HICNet Medical News Digest Fri, 18 Mar 1994 Volume 07 : Issue 09 Today's Topics: [MMWR] Impact of Expanded AIDS Definition on Case Reporting [MMWR] Measles and Measles Elimination Program Conference: Emerging Technologies in Medicine & Biology WHO Collaborating on Non-Communicable Disease Program CancerNet Update Institute of Tropical Medicine Epidemiological Bulletin 8 Jan 94 +------------------------------------------------+ ! ! ! Health Info-Com Network ! ! Medical Newsletter ! +------------------------------------------------+ Editor: David Dodell, D.M.D. 10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA Telephone +1 (602) 860-1121 FAX +1 (602) 451-1165 Compilation Copyright 1994 by David Dodell, D.M.D. All rights Reserved. License is hereby granted to republish on electronic media for which no fees are charged, so long as the text of this copyright notice and license are attached intact to any and all republished portion or portions. 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E-Mail Address: Editor: Internet: david@stat.com FidoNet = 1:114/15 Bitnet = ATW1H@ASUACAD LISTSERV = MEDNEWS@ASUACAD.BITNET (or internet: mednews@asuvm.inre.asu.edu) anonymous ftp = vm1.nodak.edu Notification List = hicn-notify-request@stat.com FAX Delivery = Contact Editor for information ---------------------------------------------------------------------- Date: Fri, 18 Mar 94 23:24:52 MST From: mednews (HICNet Medical News) To: hicnews Subject: [MMWR] Impact of Expanded AIDS Definition on Case Reporting Message-ID: <6Z9eJc7w165w@stat.com> Update: Impact of the Expanded AIDS Surveillance Case Definition for Adolescents and Adults on Case Reporting -- United States, 1993 During 1993, local, state, and territorial health departments reported 103,500 acquired immunodeficiency syndrome (AIDS) cases among persons aged greater than or equal to 13 years in the United States, an increase of 111% over the 49,016 reported in 1992 (Figure 1). This increase resulted from the expansion of the AIDS surveillance case definition in 1993*; in comparison, the number of cases based on the preexisting case definition decreased slightly. This report summarizes characteristics of persons reported with AIDS in 1993, compares these findings with data from 1992, and describes the impact of the change in the AIDS surveillance definition on AIDS case reporting.** Of cases in 1993, 55,432 (54%) were reported based on conditions added to the definition in 1993; and 48,068 (46%) were reported based on pre-1993 defined conditions--a 2% decrease from the number of cases reported in 1992 (Figure 1). Of the 55,432 cases reported based on 1993-added conditions, 50,061 persons (91%) had severe human immunodeficiency virus (HIV)-related immunosuppression only; 3988 (7%), pulmonary tuberculosis (TB); 1251 (2%), recurrent pneumonia; and 151 ( less than 1%), invasive cervical cancer (19 persons were reported with more than one of these opportunistic illnesses). The number of case reports was highest during the first quarter of 1993 (n=33,875, a 178% increase over the same period in 1992) and declined throughout the year: 18,957 cases were reported during the fourth quarter, a 67% increase over the same period in 1992. Comparing the same quarters of 1993, the median interval between date of diagnosis and date of report declined from 9 months to 4 months among persons reported with the newly added criteria but remained stable for persons reported using pre-1993 criteria. Of the cases reported in 1993, 56% had been diagnosed in earlier years, compared with 42% of cases reported in 1992. In 1993, substantial increases in the number of reported AIDS cases occurred in all regions of the United States (Table 1, page 168). Of areas reporting more than 250 cases, the proportion of cases based on the 1993-added criteria ranged from 35% in North Carolina (n=1353) to 71% in Colorado (n=1323). The increase in reported cases in 1993 was greater among females (151%) than among males (105%) (Table 1, page 168). Proportionate increases were greater among blacks and Hispanics than among whites. The largest increases in case reporting occurred among persons aged 13-19 years and 20-24 years; in these age groups, a greater proportion of cases were reported among women (35% and 29%, respectively) and were attributed to heterosexual transmission (22% and 18%, respectively). Compared with homosexual/bisexual men, proportionate increases in case reporting were greater among heterosexual injecting-drug users (IDUs) and among persons reportedly infected through heterosexual contact (Table 1). The