Actividad antiplasmodial de plantas usadas en la medicina tradicional contra la malaria en Cuba / Antiplasmodial activity of plant species used in traditional medicine for the control of malaria in Cuba

Introducción: Las plantas utilizadas en la medicina tradicional se exploran internacionalmente como fuentes valiosas de nuevos agentes antipalúdicos. Objetivos: Evaluar la actividad inhibidora in vitro frente a Plasmodium berghei de extractos de 27 especies de plantas utilizadas en el siglo pasado contra la malaria en Cuba, valorando los precedentes de estudios científicos de estas especies. Métodos: Se prepararon extractos etanólicos de 27 especies de plantas que se evaluaron in vitro a través de la inhibición de la esquizogonia de P. berghei ANKA. Se realizó una revisión basada en la consulta de artículos científicos para la clasificación de actividad basada en rangos de CI50. Resultados: Dieciséis especies mostraron precedentes de actividad inhibidora in vitro o su utilización en la medicina tradicional de otros países; siete especies no mostraron actividad coincidente. Solamente los extractos hidroalcohólicos de Euphorbia tithymaloides L. (partes aéreas) y Swietenia mahagoni (L.) Jacq. (corteza) fueron activos con CI50 ≤ 5 µg/mL, mientras para Colubrina arborescens (Mill.) Sarg. (corteza), la CI50 fue 14,3 ± 1,9 µg/mL. Extractos de 11 especies se probaron por el interés de su utilización en Cuba, sin precedentes etnobotánicos y experimentales disponibles. Entre estos, las partes aéreas de Baccharis halimifolia L. var. angustior DC; y de Oxandra lanceolata (Sw.) Baill. constituyeron fuentes antiplasmodiales de valores moderados de CI50. El resto de los extractos no fueron activos. Conclusiones: Estos resultados apoyan el uso en medicina tradicional en Cuba contra malaria de E. tithymaloides, S. mahagoni, C. arborescens, B. halimifolia y O. lanceolata, lo cual estimula a ampliar su estudio.

Introduction: Plants used in traditional medicine are studied worldwide as valuable sources of new antiplasmodial agents. Objective: To evaluate the in vitro inhibitory activity against Plasmodium berghei of extracts from 27 plant species used in the last century against malaria in Cuba and assess the previous scientific studies on these species. Methods: Ethanolic extracts from 27 plant species were prepared and evaluated in vitro by inhibiting the schizogony of P. berghei ANKA. A review of scientific papers was conducted to classify the activity based on IC50. Results: Sixteen species showed precedents of inhibitory activity in vitro or of their use in traditional medicine in other countries; seven species did not show coincident activity. Only hydroalcoholic extracts from Euphorbia tithymaloides L. (aerial parts) and Swietenia mahagoni (L.) Jacq. (bark) displayed activity at IC50 ≤ 5 µg/mL, while for Colubrina arborescens (Mill.) Sarg. (bark) IC50 was 14.3 ± 1.9 µg/mL. Extracts from 11 species, with no ethnobotanical and experimental precedents available, were evaluated given the interest of their use in Cuba. Of these species, the aerial parts of Baccharis halimifolia L. var. angustior DC and Oxandra lanceolata (Sw.) Baill. constituted antiplasmodial sources of moderate IC50 values. The rest of the extracts were not active. Conclusions: These results support the use of E. tithymaloides, S. mahagoni, C. arborescens, B. halimifolia y O. lanceolata in traditional medicine against malaria in Cuba, which stimulate further studies.

Adjusting Iron Deficiency for Inflammation in Cuban Children Aged Under Five Years: New Approaches Using Quadratic and Quantile Regression.

INTRODUCTION: Ferritin is the best biomarker for assessing iron deficiency, but ferritin concentrations increase with inflammation. Several adjustment methods have been proposed to account for inflammation's effect on iron biomarker interpretation. The most recent and highly recommended method uses linear regression models, but more research is needed on other models that may better define iron status in children, particularly when distributions are heterogenous and in contexts where the effect of inflammation on ferritin is not linear. OBJECTIVE: Assess the utility and relevance of quadratic regression models and quantile quadratic regression models in adjusting ferritin concentration in the presence of inflammation. METHODS: We used data from children aged under five years, taken from Cuba's national anemia and iron deficiency survey, which was carried out from 2015-2018 by the National Hygiene, Epidemiology and Microbiology Institute. We included data from 1375 children aged 6 to 59 months and collected ferritin concentrations and two biomarkers for inflammation: C-reactive protein and α-1 acid glycoprotein. Quadratic regression and quantile regression models were used to adjust for changes in ferritin concentration in the presence of inflammation. RESULTS: Unadjusted iron deficiency prevalence was 23% (316/1375). Inflammation-adjusted ferritin values increased iron-deficiency prevalence by 2.6-4.5 percentage points when quadratic regression correction model was used, and by 2.8-6.2 when quantile regression was used. The increase when using the quantile regression correction model was more pronounced and statistically significant when both inflammation biomarkers were considered, but adjusted prevalence was similar between the two correction methods when only one biomarker was analyzed. CONCLUSIONS: The use of quadratic regression and quantile quadratic regression models is a complementary strategy in adjusting ferritin for inflammation, and is preferable to standard regression analysis when the linear model's basic assumptions are not met, or when it can be assumed that ferritin-inflammation relationships within a subpopulation may deviate from average trends.

Moral Panics, Viral Subjects: Black Women's Bodies on the Line during Cuba's 2020 Pandemic Lockdowns.

