Vigilancia de los eventos adversos a la vacunación en Camagüey (2018)

Objetivo: Evaluar la vigilancia de los eventos adversos a la vacunación en Camagüey en 2018. Métodos: Investigación en servicios y sistemas de salud de tipo operacional, con diseño evaluativo, que abarcó desde el 1ro. de enero hasta el 31 de diciembre de 2018. La población de estudio quedó constituida por 355 trabajadores (149 médicos de la familia, 161 enfermeras de familia, 16 enfermeras vacunadoras y 29 gerentes del programa de vacunación). La información se obtuvo mediante observación, revisión documental y entrevistas. Para evaluar los componentes: estructura, procesos y resultados, se definieron diferentes criterios, indicadores y estándares. Resultados: La estructura se evaluó como definida. El 90,9 % de los indicadores relacionados con cobertura y capacitación de los recursos humanos obtuvo la puntuación máxima, y en los recursos materiales, solo en el 81,2 % de los vacunatorios se disponía del conjunto de modelos necesario para el trabajo y control. Los atributos de sensibilidad, simplicidad, flexibilidad, aceptabilidad, integralidad, oportunidad y capacidad de autorespuesta, se evaluaron satisfactoriamente (70 % o más del estándar propuesto); la sensibilidad alcanzó solo el 34,2 %. Se obtuvo una tasa de 150 eventos adversos por 105dosis aplicadas, pero sin eventos graves, y los resultados se consideraron útiles. Conclusiones: El sistema de vigilancia de eventos adversos a la vacunación en Camagüey cumplió con los estándares establecidos para la confiabilidad del programa de vacunación y la toma de decisiones: una estructura bien definida, procesos con buen funcionamiento y resultados muy útiles.

Objective: To evaluate the surveillance for adverse events to vaccination in Camagüey in 2018. Methods: Operational research in health services and systems, with an evaluative design, which covered from January 1 to December 31, 2018. The study population comprised 355 workers (149 family physicians, 161 family nurses, 16 nurse vaccinators, and 29 vaccination program managers). Information was obtained through observation, documentary review, and interviews. Different criteria, indicators, and standards were established for evaluating the structure, process and outcome components. Results: The structure was evaluated as defined. The maximum score was obtained in 90.9% of the indicators related to coverage and training of human resources. Regarding material resources, only 81.2% of the vaccination centers had the necessary set of templates to carry out the work and control. The attributes of sensitivity, simplicity, flexibility, acceptability, comprehensiveness, timeliness, and self-response capacity were evaluated satisfactorily (70% or more of the proposed standard); sensitivity reached only 34.2%. A rate of 150 adverse events per 105doses applied was obtained; severe events were not evidenced, and the results were considered useful. Conclusions: The surveillance system for adverse events to vaccination in Camagüey met the standards established for the reliability of the vaccination program and decision-making: a well-defined structure, well-functioning processes, and very useful outcomes.

Safety and effectiveness of CIMAvax-EGF administered in community polyclinics.

In spite of the advances in immunotherapy and targeted therapies, lung cancer continues to be the leading cause of cancer-related death. The epidermal growth factor receptor is an established target for non-small cell lung cancer (NSCLC), and its overactivation by the ligands can induce accelerated proliferation, angiogenesis, and metastasis as well as proinflammatory or immunosuppressive signals. CIMAvax-EGF is an epidermal growth factor (EGF)-depleting immunotherapy that is approved for the treatment of NSCLC patients in Cuba. The study was designed as a phase IV trial to characterize the safety and effectiveness of CIMAvax-EGF in advanced NSCLC patients treated in 119 community polyclinics and 24 hospitals. CIMAvax-EGF treatment consisted of four bi-weekly doses followed by monthly boosters. Overall, 741 NSCLC patients ineligible for further cancer-specific treatment were enrolled. CIMAvax-EGF was safe, and the most common adverse events consisted of mild-to-moderate injection site reactions, fever, chills, tremors, and headache. For patients completing the loading doses, the median survival was 9.9 months. For individuals achieving at least stable disease to the frontline and completing vaccination induction, the median survival was 12 months. Most of the functional activities and symptoms evaluated through the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire improved over time. In conclusion, this real-world trial demonstrated that CIMAvax-EGF was safe and effective in patients who were vaccinated in the maintenance scenario. A larger effect was seen in subjects with poor prognosis like those with squamous tumors and high EGF levels. Remarkably, this community-based intervention was very important because it demonstrated the feasibility of treating advanced lung cancer patients with active immunotherapy in primary care institutions. In addition to CIMAvax-EGF, patients received supportive care at the community clinic. Vaccine administration by the family doctors at the polyclinics reduced the patients' burden on the medical oncology services that continued providing chemotherapy and other complex therapies. We conclude that community polyclinics constitute the optimal scenario for administering those cancer vaccines that are safe and require prolonged maintenance in patients with advanced cancer, despite the continuous deterioration of their general condition. Clinical trial registration: https://rpcec.sld.cu/trials/RPCEC00000205-En, identifier RPCEC00000205.

