Eczema is the most common form of chronic dermatitis, a non-infectious skin condition characterized by an itchy rash. Commonly, across the literature, it is referred to as atopic dermatitis (AD) as well. Typically, it affects children and the situation gets better as time goes by, but adults can suffer from it as well. However, when it comes to the causes, there is no straightforward answer to explain these. By what we know about it so far, the most accurate answer would be – it is caused by a combination of genetic and environmental factors (basically, this means it is caused by something that’s written in the patient’s genetic code and something in his or her environment). However, giving that this answer can hardly satisfy the curiosity of people interested in the condition, we will discuss it in more detail and provide a broader perspective on the perplexity of eczema origin.
The roots are deep within the DNA 13
Although the pathophysiological mechanisms that cause eczema are pretty well described, their exact background remains to be a subject for academic debate. There are two widely accepted hypotheses – the first one concerns the imbalance in the immune system, and the second one concerns a defect in the skin barrier. The definitive answer to why eczema happens is still not found, but the two hypotheses offer a reasonable explanation. Also, they shouldn’t be taken as mutually exclusive but rather as points of view that complement each other.
The imbalance in the immune system hypothesis
The theory argues that the eczema results from an imbalance in the T cells production – in particular, in people with eczema, there are more T-helper 1 and T-regulatory cells (subtypes of T cells) than there should be. As a result, the amount of interleukins (substances that promote inflammatory response) is increased, so is the intensity of inflammation in the affected areas of the body.
The skin barrier hypotheses
The theory is a newer one and argues that individuals with mutations in the filaggrin gene more often develop eczema than those without the mutation. The filaggrin (filament aggregating protein) binds cells in the upper layer of the skin (referred to as epidermis) together and seals the tiny cracks between them. Filaggrin minimizes the water loss through the skin and penetration of the allergens from the environment (the size of the allergens varies – from small inorganic to large organic molecules or even microorganisms). In some people with the mutation, the production of filaggrin drops critically low, so the skin barrier doesn’t function as it should. The skin becomes more permeable for water (increased water loss), allergens and microorganisms.
The toll on health goes beyond the skin surface
Let’s take a pause from eczema causes here and briefly discuss the phenomenon known as “The Atopic March.” Our immune system works as a whole – defects in the execution of its functions reflect themselves on the whole body more often than not. Eczema is a skin condition, but the same genetic factors that lie in its background also affect other regions of the body. “The Atopic March” describes a temporal sequence of conditions that develop on the terrain of inadequate immune response seen in patients with eczema. The flaw mentioned above in the T-helper
lymphocyte function also can cause food allergies, asthma or allergic rhinitis. The eczema kicks in first and, in the early years of life, is often followed by the rest of the atopic cascade. The importance of this phenomenon lies in the fact that a timely treatment of eczema can reduce the severity of or prevent in temporary conditions that follow it.
As mentioned earlier, the leading cause of eczema is a combination of genetic and environmental factors. Not all people with the “right genetic code” develop the condition. Eczema happens only if all or the majority of contributing factors align, creating a perfect storm. In this section, we’ll take a look at contributing environmental factors. The prevalence (the number of cases of a disease present in a particular population in a given time) of eczema has increased in the past few decades at a pace that changes in gene pool cannot explain. So, the increase in prevalence is explained by changes in environmental factors. At this moment, we can’t tell for sure what those factors are. Still, the growing body of scientific evidence suggests that exposure to dust mites, various allergens, infections, irritants and antibiotics increases the prevalence of eczema 1.
The theory was introduced to the public back in 1989, and it suggests that the main cause of increased eczema prevalence may be the development and “sanitization” of society. The theory argues that the lack of adequate stimulation of the immune system in early life (children that are “too clean”) and failure of maintaining balanced gut flora in adulthood (antibiotics in food) are triggering factors in the pathogenesis of eczema. Furthermore, the hygiene hypothesis explains the rapid rise in prevalence among smaller, wealthier and more educated families in comparison with larger families and those attending a nursery.
The bottom line is that exposure to some pathogens in early life, as well as the timing of exposure, play an essential role in the pathogenesis of eczema. However, some pathogens may trigger the condition; for example, measles infection increases the risk of the disease.
References : 2,3,4,5
Soap acts as an irritant. It causes skin dryness, increases its pH, and transepidermal water loss. Several studies have shown that exposure to soap is in relation to increased eczema prevalence and that removal or avoidance of such chemicals reduces its prevalence. Some studies have shown that eczema prevalence is increased in areas with harder water, but in recent years this hypothesis has been rejected. Namely, the increased hardness of water requires increased use of soap, so the scientific community accepted the use of irritants as the cause of eczema rather than the water harness. The avoidance of irritants early in life is vital as a preventive measure – once the condition establishes, exclusion of those chemicals do not affect further development of the disease (eczema, followed by atopic march).
So, what is the main cause of eczema?
After this discussion, it is essential to underline that eczema is a multifactorial disease. Its causes are not yet fully understood, and some claims about it are still wrapped in a veil of controversy. However, here are some important takeaway notes: – The condition is a multifactorial disease caused by a combination of genetic and environmental factors. – The genetic mutations in people with eczema affect not only the skin but potentially other organ systems, primarily respiratory organs. Eczema is often only the first in a cascade of health issues that arise from altered genes. – Restriction from exposure to the microbes in the environment is in association with the increased prevalence of eczema, but some infective agents may increase the chance of disease establishment. – Once the condition establishes, it is impossible to reverse the process, but it tends to milden or completely disappear during puberty. – Exposure to skin irritants, soap in the first place, plays an important role in the pathogenesis of the disease.
