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11/Dec/2018

Professor Ricardo A. Gonzales MD Ph.D. DSc founded back in 1976 the Cuban Substance Abuse Treatment Program at the Eduardo B. Ordaz Psychiatric Hospital in Havana. During his carrier of 40 years, he founded 17 similar facilities throughout Cuba making the hospital in Havana is a national reference center for substance abuse treatment.  The Cuban approach to drug abuse is open for international patients as well. The legendary soccer player, Diego Maradona is certainly, the most well-known patient of Cuban program. 

 

What is A Cuban Approach?

The Cuban Substance Abuse treatment program lasts for 97 days (14 weeks) and during that time, the patient goes through the process of detoxification and rehabilitation. All the details are worked out- the therapy is carried out in a natural environment, overseen by a team of highly trained professionals (multidisciplinary approach to the treatment is must!). Upon the conclusion, the re-evaluation and follow up visit are scheduled.

The facilities that accommodate patients are secured and reserved only for patients on a drug abuse treatment. The treatment principle applied relies on “therapeutic communities” where patients get a chance to talk and encourage each other, share their hopes, dreams, and frustrations, which altogether contributes to the recovery.

During the first week, the team of specialists decides if the patient should stay in the program or not. In case of excessive aggression, if the patient changes his mind (patients are admitted under their own free will) or because of other medical or non-medical reasons, the team releases the patient with a recommendation about further treatment. The patients who get admitted (a vast majority of them), undergo a series of lab tests, X-ray, ECG, and other necessary medical examination procedures. After the initial assessment, a personalized therapeutic plan is made.

During the three months period, the patient is undergoing individualized physical and psychological rehabilitation program to achieve behavioral changes that will allow him a healthy (long-term sustainable) rehabilitation. Specifically, the patient learns about how to control withdrawal symptoms, how to cope with cravings, new healthy lifestyle, how to eliminate harmful behaviors and accept responsibilities and develop his or her intellectual and labor potential to its maximum.

Multidisciplinary Approach

The problem of drug abuse is complex and requires a team of many specialists- experienced internal medicine specialists, neurologists, psychologists, psychiatrists, nurses- all to be trained specifically for the treatment of drug abuse.

Drug abuse in some cases leads to a vicious, never-ending cycle of psychiatric problems- the drug abuse damages the brain which leads to psychiatric conditions (paranoid psychosis or schizophrenia for example), which deepens the problem of drug abuse and makes it even harder to quit. The art of treatment is to recognize and put under control the “layers of the problem” that developed into autonomous psychiatric conditions over time and target the treatment specifically towards addiction (once the problem of addiction is solved, other aspects of patient’s psychological condition are resolved much easier).

A number of neurological conditions due to brain damage develops in abusers over time. Recognizing and putting those under control is also very important.

To put it in simple words – drug abuse treatment is like a walk through the minefield. To get on the other side of it you need a trained and experienced team behind, otherwise, it’s just a guessing game (with low chances for success).

What Happens after the Patient Has Been Admitted to the Program?

After admission, each patient gets introduced with the program (the first week, personalized treatment, methods, goals, and other relevant info). After introduction procedure, the patient signs a therapeutic contract. Also, the patient writes his or her personal history, with self-assessment- this document helps the team of specialists to design a treatment plan and later on, after the rehabilitation is over, will help the patient understand the extent of treatment intervention he went through.

Most often, on the day of admission, the patient is introduced to the community and attends all activities with others. In case of severe withdrawal symptoms, the patient may be under intense medical attention until his or her condition stabilizes. After stabilization, the patient is integrated into the community.

Long-term Goals of Rehabilitation

The goal is lifelong abstinence from drugs and rehabilitation of consciousness, personality, and behavior. The program helps the patient make lifestyle changes that will incur the risk of relapse- patients are encouraged to avoid places, activities, and people that are cues to drug use, to identify, understand and resolve inside conflicts that may be misinterpreted as cravings (or have lead to drug abuse earlier).

