Treatment of a tibial bone defect with a motorized intramedullary bone transport nail: A case review with 32 months follow up.

Nowadays, massive segmental bone defects represent a surgical challenge for trauma surgeons. Most of these injuries appear in the context of high-energy trauma, not only significantly affecting the bones, but also involving severe injuries of the adjacent soft tissues. For these reasons, their treatment requires complex reconstruction surgeries. There are multiple techniques to treat bone defects, bone transport being one of the most widely used. Historically, external fixators (monolateral and circular) have been and still are the gold standard for performing this technique, although they are not exempt from complications. By means of specific intramedullary nails for bone transport, it is possible to minimize the complications of external fixation, allowing large tibial bone defects to be treated through distraction osteogenesis (all-internal system), which is favoured by early weight bearing.

The Health Equity Network of the Americas: inclusion, commitment, and action.

The Health Equity Network of the Americas (HENA) is a multidisciplinary network that promotes knowledge sharing and intersectoral action for equity in health and human rights in the Americas. The objectives of HENA are: 1) to share successful experiences in the development of interventions, considering the social determinants and determination of health, to achieve participatory and community-based health responses; 2) to analyze the health, social, political, environmental and economic impacts of the COVID-19 pandemic; 3) to identify the effects of pandemic care on populations most at risk because of their age and pre-existing health conditions; 4) examine the situation at borders and population movements in the spread of the pandemic and its effects on migrant populations; 5) propose strategies to ensure access to comprehensive care for pregnant women in order to reduce maternal and neonatal suffering, morbidity, and mortality; and 6) analyze violations of human rights and the right to health of historically marginalized populations, including street dwellers and other communities that depend on public spaces and the street for survival. The analytical and intervention models for health equity at HENA are based on various approaches, including social medicine, social epidemiology, medical anthropology, human ecology, and One Health.

La Red de las Américas para la Equidad en Salud (RAES) es una red multidisciplinaria que promueve el intercambio de conocimientos y la acción intersectorial para la equidad en salud y los derechos humanos en las Américas. Los objetivos de la RAES consisten en: 1) compartir experiencias exitosas en el desarrollo de intervenciones, considerando la determinación y los determinantes sociales, para lograr respuestas participativas y comunitarias en salud; 2) analizar los impactos sanitarios, sociales, políticos, ambientales y económicos de la pandemia de COVID-19; 3) identificar los efectos de la atención de la pandemia en las poblaciones de mayor riesgo por su edad y las condiciones de salud preexistentes; 4) examinar la situación de las fronteras y de los movimientos de población en la propagación de la pandemia y de sus efectos en las poblaciones migrantes; 5) proponer estrategias para asegurar el acceso a la atención integral de las mujeres gestantes, con el fin de reducir el sufrimiento, la morbilidad y la mortalidad materna y neonatal; y 6) analizar vulneraciones de derechos humanos y del derecho a la salud de poblaciones históricamente marginalizadas, incluyendo habitantes en situación de calle y otras comunidades que dependen de los espacios públicos y de la calle para sobrevivir. Los modelos analíticos y de intervención para la equidad en salud de la RAES se desarrollan desde varios enfoques, como la medicina social, la epidemiologia social, la antropología médica, la ecología humana y el de Una sola salud.

The Health Equity Network of the Americas: inclusion, commitment, and action / La Red de las Américas para la Equidad en Salud: inclusión, compromiso y acción

ABSTRACT The Health Equity Network of the Americas (HENA) is a multidisciplinary network that promotes knowledge sharing and intersectoral action for equity in health and human rights in the Americas. The objectives of HENA are: 1) to share successful experiences in the development of interventions, considering the social determinants and determination of health, to achieve participatory and community-based health responses; 2) to analyze the health, social, political, environmental and economic impacts of the COVID-19 pandemic; 3) to identify the effects of pandemic care on populations most at risk because of their age and pre-existing health conditions; 4) examine the situation at borders and population movements in the spread of the pandemic and its effects on migrant populations; 5) propose strategies to ensure access to comprehensive care for pregnant women in order to reduce maternal and neonatal suffering, morbidity, and mortality; and 6) analyze violations of human rights and the right to health of historically marginalized populations, including street dwellers and other communities that depend on public spaces and the street for survival. The analytical and intervention models for health equity at HENA are based on various approaches, including social medicine, social epidemiology, medical anthropology, human ecology, and One Health.

