A molecular epidemiological study of rabies in Cuba.

To investigate the emergence and current situation of terrestrial rabies in Cuba, a collection of rabies virus specimens was employed for genetic characterization. These data supported the monophyletic nature of all terrestrial rabies viruses presently circulating in Cuba but additionally delineated several distinct variants exhibiting limited spatial distribution which may reflect the history of rabies spread on the island. The strain of rabies currently circulating in Cuba, which emerged on the island in the early 20th century, has very close evolutionary ties to the Mexican dog type and is a member of the cosmopolitan lineage widely distributed during the colonial period. The Cuban rabies viruses, which circulate predominantly within the mongoose population, are phylogenetically distant from viruses circulating in mongooses in other parts of the world. These studies illustrate, at a global level, the adaptation of multiple strains of rabies to mongoose species which should be regarded as important wildlife hosts for rabies re-emergence. Given the recent emergence of human cases due to bat contact in Cuba, this study also included a single insectivorous bat specimen which was found to most closely resemble the rabies viruses known to circulate in Mexican vampire bats.

[Evaluation of the effectiveness of a new vaccine against human leptospirosis in groups at risk]. / Evaluación de la efectividad de una nueva vacuna contra la leptospirosis humana en grupos en riesgo.

In order to evaluate the effectiveness of a new vaccine against human leptospirosis, a prospective cohort study was done with persons in the Cuban province of Holguín who were at risk of becoming ill with leptospirosis. The study included 118,018 persons from 15 to 65 years old who were considered to face either permanent or temporary risk. The vaccinated cohort consisted of 101,137 persons. They received two vaccine doses, 6 weeks apart, of 0.50 mL via deep intramuscular injection into the deltoid muscle of the nondominant arm. The unvaccinated cohort consisted of 16,881 persons. Epidemiological surveillance began 21 days after the application of the second vaccine dose and continued for 1 year. The same criteria for suspected and confirmed cases were maintained throughout the study period. At the end of the surveillance period effectiveness was calculated as being higher than 97%. It is estimated that the vaccination program prevented eight out of ten cases that would have otherwise occurred. Vaccine reactogenicity was also measured in a subsample of 1,500 persons between 15 and 65 years old. The observed symptomatology was low. Slight pain at the injection site was the most frequent symptom (25%). The results of the study indicate the usefulness of the vaccine for disease prevention among people at risk, and its use is thus recommended.

Functional magnetic resonance imaging localization of ictal onset to a dysplastic cleft with simultaneous sensorimotor mapping: intraoperative electrophysiological confirmation and postoperative follow-up: technical note.

INTRODUCTION: Although technically challenging to obtain, ictal functional magnetic resonance imaging has been used to localize ictal onset zones in a small number of patients. We used this technique to demonstrate the inherent epileptogenicity of dysplastic cortex. METHODS: We present a 16-year-old female patient with intractable left-sided sensorimotor seizures and a congenital dysplastic cleft lying along the right rolandic fissure. Preoperative functional magnetic resonance imaging (blood oxygen level-dependent sequence, 1.5 T) localized the motor and sensory cortices to the anterior border of the cleft. During a speech activation run, the patient experienced a 20-second seizure. Initial activation was seen within the dysplastic cortex along the deep posterior margin of the cleft. Intraoperative median nerve stimulation produced a distinct N20/P20 wave inversion over the dysplastic cleft. Stimulation mapping performed with the patient awake confirmed the location of the sensorimotor cortex on the anterior border of the cleft, and preresection electrocorticography identified abundant interictal spikes along the posterior border after opening the cleft. RESULTS: After surgical resection of the dysplastic cortex, the patient exhibited transient minimal weakness and mild neglect, which resolved within 1 week. Two years after surgery, she was neurologically intact and seizure-free. CONCLUSION: This study used functional magnetic resonance imaging to demonstrate the inherent epileptogenicity of dysplastic cortex and to simultaneously map ictal and functional cortex. The N20 wave inversion can be a useful intraoperative tool for identifying the central sulcus (or its equivalent), even in the presence of abnormal cortical architecture.