largest proportionate increase in AIDS case reporting occurred among persons with hemophilia, although the total number of these cases was smaller than for the other HIV-exposure categories. Females, blacks, heterosexual IDUs, and persons with hemophilia were more likely than others to be reported with 1993-added conditions (Table 2). Most of these differences were attributable to reports of the three opportunistic illnesses added in 1993; of 5371 persons reported with a 1993-added opportunistic illness, 26% were women, 48% were heterosexual IDUs, and 63% were black. The number of Hispanics reported under the 1993-added criteria reflected reports from Puerto Rico: 38% of the 3173 reports from Puerto Rico were based on the 1993-added criteria, compared with 54% of the 15,145 cases among Hispanics from other areas. The pediatric AIDS surveillance case definition was not changed in 1993. During 1993, 968 children aged less than 13 years were reported with AIDS, an increase of 24% compared with the 783 cases reported in 1992. Of those 968 children, 50% were female, and most were either black (55%) or Hispanic (27%) and were infected through perinatal HIV transmission (93%). New York, Puerto Rico, and Florida reported 489 (51%) of the pediatric AIDS cases. Reported by: Local, state, and territorial health depts. Div of HIV/AIDS, National Center for Infectious Diseases, CDC. Editorial Note: The expansion of AIDS surveillance criteria in 1993 altered both the process of AIDS surveillance and the number of reported cases. The dramatic increase in the number of cases reported probably represents a one- time effect of the expanded reporting criteria that primarily results from reporting of persons who had newly added conditions diagnosed before 1993. The increase in the number of cases reported in 1993 (111%) exceeded the projected increase (75%) (1,2), indicating the rapid and efficient implementation of the revised AIDS surveillance criteria by many local and state health departments. Because the initial impact of the expanded case definition is likely to wane, the number of AIDS cases reported in 1994 is expected to be less than the number reported in 1993. During 1993, the number of reported cases meeting the pre-1993 AIDS surveillance definition decreased 2% from 1992. This reflects the rapid adoption of the CD4+ reporting criteria, which was used for 91% of AIDS case reports that were based on the 1993-added conditions. Therefore, the case count using pre-1993 criteria is not a precise measure of the number of cases that would have been reported if the definition had not been changed because the reporting of conditions meeting the pre-1993 criteria is affected by reporting using the CD4+ and other expanded criteria. For example, some cases reported under the expanded criteria may have had a concurrent or subsequent AIDS-defining condition in 1993 that was not reported; conversely, reporting of these pre-1993 conditions may have been enhanced by follow-up of cases initially reported with a newly added condition. In addition to active surveillance in hospitals and outpatient clinics, local health departments have employed different methods and sources to implement the expanded reporting criteria; these include laboratory-initiated surveillance for HIV antibody and CD4+ measurements (in states that require such reporting) and for AIDS-defining opportunistic infections and information obtained from TB and cancer surveillance registries (3,4). Group-specific differences may exist in the incidence of 1993-added conditions and in access to and use of HIV testing and clinical-care services. For example, the large increase in AIDS reporting among persons with hemophilia may reflect high levels of HIV testing and immunologic monitoring in this population in which new HIV infections have been rare since 1985. Females, IDUs, and blacks were most likely to be reported with new AIDS-defining opportunistic illnesses. This difference largely reflects the population coinfected with Mycobacterium tuberculosis and HIV (5). In 1993, the rate of increase in case reporting was greatest for women, racial/ethnic minorities, adolescents, IDUs, and persons infected through heterosexual contact. These trends in AIDS case reporting are similar to those observed in previous reporting years and suggest that changes in 1993 reflect, in part, underlying changes in the epidemic. Because race and ethnicity are not risk factors for HIV infection, an assessment of risk behaviors is necessary to properly target prevention efforts. The higher incidence of AIDS among