RESUMEN La Red de las Américas para la Equidad en Salud (RAES) es una red multidisciplinaria que promueve el intercambio de conocimientos y la acción intersectorial para la equidad en salud y los derechos humanos en las Américas. Los objetivos de la RAES consisten en: 1) compartir experiencias exitosas en el desarrollo de intervenciones, considerando la determinación y los determinantes sociales, para lograr respuestas participativas y comunitarias en salud; 2) analizar los impactos sanitarios, sociales, políticos, ambientales y económicos de la pandemia de COVID-19; 3) identificar los efectos de la atención de la pandemia en las poblaciones de mayor riesgo por su edad y las condiciones de salud preexistentes; 4) examinar la situación de las fronteras y de los movimientos de población en la propagación de la pandemia y de sus efectos en las poblaciones migrantes; 5) proponer estrategias para asegurar el acceso a la atención integral de las mujeres gestantes, con el fin de reducir el sufrimiento, la morbilidad y la mortalidad materna y neonatal; y 6) analizar vulneraciones de derechos humanos y del derecho a la salud de poblaciones históricamente marginalizadas, incluyendo habitantes en situación de calle y otras comunidades que dependen de los espacios públicos y de la calle para sobrevivir. Los modelos analíticos y de intervención para la equidad en salud de la RAES se desarrollan desde varios enfoques, como la medicina social, la epidemiologia social, la antropología médica, la ecología humana y el de Una sola salud.

[The Health Equity Network of the Americas: inclusion, commitment, and action]. / La Red de las Américas para la Equidad en Salud: inclusión, compromiso y acción.

The Health Equity Network of the Americas (HENA) is a multidisciplinary network that promotes knowledge sharing and intersectoral action for equity in health and human rights in the Americas. The objectives of HENA are: 1) to share successful experiences in the development of interventions, considering the social determinants and determination of health, to achieve participatory and community-based health responses; 2) to analyze the health, social, political, environmental and economic impacts of the COVID-19 pandemic; 3) to identify the effects of pandemic care on populations most at risk because of their age and pre-existing health conditions; 4) examine the situation at borders and population movements in the spread of the pandemic and its effects on migrant populations; 5) propose strategies to ensure access to comprehensive care for pregnant women in order to reduce maternal and neonatal suffering, morbidity, and mortality; and 6) analyze violations of human rights and the right to health of historically marginalized populations, including street dwellers and other communities that depend on public spaces and the street for survival. The analytical and intervention models for health equity at HENA are based on various approaches, including social medicine, social epidemiology, medical anthropology, human ecology, and One health.

Sentinel Surveillance Detects Low Circulation of Vibrio cholerae Serotype Inaba in Haiti, 2011-2012.

Over 700,000 cases of cholera were reported in Haiti between October 2010 and February 2015. In November 2011, the Cuban Medical Team serving in Haiti established a laboratory-supported sentinel surveillance system for cholera in 10 public hospitals (one in each of Haiti's 10 departments), to estimate the proportion of hospitalized patients with cholera and detect emergence of new Vibrio cholerae serotypes. Each month, the first ten stool samples collected from patients admitted with acute watery diarrhea were studied in all hospitals involved. Surveillance system findings from November 1, 2011, to October 30, 2012 showed that acute watery diarrhea was caused by V. cholerae serogroup O1 in 45.9% (210/458) of patients: Serotype Ogawa was found in 98.6% of this isolates (207/210) and serotype Inaba in 1.4% (3/210), indicating low circulation level of the latter in Haiti. Continuing laboratory sentinel surveillance of V. cholerae is needed to monitor the spread of the disease and prevent and contain outbreaks, particularly of new serotypes. It is important to ensure that these findings are systematically integrated with data available to MSPP from other surveillance sources. KEYWORDS Vibrio cholerae, serotype Inaba, serotype Ogawa, epidemiological surveillance, medical cooperation, Haiti, Cuba.

Isolation of Coxsackievirus A24 variant from patients with hemorrhagic conjunctivitis in Cuba, 2008-2009.