Brote de transmisión comunitaria de COVID-19 en un municipio de La Habana (marzo-abril, 2021)

Introducción: Una oportuna investigación de los eventos epidemiológicos de la COVID-19 garantiza minimizar la propagación de la enfermedad en la población. Objetivos: Caracterizar el brote de transmisión comunitaria de COVID-19 en un municipio de La Habana. Métodos: Estudio transversal de casos positivos de infección por SARS-CoV-2 del brote Catedral en La Habana Vieja, en 2021. Las variables analizadas fueron: edad, sexo, manzana de residencia, fecha de inicio de síntomas, fecha de diagnóstico, forma clínica, tipo de caso. Se utilizó la metodología para el estudio de brotes. Se calcularon porcentajes, diferencias de proporciones, tasas, número reproductivo efectivo y parámetro de dispersión con intervalos de confianza de 95 %. Resultados: Se notificó el brote el 23 de marzo y se cerró el 22 de abril con 106 casos (tasa de ataque 4,51 %), el pico en la notificación se produjo el 29 de marzo con 40 casos (37,73 %). La edad media fue de 43 años. Resultaron más afectados los adultos de 60 y más años (30,18 %), las mujeres (58,49 %) y la manzana 0024 (45,28 % de los casos). El 77,3 % no presentó síntomas, entre ellos dos superdispersores; los sintomáticos fueron leves y no hubo fallecidos. El número reproductivo efectivo global fue de 0,94 (IC: 0,70-1,21); superior en los asintomáticos (11,43 versus 4,00); y el parámetro de dispersión de 0,89 (IC: 0,51-2,09), superior en los sintomáticos (1,06 versus 0,69). Conclusiones: El control epidemiológico oportuno ante cada caso permitió la corta duración del brote y que no hubiesen fallecidos.

Introduction: A timely investigation of COVID-19 epidemiological events guarantees to minimize the spread of the disease in the population. Objective: To characterize the COVID-19 outbreak of community transmission in a municipality in Havana. Methods: Cross-sectional study of positive cases of SARS-CoV-2 infection of the "Cathedral" outbreak in Old Havana in 2021. The variables analyzed were: age, sex, city block of residence, date of symptom onset, date of diagnosis, clinical manifestations, and type of case. The methodology for the study of outbreaks was used. Percentages, differences in proportions, rates, effective reproductive number, and dispersion parameter with 95% confidence intervals were calculated. Results: The outbreak was reported on March 23 and closed on April 22 with 106 cases (attack rate of 4.51%). The peak was notified on March 29 with 40 cases (37.73%). The mean age was 43 years. Adults aged 60 years and older (30.18%), women (58.49%), and block 0024 (45.28% of cases) were most affected. A total of 77.3% were asymptomatic, including two superspreaders; symptomatic cases were mild and there were no deaths. The overall effective reproductive number was 0.94 (CI: 0.70-1.21); higher in asymptomatic cases (11.43 versus 4.00); and the dispersion parameter was 0.89 (CI: 0.51-2.09), higher in symptomatic cases (1.06 versus 0.69). Conclusions: Timely epidemiological control of each case ensured the short duration of the outbreak and no deaths.

