ABSTRACT The Ebola virus is a pathogen that causes high morbidity and mortality in epidemic events during which health personnel are frequently infected. Such an epidemic occurred in West Africa, prompting WHO to issue a call in 2014 for health personnel to be dispatched to affected countries. Cuba responded and signed an assistance agreement under which 265 Cuban health professionals, members of the Henry Reeve Emergency Medical Contingent, volunteered their services in the Republic of Guinea, Sierra Leone and Liberia. This article presents Cuba’s strategy of medical aid and organization of the three medical teams formed; refers to the teams’ contribution to epidemic control in treatment centers where they worked alongside other personnel; and describes measures taken in Cuba to prevent the virus from entering the country through returning volunteers or other means. In the centers where Cuban medical teams worked with other health professionals in West Africa, case fatality decreased from 80%–90% to 24%, contributing to control of the epidemic; no Ebola outbreaks occurred in Cuba. During the epidemic, two Cuban health professionals died of malaria and one physician fell ill with Ebola. This paper includes an overview of the treatment and evolution of the latter case, a doctor who contracted the disease in Sierra Leone and was treated in Geneva and Havana.

Brown algae are a source of high content of polysaccharides such as fucoidans that have important immunomodulatory properties. The aim was to determine the viability of human peripheral blood mononuclear cells (hPBMC), production of nitric oxide (NO), reactive oxygen species (ROS) and the proinflammatory cytokines IL-1α, IL-6, TNF-α and IFN -γ in cultures treated with fucoidan from Lessonia trabeculata. Fucoidan from Lessonia trabeculata from San Nicolás de Marcona-Ica Bay was used. The hPBMC were isolated using Ficoll-Hypaque, distributed at a concentration of 1x105 cells/well in complete RPMI-1640 medium and treated with different concentrations of fucoidan for 24 and 48 h. The cytotoxic activity was determined by the reduction of MTT, NO production by the Griess reaction and ROS by the reduction of NBT. The production of cytokines was quantified by ELISA. The fucoidan of L. trabeculata stimulated the proliferation of hPBMC and produced the increase of ROS at concentrations of 100-2000 μg/mL with respect to the control (p <0.001), the reaction for nitrites was negative. Fucoidan increased the production of IL-1α and TNF-α at concentrations of 100 and 10 μg/mL respectively, while the production of IL-6 and IFN-γ did not show significant differences. It is concluded that the fucoidan of L. trabeculata stimulates the proliferation of hPBMC, production of reactive oxygen species and the proinflammatory cytokines IL-1α and TNF-α that possess important immunomodulatory properties.

Las algas pardas constituyen una fuente de alto contenido de polisacáridos como los fucoidanos que poseen importantes propiedades inmunomoduladoras. El objetivo fue determinar la viabilidad de células mononucleares de sangre periférica humana (CMSPh), producción de óxido nítrico (NO), especies reactivas de oxígeno (ROS) y de las citoquinas proinflamatorias IL-1α, IL-6, TNF-α e IFN-γ en cultivos tratados con fucoidan de Lessonia trabeculata. Se empleó fucoidan de Lessonia trabeculata proveniente de la bahía San Nicolás de Marcona-Ica. Las CMSPh se aislaron empleando Ficoll-Hypaque, se distribuyeron a una concentración de 1x105 células/pocillo en medio RPMI-1640 completo y se trataron con diferentes concentraciones de fucoidan durante 24 y 48 h. La actividad citotóxica se determinó por la reducción de MTT, la producción de NO por la reacción de Griess y las ROS por la reducción del NBT. La producción de citoquinas se cuantificó por ELISA. El fucoidan de L. trabeculata estimuló la proliferación de CMSPh y produjo el incremento de ROS a concentraciones de 100-2000 μg/mL respecto al control (p<0.001), la reacción para nitritos resultó negativa. El fucoidan incrementó la producción de IL-1α y TNF-α a concentraciones de 100 y 10 μg/mL respectivamente, mientras que la producción de IL-6 e IFN-γ no mostró diferencias significativas. Se concluye que el fucoidan de L. trabeculata estimula la proliferación de CMSPh, producción de especies reactivas de oxígeno y las citoquinas proinflamatorias IL-1α y TNF-α que poseen importantes propiedades inmunomoduladoras.