BACKGROUND: An outbreak of acute hemorrhagic conjunctivitis occurred in Cuba in 2008 and 2009. OBJECTIVE: To determinate the etiological agent associated with the Cuban outbreaks of acute hemorrhagic conjunctivitis during 2008 and 2009. STUDY DESIGN: Conjunctival swabs and/or faecal samples from 382 patients with clinical diagnosis suggestive of acute hemorrhagic conjunctivitis were subject to viral culture in HEp-2 human laryngeal epidermoid carcinoma cells. Positive samples were identified by a specific Coxsackievirus A24 variant PCR and the 3C protease region of 16 isolates was sequenced for phylogenetic analysis. RESULTS: Enterovirus cytopathic effect was observed in 138 cases (36%). A higher percent of CA24v was recovered from faecal samples, 19 out of 45 cases (42.2%), than from conjunctival swabs, 127 out of 355 samples (35.8%). All isolates were identified as Coxsackievirus A24 variant. Phylogenetic analysis revealed that 2008 and 2009 Cuban outbreaks were caused by the same virus strains and that isolates were closely related to those from Taiwan (2006-2007), China (2007-2008) and Singapore (2005) with a bootstrap value of 71%. CONCLUSIONS: Outbreaks of acute hemorrhagic conjunctivitis occurred in Cuba in 2008 and 2009 were caused by Coxsackievirus A24 variant. The faecal-oral route is another mode of transmission of CA24v in the acute hemorrhagic conjunctivitis outbreaks. Phylogenetic analysis of Cuban CA24v strains involved in an acute hemorrhagic conjunctivitis outbreak in 2008 and 2009 confirms a new introduction of the CA24 variant into the Americas from South-east Asia.

Prevalence of febrile syndromes in dengue surveillance, havana city, 2007.

OBJECTIVE: Determine point prevalence of febrile syndromes and compare with prevalence reported by habitual clinical and seroepidemiologic dengue surveillance system in Havana City. METHODS: In October 2007, a descriptive, cross-sectional study was carried out in a representative sample, calculating prevalences of febrile syndromes and undifferentiated febrile syndromes. Chi-square analysis was used for rate comparisons. RESULTS: Point prevalences of febrile syndromes and undifferentiated febrile syndromes were 352.6 and 144.2 times greater, respectively, than those reported by the habitual clinical and seroepidemiologic dengue surveillance system; these differences were statistically significant (p < 0.001). CONCLUSIONS: Point prevalence of febrile syndromes was far greater than prevalence reported by the habitual clinical and seroepidemiologic dengue surveillance system, an indication of underreporting.

A myocarditis outbreak with fatal cases associated with adenovirus subgenera C among children from Havana City in 2005.

BACKGROUND: Among multiple causes of acute myocarditis, viral infection, especially that due to enteroviruses and adenoviruses, is the leading cause. In the summer 2005 an outbreak of a febrile syndrome accompanied by acute cardiac decompensation occurred in infants and young children in Havana City. Eleven patients had a rapid evolution of disease and there were 8 fatalities from cardiac failure secondary to myocarditis. OBJECTIVE: The aim of the present study was to determine the etiological agent responsible for this outbreak. STUDY DESIGN: Children admitted to the pediatric hospitals of Havana City from July 3 to August 2 with this clinical presentation were studied. Forty samples of necropsy tissue, cerebrospinal fluid, stools and serum were tested by molecular methods for 14 respiratory viruses, 6 herpesviruses and generic enteroviruses and flavirus and alfaviruses. Viral isolation was performed in A-549 cells. Isolated viruses were typed by sequence analysis. RESULTS: Adenovirus genome was detected in 6 of the 8 fatal cases-the lungs in 5 (63%) and the myocardium in 3 (37%). In two fatal cases, viral genome was detected in both lung and myocardium. Adenovirus was isolated in five fatal cases. In all three non-fatal cases, adenovirus genome was detected and adenovirus was isolated into two. Sequence analysis showed that adenovirus type 5 was the only isolate from fatal cases and adenovirus 1 the only isolate in non-fatal cases. No other viruses were found by PCR or isolation techniques. CONCLUSION: Adenovirus was the etiologic agent implicated in this myocarditis outbreak and adenovirus type 5 was associated with fatal outcome.

A new method of providing pulsatile flow in a centrifugal pump: assessment of pulsatility using a mock circulatory system.