Drug addictiveness is a complex problem that affects not only one’s health, but his or her social relations, family, and all other aspects of everyday life. The Cuban program is optimized to cope with all of these aspects and prepare a patient for a new drug-free life.

Besides drugs, the Cuban Substance Abuse Treatment Program deals with other addictions as well

Drug abuse is just one of the problems when it comes to addictive behaviors and substance abuse. Alcohol, tobacco use, marijuana and opiates abuse are also problems the Cuban program successfully deals with. Of course, the approach is optimized for each of these programs.

Reader Takeaway

The Cuban substance abuse treatment programs are developing since 1976. Professor Ricardo A. Gonzales, founding the father of substance abuse treatment on Cuba and internationally recognized expert is active even today as a consultant, but what’s even more important is his legacy to Cuba- a National Reference Center for Substance Abuse in Havana and 17 more facilities throughout Cuba that deal with the issue. Besides Cubans, these programs are available to international clients as well.

The rehabilitation process takes 3 months (sometimes more), and a rough price of the entire process with all expenses included is $26.000 (the price may differ at the point you read this article, for more info, contact the National Reference Center for Substance Abuse in Havana. During those three months, the patient is under constant attention of a team of experts.


11/Dec/2018

The incidence of lung cancer has risen dramatically.  It is already projected that near two million new lung cancer cases will occur in the United States resulting in approximately half a million fatal outcomes in 2018 (1).  According to the data provided by the Centers for Disease Control and Prevention (CDC) lung cancer has been assessed as a second leading type of cancer in both men and women.  Screening modalities of contemporary medicine have not yet addressed the issue of diagnosing lung cancer in early stages, resulting in capturing this condition as a progressive disease in most of the patients.  Conventional treatment of non-small cell lung cancer (NSCLC) including surgery, chemotherapy, and radiotherapy has very limited efficacy in advanced stages of NSCLC and has been associated with serious toxicities.  Additional problem represents cancer recurrence after conventional treatment occurring in approximately 40 percent of patients after a period of one year (2).

Cuba has produced 33 new drugs for treating cancer by the year 2012 (3).  The fastgrowing medical scientific research in Cuba continues to produce innovative medicinal products, aiming to significantly increase the quality of life in patients suffering from most complex and serious medical conditions.

Cuba’s Advancements in the Treatment of Non-Small Cell Lung Cancer

VAXIRA (RACOTUMOMAB)

An interesting and novel therapeutic approach that includes programming of body’s own immune system to fight cancer cells was investigated in Cuba.  The research prompted the development of immune therapies including therapeutic vaccines.  Vaxira is a therapeutic vaccine developed to treat NSCLC.  The medicinal product was registered in Latin American countries in 2013, after promising results shown in phase II/III study involving patients with advanced and progressive NSCLC (4).  In this study, patients that received Vaxira showed a significant increase in overall survival comparing to patients who received placebo.  Another study that involved 180 patients investigated the effects of Vaxira following conventional treatment for late-stage, recurrent NSCLC.  The results clearly showed decrease in the progression of NSCLC which directly resulted in prolonged survival periods in patients who previously received the first-line treatment for NSCLC (5).  Finally, a randomized, open-label clinical trial that involved 1082 patients with advanced NSCLC, who received standard first-line therapy, showed the response of stable disease after administering Vaxira (6).

The safety profile of Vaxira was also evaluated in clinical trials described above.  In a phase I study of Vaxira for NSCLC that was focused on patient safety, no serious adverse events that were considered to be related to treatment have occurred.  Related events included local reactions at the administration site including pain, redness, and induration.  Reactions were mild and reversible in nature (7).  Toxicity in more advanced clinical trials of Vaxira was similar to those in the phase I study described above.  Cases of a headache, joint pain, and fever were also observed, however, all events were mild to moderate in nature.