While Cuba was in a COVID-19-induced lockdown, coleras, women who wait in hours-long colas (lines) to purchase scarce goods to resell, emerged in online state media as "folk devils" responsible for the acute shortages of basic goods. Using an intersection lens, we combine fieldwork in lines and content analysis of online media to examine the creation and policing of the colera threat during the summer of 2020. Coleras were framed as immoral subjects, gendered and racialized, and often depicted as a virus that threatened the nation's health. The colera moral panic attempted to obscure class, race, and gender inequalities and structures that have made certain citizens vulnerable in the aftermath of successive waves of Cuban economic reforms. Understanding this moral panic allows us to appreciate the material scarcities and indignities to which poor Black women have been subjected, and widespread concerns about the state's failure to protect society's most vulnerable.

Durante el encierro inducido por el COVID­19 en Cuba, las coleras, mujeres que esperan horas en colas (filas) para comprar bienes escasos para revenderlos, surgieron en los medios estatales en línea como "diablas populares", responsables de la aguda escasez de bienes básicos. Usando una lente interseccional, combinamos trabajo de campo en líneas y análisis de contenido de medios en línea para examinar la creación y vigilancia de la amenaza colera durante el verano de 2020. Las coleras fueron enmarcadas como sujetas inmorales, generizadas y racializadas, y a menudo representadas como un virus que amenazaba la salud de la nación. El pánico moral sobre la colera intentó oscurecer la clase, la raza y las desigualdades y estructuras de género que han hecho vulnerables a determinados ciudadanos tras las sucesivas oleadas de reformas económicas en Cuba. Entender este pánico moral nos permite apreciar las carencias materiales y las indignidades a las que las mujeres pobres negras han sido sometidas, así como las preocupaciones generalizadas sobre la falta de protección del Estado hacia los más vulnerables de la sociedad.

Caracterización clínico-epidemiológica de la urolitiasis / Clinical-epidemiological description of urolithiasis

Introducción: Las urolitiasis ocasionan dolor, deterioro funcional renal y notorias erogaciones económicas. Objetivos: Identificar las características clínico-epidemiológicas de la nefrolitiasis. Métodos: Estudio descriptivo, transversal. Se estudiaron 2 923 personas pertenecientes a tres consultorios del Policlínico Plaza; municipio Plaza de la Revolución, provincia La Habana, Cuba., seleccionados por muestreo simple aleatorio de los 16 con que cuenta el área de salud. Los datos se obtuvieron mediante encuesta y entrevista estructurada. La información fue procesada de forma automatizada (IBMSPSS 22.0). Se utilizó análisis de distribución de frecuencias, se calcularon tasas de prevalencia, y fue empleado el test de homogeneidad. Resultados: La prevalencia de urolitiasis fue de 4,99 por cada 100 habitantes, de 6,3 entre los varones y de 5,7 en los de piel blanca. La edad promedio al diagnóstico fue de 39,3 años. Entre los factores de riesgo de litiasis predominó la alta ingestión de oxalatos (97,3 por ciento). La ecografía fue la forma de diagnóstico más usada (67,8 por ciento). La fitoterapia fue el tratamiento médico más utilizado (69,2 por ciento). Al 16,4 por ciento de los pacientes se les expidió certificado médico en los últimos dos años. Conclusiones: La prevalencia de litiasis urinaria en el Policlínico Docente Plaza de la Revolución es elevada, con predominio en el sexo masculino, en sujetos de piel blanca y en las edades medias de la vida. La alta ingestión de oxalato es el factor de riesgo de litiasis urinaria más frecuente encontrado. La forma de diagnóstico más utilizada es la ecografía y el tratamiento más empleado es la fitoterapia(AU)

Introduction: Urolithiasis causes pain, renal functional deterioration and notorious economic expenses. Objectives: To identify the clinical-epidemiological characteristics of nephrolithiasis. Methods: A descriptive, cross-sectional study was conducted in a total of 2,923 people from to three clinics of Plaza de la Revolution Teaching Community Clinic, Plaza de la Revolution municipality, Havana province, Cuba. They were selected by simple random sampling from the 16 clinics that the health area has. The data was obtained through a survey and structured interview. The information was processed automatically (IBMSPSS 22.0). Frequency distribution analysis was used, prevalence rates were calculated and the homogeneity test was used. Results: The prevalence of urolithiasis was 4.99 per 100 inhabitants, 6.3 among men and 5.7 among white-skinned men. The average age at diagnosis was 39.3 years. Among the risk factors for lithiasis, the high intake of oxalates prevailed (97.3 percent). Ultrasound was the most used form of diagnosis (67.8 percent). Phytotherapy was the most used medical treatment (69.2 percent). A medical permit was issued to 16.4 percent of the patients in the last two years. Conclusions: The prevalence of urinary lithiasis in Plaza de la Revolution Teaching Community Clinic is high, prevailing in males, in white-skinned and middle aged subjects. High oxalate intake is the most common risk factor for urinary lithiasis found. The most used form of diagnosis is ultrasound and the most used treatment is phytotherapy(AU)

Efecto antiinflamatorio y antioxidante in vitro de Curcuma longa sobre macrófagos murinos durante la infección por Helicobacter pylori