Previous studies have demonstrated the potential advantages of pulsatile flow as compared with continuous flow. However, to date, physiologic pumps have been technically complex and their application has therefore remained in the experimental field. We have developed a new type of centrifugal pump, which can provide pulsatile as well as continuous flow. The inner wall of a centrifugal pump is pulsed by means of a flexible membrane, which can be accurately controlled by means of either a hydraulic or pneumatic driver. The aim of this study was to assess the hydraulic behavior of the new pump in terms of surplus hemodynamic energy (SHE). We conducted experiments using a mock circulatory system including a membrane oxygenator. No differences were found in the pressure-flow characteristics between the new pump and a conventional centrifugal pump, suggesting that the inclusion of the flexible membrane does not alter hydraulic performance. The value of SHE rose when systolic volume was increased. However, SHE dropped when the percentage of ejection time was reduced and also when the continuous flow (programmed by the centrifugal console) increased. Mean flow matched well with the continuous flow set by the centrifugal console, that is, the pulsatile component of the flow was exclusively controlled by the pulsatile console, and was therefore independent of the continuous flow programmed by the centrifugal console. The pulsatility of the new pump was approximately 25% of that created with a truly pulsatile pump.

RETRACTED: Evidence for Other Non-Poliovirus Enteroviruses Multiplies in L20B Cells.

This article has been retracted.

Islet cell related antibodies and type 1 diabetes associated with echovirus 30 epidemic: a case report.

Type 1 diabetes associated genes account for less than 50% of disease susceptibility. Human enteroviruses have been implicated as environmental factors that might trigger and/or accelerate this autoimmune disorder. We now report of a 12-year-old girl that developed pancreatic autoimmunity and type 1 diabetes after enteroviral infection. Diabetes-associated autoimmunity was evaluated by measurement of several islet cell related autoantibodies. Neutralizing antibodies to different enteroviruses were determined in the case and eight children suffering from aseptic meningitis during a large scale epidemic. Several types of diabetes-associated antibodies were detected post-infection in the adolescent with newly diagnosed type 1 diabetes, including islet cell antibodies (ICA) and tyrosine phosphatase antibodies (IA2A). ICA but not IA2A appeared in the non-diabetic enterovirus-infected subjects. Based on virological studies, type 1 diabetes pathogenesis process could have been triggered by echovirus 30 infections. This study provides the first evidence of an association between echovirus 30 infection with the presence of pancreatic autoimmunity and type 1 diabetes. Our data suggest that echovirus 30 Cuban strain could be considered a potentially diabetogenic enteroviral variant.

Shifting the demand for emergency care in Cuba's health system.

Cuba has developed a programme of quality improvement of its health services, which includes an extramural emergency care system in which polyclinics and general practitioner networks play an important role. Using routine health information from the decentralised first line emergency units (FLES) and from the hospital emergency service (HES) for the period 1995-2000, we evaluated the effects of the emergency care subsystem reform on the utilisation rates of first line and hospital services in Baracoa and Cerro, a rural and a metropolitan municipality, respectively. In the self-contained health system of Baracoa, the reform of the emergency subsystem resulted in a first phase of increased utilisation of the FLES, followed by a second phase of gradual decrease, during which there was an increased utilisation of general practitioners. In contrast, the overall results of the reform in Cerro were unclear. The proximity to a hospital seems to be the most important element in the patient's decision on which entry point to the Cerro health system to use. A potential adverse effect of the reform is an increased emergency services utilisation in situations where GP care remains below patients' expectations. Given the current world-wide trends in health-care reform, the organisational alternatives developed in the Cuban health system might remain specific to the local contextual setting.

Injury in organs after cardiopulmonary bypass: a comparative experimental morphological study between a centrifugal and a new pulsatile pump.

The aim of this investigation was to assess organ injury provoked by a new pulsatile pump for cardiopulmonary bypass (CPB) with respect to a conventional centrifugal pump. Eight pigs in the pulsatile group (PG) and five in the centrifugal group (CG) underwent a partial CPB lasting 180 min. The animals were sacrificed 180 min after CPB was suspended, and a morphological study of fragments of ventricular wall, liver, lung, and kidney was performed. In CG, centrilobular hepatic necrosis was observed accompanied by sinusoidal dilatation and congestion, multiple focuses of myocardial ischemia, and minor to moderate pulmonary interstitial edema. In PG, diffuse centrilobular sinusoidal congestion in the liver, congestion and capillary dilatation of low intensity in the ventricular wall, and nonsignificant pulmonary interstitial septal edema was observed. In the kidney, both groups showed degenerative changes of the tubular cells and nonsignificant tubular dilatation. These results suggest a better peripheral circulation in the pulsatile group.