1. McPherson T. (2016). Current Understanding in Pathogenesis of Atopic Dermatitis. Indian journal of dermatology, 61(6), 649–655 2. Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989;299:1259–60. 3. Williams HC. Atopic eczema – Why we should look to the environment. Br Med J. 1995;311:1241–2. 4. Flohr C, Yeo L. Atopic dermatitis and the hygiene hypothesis revisited. CurrProblDermatol. 2011;41:1–34. 5. Hesselmar B, Sjöberg F, Saalman R, Aberg N, Adlerberth I, Wold AE. Pacifier cleaning practices and risk of allergy development. Pediatrics. 2013;131:e1829–37. 6. MJ Cork. The importance of skin barrier function. Taylor & Francis J Dermatological Treatment. 1997. 7. McNally NJ, Williams HC, Phillips DR, Smallman-Raynor M, Lewis S, Venn A, et al. Atopic eczema and domestic water hardness. Lancet. 1998;352:527–31. 8. McNally NJ, Williams HC, Phillips DR. Atopic eczema and the home environment. Br J Dermatol. 2001;145:730–6. 9. Font-Ribera L, Gracia-Lavedan E, Esplugues A, Ballester F, Jiménez Zabala A, Santa Marina L, et al. Water hardness and eczema at 1 and 4 y of age in the INMA birth cohort. Environ Res. 2015;142:579–85. 10. Thomas KS, Dean T, O’Leary C, Sach TH, Koller K, Frost A, et al. A randomised controlled trial of ion- exchange water softeners for the treatment of eczema in children. PLoS Med. 2011;8:e1000395.
11. Simpson EL, Chalmers JR, Hanifin JM, Thomas KS, Cork MJ, McLean WH, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy ClinImmunol. 2014;134:818–23. 12. Harris JM, Williams HC, White C, Moffat S, Mills P, Newman Taylor AJ, et al. Early allergen exposure and atopic eczema. Br J Dermatol. 2007;156:698–704. 13. Thomsen S. F. (2014). Atopic dermatitis: natural history, diagnosis, and treatment. ISRN allergy, 2014, 354250.
The field of Orthopedics surgery is related to the complications and treatment of the musculoskeletal system in a human body. This field focuses on the complications arising in bones, muscles, joints, and ligaments in a human body. Surgeons adopt both surgical and non-surgical methods in treating fractures, injuries and spine problems.
You can go to an Orthopedist to diagnose any problem related to joints, muscles or bones. They can advise you on how to prevent the same and can provide treatment if it’s the best course to take. Athletes, bodybuilders and sports person also tend to develop complications related to muscles and spine which can be treated by orthopedic surgery.
The Growing Need of More Orthopedists
It is true that orthopedists are few in numbers. This increases the misery of patients around the globe to find qualified orthopedists for their treatment. There is a huge waiting list for patients as it’s pretty hard to get a consultation with an orthopedist. This is for a simple reason that demand exceeds supply. There are countless patients but a limited number of doctors. So there is a need to promote this field of medical science with students to pick this as their career.
Orthopedic Advancements in Cuba
This is worth mentioning that Cuba has a countless number of Orthopedists who are keen on treating patients. So, this can be your next possible destination to cure your musculoskeletal disease. Most of Americans and Canadians go to Cuba to treat their problems as Cuba has become very popular in the field of Orthopedics.
The use of latest technology and medical equipment has also played a major role in the advancement of orthopedics in Cuba. Technology advancements have made it easier to handle patients without performing large incisions in their body. Orthopedic patients can be treated with much less intrusion which will help them to heal relatively faster. This resulted in very low pain infliction patients and less amount of blood loss. Orthopedists can now have a 3D (before 2D) look of the spine which increases the chances of a successful surgery.
In Addition, Cuba Offers the Following Surgical and Treatment Procedures
CubaHeal is adamant in providing the patient with all the logistical support such processing treatment requests, gaining treatment approval, and booking and visa granting support. Furthermore, our Cuban field team carries translation and personal support services and tasks for the patient and to eliminate all social boundaries and to ensure proper treatment can be availed by anyone at anytime in Cuba.
90 % of head and neck cancers are mostly squamous cell carcinomas. These carcinomas include nasopharyngeal cancer, nasal cavity, paranasal sinus cancer, oral and oro pharyngeal cancer, laryngeal cancer, hypo pharyngeal cancer and salivary gland cancer. As carcinomas their name indicates they are malignant tumors.
Oral and oro pharyngeal, laryngeal, hypo pharyngeal and salivary gland cancers are included in oral cavity cancers which are all squamous cell carcinomas and salivary gland carcinomas are adenocarcinomas. 95% of oral cavity cancers are squamous cell carcinomas. This aggressive epithelial malignancy is the sixth most common neoplasm in the world today .The overall long term survival rate has been less than 50% for the most past years. Multiple primary tumours will be present in initial diagnosis .These multiple primary tumours develop independently as a result of years of chronic mucosal epithelium exposure to carcinogens such as alcohol or tobaccos .Oropharynx cancer is due to mutations in TP53 gene and genes that regulate the differentiation of squamous cells such as p63 and notch1. Squampous cell carcinoma can arise anywhere in the oral cavity .The most common locations are the ventral surfaces of the tongue floor of the mouth lower lip soft palate and gingiva. These tumors appear as raised firm pearly plaques. Republic of CUBA has succeeded in combating these cancers.
