INTRODUCTION: Following a tripling of tuberculosis incidence in Cuba between 1991 and 1994 (from 4.7 to 14.7 per 100,000), the National TB Control Program was revamped in 1995 and the National Reference Center for Childhood TB and Provincial Childhood TB Commissions were created as a strategy for addressing this emerging health problem. OBJECTIVE: Assess the impact of Cuba's new strategy for TB control in children aged <15 years during the period 1995-2005. METHODS: A descriptive review of health services and systems was conducted in Cuba, examining 157 cases of TB diagnosed in children aged <15 years during the period 1995-2005 and comparing impact and process indicators for selected years (1995, 2000, and 2005). Impact indicators included reduction in: a) incidence; b) serious forms (peritoneal, meningeal, miliary, combined); c) mortality; and d) case outcomes (cure, death, treatment drop-out, treatment failure). Process indicators were proportion of cases with: a) microbiological tests; b) knowledge of infection source; c) diagnoses obtained through adult case contact tracing; d) time to diagnosis <60 days; and e) post-mortem diagnoses. RESULTS: During the period 1995-2005, TB rates in children aged <15 years fell by 50% (from 1.0 to 0.5 per 100,000), more evident in children <10 years. The Havana rate was three times the national rate. Diagnosis was post-mortem in three serious cases (1.9%); there were four deaths (2.5%), none after 2000. Only seven children (4.5%) had serious forms, none after 2002. Except for cases diagnosed post-mortem, all children received treatment directly supervised by health personnel. Cure rate was 99.4%; there were no treatment drop-outs or chronic cases; one relapse was reported (0.6%). Knowledge of infection source increased to 90% over the selected years. Microbiological tests were conducted in 90% of cases, with isolation in 30.9%. No isolate was drug-resistant, nor were there reports of infectious contacts with resistance. We found no HIV coinfection. At the end of the study, time to diagnosis of >60 days persisted in 40% of cases. CONCLUSIONS: Creation of a National Reference Center for Childhood TB and Provincial Childhood TB Commissions has contributed to improved TB diagnosis and control in children aged <15 years, achieving incidence similar to that during the period prior to TB re-emergence and to those of some developed countries. Improvements are needed in the work and systematic training of health personnel, especially at the primary health care level, in order to eliminate TB as a national health problem by 2015.
A cross-sectional descriptive study of 340 persons assigned to two groups, with and without family history of diabetes mellitus type 2 (DM2), was carried out. The objective was to detect whether those persons with family history of DM2 had more hyperinsulemia, metabolic syndrome, associated cardiovascular risk factors and target organ lesions, expressed in left ventricle hypertrophy, than subjects without diabetes family history. The result was that hyperinsulemia was present in 96 patients with family history of DM2 (56,5 %) and significance level of p= 0,001. Metabolic syndrome was more frequent in subjects with family history of DM2 (90) for 52,9 % of cases and p= 0,000. Hypertriglyceridemia was both the most noticeable marker of the metabolic syndrome and the most statistically significant risk factor in subjects with family history of DM2 (96 , 52,9 % of cases and p= 0,000). Left ventricle hypertrophy was associated as target organ lesion expression to subjects with family history of DM2 (36: 21,2 % and p=0,043). It was concluded that subjects with family history of DM2 are more likely to have hyperinsulinemia, metabolic syndrome, cardiovascular risk factors and target organ lesions than those persons without such a family history of DM2.
Se realizó un estudio descriptivo y transversal de 340 personas divididas en 2 grupos, con y sin antecedentes patológicos familiares de diabetes mellitus tipo 2 (APF de DM2), con el objetivo de detectar si las que presentaban APF de DM2 tenían más hiperinsulinemia, presencia de síndrome metabólico, factores de riesgo cardiovascular asociados y lesión de órganos diana, expresados en hipertrofia del ventrículo izquierdo de los sujetos que no tenían dicho antecedente. Se obtuvo como resultado que la hiperinsulinemia estuvo presente en 96 pacientes con APF de DM2 (56,5 %) y una significación de p = 0,001. El síndrome metabólico fue más frecuente en las personas con APF DM2 (90) para un 52,9 % y una significación de p = 0,000. La hipertrigliceridemia fue el marcador por excelencia del síndrome metabólico y el factor de riesgo que con más significación estadística se asoció a los sujetos con APF de DM2 (96: 52,9 % y una significación de p = 0,000). La hipertrofia ventricular izquierda (HVI) se asoció como expresión de lesión de órganos diana a los sujetos con APF de DM2 (36: 21,2 % y una significación de p = 0,043). Concluimos que los sujetos con APF de DM2 son más propensos a tener hiperinsulinemia, al síndrome metabólico, a factores de riesgo cardiovascular y a lesión de órgano diana en comparación con los que no tienen dicho antecedente.