ABSTRACT INTRODUCTION By the end of 2017, there were more than 28,000 individuals living with HIV in Cuba, over 80% receiving antiretroviral therapy, which dramatically reduces viral replication, improves immune status and decreases risk of transmission. These results could be jeopardized by emergence of HIV-1 drug resistance. In 2009, a test for HIV-1 genotypic resistance was introduced in routine clinical practice in Cuba. OBJECTIVE Investigate antiretroviral resistance and its relation to subtype distribution in HIV-1 treatment-naïve and previously treated patients in Cuba. METHODS Resistance and HIV-1 subtype distribution were determined in 342 antiretroviral treatment-naïve patients and 584 previously treated for HIV-1 whose blood specimens were sent to the Pedro Kourí Tropical Medicine Institute during 2009–2014. Transmitted drug resistance was determined using the Calibrated Population Resistance Tool v.6. Drug resistance analysis was conducted using the algorithm Rega v9.1.0. RESULTS Prevalence of transmitted drug resistance was 11.4%, and 41% of mutated viruses exhibited dual-class resistance to nucleoside reverse transcriptase inhibitor and non-nucleoside reverse transcriptase inhibitor. Overall, 84.9% of patients had ≥1 resistance mutation, 80% had ≥1 nucleoside reverse transcriptase inhibitor mutation, 71.4% had ≥1 non-nucleoside reverse transcriptase inhibitor mutation and 31.7% had ≥1 protease inhibitor mutation. K65R and K101E mutations were significantly more frequent in subtype C, L210W in CRF19_cpx, and M47V/I in CRF BGs (20, 23, 24). Full class resistance to nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors and multidrug resistance were detected in 21.2%, 32.4%, 8% and 4.1% of patients, respectively. Average percentage resistance to nucleoside reverse transcriptase inhibitor, protease inhibitor, full class resistance to nucleoside reverse transcriptase inhibitor, protease inhibitor and multidrug resistance increased in patients failing two or more regimens. Nevertheless, after 2011, a declining trend was observed in the frequency of multidrug resistance and full class resistance to nucleoside reverse transcriptase inhibitors and protease inhibitors. CONCLUSIONS Detected levels of transmitted drug resistance highlight the need for a national surveillance study in treatment-naïve patients. Resistance prevalence is high in previously treated patients but appears to be decreasing over time. The frequency of resistance mutations in recombinant forms of HIV in Cuba needs further study.

Crayfish can be intermediate hosts of larval digeneans. Cambarellus montezumae is a crustacean endemic of the Mexican plateau and is part of the diet of the inhabitants of Lerma; nonetheless, this municipality lacks parasitological studies on the species of hosts. This work is an analysis of 13 samples collected monthly proceeding from the lakeshore. Two hundred and twenty one crayfish were examined externally and internally. The metacercariae number per crayfish and per anatomical unit was registered. The prevalence, intensity and abundance were recorded each month. Ninety four crayfish were parasitized by metacercariae encysted mainly in the gills. The highest prevalence was observed in March, May and June. In spite of the slight difference in abundance between females (2.6) and males (2.4), there was no significant difference (U -Mann-Whitney test). The highest parasite burden was 26, with an average of 6 metacercariae per crayfish. In addition, all specimens with a size larger than 14 mm presented metacercariae, the only larval stage detected. C. montezumae could be considered a second intermediate host of the digenean Haematoloechus pulcher in the Salazar Lake in Mexico due to the prevalence and presence of this parasite throughout the year.