Asymptomatic SARS-CoV-2 Infection in Havana, Cuba, March-June 2020: Epidemiological Implications.

INTRODUCTION: The percentage of asymptomatic COVID-19 cases worldwide is estimated at 18-50%; 53% in Cuba specifically, and 58% in Havana, the Cuban capital and the 2020 epicenter of the country's COVID-19 epidemic. These figures, however, do not represent the transmission capacity or behavior of asymptomatic cases. Understanding asymptomatic transmission's contribution to SARS-CoV-2 spread is of great importance to disease control and prevention. OBJECTIVE: Identify the epidemiological implications of asymptomatic SARS-CoV-2 infection in Havana, Cuba, during the first wave of the epidemic in 2020. METHODS: We carried out a cross-sectional study of all confirmed COVID-19 cases diagnosed in Havana, Cuba, from March 16 through June 30, 2020. The information was obtained through review of the standardized form for investigation of suspected and confirmed cases. Examined variables included age, sex, occupation, case type and source of infection. Cases were divided into asymptomatic and symptomatic groups, and transmission was characterized through the creation of a contact matrix. Analysis was carried out in Epidat and R. RESULTS: We studied 1287 confirmed cases, of which 57.7% (743) were asymptomatic, and 42.3% (544) were symptomatic. Symptomatic presentation was the most common for both imported and introduced cases, while asymptomatic presentation was more common in autochthonic cases and infections from an undetermined source. Asymptomatic infection was more common in groups aged ⟨20 and 20-59 years, while symptomatic infection was more common in those aged ⟩60 years. In the contact matrix, 34.6% of cases (445/1287) were not tied to other cases, and 65.4% (842/1287) were infectious-infected dyads, with symptomatic-symptomatic being the most common combination. The majority of primary cases (78.5%; 1002/1276) did not generate secondary cases, and 85.6% (658/743) of asymptomatic cases did not lead to other cases (although one asymptomatic superspreader led to 90 cases in a single event). However, 63.2% (344/544) of symptomatic primary cases generated secondary cases, and 11 symptomatic superspreaders spawned 100 secondary cases in different events. CONCLUSIONS: Asymptomatic SARS-CoV-2 infection was the most common form of COVID-19 in Havana during the study period, but its capacity for contagion was lower than that of symptomatic individuals. Superspreader events under specific conditions played an important role in sustaining the epidemic.

Transmisión intrahospitalaria de SARS-CoV-2

RESUMEN Introducción: La alta transmisión de la COVID-19 propicia que el personal de salud contraiga la infección durante la atención a los pacientes con la probabilidad de propagarla a otros pacientes hospitalizados y compañeros de trabajo. Objetivo: Describir un brote intrahospitalario de COVID-19. Métodos: Estudio descriptivo, transversal realizado en el Hospital Universiario Clínico Quirúrgico " General Calixto García" , La Habana en marzo de 2020. Se estudiaron 545 personas entre pacientes y trabajadores. Los datos se recolectaron mediante fichas clínico-epidemiológicas e historias clínicas. Los casos se describieron según: tipo de personal de salud, servicios que atienden, sexo, síntomas, signos y comorbilidades. Se realizó una matriz de contactos y para evaluar la intensidad del brote se calculó el número reproductivo y el valor de dispersion. Resultados: De los 545 estudiados, 30 % fueron pacientes y 70 % trabajadores de siete servicios, 30 tuvieron el diagnóstico confirmado de SARS-CoV-2. Las acciones de control de foco se dirigieron a la identificacion, notificacion y aislamiento de los enfermos. La edad promedio fue de 45 años, el cuadro clínico caracterizado por tos, disnea y astenia. Las comorbilidades más frecuentes (60 %) fueron hipertensión arterial, cardiopatia isquémica y diabetes mellitus, asintomaticos 53,3 % y tres fallecidos. La tasa de ataque fue de 5,5 %. Conclusiones: Los trabajadores más afectados son los médicos y las enfermeras. La oportunidad en las acciones del control de foco y la calidad en la investigacion epidemiológica son esenciales para lograr un control efectivo.