Salivary gland adenocarcinomas include pleomorphic adenoma and muco epidermis carcinoma. Pleomorphic adenomas are painless slowly growing mobile discrete masses. They represent about 60% in parotid and are less common in submandibular glands. While muco epidermoid carcinoma are composed of variable mixture of squamous cells, mucus secreting cells and intermediate cells.
Nasal cavity and paranasal sinus cancers. Squamous epithelial cells of the normal nasal cavity or sinuses can become squamous cell carcinomas. This is the most common type of cancer in the nasal cavity and Paranasal sinuses. Apillomas are warts that can grow inside the nasal cavity or paranasal sinuses and destroy healthy tissue. They usually have a bumpy surface. Papillomas are not cancer, but sometimes a squamous cell carcinoma will start in a papilloma .Republic of CUBA is trying to cure these carcinomas. Different drugs are given in CUBA and 24 hour observation of a patient is done.
Treatment by Cuba health centre.
The Republic of Cuba is in the forefront in battling these cancers. Cuba is taking measures to stop these carcinomas. Available Treatments are surgery radiations and chemotherapy in combination with immunotherapy. The treatment is based on the stage of cancer and on the health of the patient.
The program is carried by guiding the patient properly and thoroughly. If the cancer has not metastasized and its size is small, we can do surgery and also can treat him through radiations. Some drugs will also be given .Chemotherapeutic agents will be given according to their effects and by keeping in mind the condition of individual because chemotherapeutic agents also destroy the normal cells. Treatment procedure is mostly same in all the cancerous patients. But it depends upon the severity and stage of cancer In CUBA by the following method we treat cancer
First of all a proper medical check-up is done .or we can say pre-application medical check-up is applied.
Anti-cancerous drugs are given.
These drugs include cyclophosphamide 200mg. This is a nitrogen mustard agent.it inhibits DNA function and its synthesis. It is given for breast cancer, ovarian cancer and chronic lymphocytic lymphoma. In republic of CUBA this drug is given with proper dosage and according to the condition, otherwise every drug has some adverse effects. This drug is given for 15 days and when further treatment starts.
Another drug which is given in republic of CUBA is NIMOTUZUMAB it is also called CIMAher EGF. It is given for head and neck cancers in combination with radiotherapy and chemotherapy. 24 Vials are given for 6 weeks treatment. It should be given with precautions otherwise nausea tremors and chills can develop.It is given in IV form.
The induction phase last six weeks corresponding to the 24 vials of the drug. The first dose will be given in republic of Cuba , and next dose he can take himself in CUBA or any other country.
There are many drugs available for the chemotherapy. These drugs are bortizomib imatinib, antimetabolites, vincristine, and etoposide. Each drug first dose is given in CUBA. Patient is monitored. If this drug found successful then second dose of the drug he can take himself.
Surgeries are also performed. That involves dissecting of the whole infected part. If less part is infected then a small part is dissected but mostly if small part is infected we took out large part even the whole part is not infected as a precaution.
These surgeries involve Total glossectomy semi glossectomy semi glossectomy partial glossectomy, trans maxillary glossectomy with neck dissection.
Total glassectomy : It is performed for the tongue .if whole tongue is affected whole tongue we be cut down so that the tumour does not metastasize. This is done in republic of CUBA with proper care.
Semi-glossectomy :It is the removal of half the tongue. This can also be done in republic of CUBA with proper care. If half tongue is not infected and other half is infected so we can perform partial dissection with proper care. We will cut half tongue if there is no chance of spreading this tumour to the other half.
Trans maxillary glassectomy with neck dissection. When cancer in the oral cavity is spread to the lymph nodes in the neck so removal of these lymph nodes is necessary because there are many lymph nodes are present in different sites of body. So cancer can spread to the different organs through lymph nodes which will be worst condition. Neck surgery is also performed in republic of CUBA. These include partial and modified neck dissections. Radical neck dissections are also performed.in which few or all lymph nodes are removed. There are also some maxillary and larynx medical programs in republic of CUBA in which partial or full dissection of the affected region is performed.
So CUBA is making a great progress in the treatment of cancer.
Cuba had the honor to host the first international conference regarding autism and inclusion in 2013. Island’s extraordinary efforts to understand, recognize and manage the condition in it’s early stages highlight the prestige and excellence of Cuba’s autism management. Cuban physicians represent global subject-matter-experts in the field of autism spectrum disorder (ASD). Cuba strives to find the best possible solutions for individuals suffering from ASD through the development of specialized ASD centers that focus on ASD treatment and inclusion of families within the society – of course, absolutely cost-free.
ASD represents a complex condition requiring multidisciplinary approach – a burden for profit- based healthcare systems. The fact that the management of ASD has been assessed as costly best illustrates the difficulties of western systems to properly address the issue of growing incidence of ASD. Waiting lists, inefficiency, high prices are the characteristics of profit-based healthcare systems that often result in inadequate management of those requiring prompt and intensive treatment. Cuba has developed a sustainable program for the management of individuals suffering from ASD focused on meeting the needs of each child.
Cuba offers a carefully tailored program for individuals suffering from autism spectrum disorder (ASD). The main goal of this program is to improve the child’s learning capabilities and reduce the symptoms of ASD. Overall, the program aims to boost the development capacity of each child with ASD. As a result, a visible improvement is seen in the child’s physical and mental abilities, due to the specific nature of the program design that is specifically tailored to meet the needs of each child individually. The program offers a peaceful and comfortable treatment environment and expert medical attention, which is very relevant for achieving the favorable treatment outcome. The facility is equipped with services and amenities such as cable TV, internet, pool, sauna, gym, pharmacy, and laundry services.