El acocil puede ser hospedero intermediario de estados larvarios de digéneos. Cambarellus montezumae es un crustáceo endémico del altiplano mexicano y es parte de la dieta de los habitantes de Lerma; sin embargo, en este municipio se carece de estudios parasitológicos. Este trabajo es un análisis de 13 muestras recolectadas mensualmente procedentes de la orilla del lago. Se examinaron 221 acociles externa e internamente. Se registró el número de metacercarias por acocil y por unidad anatómica. La prevalencia, intensidad y abundancia se registraron mensualmente. Noventa y cuatro acociles fueron positivos a la infección, principalmente en branquias. La mayor prevalencia se observó en marzo, mayo y junio. A pesar de que resultó una ligera diferencia en la abundancia entre hembras (2.6) y machos (2.4), ésta no fue significativa (prueba U -Mann-Whitney). La mayor carga de parásitos fue 26, con un promedio de 6 metacercarias por acocil, única fase larvaria encontrada. Además, todos los individuos con una longitud mayor a 14 mm resultaron parasitados. Cambarellus montezumae podría considerarse un hospedero intermediario de Haematoloechus pulcher en el lago de Salazar en el Estado de México debido a su prevalencia a lo largo del año.

INTRODUCTION: the oxidative stress (OS) has been recognized as a co-factor of HIV infection evolution to AIDS condition. OBJECTIVES: to evaluate the possible antioxidant effect and the impact on the functioning of several systems in the body, resulting in the toxicological safety of Vimang® use. METHODS: sixty eight HIV-seropositive patients were double-blind randomized in two groups; the first was supplied with Vimang® during six months and the other with placebo. Redox condition and the biochemical indexes of the hematological, renal and hepatic functions were measured. Also, dietary intake was assessed through surveys administered for 7 days at the beginning and at the end of the study. RESULTS: there were statistically significant differences between the groups regarding positive change in redox figures in Vimang® group compared to those of the placebo group. No significant difference was found either in the evaluated dietary intake indexes or in the biochemical indexes of the renal, hematological and hepatic functions at the end of the study. CONCLUSIONS: Vimang® antioxidant effect was shown, without any toxic influence during the six month-study conducted in HIV/AIDS patients.

ANTECEDENTES: el estrés oxidativo ha sido considerado como cofactor de la progresión de la infección por el VIH al estado sida. OBJETIVOS: evaluación del posible efecto antioxidante y de las funciones de diversos sistemas en el organismo, que resultan en la seguridad toxicológica para su empleo. MÉTODOS: considerando lo anterior se estudiaron 68 individuos seropositivos al VIH de modo aleatorio, a doble ciegas en dos grupos: a uno se le suministró Vimang® durante 6 meses y al otro placebo. Se hicieron determinaciones del estado redox, índices bioquímicos de función renal, hepática y hematológica, y se realizó una evaluación de la ingesta dietaria a través de encuestas durante 7 d al inicio y al final del estudio. RESULTADOS: se evidenció de manera estadísticamente significativa (p< 0,05), un cambio beneficioso en los índices redox en el grupo con Vimang® respecto al placebo. No se encontraron diferencias significativas en la comparación de los índices dietarios evaluados, ni en los índices bioquímicos de función renal, hepática y hematológica entre los grupos, ni al final del estudio. CONCLUSIONES: las evidencias demuestran el efecto antioxidante del Vimang® sin influencias tóxicas en el período de 6 meses en los individuos VIH/sida estudiados.

The adaptation of Coreil et al´s communicable disease model to the dynamics of contracting HIV from the sensitive individual perspective was intended to be explained in this article. A literature review on the situation of this disease in Cuba and worldwide by developing the phylosophical debate on concepts and the basis for a different risk approach was made. The applicability and usefulness of this model for the study of determinants involved in HIV infection was shown.

Se explicó la adaptación del modelo de las enfermedades transmisibles de Coreil y otros, a la dinámica de la adquisición del VIH desde la perspectiva del individuo susceptible. Se hizo una revisión, acerca de la situación internacional y de Cuba de esta enfermedad, mediante el desarrollo de la discusión filosófica de los conceptos y las bases de un enfoque diferente de riesgo. Se demostró la aplicabilidad de este modelo y se previó su utilidad para el estudio de los determinantes que intervienen en la adquisición de la infección.