ABSTRACT Introduction: The high transmission of COVID-19 has resulted in healthcare workers becoming infected while caring for patients and spreading the disease to other hospital patients or coworkers. Objective: To describe an in-hospital COVID-19 outbreak. Methods: A cross-sectional descriptive study conducted in March 2020 at the "General Calixto García Íñiguez" Clinical-Surgical University Hospital, Havana. The study included 545 individuals among patients and healthcare workers. The data was collected from the clinical-epidemiological profiles and the medical records. Each case was described using the following criteria: type of health worker, service provided, sex, signs, symptoms, and comorbidities. To determine the outbreak intensity, a contact matrix was created and the reproductive number and the dispersion value were calculated. Results: Of the 545 studied individuals, 30% were patients and 70% workers of seven services, 30 tested positive for SARS-CoV-2. Outbreak control actions were aimed at identifying, reporting and isolating sick individuals. The average age was 45 years. The clinical pictures was characterized by cough, dyspnea and asthenia. The most common comorbidities (60%) were hypertension, ischemic cardiopathology, and diabetes mellitus; 53.3% were asymptomatic and three people died. The attack rate was 5.5%. Conclusions: During the outbreak, medical doctors and nurses were the most affected. The timeliness of outbreak control actions and the quality of the epidemiological investigation are essential to ensure effective control.

Clinical-Epidemiological Characteristics of the First Patients Diagnosed with COVID-19 in Cuba.

INTRODUCTION: COVID-19 is caused by the novel coronavirus SARS-CoV-2 and was declared a pandemic on March 11, 2020, the same day that the first cases in Cuba were diagnosed. In Cuba, all confirmed cases of COVID-19 were hospitalized from this point forward. OBJECTIVE: Characterize the first patients diagnosed with COVID-19 in Cuba. INTRODUCTION: METHODS We carried out a descriptive, cross-sectional study of 415 suspected cases of COVID-19 admitted to the Pedro Kourí Tropical Medicine Institute in Havana, Cuba, from March 11, 2020 through April 10, 2020. (In Cuba, all patients suspected of being COVID-19-positive were admitted to hospitals or isolation centers for observation and treatment.) Of these 415 individuals, 63 (15.2%) tested positive for SARS-CoV-2. Information was obtained from the Institute's databases as well as a standardized interview form for cases confirmed or suspected as infected with the novel coronavirus. We considered the following variables: age, sex, occupation at the time of interview, national origin, personal health history, time elapsed between symptom onset and hospital admission, signs and symptoms, diagnosis and status at discharge. We based our analysis on frequency distributions and double-entry contingency tables. RESULTS: The mean age was 50 years (range: 16-94 years). The 45-54 age group represented the largest share of cases (25.4%; 16/63); persons aged ≥65 years were 20.6% (13/63); there were more men than women (55.6% vs. 44.4%). Cubans represented 52.4% (33/63) of patients while 47.6% (30/63) were from 14 countries where COVID-19 had already been identified. All foreigners and Cubans who arrived from abroad were considered imported cases (54.0%; 34/63). Health personnel (10 doctors and 1 nurse) represented 17.5% (11/63) of cases. Cough (50.8%), fever (46.0%), sore throat (22.2%) and headache (19.0%) were the most frequently reported symptoms. Asymptomatic patients represented 25.4% (16/63) of cases. Hypertension was the most frequently associated chronic disease (28.6%), followed by asthma (25.0%) and diabetes (17.9%). Patients who were admitted to hospital ≥3 days after symptom onset represented 66.7% (42/63) of cases. Mean hospital stay was 13.7 days (range: 1-27 days). Factors associated with a higher risk of contracting the disease included occupation as a healthcare worker (OR: 1.85; 95%, CI: 0.88-3.87) and aged ≥65 years (OR: 1.68; 95% CI: 0.85-3.34). Five individuals died, for a fatality rate of 7.9% (three foreigners and two Cubans; four men and one woman). Four of these patients were infected outside of Cuba and one was identified as a contact of a confirmed case. All patients who died had significant comorbidities (diabetes, asthma and hypertension). Age of deceased patients ranged from 54 to 87 years. CONCLUSION: The first patients diagnosed with COVID-19 in Cuba were admitted to the Pedro Kourí Tropical Medicine Institute in Havana. They share characteristics with those reported by other countries: more men than women were affected, and comorbidities including hypertension, diabetes and asthma were all important risk factors, as was age ≥65 years. More than half of all cases were imported, and autochthonous patients were all contacts of confirmed cases.