RESUMEN Introducción: La colonización por Helicobacter pylori produce una inflamación en la mucosa gástrica con el consecuente desarrollo de enfermedades gastroduodenales. Frente a altas tasas de resistencia antimicrobiana y la ausencia de una vacuna en humanos, la alternativa ha sido la búsqueda de extractos de plantas con propiedades antimicrobiana, antiinflamatoria, antioxidante, antifúngica y anticancerígena como la Curcuma longa. Sin embargo, al ser una especie introducida y adaptada a las condiciones climáticas del país, son necesarios los estudios preclínicos que avalen su potencial antiinflamatorio y antioxidante. Objetivo: Evaluar el efecto del extracto de C. longa sobre macrófagos peritoneales infectados con H. pylori. Métodos: Para evaluar el efecto antiinflamatorio y antioxidante del extracto de C. longa sobre macrófagos murinos infectados por H. pylori, se evaluaron diferentes concentraciones del extracto y relaciones de bacteria, y se evaluó la muerte celular mediante DAPI. Se determinó la producción de óxido nítrico, peróxido de hidrógeno y los niveles de la interleucina-1β. Resultados: La viabilidad del macrófago se afectó frente a concentraciones de 100 µg/mL del extracto de cúrcuma y a partir de 25 bacterias/macrófago. Al combinar las diferentes concentraciones del extracto con las multiplicidades bacterianas se observó una reducción en los niveles de H2O2 e IL-1β; sin embargo, la reducción del óxido nítrico se observó en el rango de 6,25-50 µg/mL del producto natural. Conclusiones: El extracto de cúrcuma cubano mostró potencial antioxidante y antiinflamatorio al disminuir la citotoxicidad celular y la producción de especies reactivas del oxígeno en macrófagos peritoneales.

ABSTRACT Introduction: Colonization by Helicobacter pylori causes inflammation of the gastric mucosa with the consequent development of gastroduodenal diseases. In view of the high antimicrobial resistance rates and the absence of a vaccine for humans, the alternative has been to search for plant extracts with antimicrobial, anti-inflammatory, antioxidant, antifungal and anticancer properties. An example is Curcuma longa. However, being as it is a species introduced and adapted to the country's climate conditions, it is necessary to conduct preclinical studies demonstrating its anti-inflammatory and antioxidant potential. Objective: Evaluate the effect of a C. longa extract on peritoneal macrophages infected by H. pylori. Methods: With the purpose of describing the anti-inflammatory and antioxidant effect of C. longa on murine macrophages infected by H. pylori, an evaluation was conducted of various extract concentrations and bacterial relationships, while cell death was assessed by DAPI. Determination was made of nitric oxide and hydrogen peroxide production, as well as of interleukin-1β levels. Results: Viability of the macrophage was affected in the presence of 100 µg/ml concentrations of the turmeric extract and as from 25 bacteria / macrophage. When different concentrations of the extract were combined with the bacterial multiplicities, a reduction was observed in H2O2 and IL-1β levels. However, nitric oxide reduction was observed within the range of 6.25-50 µg/ml of the natural product. Conclusions: The Cuban turmeric extract was found to have antioxidant and anti-inflammatory potential by reducing cell cytotoxicity and the production of reactive oxygen species in peritoneal macrophages.

Primer consenso cubano sobre el uso de terapia convencional y biológica en pacientes con artritis reumatoide / First Cuban consensus on the use of conventional and biological therapy in patients with rheumatoid arthritis

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Introduction: The development of recommendations for the treatment of rheumatoid arthritis (RA) in the Cuban context may be one of the ways to achieve better control of this disease. Objective: To reach a consensus and update relevant aspects of conventional and biological RA modifier therapy in Cuba. Methods: 18 specialists from 8 Cuban provinces, experts in RA care, were summoned, according to the years of dedication to the specialty, the conferences on this topic and their publications. The first meeting took place in March 2016 in the provincial hospital of Villa Clara, Cuba, with the participation of all the experts. A review of the literature on conventional and biological therapy previously collected by the participants was developed, and two teams were formed: the first would address everything related to conventional therapy in RA (HRCT) and the other, biological therapy in RA (TBAR). Three questionnaires related to the use of corticosteroids, HRCT and TBAR, were prepared, answered by the participants via email. In a second meeting, held in October 2016 in Havana, the analysis of all the responses provided was carried out. Questions with a response of 90% or more votes were considered as recommendations. Results: The questionnaires were answered by 95% of the participants. 9 recommendations and 1 algorithm were established. The recommendations are as follows: methotrexate is the drug of choice in the treatment of RA after diagnosis; The administration of another conventional drug (DMARDc) (azathioprine, salazosulfapyridine, antimalarials and leflunomide) is recommended in patients with a diagnosis of active RA in whom methotrexate is contraindicated or there is a failure in response - consider the administration of low doses of prednisone or equivalent (<7.5 mg/d) associated with DMARDc in patients with active moderate to severe RA, for the shortest possible time; perform serological control including tests for hepatitis B and C viruses and screening for HIV in all patients diagnosed with RA before starting treatment with DMARDc and biologics; in patients in remission or, at least, with a DAS-28 below 3.2, consideration should be given to withdrawing one of the DMARDs or reducing, to the minimum possible expression, the dose of both disease modifiers; if methotrexate fails, tocilizumab in combination with methotrexate or as monotherapy will be indicated. Conclusions: Aspects related to conventional therapy with methotrexate, azathioprine, salazosulfapyridine, antimalarials and leflunomide were agreed. The value of early diagnosis and immediate initiation of DMARDc therapy and the use of glucocorticoids was analyzed. Treatment with tocilizumab, the only biological available in Cuba against RA, will be administered when there is a failure in the response to conventional therapy and combinations between these drugs. It is recommended to hold educational conferences through the mass media aimed at patientshttp(AU)

Long term simulations of potential oil spills around Cuba.