The program duration is 38 days. During this period, a set of activities is performed that may be divided into two main stages – evaluation and treatment. A detailed description of each phase is given below.
Stage 1 – Evaluation
During the evaluation phase, the information regarding the ASD nature of each child is obtained through consultation with specialists, laboratory and clinical investigations, as well as specific assessments necessary for evaluation and staging of the disease.
The initial steps in the evaluation phase include consultations with the team of experienced specialists in order to plan and tailor the comprehensive treatment and rehabilitation program for each child. This includes assessments performed by pediatricians, neuro-pediatricians, child psychologists, genetics specialists, logophobia specialists as well as otorhinolaryngologists. Furthermore, detailed laboratory investigations are required for disease evaluation and assessments. Biochemistry panel includes measurements of urea, creatinine, serology investigations, urine metabolic testing, complete blood count, sedimentation rate, blood glucose level, including but not limited to liver function tests.
Following initial testing, complex assessments are performed in order to get the clear picture regarding disease nature and severity. The assessments are performed by highly experienced subject-matter-experts and include logopedic evaluation, neuropsychologic assessment, Brunet-Lezine scale evaluation, as well as psychotherapy assessment and evaluation. Additionally, during the assessment period imaging studies may be performed such as brain MRI, evoked potential studies, EEG etc.
Once all the information has been gathered and a treatment plan has been tailored, the findings and possible management options are discussed with the family. The duration of this phase is dependable on the nature of the underlying disease as well as the child’s abilities to adapt to the new environment. Approximately, it takes no longer than 10 days in order to complete the evaluation and tailor the specific treatment.
Stage 2 – ASD Management
ASD represents a complex disorder requiring multidisciplinary and individual treatment approach for each child. This program offers multiple treatment modalities including equine therapy, sensorial stimulation techniques, occupational therapy, language therapy, ozone treatment as well as trans-cranial electric stimulation, which has been proven useful in hyperkinetic patients. Treatment is conducted by highly experienced experts with the constant involvement of parents. The focus is on speech therapy that lasts for 20 days and involves both therapists and parents. This treatment modality lasts approximately 20 days and is conducted each day excluding Sundays and public holidays. Depending on the child’s ability to accept the treatment approach, initial sessions may last from 20 minutes to one hour. Protocol for conducting the therapy is tailored based on the individual characteristics of each child. It is strongly advised for the child to continue this treatment approach at home, once the language therapy is finished since this will ensure the long-lasting results in the future.
Occupational therapy will last approximately 30 days where the intensive treatment will aim to reduce neurological, mental and physical barriers of each child with ASD. This program allows a child to develop and maintain self-care activities, increases the overall productivity and enables a child to participate in leisure activities. The intensive treatment protocol is comprised of two treatment sessions during the day (in the morning and in the afternoon) approximately lasting for an hour or longer. The responsiveness of a child is stimulated by various methods including images projection, object identification, interactive and didactic games, palpation exercises as well as equine therapy.
At the end of each treatment, a detailed report is issued to parents with all of the activities performed at the site including detailed expert recommendations for further treatment and rehabilitation.
Professor Ricardo A. Gonzales MD Ph.D. DSc founded back in 1976 Cuba’s first health facility for substance abuse treatment 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 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’s a Cuban approach?
The 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.
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 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.
Readers take away
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.
Current Challenges in the Treatment of Retinitis Pigmentosa
CubaHeal Research Department
Retinitis pigmentosa (RP) represents a rare and severely debilitating group of disorders affecting vision that have a genetic background and are slowly progressive by nature (1). Despite the continuing efforts of the scientific community directed towards the understanding and treatment of the disease, RP still remains incurable. Management of RP was investigated in various preclinical models, as well as in numerous clinical trials on humans in the United States, however, the effective and safe solution to this problem was not yet found.
Retinitis pigmentosa causes a progressive and irreversible vision damage caused by deterioration of photosensitive cells (especially rods) in the retina (2). Early symptoms usually represent the loss of the peripheral visual field, followed by further vision narrowing, which may eventually result in complete blindness. Treatment options in the United States are currently quite limited. The management of RP mostly includes vitamin supplementation, aiming to hold off the progression of the degenerative process. However, even vitamin supplementation, besides its’ limited effectiveness, has its safety concerns. Vitamin A supplementation is not recommended in certain individuals since it may cause fertility issues and severe osteoporosis (3). Preventative measures, such as avoiding light exposure in the early phases of the disease did not prove to be highly effective.
When reviewing the current treatment options, it seems that RP still represents a challenging task. In order to improve the quality of life of patients suffering from this degenerative and progressive disorder, Cuban experts have developed a sophisticated and effective method for the management of RP.
Solution Offered by Cuban Experts
The main treatment objective is to limit the disease progression by improving the vascularization of the retina. The management of RP in Cuba practiced now, that is focused on eye vascularization, has been developed and improved for more than two decades. The milestone of therapy is to bring as much blood, oxygen, and nutrients as possible to the eye. This is being performed by encouraging the development of blood vessels. There have been some attempts in Russia to transplant the stem cells that would develop into the healthy retinal tissue, however, scientists were mostly frustrated by failure since the stem cells could not successfully engraft due to the lack of the healthy vascular supply (4). Cells remodeling was also attempted; however, this study was suspended due to the lack of efficacy. Cuba offers a sustainable treatment option that focuses on limiting or completely inhibiting the progression of degenerative vascular changes in the retina. There are several treatment approaches that are being applied to the overall management plan. They include eye surgery, ozone therapy, electrostimulation and drugs (5).
