Immunology is highly specialized and utilized in prophylactic vaccines, laboratory tests and treatments for patient care. It is also an essential tool for cutting-edge biomedical research designed to deepen scientific understanding and produce new therapies and technologies.[1] At the William Soler Pediatric University Hospital in Havana, as pediatric immunologists, we work to improve our patients’ […]
Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown etiology. The only means of reducing its morbidity and mortality remains early diagnosis followed by timely medical treatment. SLE affects all populations worldwide, although prevalence rates differ between population groups, with higher rates among women of reproductive age and for African, Asian, and Hispanic ethnicities.[1] […]
Gestational diabetes is the most common endocrine disorder affecting pregnant women and its prevalence is on the rise. Prevalence in Cuba is about 5.8%, and global prevalence ranges from 2% to 18% depending on the criteria applied. Gestational diabetes can lead to adverse gestational outcomes, such as fetal death, preterm delivery, dystocia, perinatal asphyxia and neonatal complications. Prompt, accurate diagnosis allowing early treatment can benefit both mother and child. The disease is asymptomatic, so clinical laboratory testing plays a key role in its screening and diagnosis. Cuba’s approach to diabetes screening and diagnosis differs from some international practices. All pregnant women in Cuba are screened with a fasting plasma glucose test and diagnosed using modified WHO criteria. Some international recommendations are to skip the screening step and instead follow the diagnostic criteria of the Hyperglycemia and Adverse Pregnancy Outcomes study. In Cuba, gestational outcomes for women with diabetes (including gestational diabetes) are satisfactory (preeclampsia 5%; preterm delivery 12%; neonatal macrosomia 7.5%; congenital abnormalities 4.3% and perinatal deaths 4.8%). These data do not indicate a need to change established screening and diagnostic criteria.
KEYWORDS Gestational diabetes, screening, diagnosis, early detection, early diagnosis, Cuba
Translated from the Spanish and reprinted with permission from the Revista Anales de la Academia de Ciencias de Cuba, [online] Vol. 2, No. 2, 2012. Original available at: http://www.revistaccuba.cu/index.php/acc/article/view/126
Dementia is a syndrome that has great repercussions for quality of life of patients and their families, as well as a high social cost. A [2009] systematic review of research evidence and consensus of expert opinions showed that 36 million people live with dementia worldwide, with 4.6 million new cases every year (similar to the global incidence of nonfatal stroke). The prevalence of dementia in older Cubans is high, with rates ranging from 6.4% to 10.2%, or about 130,000 persons (1.1% of the total population). This number is expected to rise to 260,000 by 2030. The age-standardized annual incidence of dementia is also high: 21 per 1000 population, with 28,750 new cases annually. Dementia is the leading cause of disability among older adults and is the main cause of dependency, financial burden and caregiver stress.
In this review, we highlight the importance of epidemiological research to obtain greater knowledge of the disease, improve health services, promote actions for prevention and early diagnosis, and implement a national strategy to address dementia in the Cuban population, itself now immersed in two processes: accelerated demographic aging and epidemiologic transition.
KEYWORDS Dementia, Alzheimer disease, epidemiology, risk factors, prevention, diagnosis, treatment
INTRODUCTION Differentiating between HIV-1 and HIV-2 infection is the first step to understanding HIV transmission, epidemiology and pathogenesis in geographical areas where both viruses circulate. In Cuba, positive results in mixed HIV-1/2 screening assays are confirmed by HIV-1 Western blot. Indeterminate results constitute the main limitation of this test and HIV-2 infection is among their possible causes; hence the importance of second-stage screening and confirmatory tests for HIV-2 infection.
OBJECTIVE Investigate the contribution of HIV-2 antibodies to negative or indeterminate HIV-1 Western blot results in serum samples from 2005 through 2008 in Cuba.
METHODS HIV-2 reactivity was studied using the ELISA DAVIH–VIH-2 diagnostic kit (Cuba) in 1723 serum samples with negative or indeterminate results for HIV-1 Western blot from January 2005 through December 2008. Duplicate sera reactive by ELISA were confirmed by HIV-2 Western blot, results interpreted according to WHO criteria. The epidemiological interview established by Cuba’s National Program for Prevention and Control Sexually-Transmitted Diseases and HIV/AIDS was applied to HIV-2 Western blot-positive patients.
