Sunday, October 30, 2011

The case of Laura Pollán: Death by Purposeful Medical Neglect

A medical analysis of the painful, tragic and unnecessary death of Laura Pollán

by Dr. Oscar Elías Biscet

Photo from September 24, 2011 of Laura Pollán being scratched during protest

On several occasions I visited in solidarity with the Lady in White Laura Pollán and to present my condolences to her family. During these visits, some dissidents raised concerns to me for the beginning and the fatal outcome of her disease. They wondered if it was possible that the disease had been caused by a bite or scratch by someone. This extreme but real and justified suspicion, by the Cuban opposition is based on the intense and constant repression of a Stalinist Castro police acting with the cruelty and cowardice of terrorists.

The Cuban democratic opposition is subjected to continuous and prolonged stress as a mechanism of destabilization of the political police. This type of stress leads in the human person to an imbalance of their state of health, both physically and mentally. Neutralization is one of the basic techniques in the work of agents of the regime that kill, eliminate or get rid of political opponents, such as forcing an organization to cease their activities or disintegrate completely.

During our turbulent past, the Castro regime has committed multiple extrajudicial political killings that it has disguised as accidents, false legal proceedings, and even street fights, and even diseases without reason or apparently accurate medical diagnosis.

Now, if the Castro government decided to kill with impunity the leader of the Ladies in White it could not have done it with chemicals that trigger the process of poisoning by ingestion, inhalation or skin contact. The reason is that these products are only in the hands of the state and the family access to the corpse, the felony would have been discovered.

The most suitable way the regime would have had to commit this morbid crime would have been through diseases caused by elements within the broad field of biotechnology in the country. To the point, that the government of Cuba has been included in several lists of the Department of State of the United States as a bioterrorism threat to the free world.

It is common knowledge that Laura Pollán was bitten and scratched by a State Security agent on September 24 of this year and eight days later fell ill in critical condition. As a physician, immediately I asked myself the following questions: Which diseases can be transmitted by direct contact from person to person? Were the scratches caused by human nails or sharp objects? What is the epidemiological state in the region and the nation?

The transmission of disease through a human bite is rare not only in Cuba but also in the world. This should at least meet two characteristics, namely that the bite lacerate the human skin and infected salivary secretions of the perpetrator come in contact with her, or that the bite lacerate the human skin and that the aggressor have lesions in the buccal mucosa allowing offender's blood to make contact with the wound of the victim.

In both cases there are few diseases described that can be transmitted this way. One is human rabies, which is a very rare disease. In fact, it has only confirmed that it occurred when checked for in corneal transplants of persons who have died of a undiagnosed central nervous system disease. In some regions where the disease is endemic, human autopsies show evidence of rabies as low as 1 to 2%. The animals are the reservoir of the disease, especially dogs, cats, bats and nearly all mammals. In Cuba, for example, there are no diagnosed cases of human transmission.

Actinomycosis is another rare disease transmitted by the bite of a human being. Its natural reservoir is man. The infectious agent Actin-mycesisraelii is an anaerobic organism that produces a chronic infection localized of granulomas strongly indurated of purulence and fibrosis. They are located in the abdomen, chest and jaw. In these cases septicemia spread may occur with a generalized infection.

There are other human infectious diseases that are transmitted through blood and saliva. Needles, syringes and other instruments contaminated from intravenous use is another common means of spread of infectious entities. In some cases the infection can be spread by contamination of wounds or lacerations, as well as mucous membrane exposure to infected blood and blood products.

On the other hand, there are diseases such as hepatitis B and C, AIDS, infectious mononucleosis, cytomegalovirus infection, syphilis, Ebola-Marburg and others that could be transmitted by infected blood contact with wounds or skin lacerations. Although in reality, the medical literature contains no specific examples of these processes cases transmitted by human bites. For its part, infectious mononucleosis, cytomegalovirus and hepatitis B are infectious in human saliva and one of the routes of infection is the kiss. It is also possible that skin wounds in contact with contaminated saliva but not in the medical literature there are recorded cases of human bites.

Also, through sharps all the diseases described in the previous paragraph can be transmitted. But this does not seem to have been the method used to attack Laura. The scratches were made by human hands, in medical literature, does not know of any disease that has been transmitted in this way. In the case of shigellosis bacteria may be present in the nails of individuals but their way of transmission is by direct or indirect fecal-oral route.