Simulations over eight years of continuous surface oil spills around Cuba are carried out to identify the most likely stranding (beaching) locations. The open source Lagrangian oil drift model OpenOil is applied with high resolution hydrodynamic forcing. The actual fraction of the released oil mass reaching different regions is calculated, revealing small differences between a light and a heavy crude oil type. Similar stranding rates for the two oil types are found. Another important conclusion is that, due to the high temporal variability in stranding rates, short term simulations of a few weeks are not suitable to assess environmental risk. The highest stranding rates are simulated in winter in Northern Cuba. It is also found that oil could reach Northern Cuba, Yucatan or Florida in about 3-5 days after a spill.

Producción científica cubana en Medicina en SCImago Institutions Rankings: distribución temática, impacto y colaboración / Cuban scientific output about Medicine in SCImago Institutions Rankings: thematic distribution, impact and international collaboration

La investigación en salud constituye la piedra angular de los sistemas de salud efectivos y eficientes; por tanto, en su evaluación es necesario estudiar la producción científica del país. El objetivo de este trabajo fue caracterizar la producción científica cubana en medicina en cuanto a su distribución temática, productividad, impacto y colaboración internacional. Para esto se realizó un estudio bibliométrico en el área temática de la Medicina y las categorías que lo componen. La base de datos utilizada fue SCImago Insitutions Rankings, a partir de datos de Scopus, en el período 2012-2017. Se hallaron indicadores bibliométricos: cuantitativos (basados en espacio de documentos); de impacto (basados en número de citas); y de la colaboración internacional (coautoría con autores de otros países). La producción científica cubana en Medicina estuvo constituida por un total de 6191 contribuciones: el 83,4 por ciento corresponde a artículos originales y el 7,40 por ciento a trabajos de revisión. Las categorías con mayor volumen de producción son: salud pública, medicina ocupacional y medioambiental (17,56 por ciento); políticas de salud (10,73 por ciento); alergia e inmunología (7,30 por ciento) y enfermedades infecciosas (6,69 por ciento). La medicina familiar aparece como debilidad en la publicación. En impacto y colaboración internacional se destacan la neurología clínica, la microbiología y las enfermedades infecciosas. Se concluye que el país hace mayor esfuerzo en las categorías de las ciencias de la Salud. Teniendo en cuenta el protagonismo de la atención primaria en el sistema nacional de salud y las principales causas de muertes, es necesario incrementar las acciones para fortalecer la publicación en la cardiología y la oncología(AU)

Health research is the cornerstone of effective, efficient health systems. Its evaluation should therefore include an assessment of the country's scientific output. The purpose of the study was to characterize the Cuban scientific output about medicine in terms of its topic distribution, productivity, impact and international collaboration. To achieve this end, a bibliometric study was conducted about medicine and the categories making it up. The database used was SCImago Institutions Rankings based on Scopus data from the period 2012-2017. The bibliometric indicators found were quantitative (based on document counts), impact (based on the number of citations) and international collaboration (co-authorships with overseas authors). Cuban scientific output about medicine consists of a total 6 191 contributions, of which 83.4 per cent are original papers and 7.40 percent are review papers. The best represented categories are public health, occupational and environmental medicine (17.56 percent), health policies (10.73 percent), allergy and immunology (7.30 percent) and infectious diseases (6.69 percent). Family medicine is scantly represented. Clinical neurology, microbiology and infectious diseases stand out in terms of impact and international collaboration. It is concluded that the country makes a greater effort in the categories of health sciences. Considering the leadership of primary health care in the national health system and the leading causes of death, it is necessary to enhance the actions aimed at strengthening publication in the fields of cardiology and oncology(AU)

Estrategia nacional para la prevención y el control de las enfermedades no trasmisibles y sus factores de riesgo: Cuba 2020-2025 / National strategy for the prevention and control of non-communicable diseases and their risk factors: Cuba 2020-2025

Las enfermedades no trasmisibles desde hace más de dos décadas ocupan las primeras causas de muerte y de discapacidad en el mundo, incluso desde edades tempranas de la vida, en la región de las Américas y en Cuba. Estas características responden a la transición epidemiológica, demográfica y tecnológica induci- das por el desarrollo de vacunas, procesos y medicamentos; a la globalización, el avance en general y los cambios de comportamientos y estilos de vida, entre otros factores determinantes. Las enfermedades crónicas no deben considerarse en forma aislada, sino como una parte del estado de salud del individuo, que puede ser susceptible de sufrir múltiples riesgos de salud. La atención a esta condición, por su magnitud, requiere la implementación de políticas, estrategias integrales y multisectoriales basadas en la Estrategia de Atención Primaria de Salud con énfasis en el fortalecimiento del primer nivel de atención y sus acciones en los componentes de promoción de la salud y prevención de enfermedades. El Ministerio de Salud Pública, con una amplia participación de los diferentes actores sociales involucrados, propone el presente Plan Estratégico en un marco de acción nacional para atender integralmente a las enfermedades no trasmisibles, con un enfoque holístico, multisectorial y multidimensional, que permita desarrollar intervenciones que incidan en la determinación social de la salud, a través de acciones efectivas de promoción de la salud, prevención de enfermedades, tratamiento, rehabilitación y cuidados paliativos y crónicos. La implementación de este Plan es una herramienta que servirá para facilitar el cumplimiento de los esfuerzos nacionales encaminados al logro de la meta global de reducción de hospitalizaciones evitables y mortalidad prematura por las enfermedades no trasmisibles, lo que permitirá el mejoramiento en la atención de las personas con morbilidades como las enfermedades cardiovasculares, la diabetes, el cáncer y la enfermedad pulmonar obstructiva crónica y aumentar la calidad de vida y el bienestar de la población cubana.

Antioxidants in Plants: A Valorization Potential Emphasizing the Need for the Conservation of Plant Biodiversity in Cuba.