A very sophisticated and unique surgical technique is used to increase the blood flow within the part of the eye responsible for providing blood supply to the retina. When this technique is performed, retina remains adequately nourished and oxygenated. This allows normal retinal function and prevents further deterioration of vision. By stimulating the blood flow within the retina, visual acuity increases, and retina is encouraged to grow, and not deteriorate. The final result is stabilization of the disease and rapid improvement in both central and peripheral vision (6). Ophthalmologists from all over the world refer their patients to Cuba, for this surgery to be performed due to its’ efficacy and safety.
It has been recognized that ozone improves cell metabolism, boosts the cell energy levels and exhibits antioxidant properties (7). The ozone is either administered rectally or being injected into the bloodstream. Ozone provides detoxification effects by blocking the harmful lipid peroxidation that occurs in retinal cells affected with retinitis pigmentosa. The ozonotherapy also promotes the blood flow surrounding retina, thereby directly improving the retinal function. In order to ensure the best possible results, the patient should receive 14 cycles of treatment during the course of the whole therapy.
Electrical stimulation produces a micro-massage effect that stimulates micro-circulation and lymphatic drainage. These effects promote electro-ionic balance and provide an additive effect to the ozonotherapy (8). This method has demonstrated a high efficacy. Another benefit of this treatment modality includes reinforcing the process of the perception of visual stimuli within the brain. The electro-stimulation includes the application of pleasant therapeutic electrical currents on the head, neck, soles of the feet, and palms of the hands. For the complete and best possible effect, 10-15 treatment sessions are needed to be performed. During the full treatment course, drugs including immune-modulators, oxide-reductive substances, minerals, and vitamins are administered to boost the treatment effects.
Cuban scientists investigated the effects of ozone treatment on the visual field in participants that had retinitis pigmentosa. This was a controlled, randomized and double-blind study, with the study design that ensures a high level of evidence. 68 participants were enrolled in the trial. Half of the subjects received ozone treatment, while the other half received placebo. The study demonstrated that three times more subjects in the ozone group experienced a significant improvement in the visual field, compared to those who received placebo. Subjects with early stages of the disease experienced greater improvement with more long-lasting effects, which underlines the importance of early intervention. Subjects at early phases of the disease also experienced more stable and sustainable treatment effects. In conclusion, this study showed that ozone treatment had beneficial effects on patients with RP.
Another double-blind, placebo-controlled study also evaluated the effects of ozone treatment in patients with retinitis pigmentosa. This study had an even greater number of participants (168). This study also demonstrated the significant improvement in patients treated with ozone therapy compared to patients that received placebo. Interestingly, approximately a half of the patients that had treatment response also succeeded to maintain the response for the longer period of time (9).
A study that investigated the redox-balance in patients with RP receiving ozone treatment concluded that ozone therapy represents a safe therapeutic modality since no side effects related to treatment were observed during the course of the trial. Therefore, ozone therapy can be safely administered to patients with RP without any risk of side effects (10).
Treatment of RP still represents a challenging task in the western countries. Vitamin supplements and avoiding excessive light are just not sufficient enough to provide any benefit to patients suffering from this severely debilitating illness. Various treatment approaches including stem cells transplantation and remodeling of the retinal cells have failed to demonstrate effectiveness. Stem cells failed to engraft, and retinal cell remodeling was not possible both because of the vascularization impairment that occurs in this serious illness. Cuban researchers and medical experts decided to target exactly this disease characteristic by improving the blood flow in the eye, which allows retina to properly function. Improvement of eye circulation ensures the adequate oxygenation of retinal tissue and postpones or completely stops the degenerative processes within the retina. Clinical trials and plenty of satisfied patients worldwide guarantee treatment success. Thousands of international patients referred to Cuba for the treatment of RP have experienced benefits following treatment. Clinics in Cuba still represent the only hope for people suffering from this genetic disorder. Cuban experts have found a solution to postpone or completely stop the development of the negative effects on the quality of life of patients suffering from RP.
Baumgartner, W. (2000). Etiology, pathogenesis, and experimental treatment of retinitis pigmentosa. Medical Hypotheses, 54(5), 814-824. Medline Plus Encyclopedia. Retrieved on July 1st, 2018, from http://www.nlm.nih.gov/medlineplus/ency/article/001029.htm Jayashree N Sahni et al. (2011). Therapeutic Challenges to Retinitis Pigmentosa: From Neuroprotection to Gene Therapy. Curr Genomics. 12(4): 276–284. Health Services International (Servimed) Inc. Retrieved on July 1st 2018, from http://www.healthservicecuba.com/retinitis-pigmentosa/ Centro Internacional de Retinosis Pigmentaria Camilio Cienfuegos de Cuba. Tratamiento cubano para la Retinosis Pigmentaria. Retrieved on July 1st, 2018, from http://www.infomed.sld.cu/instituciones/retinosis/quienesomos/quienesomos.html Garcia Layana, A. (2003). La cirugía de la retinosis pigmentaria en Cuba. Communication presented at Archivos de la Sociedad Española de Oftalmología, Madrid. Copello, M., Eguía, F., Menéndez, S., & Menéndez, N. (2003). Ozone Therapy in Patients with Retinitis Pigmentosa. Ozone: Science & Engineering, 25(3), 223-232. Berson, E., Remulla, J., Rosner, B., Sandberg, M., & Weigel-DiFranco, C. (1996). Evaluation of patients with retinitis pigmentosa receiving electric stimulation, ozonated blood, and ocular surgery in Cuba. Arch Ophthalmol, 114(5), 560-563. Pérez, L. J. (2004). Ozone therapy in retinitis pigmentosa. Communication presented at 4th International Symposia on Ozone Applications, Cuba. Menéndez, S., Hernández, F., & Copello, M. (2004). Ozone therapy and redox balance in patients with Retinitis Pigmentosa. Communication presented at 4th International Symposia on Ozone Applications.