Aportes al conocimiento acerca de la permanencia y circulación del poliovirus vacunal en el ambiente / Contribution to knowledge about the permanence and circulation of poliovirus vaccine in the environment

La erradicación de la poliomielitis mundialmente es una meta cercana y presupone la adopción de estrategias efectivas y seguras. Conocer cuánto tiempo pueden circular y permanecer en el ambiente las cepas de poliovirus derivadas de la vacuna oral de virus atenuado, resultó esencial en la definición de las medidas a asumir y fue el objetivo del presente trabajo. Se analizaron muestras de heces fecales y aguas albañales, obtenidas semanalmente al finalizar la Campaña Nacional de Vacunación Antipolio del año 1998 en Cuba. Los virus se aislaron e identificaron mediante cultivo y pruebas de neutralización para la identificación de poliovirus, en el caso particular de las aguas albañales se empleó además el método de la reacción en cadena de la polimerasa. Se trazaron las curvas de eliminación en ambos medios y se concluyó que la permanencia de los virus en el ambiente no sobrepasa las 12 semanas posteriores a la inmunización con la vacuna oral de virus atenuado

Estudio por Western Blot de sueros de pacientes con neuropatía epidémica / Study by Western Blot of sera from patients with epidemical neuropathy

Se estudió la respuesta inmune de un grupo de pacientes con neuropatía epidémica y de individuos controles mediante la tècnica de inmunoblotting frente a las proteinas del virus Coxsackie y a las proteínas de la cepa de efecto lento aislada en nuestro laboratorio. Se estudiaron 13 sueros de pacientes con neuropatía epidémica y 9 sueros controles. De los 13 sueros estudiados, 8 (61,5 por ciento) reconocieron a la proteína VPI y 2 sueros (15,3 por ciento) a la proteína VPO de la cepa 47/93. De los 9 controles estudiados, 4 (44,4 por ciento) reconocieron la proteína VPI y 3 sueros (33,3 por ciento) la proteína VPO solamente. Con el antígeno preparado a partir de la cepa de efecto lento, en 5(38,5 por ciento) sueros de pacientes con 2 sueros (22,5 por ciento) de controles se obtuvo una señal específica. Es de destacar en este último caso que la proteína observada tenía un peso molecular de 41 300 D, era de menor talla que la proteína precursora detectada frente a la cepa 47/93, que fue de 45 000 D

Identificacion por ELISA de agentes productores de efecto citopatico ligero aislados durante la epidemia de neuropatia en Cuba, 1991 / Identification by ELISA of light cytopathic effect-producin agents isolated during the neuropathy epidemy in cuba, 1991

Utilizando como referencia la cepa 44/93 aislada durante la epidemia de neuropatia en Cuba en 1991 y caracterizada como productora en cultivo celular de efecto citopatico ligero (ECP-L), se logro la normalizacion de un ELISA para la identificacion rapida de otras cepas con similar efecto. El ensayo consistio en un ELISA tipo sandwich donde las condiciones seleccionadas para cada reactivo (10 g/mL para el anticuerpo de recubrimiento, 1 mg/mL para el antigeno y dilucion 1/2 000 para el conjugado) permitieron una adecuada discriminacion entre el antigeno y el control de antigeno para la cepa de referencia empleada. La evolucion de un papel de cepas virales de referencia y de otras cepas productoras de ECP-L, mostro un 100 por ciento de coincidencia entre este metodo y el aislamiento en cultivo celular. Los resultados obtenidos nos permiten recomendar la utilizacion de este ensayo como una alternativa mas precisa en la identificacion de estos agentes

Caracterizacion fisico-quimica de los agentes aislados durante el brote de neuropatia epidemica en Cuba. Parte I / Physical and chemical characterization of isolated agents during the outbreak of epidemic neuropathy in Cuba. Part I

En el presente trabajo se reportan las caracteristicas fisico-quimicas presentadas por los agentes aislados con muestras de pacientes con neuropatia epidemica. Los Enterovirus aislados se comportaron en la forma descrita para estos virus. Los agentes productores de efecto citopatico ligero (ECP-L) se comportaron en forma variable en lo que se refiere a la sensibilidad al cloroformo, por otra parte no fueron sensibles al acido fosfonoacetico (PAA) ni al cloruro de guanidina (GHCl) y crecieron en celulas previamente tratadas con bromodeoxiuridina (BDUR). Estos resultaron sugirieron la presencia de 2 agentes que recuerdan a los Enterovirus y a virus envueltos. Se necesita continuar profundizando en los estudios de caracterizacion de estos agentes