Plants are phytochemical hubs containing antioxidants, essential for normal plant functioning and adaptation to environmental cues and delivering beneficial properties for human health. Therefore, knowledge on the antioxidant potential of different plant species and their nutraceutical and pharmaceutical properties is of utmost importance. Exploring this scientific research field provides fundamental clues on (1) plant stress responses and their adaptive evolution to harsh environmental conditions and (2) (new) natural antioxidants with a functional versatility to prevent and treat human pathologies. These natural antioxidants can be valorized via plant-derived foods and products. Cuba contains an enormously rich plant biodiversity harboring a great antioxidant potential. Besides opening new avenues for the implementation of sustainable agroecological practices in crop production, it will also contribute to new strategies to preserve plant biodiversity and simultaneously improve nature management policies in Cuba. This review provides an overview on the beneficial properties of antioxidants for plant protection and human health and is directed to the valorization of these plant antioxidants, emphasizing the need for biodiversity conservation.

Percepción etnobotánica de los campesinos sobre la flora arvense en fincas de la agricultura suburbana en Santiago de Cuba, Cuba / Ethnobotanical perception of the farmers about the weed flora in farms of suburban agriculture in Santiago de Cuba, Cuba

Currently the weed species are a resource to conserve. The objective was to evaluate the ethnobotanical perception of the peasants about the weed flora in farms of suburban agriculture in Santiago de Cuba, Cuba. An ethnobotanical study was developed and the percentage of known species, percentage of species per management action and the percentage of weed species with potential utility was determined. The spectrum of use, the categories of use and the species richness by category were also taken into account. The weed species found in each of the farms were identified by at least 60% of the producers conferring more than 70% of this flora potential utilities such as medicinal, animal feed and agricultural. Although different forms of management for these species were identified, more than 40% are eliminated regardless of the potential benefits that productive systems can bring to this.

Actualmente las especies arvenses son un recurso a conservar. El objetivo fue evaluar la percepción etnobotánica de los campesinos sobre la flora arvense en fincas de la agricultura suburbana en Santiago de Cuba, Cuba. Se desarrolló un estudio etnobotánico y se determinó el porcentaje de especies conocidas, porcentaje de especies por acción de manejo y el porcentaje de especies arvenses con utilidad potencial. También se tuvo en cuenta el espectro de uso, las categorías de uso y la riqueza de especies por categoría. Las especies arvenses que se encuentran en cada una de las fincas fueron identificadas por al menos el 60% de los productores confiriéndoles a más del 70% de esta flora utilidades potenciales como medicinal, alimento animal y agrícola. Aunque se identificaron diferentes formas de manejo para estas especies, más del 40% resultan eliminadas independientemente de los beneficios potenciales que puedan aportar a estos sistemas productivos.

Insights into the Phytochemistry of the Cuban Endemic Medicinal Plant Phyllanthus orbicularis: Fideloside, a Novel Bioactive 8-C-glycosyl 2,3-Dihydroflavonol.

Phyllanthus orbicularis (Phyllanthaceae) is an endemic evergreen tropical plant of Cuba that grows in the western part of the island and is used in traditional medicine as an infusion. The aqueous extract of this plant presents a wide range of pharmacological activitiessuch as antimutagenic, antioxidant and antiviral effects. Given the many beneficial effects and the great interest in the development of new pharmacological products from natural sources, the aim of this work was to investigate the phytochemistry of this species and to elucidate the structure of the main bioactive principles. Besides the presence of several known polyphenols, the major constituent was hitherto not described. The chemical structure of this compound, here named Fideloside, was elucidated by means of HR-ESIMS/MSn, 1D/2D NMR, FT-IR, and ECD as (2R,3R)-(-)-3',4',5,7-tetrahydroxydihydroflavonol-8-C-ß-D-glucopyranoside. The compound, as well as the plant aqueous preparations, showed promising bioactive properties, i.e., anti-inflammatory capacity in human explanted monocytes, corroborating future pharmacological use for this new natural C-glycosyl flavanonol.

Interacciones socioculturales de los médicos cubanos participantes del Programa Más Médicos en Brasil / Sociocultural interactions of Cuban doctors participating in the More Doctors Program in Brazil

El Programa Más Médicos (PMM) fue creado en Brasil, en 2013, en el contexto de la necesidad de ampliar y garantizar el acceso y la cobertura de los cuidados básicos de salud, principalmente para la población con mayor vulnerabilidad social. Se trata de una iniciativa de carácter holístico, creada no sólo para resolver el problema de la escasez de médicos en el país, sino también para asegurar el desarrollo de las capacidades para la atención básica, además de invertir en la infraestructura necesaria y en la formación del personal de la salud, tanto en cantidad como en calidad. Finalmente, el reclutamiento de médicos tiene carácter de emergencial, pues pretende llenar vacíos de cobertura en municipios carentes. El PMM trajo impactos desde su inicio, percibido de forma positiva por las poblaciones objetivo, permitiendo así superar las fuertes críticas que recibió de algunos segmentos de la sociedad, incluso de la corporación médica. El hecho es que actualmente este programa se identifca como auténtica «marca¼ de salud pública, en términos de satisfacción de usuarios y gestores y de resolución de problemas de salud para la población brasileña. Este libro presenta una nueva visión sobre el PMM, aún poco explorada, al ingresar en los escenarios de práctica para responder preguntas importantes acerca de las interacciones socioculturales de los médicos cubanos reclutados, con el objetivo declarado de producir conocimiento, pero además para promover mejoras en la participación de extranjeros en la atención primaria que el SUS ofrece a la población, aún limitada. Su lectura presentará percepciones, memorias e incluso explicaciones para quien, de una forma u otra, está asociado con el desarrollo del PMM, particularmente aquellos en una posición comprometida con la salud y con el reconocimiento de los cuidados primarios de la salud como el verdadero camino para el desarrollo del sistema de salud.