A longitudinal prospective study was made to evaluate the clinical, immunological and virological response of a cohort of 34 AIDS patients in Cienfuegos provinces, who had been treated with highly active antiretroviral therapy (HAART). Males comprised 67.6% of the total number and average age was 32 years. Sexual infection path was identified in 91.2 % of cases. The CD4+ T counting under 200 cells defined AIDS in 79.4 % of individuals. Twenty six patients suffered minor opportunistic infections (76.5 %) whereas 32.4 % got sick due to some major opportunistic disease prior to the therapy. After this therapy, these frequencies lowered to 20.6 % and 11.8 % respectively. Average CD4+ counting at the starting of HAART was 196 cell/mm³ and exceeded 400 cells in the rest of further countings. From a PVC average of 15 251 copies/ml one year after therapy, this figure reduced to 8 048 copies at 2 years. Only 10 cases required hospitalization after a HAART (29.4%). Treatment adherence reached over 80% and was correlated to immunological restoration. Survival after one year was 100 % and only 2 patients died in the following 4 years. The positive impact of HAART on the frequency of opportunistic infections, immunological restoration and survival was proved.

Se realizó un estudio propectivo y longitudinal con el propósito de evaluar la respuesta clínica, inmunológica y virológica de una cohorte de 34 enfermos de SIDA en la provincia de Cienfuegos tratados con terapia antirretroviral de alta eficacia (TARVAE). Del sexo masculino eran 67,6 % y la media de edad 32 años. La vía de infección sexual se identificó en 91,2 %. Del total de individuos, 79,4 % definieron el SIDA por recuento de LTCD4+ < 200 células. Padecieron de infecciones oportunistas menores 26 enfermos (76,5 %) y 32,4 % enfermó por alguna oportunista mayor antes de la TARVAE. Posterior a esta, las frecuencias se redujeron a 20,6 y 11,8 %, respectivamente. El recuento medio de LTCD4+ al inicio de la TARVAE fue 196 células/mm³, y superó las 400 células en el resto de las mediciones. De una media de CVP de 15 251 copias/mL al año de la terapia, disminuyó a 8 048 copias a los 2 años. Solo 10 casos requirieron hospitalización después de la TARVAE (29,4 %). La adherencia a la terapia superó 80 % y se correlacionó con la restauración inmunológica. La supervivencia al año fue de 100 % y durante los 4 años fallecieron 2 enfermos. Se demostró el impacto positivo de la TARVAE en la frecuencia de infecciones oportunistas, la restauración inmunológica y la supervivencia.

OBJECTIVE: To compare the standard cervical cancer screening procedure -the Papanicolaou test or Pap smear- with detection through visual inspection using acetic acid (VIA), and visual inspection with acetic acid assisted by Aviscope (VIAM). MATERIAL AND METHODS: The study was conducted between October 1998 and December 2000, in two Mixteca regions in Oaxaca, Mexico. A field trial design was used to randomize the two regions to either of the two inspection methods. In one region 2,240 women received VIA; in the other, 2,542 women received VIAM. Women positive to visual inspection and a subsample of women with negative results were referred for colposcopy and, if necessary, cervical biopsy. Statistical data analysis consisted of descriptive statistics and comparison of groups using chi-squared tests. Diagnostic values were obtained for VIA and VIAM, using as gold standards colposcopy and biopsy. RESULTS:VIAM identified a higher proportion of women with a cervical abnormality (16.3%) than VIA (3.4%), as well as normal women (58.5% vs. 53.8%). VIA identified a higher proportion of women with benign changes (41.2%) than VIAM (19.6%). VIAM had a greater sensitivity (p>0.05) but lower specificity (p<0.05) than VIA, using as gold standards colposcopy and biopsy. CONCLUSIONS: The two study groups were comparable for age, parity and cytological results; however, visual inspection results were different between the groups: VIAM identified more lesions confirmed by biopsy. The diagnostic utility of VIAM and VIA was lower than expected. Training of clinical personnel in visual inspection is critical to improve the effectiveness of these screening methods.