Vaxira was initially developed in Cuba.  The well-recognized efficacy of this medicinal product in the treatment of NSCLC prompted multiple investigations for a wide variety of conditions including melanoma, breast, and lung cancer at different locations worldwide (Spain, Brasil, Singapore).

CIMAVAX-EGF

It has been recognized that malignant cells express epidermal growth factor (EGF) receptor in higher amounts than non-malignant cells.  This particular characteristic of tumor cells enables them to grow more rapidly and spread more aggressively (8).  CIMAvax-EGF vaccine expresses anti-cancer activity by stimulating the production of anti-EGF antibodies, which inactivate the circulating EGF directly inhibiting the proliferative nature of malignant tumor (9).

The effectiveness of CIMAvax-EGF was demonstrated in Phase II clinical trial, conducted in 80 patients with NSCLC, who were previously treated with standard platinum-based chemotherapy.  Patients treated with CIMAvax-EGF showed increased survival trends (10).  A Phase III open-label efficacy study that was conducted on the sample of 405 patients that suffered from a late-stage NSCLC showed a significant increase of 5-year survival in those who received the vaccine.  The 5-year survival rate for vaccinated patients was approximately 16% in comparison to control group, where 5-year survival was 6% (11).  Interestingly, it has been noted that following vaccination, levels of EGF remained low in patients with long-term survival (more than 2 years).  EGF level proved to be a powerful prognostic factor for overall survival and cancer recurrence (12).  CIMAvax-EGF can be administered concomitantly with standard platinum-based cytotoxic treatment for NSCLC.  It is advised to administer the vaccine during or prior to platinum-based treatment in order to achieve the best possible response and efficacy (13).

The safety profile of CIMAvax-EGF was evaluated in the aforementioned clinical trials.  The most frequent reactions associated with the use of CIMAvax-EGF were local administration site reactions including pain and redness, as well as systemic reactions such as fever, headache, chills, and shortness of breath.  It is clear that the benefits of this vaccine outweigh the risks related to the administration of CIMAvax-EGF.

Due to the extensive therapeutic potential of CIMAvax-EGF, a Phase IV clinical trial was launched that enrolled more than 1000 patients with NSCLC (14).  It was shown that the use of this vaccine is safe and beneficial to patients with NSCLC.  Preliminary evidence suggested that besides the increase in overall survival, CIMAvax-EGF improved the quality of life of enrolled patients by increasing the emotional well-being and reducing symptoms and signs of fatigue.

This revolutionary medicinal product prompted new research focused on other types of cancers including prostate cancer and gave hope both to the scientific community and patients that the cure for NSCLC is on the horizon.