RESULTS Among all sera studied, HIV-2 ELISA identified 12 reactive serum samples (0.70%) and 1711 non-reactive (99.30%). Western blot analysis of the 12 ELISA-reactive samples confirmed two positive samples (16.67%), 4 negative (33.33%) and 6 indeterminate (50%). Positive samples reacted against the p16, p26, gp36, p53, p56, p68 and gp105 proteins. All 12 ELISA-reactive samples belonged to the HIV-1 Western blot indeterminate group. The two HIV-2–positive samples showed well defined reactivity to gp160, p53, p55 and p34 of HIV-1. HIV-1 seroconversion was observed in all 10 remaining samples during serological followup.
CONCLUSIONS Two new HIV-2 seropositive cases were diagnosed using DAVIH–VIH-2 and HIV-2 Western blot in indeterminate HIV-1 Western blot samples. Results support the recommendation that HIV-2 Western blot be included in the diagnostic algorithm for HIV-1/2 to followup negative or indeterminate HIV-1 Western blot results.
KEYWORDS Diagnosis, laboratory techniques and procedures, antibodies, HIV-2, Western blot, enzyme-linked immunosorbent assay, algorithm, Cuba
| Introduction Despite advances in diagnostic techniques and treatment, lung cancer is the leading cause of cancer death worldwide and in Cuba. Prompt initiation of cancer therapy depends on rapid diagnostic confirmation; however, most patients are diagnosed at an advanced stage. In the Cuban health system, primary, secondary and tertiary levels of care are interrelated; patients may seek care at any level or may be referred from one to another. Lung cancer diagnoses are confirmed at the tertiary level.
Objective Determine the length of diagnostic delay in patients diagnosed with non-small-cell lung cancer (NSCLC) at a tertiary care facility in Havana, Cuba, as well as mean diagnostic delay attributable to the patient and to the health system by level of care. Methods A descriptive observational study of 96 patients with a cytologically and/or histologically confirmed diagnosis of non-small-cell lung cancer was conducted in 2005–2007. Patients initially sought care for disease symptoms at primary, secondary or tertiary levels in the Cuban public health system, but diagnosis of all patients was confirmed at a specialized tertiary care facility. Total diagnostic delay was calculated as the time elapsed from onset of symptoms to confirmation of NSCLC diagnosis. Variables also included diagnostic delay attributable to the patient and diagnostic delay attributable to the health system by level of care. Data were arranged in tables and analyzed by absolute value, percentage, mean, and standard deviation. Results Of the 96 patients studied, 69% were male, and 54% were aged 50–69 years. Fifty-five percent of patients sought medical care within 15 days of onset of symptoms, 21% within 16–30 days, and 3% waited >90 days. Mean diagnostic delay attributable to the patient was 18.19 ± 3.45 days while mean diagnostic delay attributable to the health system was 61.63 ± 18.50 days, and overall diagnostic delay was 73.13 ± 17.53 days. For the 71% of patients seen in primary care, mean diagnostic delay was 29.51 ± 4.53 days; for the 45% seen exclusively or additionally at the secondary level, mean diagnostic delay was 24.45 ± 7.31 days. Upon admission at the tertiary care level, mean diagnostic confirmation delay was 18.23 ± 3.68 days. Conclusions Diagnostic delay of lung cancer patients in this study was prolonged. Appropriate strategies are needed for reducing this delay. Keywords: Lung cancer, non-small-cell lung carcinoma, diagnosis, delivery of health care |
Honduras was one of the Central American countries most severely hit by Hurricane Mitch. Torrential rains and heavy flooding created conditions conducive to a leptospirosis outbreak in the country. A group of Cuban scientists studied 68 patients from the Department of Cortés – one of the country’s hardest hit areas – presenting clinical and epidemiological profiles indicative of leptospirosis. Blood and serum samples were taken from all subjects. A microscopic agglutination test (MAT) was used to identify Leptospira strains and to assess protection conferred by vax-SPIRAL® (Cuban leptospirosis vaccine) against the isolated strain. Prevalence of leptospires in the kidneys and liver was also verified. A male predominance was found in the group aged 15-49 years. Municipalities in this Department with the largest number of cases were San Pedro Sula, La Lima, and Chamelecón. The most frequent symptoms included fever, headache, myalgia, and generalized discomfort. Over 80% of subjects reported presence of rodents in their homes, as well as contact with stagnant water and domestic animals. The strain isolated from positive blood cultures was from the Icterohaemorrhagiae serogroup, which was highly virulent in the animal model used. Protection was 100% in hamsters inoculated with vax-SPIRAL® and subsequently challenged with the Honduran strain. Additionally, macroscopic analysis of organs from immunized animals that survived the challenge showed no signs of leptospirosis infection.
Keywords: Leptospirosis, vaccine, serology, diagnosis, classification