non-Hispanic blacks and Hispanics than among non-Hispanic whites emphasizes the need for culturally sensitive and appropriate prevention messages. Although the pediatric case definition remained unchanged in 1993, the number of children reported with AIDS increased and paralleled the increase in AIDS among women. The surveillance information available as a result of the expanded AIDS reporting criteria provides a representative and more complete estimate of the number and distribution of persons with severe HIV-related immunosuppression and three major HIV-related illnesses that are particularly important among groups in whom the growth of the AIDS epidemic has been greatest. In general, persons with 1993-added conditions had higher CD4+ counts than other persons with AIDS. The ability to conduct surveillance for persons in earlier stages of HIV infection should result in more prompt recognition of changes in the trends of HIV transmission and disease. The expanded reporting criteria also have made reporting more complete because persons with 1993-added conditions who had died would not have been reported if the AIDS surveillance definition had not been changed. The addition of the pulmonary TB reporting criteria has more than doubled the number of persons with AIDS reported with TB. Although the number of HIV-infected women reported with invasive cervical cancer is relatively small, the inclusion of this potentially preventable and life- threatening condition in AIDS surveillance efforts provides an opportunity to monitor gynecologic care for HIV-infected women. The expanded AIDS surveillance information should facilitate community efforts to plan, direct, and evaluate HIV-prevention and HIV-care programs. References 1. CDC. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR 1992;41(no. RR-17). 2. CDC. Impact of the expanded AIDS surveillance case definition on AIDS case reporting--United States, first quarter, 1993. MMWR 1993;42:308-10. 3. CDC. Assessment of laboratory reporting to supplement active AIDS surveillance--Colorado. MMWR 1993;42:749-52. 4. Trino R, McAnaney J, Fife D. Laboratory-based reporting of AIDS. J Acquir Immune Defic Syndr 1993;6:1057-61. 5. Slutsker L, Castro KG, Ward JW, Dooley SW. Epidemiology of extrapulmonary tuberculosis among persons with AIDS in the United States. Clin Infect Dis 1993;16:513-8. * On January 1, 1993, the AIDS surveillance case definition for adolescents and adults was expanded beyond the definition published in 1987 to include all human immunodeficiency virus-infected persons with severe immunosuppression (less than 200 CD4+ T-lymphocytes/microliter or a CD4+ T-lymphocyte percentage of total lymphocytes of less than 14), pulmonary tuberculosis, recurrent pneumonia, or invasive cervical cancer (1). ** Single copies of this report will be available free until March 11, 1995, from the CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849- 6003; telephone (800) 458-5231. ------------------------------ Date: Fri, 18 Mar 94 23:25:57 MST From: mednews (HICNet Medical News) To: hicnews Subject: [MMWR] Measles and Measles Elimination Program Message-ID: Measles -- Puerto Rico, 1993, and the Measles Elimination Program In the Commonwealth of Puerto Rico, a resurgence of measles peaked in 1990 when 1805 cases (51.3 cases per 100,000 population) and 12 measles- related deaths were reported. This report summarizes the persistence of measles transmission in Puerto Rico in 1993 and describes the Puerto Rico Measles Elimination Program. Because of similarities in clinical features of measles and dengue (which is endemic in Puerto Rico [1]), since 1991 only measles cases serologically confirmed by enzyme-linked immunosorbent assay have been reported to CDC. In 1993, 355 measles cases were reported (10.1 per 100,000). Cases were reported from each region of Puerto Rico (Figure 1); the largest outbreaks were reported from Arecibo (219 cases [53.7 per 100,000]), Ponce (46 [8.2]), and Metropolitan (including San Juan) (31 [3.7]). Confirmed cases were reported in each month; nearly half of all cases occurred during April (48 cases), May (77), and June (52); fewer than 10 cases occurred each month during October- December. Most (254 [72%]) cases occurred among preschool-aged children (i.e., aged 0-5 years); 116 (33%) occurred among infants (i.e., aged less than 12 months). Among the 248 (70%) persons with measles for whom vaccination status was known, 149 (60%) were unvaccinated; these unvaccinated persons constituted 93% of infants, 56% of children aged 1-5 years, 2% of school-aged children, and 64% of