Systemic Ozone Therapy by Rectal Insufflation for Immunoglobulin A Deficiency.

INTRODUCTION: IgA deficiency is a primary immunodeficiency predominantly due to an antibody defect, for which there is no replacement therapy. Treatment consists of prevention and treatment of infections and other associated conditions. Given the immunomodulatory and regulatory properties of the redox balance of ozone therapy in infectious and inflammatory conditions, evaluation of its effect on IgA deficiency is of interest. OBJECTIVE: Assess the benefits and possible adverse effects of ozone treatment in patients with IgA deficiency. METHODS: A monocentric randomized controlled phase 2 clinical trial (RPCEC 00000236) was carried out, after approval by the Institutional Ethics Committee of the Roberto Rodríguez Fernández Provincial General Teaching Hospital in Morón, Ciego de Ávila Province, Cuba. Included were 40 patients aged 5-50 years, distributed in 2 groups of 20, after agreeing to participate and signing informed consent. The experimental group received 2 cycles of ozone by rectal insufflation for 20 days (5 times a week for 4 weeks each cycle) with a 3-month interval between cycles, for a total of 40 doses, with age-adjusted dose ranges. The control group was treated with leukocyte transfer factor (Hebertrans), 1 U per m2 of body surface area subcutaneously, once weekly for 12 weeks. Frequency of appearance and severity of clinical symptoms and signs of associated diseases, serum immunoglobulin concentrations and balance of pro-oxidant and antioxidant biomarkers were recorded at treatment initiation and one month after treatment completion. Therapeutic response was defined as complete, partial, stable disease or progressive disease. Descriptive statistics and significance were calculated to compare groups and assess effect size. RESULTS: One month after treatment completion, 70% of patients in the experimental group experienced significant increases in IgG(p = 0.000) and IgM (p = 0.033). The experimental group also displayed decreased pro-oxidation biomarkers, glutathione modulation and increased antioxidant enzymes, with reduced oxidative stress; none of these occurred in the control group. Complete therapeutic response was achieved in 85% of patients in the experimental group and only 45% in the control group. Mild, transient adverse events were reported in both groups. CONCLUSIONS: Ozone therapy by rectal insufflation is a suitable therapeutic option for treating IgA deficiency because it produces antioxidant and immunomodulatory effects and is feasible, safe and minimally invasive. CONTRIBUTION OF THIS RESEARCH: This paper introduces in Cuba a new treatment a for IgA deficiency, with immunomodulatory and antioxidant effects offering substantial clinical benefits to patients with this immunodeficiency.

Evaluation of the feeding value of Dichrostachys cinerea pods for fattening pigs in Cuba.

Dichrostachys cinerea (L.) Wight & Arn. is a tropical leguminous shrub widely regarded as an invasive species in Cuba, after having invaded a significant proportion of its arable land during the past decades. Concurrently, smallholder pig producers are highly constrained by the scarcity of protein feeds. This study aimed to assess the feeding value of D. cinerea pod meal (DCPM) as an alternative protein supplement for pigs in Cuban smallholder production systems. An on-farm feeding trial was carried out with three groups (N = 10) of growing-fattening pigs over 60 days, where DCPM replaced 0, 15, and 30% in DM of a dietary commercial concentrate. Then, in an in vivo digestibility trial with eight growing pigs, apparent digestibilities of DCPM were determined for dry matter (DM), organic matter (OM) and crude protein (CP). Finally, in vitro digestibilities for OM (fecal and ileal) and CP (ileal) were determined. In the feeding trial, pig body weight gains were not affected by increased dietary substitution levels of concentrate for DCPM. Blood parameters, with a few exceptions, did not show significant differences among groups. Values for in vivo OM and CP digestibilities were 40.81 and 50.26%, and substantially higher than in vitro values. In conclusion, our results showed that at least 30% of DM in commercial concentrate could be substituted by DCPM without affecting pig growth performances under Cuban smallholder conditions. The low digestibility of DCPM is, however, not acceptable for intensive pig production systems. In vitro enzyme digestibility methods developed for commercial pig feeds are not suitable for DCPM without further calibration.

Content design and validation of a Standard Operating Procedure to provide pharmacotherapy follow-up for the elderly in Cuba

ABSTRACT Incorporating methodological tools that allow uniform and standardized development from the clinical pharmacy services to the Pharmaceutical Care practice, is nowadays a necessity. Considering the importance of pharmaceutical care provision to elderly patients, this manuscript introduces the design and content validation of a standard operating procedure to provide pharmacotherapy follow-up to the elderly in nursing homes in Cuba. The procedure was designed based on a deep analysis of documents relative to experiences focused on holistic care to elderly patients, criteria for the identification and assessment of potentially inappropriate prescriptions and the relationship between functional geriatric evaluation and the use of drugs. The content validation was conducted by a panel of experts, using the Delphi methodology, through two working sessions. In addition, we used Likert-type scale to evaluate the procedure by experts, in line with the indicators described. In general, the criteria issued by the experts were very appropriate and allowed us to modify, add or keep several elements of the instrument for the final version. The findings demonstrated that the instrument can be used at any level of health care.