It has been estimated according to the data published by the World Health Organization that 1 in 160 children worldwide suffers from autism. The exact number is quite challenging to estimate for various reasons. It is presumed that Cuba has a lower rate of children with autism spectrum disorder when compared with the United States. Yet, Cuba has taken autism quite seriously and constantly develops and improves strategies aimed to increase the quality of life of children with this serious medical disorder and their families. The country has established specialized centers focused both on the treatment of children and inclusion of the families in the society, which is of course absolutely costs free. In 2013, Cuba was the country to host the First International Forum on Autism and Inclusion. This conference gathered the globally recognized experts in the field of autism spectrum disorder (ASD). The focus of the conference was to establish methods and discuss the significance of an early diagnosis of ASD and effective inclusion of such families in the society. The conference alone mirrors the country’s efforts to seek for the best possible ways to make the lives better for children with ASD and their families.
It has been estimated according to the data published by the World Health Organization that 1 in 160 children worldwide suffers from autism. The exact number is quite challenging to estimate for various reasons. It is presumed that Cuba has a lower rate of children with autism spectrum disorder when compared with the United States. Yet, Cuba has taken autism quite seriously and constantly develops and improves strategies aimed to increase the quality of life of children with this serious medical disorder and their families. The country has established specialized centers focused both on the treatment of children and inclusion of the families in the society, which is of course absolutely costs free.
In 2013, Cuba was the country to host the First International Forum on Autism and Inclusion. This conference gathered the globally recognized experts in the field of autism spectrum disorder (ASD). The focus of the conference was to establish methods and discuss the significance of an early diagnosis of ASD and effective inclusion of such families in the society. The conference alone mirrors the country’s efforts to seek for the best possible ways to make the lives better for children with ASD and their families.
Treatment of Autism in Cuba
The program aimed to increase the quality of life of persons living with ASD is coordinated by the Cuban Ministry of Public Health and Ministry of Education. Other public sectors including culture, media, and sports institutions are also involved in the program for helping ASD individuals to reach the best of their abilities. The program consists of individualized, multi-disciplinary training aimed at developing and empowering skills. The ASD individuals also receive specialized education and advocacy support. The individualized treatment is tailored by the specialized Diagnostic Commission when the type and severity of the disease are taken into consideration. Treatment is focused on early intervention.
The treatment for ASD is conducted in the peaceful and comfortable environment in order to ensure the best possible effects of the treatment plan and to allow the improvement the patient’s mental and physical abilities. The objective of each individualized treatment plan is to ameliorate the symptoms of the disease and improve the child’s learning capacity. As already mentioned, the treatment is tailored according to the individual needs of each child.
Each medical facility that deals will the treatment of autism is equipped with rooms that resemble those in a hotel (cable TV, phone, dry cleaning services). The facility contains sauna, pool, gym, internet access, shops, and pharmacies.
Treatment Stage 1: Assessment
The first stage of treatment consists of detailed assessments and evaluations that include laboratory and imaging analyses, and consultations with different specialists. The child is examined and evaluated by a pediatrician, neurologist, psychologist, speech therapist, and psychiatrist. The laboratory panel consists of hemogram, serology testing, serum glucose, sedimentation, urine analyses, creatinine and liver functions tests. Additionally, specific testing consists of magnetic resonance brain imaging, evoked potentials, and electroencephalography. Each patient undergoes logopedic assessment, neuropsychological evaluation, Brunet-Lezine scale evaluation as well as psychotherapeutic treatment assessment. Within the first stage, parents are also introduced to the team of experts and the treatment plan is referred to the parents once completed. The phase duration is approximately one week, depending on the patient’s characteristics.
Treatment Stage 2: Therapy and Rehabilitation
The duration of actual treatment is approximately 30 days, but this may vary depending on the patient’s characteristics. The tools that are used in the treatment of autism include equine therapy, occupational treatment, language therapy, sensorial stimulation, ozone treatment and trans-cranial electric stimulation if needed (in hyperkinetic patients). Language treatment is carried out each day. In the beginning, the language rehabilitation sessions last one hour during the day, but this is extended later to two sessions each day.
Language rehabilitation usually lasts 20 days. During this treatment, the child is being constables evaluated by the experts and the progress is being monitored. Based on the effects of treatment, the language rehabilitation process is further re-tailored based on the response of each child. Therefore, each treatment protocol is being adjusted by the characteristics of each child. Language rehabilitation is broad and intensive. During each treatment, specialist conducts sensorial stimulation techniques such as facial massage. Specialized teams also work with family members or companions in order to ensure the best possible communication results. Family members or companions are taught to conduct language exercises and sensorial stimulation as continuing the language training after the child leaves the facility is essential for obtaining good treatment results.
Occupational treatment is also a very important feature of the overall rehabilitation program. This treatment aims to help the patients overcome the obstacles of physical and mental barriers present within the ASD, which restrict the everyday activities such as self-care, productivity, and participation in leisure activities. The treatment is conducted each day in two sessions. Specialists work with object identification, images projection and touching through interactive and didactic games.
As a part of occupational treatment, the children are engaged in outdoor activities. Engaging and stimulative games and exercises are being tailored for each child in order to learn about the surroundings. This treatment is also tailored based on the child’s preferences. Children are stimulated with colors, various physical activities including swimming in the pool, soccer, horseback riding etc. The specialists carefully monitor the children and adjust the program based on the child’s response to each stimulation. The length and duration of occupational therapy are also assessed based on the child’s characteristics and the progress being made with this treatment approach. This treatment has a goal to improve the patient’s productivity, physical performance, and sensorial activity.