BIBLIOGRAPHY

  1. Cancer statistics, 2018. Siegel RL, Miller KD, Jemal A. s.l. : CA Cancer J Clin, 2018, Vol. 68(1). 7.
  2. Survival after recurrent nonsmall-cell lung cancer after complete pulmonary resection. Sugimura H, Nichols FC, Yang P, Allen MS, Cassivi SD, Deschamps C, Williams BA, Pairolero PC.s.l. : Ann Thorac Surg, 2007, Vol. 83(2). 409.
  3. Profit vs health? Comparing the business models of Cuban and US pharma. Baden, Denise, Davies, Courtney and Wilkinson.s.l. : Monograph (Working Paper), Southampton, GB University of Southampton 12pp, 2015.
  4. A randomized, multicenter, placebo-controlled clinical trial of racotumomab-alum vaccine as switch maintenance therapy in advanced non-small cell lung cancer patients. Alfonso, S et al.s.l. : Clin Cancer Res, 2014, Vol. 20(14). 3660-71.
  5. Active immunotherapy in patients with progressive disease (PD) after first-line therapy. Gomez, R.E., Alfonso, S et al. s.l. : 49th Annu Meet Am Soc Clin Onco (ASCO), 2013. Abst 3086.
  6. Trial proactive: A prospective, randomized, multicenter, open label phase III study of active specific immunotherapy with racotumomab plus best support treatment versus best support treatment in patients with advanced non-small cell lung cancer. Roberto E Gomez, Amparo Macias, Tania Crombet, Ana Maria Vazquez et al. s.l. : Journal of Clinical Oncology.
  7. An anti-idiotype vaccine elicits a specific response to N-glycolyl sialic acid residues of glycoconjugates in melanoma patients. Alfonso, M et al. s.l. : J Immunol, 2002, Vol. 165(5). 2523-9.
  8. Molecular epidemiology of lung cancer and geographic variations with special reference to EGFR mutations. Mitsudomi, T. s.l. : Transl Lung Cancer Res, 2014, Vol. 3(4). 205-11.
  9. Clinical development and perspectives of CIMAvax EGF, Cuban vaccine for non-small-cell lung cancer therapy. Rodríguez PC, Rodríguez G, González G, Lage A. s.l. : MEDICC Rev, 2010, Vol. 12(1). 17-23.
  10. Phase II randomized controlled trial of an epidermal growth factor vaccine in advanced non-small-cell lung cancer. Neninger Vinageras E, de la Torre A, Osorio Rodríguez M, Catalá Ferrer M, Bravo I, Mendoza del Pino M, Abreu Abreu D, Acosta Brooks S, Rives R, del Castillo Carrillo C, González Dueñas M, Viada C, García Verdecia B, Crombet Ramos T, González Marinello G. s.l. : J Clin Oncol, 2008, Vol. 26(9). 1452-8.
  11. A Phase III Clinical Trial of the Epidermal Growth Factor Vaccine CIMAvax-EGF as Switch Maintenance Therapy in Advanced Non-Small Cell Lung Cancer Patients. Rodriguez, PC et al. s.l. : Clin Cancer Res, 2016, Vol. 22(15). 3782-90.
  12. Biomarkers related to immunosenescence: relationships with therapy and survival in lung cancer patients. Saavedra D, García B, Lorenzo-Luaces P, González A, Popa X, Fuentes KP, Mazorra Z, Crombet T, Neninger E, Lage A. s.l. : Cancer Immunol Immunother, 2016, Vol. 65(1). 37-45.
  13. Combining an EGF-based cancer vaccine with chemotherapy in advanced nonsmall cell lung cancer. Neninger E, Verdecia BG, Crombet T, Viada C, Pereda S, Leonard I, Mazorra Z, Fleites G, González M, Wilkinson B, González G, Lage A. s.l. : J Immunother, 2009, Vol. 32(1). 92-9.
  14. CIMAvax EGF (EGF-P64K) vaccine for the treatment of non-small-cell lung cancer. Crombet Ramos T, Rodríguez PC, Neninger Vinageras E, Garcia Verdecia B, Lage Davila A. s.l. : Expert Rev Vaccines, 2015, Vol. 14(10). 1303-11.

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10/Dec/2018

The Havana School of Medicine

The Havana School of Medicine, founded in January 1728, is one of the four founding schools of The Royal and Pontifical University of Saint Jerome of Havana. Since its commencement until present the Havana school of Medicine remains the only Medicine school based in Havana


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10/Dec/2018

where the DOCTOR IN DENTISTRY

The Doctor in Dentistry has a mandatory pre-medical Spanish speaking students unless showing the mastery of the Spanish Language, demonstrated through a proficiency test (oral and written) at a price of 75 CUC which is not included in the price of any of the under grade careers 


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10/Dec/2018

NURSING

The Nursing has a mandatory pre-medical Spanish proficiency course for non spanish speaking students unless showing the mastery of the spanish language, demonstrated through a pro-efficiency test (oral and written) at a price of 75.00 CUC which is included in the price of any of the Under Grade careers

Introduction:

Cira Garcia Central Clinic, located in Havana, is a holder of the quality certificate ISO-9001: 2008, which was worthy to complete the review process that verified the excellence of its services. This center is backed by national and international accreditation as a unit that meets the requirements of safety, quality and efficiency of the processes evaluated for compliance.