MR and cerebrospinal fluid enzymes as sensitive indicators of subclinical cerebral injury after open-heart valve replacement surgery.

PURPOSE: To evaluate MR imaging and lumbar cerebrospinal fluid enzymes as potential sensitive indicators of cerebral injury after open-heart valve replacement surgery. METHODS: Thirty-four patients with cardiac valvular disease were prospectively entered into this study and then underwent valve replacement or repair under cardiopulmonary bypass using a membrane oxygenator. In 26 patients, MR head images were obtained 12 to 24 hours before surgery; repeat MR images were obtained between 1 and 2 weeks after surgery. In 18 patients, lumbar puncture cerebrospinal fluid was analyzed 24 to 48 hours after surgery; the analyses included measurement of lactic dehydrogenase, creatine phosphokinase, adenylate kinase, and neuron-specific enolase. RESULTS: After surgery, MR imaging showed new ischemic lesions in 15 (58%) of 26 patients: 7 with deep white matter hyperintense lesions; 5 with brain stem, caudate, cerebellar, or thalamic/basal ganglia infarcts; 1 with intraparenchymal hemorrhage; 1 with a subdural hematoma and cortical infarct; and 1 with a corpus callosum lesion consistent with calcium or air. These new ischemic lesions seen on MR images were associated with a focal neurologic deficit in only 4 (27%) of the 15 patients. Neuron-specific enolase and lactic dehydrogenase were abnormally elevated after surgery in 5 (28%) of 18 patients. Adenylate kinase and creatine phosphokinase (brain isozymes) were elevated in one (67%) of the patients. Two (40%) of the five patients with abnormally high neuron-specific enolase or lactic dehydrogenase after surgery also showed a new focal neurologic deficit. CONCLUSIONS: MR imaging is a sensitive measure of subclinical cerebral ischemia after cardiac valve replacement under cardiopulmonary bypass. Cerebrospinal fluid neuron-specific enolase and lactic dehydrogenase are less sensitive than MR imaging for detecting subclinical cerebral ischemia, but these values were elevated after surgery more frequently than was adenylate kinase in our patients.

[Human leptospirosis behavior in Cuba]. / Algunas consideraciones sobre el comportamiento de la leptospirosis humana en Cuba.

A description is made of the antecedents of human leptospirosis in Cuba and the behavior of the disease from 1981. An analysis with regards lethality and incidence during the five-year period 1986-1990 was carried out; the most affected provinces, the months of highest occurrence, and the most hazardous occupations, are listed. The present situation of human leptospirosis in Cuba is described and recommendations are provided.

Neuropsychological deficits accompanying striatonigral degeneration.

This study presents a structural and functional description of a case of striatonigral degeneration (SND) and emphasizes neuropsychological findings. The patient, a 55-year-old woman with progressive and relatively intractable rigidity and bradykinesia, particularly of the right side, was studied with brain MR scans and with a wide variety of sensory, motor, and cognitive tests known to be subserved by specific brain regions. T2-weighted MR images revealed curvilinear areas of high signal in the lateral putamen at low magnetic field strength (0.3T) and adjacent regions of marked low signal in the posterior-lateral putamen at high magnetic field (1.5T). High signal changes in the insular cortex were also noted on the high field images. Letter fluency and short-term memory as well as motor speed, strength, and sequencing were selectively impaired. Taken together, the data of this case suggest that structural involvement of the putamen resulted in dysfunctions usually associated with the primary motor cortex and orbitofrontal cortex, while sparing functions of other frontal regions as well as temporal and parietal cortices.

[Several results of a Toxoplasma survey]. / Algunos resultados sobre una encuesta de Toxoplasma.

A pilot Toxoplasma survey was conduct in Ciego de Avila province during the month of September, 1985, to assess, in practice, the methodologic structure proposed for the National Toxoplasma Survey. Of the 292 listed individuals, 284 were surveyed during the field work phase (97.2%) and the remaining 2.8% of no response was due mainly to the fact that dwellers were not at home during the visit. The best day for this type of survey resulted to be Sunday, in the morning. No difficulty was noted with the used modelling, and results obtained in the application of used techniques and procedures are appropriate for use in the National Toxoplasma Survey. The prevalence rate of anti- Toxoplasma antibodies was 55.9%. There was a significant association between some risk factors such as: living with cats, ingestion of non potable water and ingestion of raw meat.