Final Report and Recommendations
Once the treatment is considered completed, the experts will tailor the final report consisted of the diagnosis, severity, and prognosis of the ASD. Based on the vigilant monitoring of the child during each stage of treatment, the experts will issue the comprehensive recommendations for each child regarding further treatments and ASD management approaches.
Cuba is investing a lot of effort in advancing the management of children suffering from ASD. Prestigious medical centers in Cuba have programs based on the extensive international experience in autism management. Treatment protocols for ASD are in line with the globally accepted international medical standards. Cuba invests in the training of staff that deals with kids suffering from ASD. There is still a lot to be learned about ASD in order to provide the best possible treatments for ASD patient and their families. Cuba has proven to take this issue seriously and professionally.
Life expectancy of Cuban population has increased significantly over the past decade. In 2014, an average life expectancy was shown to be 78.5 years (1). It is predicted that approximately a third of the entire population in Cuba is going to reach the age of 60 by the year 2030 (2). The increased life expectancy, increase in the prevalence of elderly population combined with an unhealthy lifestyle represents a significant risk of increased cancer burden for the people living in Cuba. In 2012, cancer became a leading cause of death in Cuba, counting for approximately a quarter of all fatal outcomes (3). Due to these data, Cuba has developed strong mechanisms of cancer prevention, management, and research that are comparable to those in the developed countries. A comprehensive and systematic approach to cancer prevention, early diagnosis, treatment and palliative care has shown results including increased survival and better quality of life in patients suffering from cancer (4).
The strategy of fighting cancer in Cuba has been established a decade ago. The main objectives include education and communication of cancer risk factors to the general population, early detection of cancer in the primary healthcare setting, treatment and supportive care in highly specialized institutions, as well as research and development of innovative therapeutic modalities against various types of cancer (5). A very developed network of primary healthcare institutions enables the physicians to discover cancer in the early stages. These patients are then referred to specialized institutions where an adequate diagnostics and staging are being made, followed by cancer management techniques. Following the implementation of the abovementioned strategy, cancer survival rates in Cuba have shown increasing trends, which are comparable to those in developed countries.
Due to an increased prevalence of cancer, Cuba has invested a significant amount of funds to cancer treatment and research in order to achieve the highest standards in cancer management. Some of the fascinating achievements of Cuban approach to cancer will be reviewed in this article.
NATIONAL INSTITUTE OF ONCOLOGY AND RADIOBIOLOGY (INOR)
INOR serves as an international medical center that provides advanced and highly sophisticated medical care for cancer patients from all over the globe. Highest standards in the management of cancer are implemented at this institution with the goal to cure, improve and increase the quality of life of each patient that seeks medical attention. Advanced treatment modalities, holistic approach to each patient, integrative rehabilitation techniques combined with the use of natural healing methods are just some of the services aimed to increase patient welfare at this institution. INOR conducts scientific and educational activities related to the nature and biology of cancer. Various clinical trials are being conducted at this facility in order to investigate and evaluate novel and promising cancer treatment regimens (6). Patients from more than 50 counties worldwide including Europe, USA and Canada have been treated at this institution with exceptional quality of care.
SUCCESSFUL MANAGEMENT OF LEUKEMIA
In Cuba, the overall survival of kids suffering from acute lymphoblastic leukemia following standard therapeutic protocols is approximately 85% in standard risk patients (7). The improvement after the application of last generation cytotoxic treatments is seen in approximately 98% of children. Bone marrow transplants are performed with high success rates. Additionally, Cuba performed transplantation of cord blood hematopoietic stem cells in order to treat various forms of leukemia. All of the treatments are totally free of charge for all Cubans.
NON-MELANOMA SKIN CANCER
Skin cancer is among the most frequent cancers in Cuba (8). The challenges in the treatment of nonmelanoma skin cancers include non-resectable, aggressive and recidivant forms, which are difficult to treat and often lack in proper and effective therapeutic modalities. The successful management of nonmelanoma skin cancer in Cuba is reflected in the application of the novel combination of two interferons. More than 400 patients have been treated with this combination with high rates of success, reaching clinical remission in approximately 65% of cases (8).
Oral cancer was among the most frequent forms of cancers in Cuba. The development of preventative actions including regular oral examination of individuals at least once a year led to significant decrease in the incidence of advanced oral cancer. The vigilant approach to early detection of oral cancer resulted in significantly higher detection rates of low-grade oral cancers that are more sensitive to treatment and have much better prognosis (9).
Early detection of cancer remains the focus in the fight against malignancy in Cuba. Highly developed primary health care system represents a pillar stone of Cuban medical care. The early detection of malignancy on a primary health care level directly resulted in significantly better therapeutic outcomes in patients suffering from various types of cancer. The increasing aging of Cuban population increased the risks of developing malignancies. Therefore, Cuba has developed tertiary centersfor cancer diagnostics, staging, treatment and research. These centers are operating with the highest international standards in cancer management and offer innovative approaches in cancer treatment that are completely free of charge for any Cuban, rating the success of cancer management in Cuba to be among those in highly developed countries.