adults (Table 1). From 1983 to 1990, Puerto Rico required one dose of measles-mumps-rubella vaccine (MMR) for school entry, and annual audits during 1990-1992 indicated approximately 95% coverage among children in all grades. Since 1990, two doses of MMR have been required for school entry, and annual audits during 1991-1992 indicated approximately 90% coverage with two doses among children entering school. In 1990, Puerto Rico lowered the recommended age for routine vaccination with MMR to 12 months. Vaccination coverage with one dose of MMR by 24 months (estimated by retrospective studies of children entering school in 1992) was 69%. To eliminate indigenous measles transmission in Puerto Rico by 1996, the Puerto Rico Department of Health (PRDH) is conducting the Puerto Rico Measles Elimination Program, an islandwide effort comprising a mass vaccination campaign, increased measles surveillance, and aggressive outbreak control. Reported by: C Feliciano, MD, Secretary of Health; E Pintado Diaz, MD, Central Office of AIDS and Communicable Diseases Affairs; E Calderon, V Rodriguez, Immunization Program; C Deseda, MD, Measles Elimination Program; C Rodriguez, Div of Epidemiology; JV Rullan, MD, Commonwealth Epidemiologist, Puerto Rico Dept of Health. National Immunization Program; Div of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, CDC. Editorial Note: Elimination of indigenous measles in the United States by 1996 is a goal of the Childhood Immunization Initiative (2). The approach adopted in Puerto Rico to meet this objective is based on a measles-elimination strategy advocated by the Pan American Health Organization (PAHO). This strategy, implemented by 14 Latin American countries and all 17 English- speaking Caribbean countries, supplements routine vaccination with mass vaccination campaigns for children aged less than 15 years regardless of previous vaccination status and enhances surveillance for febrile rash illness. Since September 1991, no confirmed indigenous measles cases have been reported from the English-speaking Caribbean countries or Cuba (Expanded Program on Immunization, PAHO, unpublished data, 1994). Because effective school vaccination laws have resulted in high (greater than 90%) MMR coverage among all school-aged children in Puerto Rico, PRDH will focus its mass vaccination campaign on preschool-aged children, among whom most (72%) of the recent cases have occurred. This campaign, scheduled for March 16-19, 1994, will target the approximately 353,000 children in Puerto Rico aged 6 months-5 years, regardless of previous measles vaccination history. In addition, health-care providers will assess vaccination status of children for whom records are available for oral poliovirus vaccine, diphtheria and tetanus toxoids and pertussis vaccine, and Haemophilus influenzae type b vaccine and will administer needed vaccines. Following the campaign, PRDH will conduct a population-based evaluation of the vaccination coverage achieved. Other elements of the measles elimination program in Puerto Rico are to increase measles surveillance and to implement aggressive outbreak control. PRDH will establish a febrile rash illness reporting system. All health-care providers will be encouraged to promptly report to PRDH every case of febrile rash illness, which will be investigated within 24 hours of report. Measles surveillance will continue to be coordinated with the PRDH Community Hygiene Division (which conducts dengue surveillance) and CDC's Dengue Branch, Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, in San Juan to provide additional laboratory diagnosis of cases of rash illness. Private laboratories will be requested to notify PRDH on receipt of any specimen submitted for measles serology. A case-response protocol will enable PRDH to implement outbreak-control measures as soon as a diagnosis of measles is considered likely--ideally within 3 days of rash onset. Control measures will include enhanced case investigation, contact tracing, and vaccination of contacts. Because measles may circulate independently among older vaccinated persons (without a reservoir of susceptible preschool-aged children to sustain transmission), measles circulation in Puerto Rico could persist despite a successful mass vaccination campaign. Enhanced surveillance efforts will be needed to identify this trend and to stimulate development of additional strategies to interrupt transmission. In addition, continued efforts to improve timely vaccination of preschool-aged children will be necessary to maintain the high vaccination coverage level anticipated following the campaign. References 1. Dietz VJ, Nieburg P, Gubler DJ, Gomez I. Diagnosis of measles by clinical case definition in dengue-endemic areas: implications for measles surveillance and control. Bull World Health Organ 1992;47:745-50. 