OBJETIVO: Se comparan los nuevos métodos de detección de lesiones preneoplásicas del cérvix-inspección visual con ácido acético (IVAA) e inspección visual con ácido acético y magnificación (IVAM) con el aparato AviScopeMR- y el método tradicional de detección por citología. MATERIAL Y MÉTODOS: El estudio se llevó a cabo entre octubre de 1998 y diciembre de 2000, en dos zonas de la región de La Mixteca, en Oaxaca, México. El diseño de estudio fue de tipo ensayo comunitario. El IVAA correspondió a un brazo del estudio y el IVAM a otro; ambos métodos de detección se practicaron en mujeres que tenían entre 20 y 65 años de edad. Se incluyeron 2 240 mujeres en el brazo IVAA y 2 542 en el brazo IVAM. Las mujeres en las que la inspección visual dio un resultado positivo y una submuestra de las mujeres con resultado negativo, fueron referidas a colposcopía y, en caso de ser necesario, a biopsia de tejido cervicouterino. El análisis estadístico se presenta descriptivamente y los grupos se compararon con la prueba de Ji-cuadrada. Se presentan además los resultados de los valores diagnósticos de IVAA e IVAM, comparados con el diagnóstico por colposcopía y biopsia. RESULTADOS: El método IVAM detectó un mayor porcentaje de mujeres identificadas con alguna anomalía (16.3%) que el IVAA (3.4%), así como de mujeres normales (58.5% vs. 53.8%, respectivamente). Por otra parte, el método IVAA identificó a más mujeres con cambios benignos (41.2%) que el IVAM (19.6%). Este último tuvo una mayor sensibilidad (p>0.05) y una menor especificidad (p<0.05) que IVAA, usando como estándar de oro la colposcopía y la biopsia. CONCLUSIONES: Ambas poblaciones de estudio presentaron características similares en cuanto a edad, paridad y resultados citológicos; sin embargo, los hallazgos a partir de la inspección visual fueron muy distintos entre los dos grupos; el grupo IVAM identificó más lesiones confirmadas por biopsia. La utilidad diagnóstica de IVAM e IVAA fue menor que la esperada. La capacitación práctica del personal clínico en inspección visual es crítica para la efectividad de este método.

OBJECTIVE: To compare the standard cervical cancer screening procedure -the Papanicolaou test or Pap smear- with detection through visual inspection using acetic acid (VIA), and visual inspection with acetic acid assisted by Aviscope (VIAM). MATERIAL AND METHODS: The study was conducted between October 1998 and December 2000, in two Mixteca regions in Oaxaca, Mexico. A field trial design was used to randomize the two regions to either of the two inspection methods. In one region 2,240 women received VIA; in the other, 2,542 women received VIAM. Women positive to visual inspection and a subsample of women with negative results were referred for colposcopy and, if necessary, cervical biopsy. Statistical data analysis consisted of descriptive statistics and comparison of groups using chi-squared tests. Diagnostic values were obtained for VIA and VIAM, using as gold standards colposcopy and biopsy. RESULTS:VIAM identified a higher proportion of women with a cervical abnormality (16.3%) than VIA (3.4%), as well as normal women (58.5% vs. 53.8%). VIA identified a higher proportion of women with benign changes (41.2%) than VIAM (19.6%). VIAM had a greater sensitivity (p>0.05) but lower specificity (p<0.05) than VIA, using as gold standards colposcopy and biopsy. CONCLUSIONS: The two study groups were comparable for age, parity and cytological results; however, visual inspection results were different between the groups: VIAM identified more lesions confirmed by biopsy. The diagnostic utility of VIAM and VIA was lower than expected. Training of clinical personnel in visual inspection is critical to improve the effectiveness of these screening methods.