1. Oficina Nacional de Estadistica. Anuario demográfico 2014. http://www.one.cu/anuariodemografico2014.htm. [Online] 2. National Statistics Bureau (CU). El envejecimiento de la población cubana. http://www.one.cu/publicaciones/cepde/envejecimiento/ envejecimiento2008.pdf. [Online] 3. Dirección Nacional de Registros Médicos y Estadísticas de Salud. Anuario Estadístico de Salud de Cuba. http://files.sld.cu/dne/files/2015/04/anuario-estadistico-de-salud-2014. [Online] 2018. 4. WHO. Cuba – Battling cancer with biotechnology. http://www.who.int/features/2013/cuba_biotechnology/en/. [Online] 2018. 5. Teresa Romero Pérez, Yaima Galán Alvarez and Rolando Camacho Rodríguez. THE BURDEN OF CANCER IN CUBA AND CURRENT STRATEGIES FOR CANCER CONTROL. http://www.cancercontrol.info/cc2016/the-burden-of-cancer-in-cuba-and-current-strategies-for-cancer-control/. [Online] 2018. 6. INOR. National Institute of Oncology and Radiobiology. http://instituciones.sld.cu/inor/. [Online] 2018. 7. Results of the treatment of child Acute Lymphoid Leukemia in Cuba. Alejandro, González-Otero et al. s.l. : Revista Cubana de Hematologia, Inmunologia y Hemoterapia, 2014, Vol. 30(1). 36-46. 8. HeberFERON, formulation based on IFNs alpha2b and gamma for the treatment of non-melanoma skin cancer. Lorenzo, Anasagasti-Angulo et al. 10(6), s.l. : Australasian Medical Journal, 2017. 9. Research on cancer prevention, detection and management in low- and medium-income countries. R. Sankaranarayanan, P. Boffetta. 10, s.l. : Annals of Oncology, 2010, Vol. 21. 1935–1943.
Canadian Woman’s Successful Use of Cuban Vaccine Gives Mesothelioma Patients Hope
A Cuban vaccine called CIMAvax EGF, which is currently undergoing U.S. testing for its effectiveness in treating mesothelioma and other cancers, has apparently saved the life of a Canadian woman diagnosed with non-small cell lung cancer. Judy Bryden of Regina, Saskatchewan was originally diagnosed with the terminal form of cancer back in 2016 and given just a year to live.
She initially pursued traditional forms of treatment in Canada, including chemotherapy and radiation therapy. After that protocol failed to stop the advancement of her disease she and her husband began researching alternative treatments, and that is when they learned about the success that the Cubans were having with their remarkable cancer vaccine. They contacted an outfit called CubaHeal, which is specifically set up to help people from outside of Cuba to visit the country for treatment, paid a small fee for the process, then traveled there for treatment and to purchase several doses of the vaccine to bring back to her home. The total cost of the trip was $14,500, a fee that was well worth it as her physician says she is now in remission.
CIMAvax has long been discussed as offering great hope for mesothelioma patients. It activates the immune system against a specific protein that has been identified as facilitating cancer cell growth. It is already in clinical trials in the United States following an agreement between the Roswell Park Comprehensive Cancer Center in New York and the Cuban government that was struck in April of 2015. The Phase I clinical trial began in January of 2017 and is expected to take at least two years, followed by another year or two for the Phase II portion of the trial. The drug has already been approved for use in Bosnia and Herzegovina, Colombia, Cuba, Paraguay and Peru.
A Regina woman wants to spread the word about a vaccine she received in Cuba that she says has kept her alive.
Judy Bryden was diagnosed with lung cancer in 2016, after returning home from a trip with a cold. She underwent numerous scans and, in November 2016, she began chemotherapy. Bryden said the chemotherapy nearly killed her and didn’t cure the cancer. She went through five radiation treatments, and the cancer survived. Following that, a doctor recommended palliative chemotherapy, suggesting Bryden only had one year to live.
“When they told me I had a year to live, I said I was going to prove them wrong. I didn’t know how, but I was going to prove them wrong,” Bryden said.
Bryden refused a second round of chemo. It was at that time that her husband Lorne Bryden first heard about the Cimevax EGF vaccine.
“I searched the internet and found a company called CubaHeal in Brantford, Ontario,” Lorne said. “They were able to put the whole thing together for us, for a fee, of course.”
“When they found (CubaHeal), there was something about it that just felt right. It just felt right at its core,” said Pamela Bryden, Bryden’s daughter.
Lorne submitted Bryden’s medical information, and went on to pay $135. Bryden was approved for treatment, but they had to travel to Cuba.
The vaccine is currently not available in Canada. Health Canada says that is not because of any known safety concerns about the drug. Instead, Health Canada simply does not actively solicit new drug submissions. No application has been submitted for Cimevax EGF yet.
The vaccine works by targeting the epidural growth factor (EGF) which is a protein found naturally in the body. In certain types of cancers, the body produces too much EGF, forcing the cells to grow and divide uncontrollably.
“The company is responsible for submitting an application to Health Canada, so their product can be approved on the Canadian market. Only once we receive that application, will we review an application,” Health Canada spokesperson Renelle Briand said.
The Brydens returned from Cuba in March 2017, with four doses to be injected every 14 days. A CT scan of Bryden this past February found no cancer.
The treatment isn’t cheap. A trip to Havana, plus a year’s supply of injections, costs about $14,500. But it’s still much less than the $65,000 dollar treatment Lorne found for sale in Tijuana, Mexico.
“I wish Cimevax was here for people, because it’s $1,000 a month that we pay,” Bryden said. “It’s worth it.”
Bryden hopes her story encourages others to try the treatment themselves. A recent CT scan shows the cancer has not spread, and CubaHeal has approved another year of vaccines for Bryden. Lorne is planning to leave on March 19 to go pick up the vaccine.
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.