Actividad antiagregante plaquetaria pero no anticoagulante de extractos de Morinda citrifolia L / Antiplatelet but not anticoagulant activity of Morinda citrifolia L. leaf extracts

Introduction: morinda citrifolia L (Noni) is a medicinal plant species that has gained popularity among Cuban population, suggesting the need to characterize the pharmacological activities of noni preparations developed in Cuba. Objective: assessing the effects of Noni leaf and fruit extracts on platelet aggregation and blood coagulation, as well as the possible influence of plant age, leaf maturity and extract total phenol and flavonoid contents on it. Methods: green and yellow leaves and light yellow fruits were collected from three- and six- year old Noni trees. Leaf (30 g/100 mL w/v) and fruit (100 g/100 mL w/v) extracts were prepared by maceration in 50 percent alcohol and water respectively. The concentrations of total soluble solids (TSS), phenolic compounds (PHEN) and flavonoids expressed as quercetin (FLV) in the extracts were determined. The in vitro effects of leaf (0,4 and 0,8 mg TSS/mL) and fruit (0,6 and 1,2 mg TSS/mL) extracts on ADP-induced platelet aggregation (PA), prothrombin time (PT) and partial activated thromboplastine time (PATT) in human plasma was determined. Furthermore, the ex vivo effects of a leaf extract (42 and 378 mg TSS / kg i.p. and 630 mg/kg p.o.) on these variables of rat plasma were assessed. Results: fruit extracts showed higher TSS, but lower PHE and FLV values than leaf extracts. Leaf but not fruit extracts inhibited ADP-induced PA that was independent on plant age and leaf maturity. A significant reduction of PA was ex vivo induced by a leaf extract in rats. TP and PATT were not modified during in vivo or ex vivo experiments. Conclusion: noni leaf hydro-alcohol extracts developed in Cuba have antiplatelet but not anticoagulant effect(AU)

Introducción: morinda citrifolia L (Noni) ha ganado popularidad entre la población cubana, lo que sugiere la necesidad de caracterizar farmacológicamente las preparaciones de noni desarrolladas en Cuba. Objetivo: evaluar los efectos de extractos de hojas y frutos de Noni sobre la agregación plaquetaria y la coagulación sanguínea, así como la influencia de la edad de la planta, la madurez de la hoja y los contenidos de fenoles totales y flavonoides. Métodos: hojas verdes y amarillas y frutos ligeros amarillos fueron recolectados de plantas de noni de tres y seis años de edad. Extractos de hojas (30 g/100 mL w/v) y frutos (100 g/100 mL w/v) estuvieron preparados por maceración en alcohol al 50 por ciento y agua, al respecto. Las concentraciones de sólidos totales (TSS), compuestos fenólicos (PHEN) y flavonoides expresados como quercetina (FLV) fueron determinadas. Los efectos de los extractos de hojas (0,4 y 0,8 mg TSS/mL) y de frutos (0,6 y 1,2 mg TSS/mL) sobre la agregación plaquetaria (PA) inducida por ADP, el tiempo de protrombina (PT) y el tiempo parcial de tromboplastina parcial activado (PATT) fueron determinados en plasma humano in vitro y los efectos de un extracto de hojas (42 y 378 mg TSS/kg i.p. y 630 mg/kg p.o.) sobre estas variables de plasmas de ratas fueron evaluados ex vivo. Resultados: los extractos de frutos tuvieron mayor contenido de TSS pero menores de PHEN y FLV que los de hojas. Estos últimos inhibieron la PA in vitro en plasma humano independiente de la edad de la planta y la madurez de las hojas. Un extracto de hojas indujo significativa reducción de PA ex vivo en ratas. TP y PATT no fueron modificados en ninguna situación experimental. Conclusión: extractos hidroalcohólicos de hojas de Noni desarrollados en Cuba tienen efecto antiagregante plaquetario pero no anticoagulante(AU)

Antiplatelet but not anticoagulant activity of Morinda citrifolia L. leaf extracts / Actividad antiagregante plaquetaria pero no anticoagulante de extractos de Morinda citrifolia L

INTRODUCCIÓN: morinda citrifolia L (Noni) ha ganado popularidad entre la población cubana, lo que sugiere la necesidad de caracterizar farmacológicamente las preparaciones de noni desarrolladas en Cuba. OBJETIVO: evaluar los efectos de extractos de hojas y frutos de Noni sobre la agregación plaquetaria y la coagulación sanguínea, así como la influencia de la edad de la planta, la madurez de la hoja y los contenidos de fenoles totales y flavonoides. MÉTODOS: hojas verdes y amarillas y frutos ligeros amarillos fueron recolectados de plantas de noni de tres y seis años de edad. Extractos de hojas (30 g/100 mL w/v) y frutos (100 g/100 mL w/v) estuvieron preparados por maceración en alcohol al 50 % y agua, al respecto. Las concentraciones de sólidos totales (TSS), compuestos fenólicos (PHEN) y flavonoides expresados como quercetina (FLV) fueron determinadas. Los efectos de los extractos de hojas (0,4 y 0,8 mg TSS/mL) y de frutos (0,6 y 1,2 mg TSS/mL) sobre la agregación plaquetaria (PA) inducida por ADP, el tiempo de protrombina (PT) y el tiempo parcial de tromboplastina parcial activado (PATT) fueron determinados en plasma humano in vitro y los efectos de un extracto de hojas (42 y 378 mg TSS/kg i.p. y 630 mg/kg p.o.) sobre estas variables de plasmas de ratas fueron evaluados ex vivo. RESULTADOS: los extractos de frutos tuvieron mayor contenido de TSS pero menores de PHEN y FLV que los de hojas. Estos últimos inhibieron la PA in vitro en plasma humano independiente de la edad de la planta y la madurez de las hojas. Un extracto de hojas indujo significativa reducción de PA ex vivo en ratas. TP y PATT no fueron modificados en ninguna situación experimental. CONCLUSIÓN: extractos hidroalcohólicos de hojas de Noni desarrollados en Cuba tienen efecto antiagregante plaquetario pero no anticoagulante.

