cause of female infertility, Cuba has no national baseline studies on the circulation and co-circulation of these agents, the synergistic effect of which may be a risk factor for occurrence and development of precancerous cervical lesions. Additionally, few local studies have examined risk factors for infection.
OBJECTIVE Determine the frequency of infection by human papillomavirus and Chlamydia trachomatis and their association with sociodemographic, clinical and epidemiological variables in women seeking routine Pap smears or other medical services at the primary care level in Cuba.
METHODS A cross-sectional study was conducted among 500 women aged 16–67 years (100 from Havana, 200 from Villa Clara and 200 from Holguín Provinces, Cuba), from August through December 2015. Chlamydia trachomatis infection was detected by real-time polymerase chain reaction and 35 genotypes of human papillomavirus by low-density microarray. We then examined the association of infection with sociodemographic, clinical and epidemiological variables.
RESULTS Human papillomavirus was detected in 14.8% (74/500) of the women. Of the 29 genotypes identified, 79.7% (59/74) were oncogenic high-risk types. Type 16 was the most frequently identified (23%; 17/74), followed by type 31 (10.8%; 8/74) and then by types 33, 53, 61 and 66 in equal proportions (8.1%; 6/74). Infection frequency was greater in women aged ≤25 years (38.8%; 31/80), students (46.7% 7/15), single (23.0%; 40/174) and among those who reported having more than 3 sexual partners in the last 2 years (41.0%; 17/41). Differences were found among provinces for circulating genotypes and infection-related variables. Human papillomavirus infection from genotypes 16, 31, 33, 53, 61, 66, 68 and 89 was associated with the 7.9% (30/382) of women who had positive Pap tests. Infection from Chlamydia trachomatis was positive in 1% (5/500) of women, all aged ≤25 years. Coinfection by Chlamydia trachomatis and HPV was found in one woman infected with human papillomavirus genotype 61.
CONCLUSIONS Frequency of human papillomavirus is high in the three Cuban provinces studied, with greater frequency of genotype 16 and other oncogenic high-risk types. For both agents, infection is more frequent in young women and adolescents. Positive Pap tests are frequently associated with HPV infection. Prevalence findings from this study could be used as a baseline for future research or interventions.
KEYWORDS Human papillomavirus, microarrays, genotypes, Chlamydia trachomatis, real-time polymerase chain reaction, women, Cuba
ABSTRACT
Cuba has one of the fastest aging populations in Latin America and the Caribbean (20.4% of the population aged ≥60 years by 2018) and life expectancy has climbed to nearly 79 years. This demographic shift has prompted a number of initiatives to address the needs of older adults and promote active, healthy longevity.
At the community level in Cienfuegos Province, an educational program was implemented designed to foster a more active role in society for older adults and improve their quality of life upon retirement, as well as to reinforce a positive culture of aging. The program ran from June 2010 to June 2018 in the Mental Health Department of the Dr Enrique Barnet Polyclinic in the Santa Isabel de las Lajas Municipality. Twenty-two groups were constituted of 330 older adults who were trained for 10 weeks in techniques of self-awareness, personal growth, development of social skills, use of social support networks, adoption of healthy lifestyles and formulation of retirement plans. Results were assessed for each group one year after program completion and the information summarized.
Participants whose definitions of “older adult” and “retirement” were rooted in nondiscriminatory concepts increased from 53 to 303 and retirees not incorporated into active social/economic life decreased from 228 to 36. At the outset, only 22% had coping mechanisms to manage their new role as retirees and 9% had a life plan for retirement. One year after finishing the program, 318 (96%) reported they were prepared to face this new stage in their lives and 294 (89%) had completed life plans; at the start, 116 (35%) were taking antidepressants and one year later, 103 of them had reduced or eliminated the drugs. The program enriched participants’ culture of aging, as well as relationships with their families and their communities.
KEYWORDS Retirement, aging, community health planning, Cuba
Unilateral Optic Neuritis in Cuban Patients with a History of Arbovirus Infection To the Editors: Seven patients with clinical signs consistent with optic neuritis were diagnosed and treated in the neuro-ophthalmology service of the Hermanos Ameijeiras Clinical-Surgical Teaching Hospital in Havana, Cuba from August 6 through November 16, 2018. Clinically, optic neuritis should be distinguished […]