What is definitely motive for concern is the epidemiological state in the island. In our country there are several infectious processes that trigger epidemics in several provinces, especially in Havana. These epidemics are those of the H1N2 influenza virus, the respiratory syncytial and dengue. The first two were publicly acknowledged by the government authorities in the Saturday October 12, 2011 edition of Granma newspaper. The dengue epidemic remains hidden so as not to alarm foreign tourists and threaten desperately needed foreign exchange.

However, in the course followed by the disease in Laura Pollán there existed things that caught my attention as a physician and that led me to an early diagnosis. Vomiting, chills, joint pains, severe weakness, fever and shortness of breath are associated with an epidemic of dengue. Incredibly, the patient's skin was not reviewed to discover escarlatiforme or maculopapular, or the presence of petechiae that are unmistakable signs of this process, nor indicated the loop or tourniquet test that is done at the foot of the bed.

Nor were immunological investigations performed for the diagnosis of dengue in the health center where she was treated. Four days after admission to the intensive care unit of Hospital Calixto Garcia, precisely because of the orientation of an independent physician and friend of the family, it is decided to search in the skin of the patient and verify the presence of petechiae on the chest.

Before being admitted the hemoglobin was at 12g/l and two days after admission to hospital 6g/l, because there was a bleeding that was never reported to the family. Even transfused 500mm/l of blood, increasing hemoglobin 8.6g/l. Arterial blood pressure was 74/57 that constitutes a low differential pressure. So, the patient is in a serious state, I would say in an irreversible vascular shock, which went from a moderate awareness to stupor and finally coma.

This alteration of consciousness was not communicated to the family. The proof is that while they had their eyes occluded with moist gauzes, method utilized in comatose cases, in the medical reports limited themselves to saying that they had her sedated. Hemoglobin dropped from 12 to 6 g/l. Why? For post-hemorrhagic anemia due to hemolytic anemia. This last factor explains the final diagnosis that they gave the patient of an acute respiratory failure because of the respiratory syncytial virus (RSV).

But there was no jaundice of skin or mucosa, or other hemolytic sign. But when I saw the skin of the corpse during the course of the funeral it was translucent and white. As could be described as pale alabaster skin that is caused by acute hemorrhage and contrasts with hemolytic anemias where the skin takes on a yellowish color. There was also a generalized edema that deformed her, defining feature of renal failure, improper RSV and very common in hemorrhagic dengue fever/dengue shock syndrome (DHF/DSS).

Dengue viruses include immunological types 1, 2, 3 and 4 and are flaviviruses, which are transmitted by arthropods, generally the mosquito Aedes aegypti. These same viruses cause hemorrhagic dengue fever. In rare cases, primary infections with dengue virus cause a syndrome of hemorrhagic fever (HF). Although most frequent to the onset of HF is the previous infection with heterologous dengue predisposes.

However, the patient Laura Pollán's was misdiagnosed with the illness of respiratory distress or acute respiratory failure because of the respiratory syncytial virus. This is a negative RNA virus of the paramyxovirus family. The largest number of affected is between infants and children that in certain environments such as nurseries, approaches 100%. At the age of two years most children will have been infected. And it is the cause of 25% of hospitalizations for pneumonia in infants and young children and 75% of cases of bronchiolitis in this age group.

In older children and adults the disease is milder than in infants. In adults, it appears as a common cold. In the elderly, often in patients admitted to health facilities, and patients with immunodepressive process or treatment serious infections appear of the lower portion of the airways. None of these symptoms is unrelated to the physical condition of the patient who, though a person who started the third age and suffered from chronic but compensated illnesses, behaved like a healthy person. This patient presented failures in all vital organs: lung, brain, heart, liver, pancreas, kidney and hematopoietic system observed in hemorrhagic dengue fever and not in respiratory failure by syncytial virus.

Nevertheless dengue can cause hemorrhagic shock syndrome or disseminated vascular coagulation. Both processes can cause acute respiratory failure, which would justify its severity and death. There is concrete evidence that the closest relatives, friends and dissidents expressed suspicions about a possible assassination by the communist regime's political police. Now, what has been proven over and over again is the stubborn nature of the regime at this sad, tragic and unnecessary death.

Original Spanish text available here.

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