INTRODUCTION: morinda citrifolia L (Noni) is a medicinal plant species that has gained popularity among Cuban population, suggesting the need to characterize the pharmacological activities of noni preparations developed in Cuba. OBJECTIVE: assessing the effects of Noni leaf and fruit extracts on platelet aggregation and blood coagulation, as well as the possible influence of plant age, leaf maturity and extract total phenol and flavonoid contents on it. METHODS: green and yellow leaves and light yellow fruits were collected from three- and six- year old Noni trees. Leaf (30 g/100 mL w/v) and fruit (100 g/100 mL w/v) extracts were prepared by maceration in 50 % alcohol and water respectively. The concentrations of total soluble solids (TSS), phenolic compounds (PHEN) and flavonoids expressed as quercetin (FLV) in the extracts were determined. The in vitro effects of leaf (0,4 and 0,8 mg TSS/mL) and fruit (0,6 and 1,2 mg TSS/mL) extracts on ADP-induced platelet aggregation (PA), prothrombin time (PT) and partial activated thromboplastine time (PATT) in human plasma was determined. Furthermore, the ex vivo effects of a leaf extract (42 and 378 mg TSS / kg i.p. and 630 mg/kg p.o.) on these variables of rat plasma were assessed. RESULTS: fruit extracts showed higher TSS, but lower PHE and FLV values than leaf extracts. Leaf but not fruit extracts inhibited ADP-induced PA that was independent on plant age and leaf maturity. A significant reduction of PA was ex vivo induced by a leaf extract in rats. TP and PATT were not modified during in vivo or ex vivoexperiments. CONCLUSION: noni leaf hydro-alcohol extracts developed in Cuba have antiplatelet but not anticoagulant effect.

Chang Pon Piang: un médico chino / Chang Pon Piang: a Chinese physician

La medicina tradicional china se expandió por Europa en los siglos XVI y XVII a través de las crónicas de los misioneros. Entra a la isla de Cuba amparada por la Orden Real del 7 de julio de 1847, que legalizaba el uso de braceros asiáticos en Cuba. En 1854 llega Chang Pon Piang a La Habana a bordo de un bergantín de emigrantes chinos culíes. Incluía en su terapéutica medicamentos preparados a partir de plantas medicinales cubanas o productos extranjeros importados que compraba en cualquiera de los establecimientos de la Capital. Acusado de ejercicio ilegal de la medicina se traslada en el año 1871 a Cárdenas, donde ejerce su profesión hasta su enigmática muerte(AU)

Chinese traditional medicine spread out over Europe in the XVI and XVII centuries through the missionaries chronicles. It entered the Island of Cuba protected by the Royal Order of July 7th, 1847, legalizing the use of Asiatic laborers in Cuba. Chang Pon Piang arrives to Havana in 1854 on-board of a brig of Chinese emigrant-laborers. He included in his therapy medicines prepared using Cuban medicinal plants or foreign imported products he used to buy in stores of the Capital. Accused of illegally practicing medicine, he moved to Cardenas where he practiced his profession up to his enigmatic death(AU)

Impacto de las revistas médicas cubanas en Scopus / plantas medicinales medicina tradicional

Con el objetivo de determinar el comportamiento de los índices de citación de las contribuciones de autores cubanos en el área de la Medicina en Scopus, así como la distribución de ciertas variables de interés a los efectos de explicar el comportamiento de dichos niveles de citación, se identificaron y compararon los índices de citación de Cuba en Scopus con respecto a un grupo de países latinoamericanos seleccionados. Para esto se utilizó SCImago Journal & Country Rank. La producción científica de Cuba en ciencias de la salud duplica prácticamente la producción del resto de las áreas del conocimiento en Scopus; de ella, el 69,27 por ciento corresponde a Medicina; el 62,87 por ciento se publicó en revistas nacionales y el 66,44 por ciento se publicó en español. El índice de citación de la producción científica de Cuba en Medicina es muy inferior a los que presentan los países considerados como productores mayores y moderados de literatura médica en América Latina. Entre 2009 y 2011, las revistas médicas cubanas publicaron 1 815 artículos citables. Sin embargo, en 2012, solo recibieron 80 citas para un promedio de 0,044 por artículo publicado. El volumen de la literatura médica de Cuba publicada en revistas nacionales, procesadas por Scopus, unido a sus pobres índices de citación, reduce sustancialmente los índices de citación de Cuba como país. Urge, por tanto, elevar la calidad de las contribuciones publicadas por estas revistas con vistas a disminuir su volumen total y aumentar sus niveles de citación(AU)

Scopus citation indexes for contributions by Cuban authors in the field of health sciences were identified and compared with those of selected Latin American countries to determine and explain their behavior based on the distribution of certain variables of interest. Use was made of SCImago Journal & Country Rank. Cuban scientific production in health sciences in Scopus practically doubles other knowledge areas. 69,27 percent of such production corresponds to medicine, 62,87 percent was published in national journals and 66,44 percent in Spanish. The citation index for Cuban scientific production in health sciences is considerably lower than for countries considered as great and moderate producers of medical literature in Latin America. From 2009 to 2011 Cuban medical journals published 1 815 citable papers. However, only 80 citations were received in 2012, for an average of 0,044 per published paper. The volume of Cuban medical literature published in national journals and processed by Scopus, together with their poor citation indexes, substantially lowers the citation indexes of Cuba as a country. It is thus urgent to increase the quality of the contributions published by these journals with a view to reducing their total volume and raising citation levels(AU)