Transmission of tuberculosis in Havana, Cuba: a molecular epidemiological study by IS6110 restriction fragment length polymorphism typing

The combination of molecular and conventional epidemiological methods has improved the knowledge about the transmission of tuberculosis in urban populations. To examine transmission of tuberculosis in Havana, Cuba, with DNA fingerprinting, we studied 51 out of 92 Mycobacterium tuberculosis strains isolated from tuberculosis patients who resided in Havana and whose infection was culture-confirmed in the period from September 1997 to March 1998. Isolates from 28 patients (55 percent) had unique IS6110 restriction fragment length polymorphism (RFLP) patterns, while isolates from 23 others (45 percent) had identical patterns and belonged to 7 clusters. Three clusters consisting of six, five and two cases were each related to small outbreaks that occurred in a closed setting. Three other clustered cases were linked to a large outbreak that occurred in another institution. Younger patients were more correlated to clustering than older ones. The finding that 45 percent of the isolates had clustered RFLP patterns suggests that recent transmission is a key factor in the tuberculosis cases in Havana. The IS6110 RFLP typing made it possible to define the occurrence of outbreaks in two closed institutions

Diabetes education for the family, patient and paramedical staff.

Diabetes education should fulfill definable objectives and be provided in an orderly way to match the child and family's ability and readiness to learn. The main aims of education are (1) gaining an understanding of diabetes (2) developing practical skills in care (3) acquiring attitudes of optimism and self-confidence (4) acquiring detailed knowledge of management and (5) developing the ability to make management decisions. Families can respond to education as they overcome their initial shock and grief. Their ability to learn is enhanced by professional support in the anxious task of assuming responsible care for their child. It is helpful to involve all the family and both parents so they can support each other, share responsibility and enjoy the satisfaction of contributing to their child's good health. The child after infancy, should participate in care as much as he is able, and is consistent with his developmental stage. People learn in different ways and it is helpful to have different teaching methods available: individual learning, group discussion, reading material, visual aids and seminars. For the older child and teenager, camps enhance self-esteem and reinforce learning and allow the family to profit by their own experience. Paramedical staff should meet regularly to maintain their competence and ensure that teaching is consistent.

Accidentes vasculares encefalicos y migranas. / Cerebrovascular disease and migraine

La migrana puede asociarse a enfermedades vasculares encefalicas a traves de diversos mecanismos. En algunos casos puede asociarse a un infarto cerebral dejando un deficit neurologico permanente.En otros se presenta en relacion a una malformacion vascular intracraneana. Por ultimo, puede simular un accidente isquemico transitorio al presentarse solo los prodromos y no ser seguidos de la cefalea caracteristica. Se analiza la controversia existente en la literatura al respecto, considerando tanto aquellos estudios exclusivamente clinicos como las escasas publicaciones con descripciones anatomopatologicas y otras mas recientes que incluyen evaluaciones con tomografia axial computada de craneo

Las respuestas evocadas y su aplicacion clinica. / Evoked responses and its clinical use

En los ultimos anos ha ido adquiriendo creciente importancia el registro de las respuestas evocadas visuales, auditivas y somatosentitivas. Mediante este metodo es posible pesquisar lesiones en el Sistema Nervioso Central que aun no han dado manifestaciones clinicas. Entre las diversas aplicaciones que tiene destaca su contribucion al diagnostico de Esclerosis Multiple donde estan alteradas aproximadamente en un 90% de los casos