Characterization of Adverse Events Following Childhood Immunizations in Pinar del Río, Cuba.

INTRODUCTION: The Cuban national program for childhood immunizations began in 1962 and has included a surveillance system for monitoring adverse events following immunization since 1999. The expected rate of adverse events following childhood immunization in Cuba is 50 per 100,000 vaccine doses administered. In 2017, Pinar del Río Province reported higher-than-expected rates of adverse events, which motivated this study on their frequency and types. OBJECTIVE: Characterize adverse events following immunization reported in children in Pinar del Río Province in 2017. METHODS: We examined reports of adverse events following immunization in children from 2 months through 14 years of age in Pinar del Río Province, Cuba, from January 1, 2017 through December 31, 2017. We found 487 adverse events that met the criteria established by the national surveillance system. Information was obtained from epidemiological surveys of adverse events following immunization in Pinar del Río Province municipalities. Recorded were age, municipality, signs and symptoms, vaccine type, number of doses, anatomical site and route of vaccine administration, and the institution where the child was vaccinated. We estimated proportions for intensity and frequency related to vaccination, and calculated rates for 100,000 vaccine doses administered. We then compared the rates of observed adverse events with those of expected events. RESULTS: The overall rate of adverse events was 305.6 per 100,000 doses administered. Highest rates were reported in children aged ⟨1 year (580.9 per 100,000 doses administered); in Guane Municipality (610 per 100,000 doses), for the pentavalent (DTwP-HB-Hib) vaccine (1567.7 per 100,000 doses), and in applications to the anterolateral quadrant of the thigh (772.5 per 100,000 doses). Symptoms classifi ed as moderate, common, and general occurred more often, with fever being the most frequent. Severe induration, hypotonic and hyporesponsive episodes, persisten crying and rashes were observed more frequently than expected. CONCLUSIONS: The rate of adverse events following childhood immunization is similar to that reported in other provinces and elsewhere in the world. Of all childhood vaccines, the pentavalent vaccine is the most reactogenic. The absence of serious adverse events demonstrates the safety of childhood immunization in Cuba.

Allele Frequency of ACE2 Intron Variants and Its Association with Blood Pressure.

Angiotensin-converting enzyme 2 (ACE2) is known as the counter-regulator of the renin-angiotensin system, it cleaves angiotensin II to render Ag 1-7, a potent vasodilator with multiple roles in cardiovascular protection. A few studies have pinpointed ACE2 polymorphisms and their relationship with heart function and hypertension in a sex-dependent manner. These observations still lack replication mostly for admixed populations. This study aimed to report minor allele frequencies of four ACE2 intron variants, rs2285666, rs2048683, rs2106809, and rs4240157, derived from previous research using the GSA, v1.0, microarray in 1231 hypertensive and nonhypertensive patients. Logistic and multiple linear regression models were developed to identify potential associations with hypertension status and systolic and diastolic blood pressure (SBP and DBP). Allele frequency differences were identified for ACE2 rs2048683 and rs4240157 in populations with European ancestry and people of the Americas. Regression analyses identified a significant association of ACE2 rs2048683 and rs4240157 with SBP/DBP in males or females. Our observations confirm sex differences in ACE2 genetic associations with SBP and DBP and contribute to the collection of genetic variation in ACE2 for admixed populations.

A Cuban Perspective on the Antivaccination Movement.