OBJETIVO: Se comparan los nuevos métodos de detección de lesiones preneoplásicas del cérvix-inspección visual con ácido acético (IVAA) e inspección visual con ácido acético y magnificación (IVAM) con el aparato AviScopeMR- y el método tradicional de detección por citología. MATERIAL Y MÉTODOS: El estudio se llevó a cabo entre octubre de 1998 y diciembre de 2000, en dos zonas de la región de La Mixteca, en Oaxaca, México. El diseño de estudio fue de tipo ensayo comunitario. El IVAA correspondió a un brazo del estudio y el IVAM a otro; ambos métodos de detección se practicaron en mujeres que tenían entre 20 y 65 años de edad. Se incluyeron 2 240 mujeres en el brazo IVAA y 2 542 en el brazo IVAM. Las mujeres en las que la inspección visual dio un resultado positivo y una submuestra de las mujeres con resultado negativo, fueron referidas a colposcopía y, en caso de ser necesario, a biopsia de tejido cervicouterino. El análisis estadístico se presenta descriptivamente y los grupos se compararon con la prueba de Ji-cuadrada. Se presentan además los resultados de los valores diagnósticos de IVAA e IVAM, comparados con el diagnóstico por colposcopía y biopsia. RESULTADOS: El método IVAM detectó un mayor porcentaje de mujeres identificadas con alguna anomalía (16.3%) que el IVAA (3.4%), así como de mujeres normales (58.5% vs. 53.8%, respectivamente). Por otra parte, el método IVAA identificó a más mujeres con cambios benignos (41.2%) que el IVAM (19.6%). Este último tuvo una mayor sensibilidad (p>0.05) y una menor especificidad (p<0.05) que IVAA, usando como estándar de oro la colposcopía y la biopsia. CONCLUSIONES: Ambas poblaciones de estudio presentaron características similares en cuanto a edad, paridad y resultados citológicos; sin embargo, los hallazgos a partir de la inspección visual fueron muy distintos entre los dos grupos; el grupo IVAM identificó más lesiones confirmadas por biopsia. La utilidad diagnóstica de IVAM e IVAA fue menor que la esperada. La capacitación práctica del personal clínico en inspección visual es crítica para la efectividad de este método.

O colo uterino é a localização tumoral mais importante em mulheres na América Latina, ocorrendo aproximadamente 52 mil novos casos anualmente na região. Assim, a necessidade de melhorar a eficiência e efetividade dos programas de rastreamento de câncer de colo uterino (PRCC) é fundamental para que ocorra o decréscimo do sofrimento desnecessário experimentado por essas mulheres. Este trabalho aborda questões essenciais para revitalizar o PRCC, tal como proposto pela regulamentação oficial no México. Um marco teórico para institucionalização do PRCC é delineado, seguindo-se a apresentação de estratégias, visando fortalecer seu desempenho por meio de medidas organizacionais capazes de assegurar a qualidade da assistência prestada. O trabalho focaliza as atividades seguintes: 1) melhora da cobertura; 2) implementação no controle de qualidade da obtenção de amostras para exame; 3) melhoria na qualidade de interpretação do exame de Papanicolau; 4) garantia de tratamento na presença de anomalias detectadas; 5) melhoria do seguimento; 6) desenvolvimento de medidas de controle da qualidade e 7) desenvolvimento de sistemas de monitoramento e de informação em vigilância epidemiológica.

The uterine cervix is the most common cancer site for females. Approximately 52,000 new cases occur annually in Latin America, thus the need to improve efficiency and effectiveness of Cervical Cancer Screening Programs (CCSP) is mandatory to decrease the unnecessary suffering women must bear. This paper is addressing essential issues to revamp the CCSP as proposed by the Mexican official norm. A general framework for institutionaling CCSP is outlined. Furthermore, strategies to strengthen CCSP performance through managerial strategies and quality assurance activities are described. The focus is on the following activities: 1) improving coverage; 2) implementing smear-taking quality control; 3) improving quality in interpretation of Pap test; 4) guaranteeing treatment for women for whom abnormalities are detected; 5) improving follow-up; 6) development of quality control measures and 7) development of monitoring and epidemiological surveillance information systems. Changes within the screening on cervical cancer may be advocated as new technologies present themselves and shortcomings in the existing program appear. It is crucial that these changes should be measured through careful evaluation in order to tally up potential benefits.