2. CDC. Reported vaccine-preventable diseases--United States, 1993, and the Childhood Immunization Initiative. MMWR 1994;43:57-60. ------------------------------ Date: Fri, 18 Mar 94 23:26:28 MST From: mednews (HICNet Medical News) To: hicnews Subject: Conference: Emerging Technologies in Medicine & Biology Message-ID: **************************************************************************** * * * Artificial Neural Networks in Engineering (ANNIE '94) * * St. Louis, Missouri, November 13-16, 1994 * * * * Announcement of The New Track * * "Emerging Technologies in Medicine and Biology" * **************************************************************************** Dear Colleague, I am organizing a new track on EMERGING TECHNOLOGIES IN MEDICINE AND BIOLOGY for the upcoming Artificial Neural Networks in Engineering (ANNIE'94) Conference to be held in St Louis, Missouri, November 13-16, 1994. This new track will include five special sessions: 1. Time-Frequency and Wavelet Transforms in ENGINEERING, MEDICINE and BIOLOGY. 2. Fuzzy Logic in MEDICINE and BIOLOGY. 3. Neural Networks and Artificial Intelligence in MEDICINE and BIOLOGY. 4. Virtual Really in ENGINEERING, MEDICINE and BIOLOGY. 5. Chaos and Fractals in ENGINEERING, MEDICINE and BIOLOGY. If you are interested in submitting a paper or papers to this track, please send a letter of intent, an information sheet that includes the full name of the author(s), title, address, phone number and FAX or e-mail address (if applicable) by March 21, 1994 to: Dr. Cihan Dagli, Conference Chair 223 Engineering Management Building University of Missouri-Rolla Rolla, MO 65401-0249 USA Phone:(314) 341-4374 Fax: (314) 341-6567 e-mail:dagli@shuttle.cc.umr.edu and one copy to me Dr. Metin Akay, Organizing Committee Member Biomedical Engineering Debt. Rutgers University P.O. Box. 909 Piscawatay, NJ 08854 Phone:(908) 932-4906 Fax: (908) 235-7048 e-mail:akay@gandalf.rutgers.edu Full papers are due by May 20, 1994. Authors will be notified of the status of their submittal by July 8, 1994 and camera-ready papers will be due by August 12, 1994. Approximately six to eight pages will be allocated for each accepted paper in the proceedings. I hope you will be able to join us in what promises to be an exciting meeting discussing the recent advances in Biomedical Engineering Research. Looking forward to hearing from you. Sincerely, Metin Akay, Ph.D. Visiting Professor Biomedical Engineering Dept. Rutgers University P.O. Box. 909 Piscawatay, NJ 08854 Phone:(908) 932-4906 Fax: (908) 235-7048 e-mail:akay@gandalf.rutgers.edu ------------------------------ Date: Fri, 18 Mar 94 23:27:12 MST From: mednews (HICNet Medical News) To: hicnews Subject: WHO Collaborating on Non-Communicable Disease Program Message-ID: <249eJc10w165w@stat.com> WHO COLLABORATING CENTERS ON NON-COMMUNICABLE DISEASES DISCUSSION GROUP WHONCD-L The Division of Health and Development of the Pan American Health Organization (PAHO) is pleased to announce to all participants at WHO Collaborating Centers on Non Communicable Diseases that the discussion group list WHONCD-L has been deployed at db2.nlm.nih.gov server as a part of the recommendation of the meeting. Your messages should be addressed to whoncd-l@db2.nlm.nih.gov and the Server will automatically distribute it among the participants. We hope to improve later with specific networks on specialized areas of interest. We hope that the WHONCD-L will be a useful instrument to share, exchange and promote information among WHO Collaborating Centers in USA and Canada with the Latin America and Caribbean research community. We would like to thank all WHO Collaborating Centers Directors for their relevant contributions, suggestions and recommendation oriented to support more dynamic information access on scientific matters. Let us be simple to start with. To subscribe to WHONCD-L please send an E-mail to: listserv@db2.nlm.nih.gov and in the body of the letter type: subscribe whoncd-l following with your name For more information about this discussion group please contact Dr. Carlos A. Gamboa ------------------------------ Date: Fri, 18 Mar 94 23:28:02 MST From: mednews (HICNet Medical News) To: hicnews Subject: CancerNet Update Message-ID: ************************************************* * NATIONAL INSTITUTE * * C A N C E R * * INTERNATIONAL INFORMATION * * C E N T E R * ************************************************* * Cancernet@icicb.nci.nih.gov * ********************************** ************************************************************************** * The National Cancer Institute staff responsible for the pilot study * * of PDQ use would like to thank all users of CancerNet who responded * * to our request to participate in the survey of PDQ use and user * * satisfaction. 