Vaccination is one of the most cost-effective interventions for control of communicable diseases. This health achievement could flounder if measures are not taken by health systems to prioritize immunization, increase vaccination rates and educate health professionals to address public concerns about vaccine safety and efficacy. Parents' refusal to vaccinate their children directly affects public health, because it puts both individual and group immunity in danger; immunization coverage is effective only when high population coverage is attained. The growing number of antivaccination (antivaxxer) groups around the world is alarming, contributing to falling vaccination rates. Troubling consequences include disease outbreaks in several countries globally and in our hemisphere. This article looks at the history and features of antivaxxer movements around the world and proposes ways the Cuban health system, through its National Immunization Program, can address dangers for the population associated with potentially negative infiuences of social-network antivaxxer campaigns. The paper underscores the role of mass and social media, health professional training and sustained competence, and the importance of a vaccine-related adverse events surveillance system. KEYWORDS Vaccination, immunization, antivaccination move-ment, antivaccine groups, primary health care, society, communi-cations media, social media, Cuba.

Purificación del toxoide pertúsico de Bordetella pertussis / Pertussis Toxoid Purification of Bordetella pertussis

Introducción: el toxoide pertúsico es una proteína muy utilizada en las vacunas acelulares contra la tosferina. Desarrollar un protocolo para su purificación con pocos pasos y con parámetros de purificación adecuados, es muy importante para su caracterización química y la valoración de los efectos adversos que puede provocar al inocular principalmente a ratones. Los protocolos de purificación descritos en la literatura científica involucran varios pasos de purificación y bajos rendimientos. Objetivo: desarrollar un protocolo de purificación del toxoide pertúsico que garantice un grado de pureza alto y un rendimiento de más de 80% a partir de cultivos de un mutante de B. pertussis obtenido en el Centro Nacional de Investigaciones Científicas (CNIC). Métodos: para purificar el toxoide se usó una columna de intercambio catiónico Fractogel EMD SO-3 y se eluyó incrementando el pH y la concentración salina por pasos hasta obtener los resultados esperados. La determinación de proteínas totales se realizó mediante el micrométodo linealizado de Bradfor10 usando como patrón albúmina de suero bovina (BSA). Resultados: se obtuvo 3,28 mg de toxoide por cada litro de cultivo con un rendimiento de 86,7% y un grado de pureza de 96,7%. Conclusiones: el procedimiento de purificación descrito permite obtener el toxoide pertúsico con un rendimiento mayor que el 80% y alto grado de pureza, lo que garantiza la calidad requerida para su caracterización bioquímica e inmunológica.

Introduction: pertussis toxoid is a widely used in acellular vaccines against pertussis protein. Develop a protocol for purification with few steps and with parameters suitable purification is very important for chemical characterization and assessment of adverse effects that can lead to inoculate mainly mice. Purification protocols described in scientific literature involve several purification steps and low yields. Objective: to develop a protocol for purification of pertussis toxoid to ensure a high degree of purity and a yield of over 80% from cultures of a mutant of B. pertussis obtained at the National Center for Scientific Research (CNIC). Methods: for purifying the toxoid cation a Fractogel EMD SO-3 cationic interchange column was used by increasing the pH and salt concentration to obtain the expected results. The total protein determination was performed using linearized macromethod of Bradfor10 using as bovine serum albumin standard (BSA). Results: 3.28 mg toxoid was obtained per liter of culture with a yield higher than 86.7% and a purity of 96.7%. Conclusions: the purification process described allows for the pertussis toxoid with a higher yield than 80% and high purity, ensuring the quality required for biochemical and immunological characterization.