O colo uterino é a localização tumoral mais importante em mulheres na América Latina, ocorrendo aproximadamente 52 mil novos casos anualmente na região. Assim, a necessidade de melhorar a eficiência e efetividade dos programas de rastreamento de câncer de colo uterino (PRCC) é fundamental para que ocorra o decréscimo do sofrimento desnecessário experimentado por essas mulheres. Este trabalho aborda questões essenciais para revitalizar o PRCC, tal como proposto pela regulamentação oficial no México. Um marco teórico para institucionalização do PRCC é delineado, seguindo-se a apresentação de estratégias, visando fortalecer seu desempenho por meio de medidas organizacionais capazes de assegurar a qualidade da assistência prestada. O trabalho focaliza as atividades seguintes: 1) melhora da cobertura; 2) implementação no controle de qualidade da obtenção de amostras para exame; 3) melhoria na qualidade de interpretação do exame de Papanicolau; 4) garantia de tratamento na presença de anomalias detectadas; 5) melhoria do seguimento; 6) desenvolvimento de medidas de controle da qualidade e 7) desenvolvimento de sistemas de monitoramento e de informação em vigilância epidemiológica.

The uterine cervix is the most common cancer site for females. Approximately 52,000 new cases occur annually in Latin America, thus the need to improve efficiency and effectiveness of Cervical Cancer Screening Programs (CCSP) is mandatory to decrease the unnecessary suffering women must bear. This paper is addressing essential issues to revamp the CCSP as proposed by the Mexican official norm. A general framework for institutionaling CCSP is outlined. Furthermore, strategies to strengthen CCSP performance through managerial strategies and quality assurance activities are described. The focus is on the following activities: 1) improving coverage; 2) implementing smear-taking quality control; 3) improving quality in interpretation of Pap test; 4) guaranteeing treatment for women for whom abnormalities are detected; 5) improving follow-up; 6) development of quality control measures and 7) development of monitoring and epidemiological surveillance information systems. Changes within the screening on cervical cancer may be advocated as new technologies present themselves and shortcomings in the existing program appear. It is crucial that these changes should be measured through careful evaluation in order to tally up potential benefits.

25 children of HIV-1 seropositive mothers have been born in Cuba so far. Only 12 (48 %) of them, who are seropositive, have been studied. 4 of them (33,3 %) developed AIDS. Besides, we followed a case who got the disease by a blood transfusion. These children are monthly followed-up at the outpatient department since their birth, and PCR (polymerase chain reaction), ELISA, and Western-Blot for HIV-1 are carried out at 3 and 9 months of age. The diagnostic is confirmed using the some tests at 18 and 36 months of age in order to hnow whether they are carriers or not.

Hasta el momento, han nacido en Cuba 25 niños hijos de madres seropositivas al virus de inmunodeficiencia humana-1 (VIH-1). De estos niños, sólo hemos estudiado 12 (48 %) que son seropositivos, y 4 de estos últimos (33,3 %) desarrollaron el SIDA. Además, seguimos un caso que ha desarrollado esta enfermedad, en el cual la vía de transmisión fue una transfusión sanguínea. Desde su nacimiento, estos niños son seguidos mensualmente en consulta externa, y se les realiza PCR (reacción en cadena polimerasa), ELISA y Western-Blot para VIH-1 a los 3 y 9 meses de edad; y su confirmación diagnóstica se lleva a cabo mediante estas mismas pruebas a los 18 y a los 36 meses de edad, con el fin de conocer si son o no portadores del virus.