The role of spinal cord MRI in the diagnosis of multiple sclerosis.

In this study we evaluated the effectiveness of high field thin slice surface coil MRI in demonstrating MS plaques in the cervical and upper thoracic spinal cord. MRI seems to be in our experience a sensitive indicator of spinal cord involvement in patients suffering from MS.

Magnetic resonance imaging of the midbrain in Parkinson's disease.

We have analyzed magnetic resonance images of the midbrain in patients with Parkinson's disease, and have found that there is a narrowing of the signal from the pars compacta of the substantia nigra relative to controls. The nature of the histological changes that may be responsible for this effect is discussed. Magnetic resonance imaging has the potential of becoming a useful diagnostic tool in the management of parkinsonism.

Depressed cerebellar glucose metabolism in supratentorial tumors.

Fifty-four patients with supratentorial tumor and one with brainstem tumor were examined with positron emission tomography (PET) using [18F]fluoro-deoxyglucose (FDG). Twenty-one of these cases had satisfactory studies of the cerebellum. Of these, 12 showed significant metabolic asymmetry between the two cerebellar hemispheres, with the rate of glucose utilization in the hemisphere contralateral to the cerebral tumor being 8-34% lower than on the ipsilateral side, as compared with a right-left asymmetry of only--1.6% +/- 2.1% standard deviation for a group of 5 normal subjects. In these 12 cases the tumor involved the sensorimotor cortex and/or the thalamus with varying degrees of hemiparesis being present. For the remaining 9 patients with no significant cerebellar metabolic asymmetry, the tumor involved regions other than the sensorimotor cortex, and unilateral motor dysfunction was not a prominent clinical feature. The correlation between cerebellar metabolic suppression and unilateral motor dysfunction observed in our cases appears to be due to impairment or interruption of the cortico-thalamo-ponto-olivo-cerebellar circuitry by either the tumor itself or by edema. These results illustrate the ability of FDG-PET scans to detect metabolic changes, not apparent on CT scans, in areas of the brain remote from the primary lesion.

EEG, transmission computed tomography, and positron emission tomography with fluorodeoxyglucose 18F. Their use in adults with gliomas.

We evaluated the relationship between findings from EEG, transmission computed tomography (CT), and positron emission tomography in 23 adults with gliomas. The cortical metabolic rate was suppressed in patients with and without focal slowing. Focal delta activity was not related to involvement of gray or white matter. Rhythmic delta activity and focal attenuation of background amplitude on EEG, however, were correlated with involvement of the thalamus.

[18F]fluorodeoxyglucose positron emission tomography in refractory complex partial seizures.

Positron emission tomography with simultaneous electroencephalographic monitoring was performed with [18F]fluorodeoxyglucose in 20 patients with complex partial seizures who had normal computed tomographic scans. Seven patients had only unilateral epileptiform discharges on the electroencephalogram, 3 had predominantly unilateral discharges, and 10 had nonlocalized epileptiform abnormalities. Positron emission tomography showed a hypometabolic lesion in 16 of the 20 patients. Pathological changes in the hypometabolic region were found in postoperative specimens in 4 of 5 patients studied. Positron emission tomography was unaffected by the seizure frequency, state of alertness, or number of spike discharges during the scan. There was a tendency for patients to have higher overall metabolic rates when taking less medication. Seizures occurring during [18F]fluorodeoxyglucose uptake in 3 patients produced a hypermetabolic area at the interictal hypometabolic focus. Positron emission tomography sometimes showed more widespread hypometabolism than suspected on the basis of the scalp-recorded electroencephalogram. The frontal lobe showed a greater degree of hypometabolism than the temporal lobe in 3 patients. Focal lesions may be identified by positron emission tomography even if the electroencephalographic abnormality is not well localized.