This has not been easy, the International Organization for Standardization (ISO) is very demanding, and the results collected are the fruition of years of collective work, consolidated achievements and continuous improvement of organizational performance.

The ISO-9001 is an international standard that enhances the effectiveness and efficiency of products and services provided, patient-centered, since it is measured and taken into account their satisfaction at all times.

The clinic’s monthly assessments are coordinated by well-defined protocols to ensure the optimization of care and patient safety, for which there are a number of mechanisms in each area.

This resulted in the quality of care for patients treated in the hospital, diplomats, foreign businessmen based in Cuba and foreigners who come seeking the prestige of Cuban medicine, many of whom wish to institutions that have this accreditation.

Last year alone, medical professionals at the clinic attended to 3,058 whereby 953 patients received ambulatory care, 450 patients received major operations, 770  patients received minor surgery, minor operations and other 885 in emergency.

In these moments are a greater number of patients from Angola in the first place, followed by Canada, Italy, Spain and Russia.

Many of the clinic’s visitors seek medical checkups and other health programs, orthopedics and trauma, along with cosmetic surgery.

Cira Garcia Central Clinic belongs to the Public Health National System of Cuba, and it is part of the subsystem of attention to foreign patients.

The Cira Garcia Clinic is a centerfor specialized medical care backed by high scientific rigor of their doctors.It utilizes state of the art advanced medical technologies to ensure qualitycare in preventive and curative treatments. The clinic has more than sixdecades in the service of health and is considered as an internationalreference center in health care to diplomats accredited in Cuba, foreignbusinessmen, tourists and visitors seeking excellent health services and care.

Facilities:

  1. Suites

The Clinic has an area of more than 7 200 m2. It counts on three hospitalization levels in which 39 private rooms are distributed.

Each suite includes the following:

  • Patient electronicbed with possibilities of direct oxygen and central aspiration;
  • Companion bed;
  • Full bathroom withhot and cold water 24 hours a day;
  • Air condition;
  • Satellite TV;
  • Night light;
  • Inter communicationwith nursery post;
  • Equipment fordisabled person; and
  • Safe box
  • Surgical theaters:

The modern surgical theaters include first level technology with the very professional personnel that allow them to offer medical services of excellence that characterize this medical institution. The surgical theaters also offer the following sections:

  • Pre-anesthesia and post-anesthesia recovery;
  • Progressive care unit with intensive and intermediate care;
  • Clinic labs of pathologic anatomy and microbiology, with quick response equipment; and
  • A full lab of applied physiology and a modern service of inner image.
  • Medical services offered:
  • Diagnostic program CHECK-UP;
  • Consultation with the best specialists (Cuban therapists are experts, who coordinate the exchange of views of all the necessary specialists);
  • Surgery (general surgery, neurosurgery, minimally invasive surgery, radiosurgery);
  • Orthopedics and Traumatology;
  • Gynecology;
  • Plastic surgery;
  • Urology;
  • Otolaryngology;
  • The treatment of autoimmune diseases (multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis);
  • Treatment of diabetes mellitus and diabetic foot;
  • Dentistry; and
  • Physical rehabilitation of treatment protocols.
  • Additional services and facilities:

  • Cafeteria;
  • Laundry service;
  • Ambulances, microbuses and care; and
  • Migration Procedures; 

Mission:

To offer health services with optimum scientific quality, honesty and deep human content, to the diplomatic corps accredited in Cuba, to foreign business men established in Cuba and to foreign persons who come to our country searching for the scientific progress and prestige of Cuban medicine.




In short words


CubaHeal Medical is a global organization specialized in facilitating medical treatments, medical education, in addition to patient and student care in the Republic of Cuba. CubaHeal is a loyal supporter of the Republic of Cuba, the Cuban people, the Cuban revolution, and the Cuban revolutionary leadership.




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