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Please send comments or questions to: Cheryl Burg NCI International Cancer Information Center Internet: cheryl@icicb.nci.nih.gov ------------------------------ Date: Fri, 18 Mar 94 23:28:44 MST From: mednews (HICNet Medical News) To: hicnews Subject: Institute of Tropical Medicine Epidemiological Bulletin 8 Jan 94 Message-ID: IPK - EPIDEMIOLOGICAL BULLETIN Vol 4e / No.01 Date: 01/08/94 Institute of Tropical Medicine Pedro Kouri National Epidemiology Office Ministry of Public Health ------------------------------------------------------------ Cuba. Cases and Cumulative of selected notifiable diseases. Week ending 01/08/94. ------------------------------------------------------------ DISEASES IN THIS WEEK CUMULATIVE 1992 1993 1992 1993 ------------------------------------------------------------ TYPHOID FEVER * * * * SHIGELLOSIS 4 1 4 1 AMEBIAN D. 47 * 47 * TUBERCULOSIS 2 1 2 1 HANSEN DISEASE 1 1 1 1 PERTUSSIS * * * * SCARLET FEVER 9 2 8 2 MENINGOCOCCAL M.(1) 3 1 3 1 MENINGOCCEMIES(1) * * * * TETANUS * * * * VIRAL M. 32 66 32 66 BACTERIAL M. 21 16 21 16 VARICELLA 705 380 705 380 MEASLES * * * * RUBELLA * * * * VIRAL HEPATITIS 301 148 301 148 MUMPS * * * * MALARIA * 10 * 10 LEPTOSPIROSIS 5 13 5 13 SYPHILIS 118 217 118 217 GONORRHEA 391 317 391 317 ACUMINATA COND. 31 29 31 29 ------------------------------------------------------------ Source: 1993, MND (Written Report) EIG-IPK. 1994, MND (Phone Report) EIG-IPK. (1) DIS * Means 0 reported case. Medical Consultations of Acute Diarrhoeal Diseases. Week ending 01/08/94 ------------------------------------------------------- AGE IN THIS WEEK CUMULATIVE GROUPS 1993 1994 1993 1994 ------------------------------------------------------- <1 4007 3123 4007 3123 1 - 4 4816 4052 4816 4052 5 - 14 2886 2707 2886 2707 15 - 64 11025 9127 11025 9127 > 65 1198 1137 1198 1137 ------------------------------------------------------- Source: MND (Phone Report). Medical Consultations of Acute Respiratory Infections. Week ending 01/08/94 ------------------------------------------------------- AGE IN THIS WEEK CUMULATIVE GROUPS 1993 1994 1993 1994 ------------------------------------------------------- <1 8208 7031 8208 7031 1 - 4 21200 15240 21200 15240 5 - 14 16829 12109 16829 12109 15 - 64 30124 21999 30124 21999 > 65 3655 2597 3655 2597 ------------------------------------------------------- Source: MND (Phone Report). Notified Outbreaks. Week 01/01/94 - 01/05/94. ------------------------------------------------------------ DISEASES OUTBREAKS CASES PROVINCES ------------------------------------------------------------ F.T.D 2 46 HOLGUIN 1/33 SANT. DE CUBA 1/13 ------------------------------------------------------------ LEPTOSPIROSIS 1 13 SANT. DE CUBA ------------------------------------------------------------ Source: DIS. ------------------------------------------------------------ This bulletin was prepared with the 60% of provinces- days-information. The offered indexes are provisionals and were taken from the daily report of the Direct Information System (DIS) remitted by Provincial Centers of Hygiene and Epidemiology, from the weekly phone report of Mandatory Notifiable Diseases (MND) remitted by National Statistics Division of the Ministry of Public Health, and from the Reference Laboratories of the Institute of Tropical Medicine Pedro Kouri. ------------------------------------------------------------ This is the weekly IPK-Epidemiological Bulletin emitted via Electronic Mail. The numbering plan agree with the IPK-Epidemiological Bulletin edited by Institute of Tropical Medicine Pedro Kouri and it is an abbreviated version. If you are interested in receiving this bulletin, please send your electronic address to: Lic. Andres M. Alonso Institute of Tropical Medicine Pedro Kouri ipk-b@infomed.cu ------------------------------ End of HICNet Medical News Digest V07 Issue #09 *********************************************** --- Editor, HICNet Medical Newsletter Internet: david@stat.com FAX: +1 (602) 451-1165 Bitnet : ATW1H@ASUACAD -------------------------------------------------------------------------------