Purificación del toxoide pertúsico de Bordetella pertussis / Pertussis Toxoid Purification of Bordetella pertussis

Introducción: el toxoide pertúsico es una proteína muy utilizada en las vacunas acelulares contra la tosferina. Desarrollar un protocolo para su purificación con pocos pasos y con parámetros de purificación adecuados, es muy importante para su caracterización química y la valoración de los efectos adversos que puede provocar al inocular principalmente a ratones. Los protocolos de purificación descritos en la literatura científica involucran varios pasos de purificación y bajos rendimientos.Objetivo: desarrollar un protocolo de purificación del toxoide pertúsico que garantice un grado de pureza alto y un rendimiento de más de 80% a partir de cultivos de un mutante de B. pertussis obtenido en el Centro Nacional de Investigaciones Científicas (CNIC).Métodos: para purificar el toxoide se usó una columna de intercambio catiónico Fractogel EMD SO-3 y se eluyó incrementando el pH y la concentración salina por pasos hasta obtener los resultados esperados. La determinación de proteínas totales se realizó mediante el micrométodo linealizado de Bradfor10 usando como patrón albúmina de suero bovina (BSA).Resultados: se obtuvo 3,28 mg de toxoide por cada litro de cultivo con un rendimiento de 86,7% y un grado de pureza de 96,7%.Conclusiones: el procedimiento de purificación descrito permite obtener el toxoide pertúsico con un rendimiento mayor que el 80% y alto grado de pureza, lo que garantiza la calidad requerida para su caracterización bioquímica e inmunológica.(AU)

Introduction: pertussis toxoid is a widely used in acellular vaccines against pertussis protein. Develop a protocol for purification with few steps and with parameters suitable purification is very important for chemical characterization and assessment of adverse effects that can lead to inoculate mainly mice. Purification protocols described in scientific literature involve several purification steps and low yields.Objective: to develop a protocol for purification of pertussis toxoid to ensure a high degree of purity and a yield of over 80% from cultures of a mutant of B. pertussis obtained at the National Center for Scientific Research (CNIC).Methods: for purifying the toxoid cation a Fractogel EMD SO-3 cationic interchange column was used by increasing the pH and salt concentration to obtain the expected results. The total protein determination was performed using linearized macromethod of Bradfor10 using as bovine serum albumin standard (BSA). Results: 3.28 mg toxoid was obtained per liter of culture with a yield higher than 86.7% and a purity of 96.7%.Conclusions: the purification process described allows for the pertussis toxoid with a higher yield than 80% and high purity, ensuring the quality required for biochemical and immunological characterization.

Diagnostic parameters of serological ELISA for invasive amoebiasis, using antigens preserved without enzymatic inhibitors.

Amoebiasis is the third cause of death due to parasites in the world. Although, numerous serodiagnostic and salivary tests have been developed, the majority of these assays lack sensitivity in endemic zones to detect acute amoebic liver abscess. The two main limiting factors to develop reliable assays are the high levels of anti-amoeba antibodies in populations living in endemic zones, and the proteolysis of amoebic extracts even treated with inhibitors. Our group reported a method to preserve amoebic antigens without using enzymatic inhibitors (IC:MC fraction) that shows stability for years. Here we describe the development of a serologic ELISA to diagnose amoebiasis made with IC: MC antigens, and its validation for clinical use in endemic areas. In our study, we included sera from 66 patients diagnosed with acute amoebic liver abscess and 33 volunteers living in an endemic area for amoebiasis. Our assay was compared with an indirect haemagglutination assay (IHA) an ELISA elaborated with antigens derived from untreated trophozoites. The ELISA made with IC: MC antigens presented more reproducibility compared to other assays. Sera from 95% ALA patients showed a positive value. The ELISA (IC: MC) detected 97% of patients with ALA compared to an 81% using IHA. The parameters of ELISA (vs. IHA) were Sensitivity 98% (81%), Specificity 96% (97%), Positive predictive value 98% (96%), Negative predictive value 96% (73%) and Accuracy 98% (87%). A negative serologic test does not rule out the diagnosis of invasive amoebiasis. The ELISA made with antigens preserved without using enzymatic inhibitors has valuable serodiagnostic value to diagnose acute amoebic liver abscess, even in populations living in endemic zones of amoebiasis carrying antibodies against amoebas. In conclusion, ELISA-IC:MC presented better diagnostic parameters than IHA although a negative serologic test does not rule out acute invasive amoebiasis.

Síndrome de Noonan. Presentación de un caso / Noonan’s Syndrome. Case Report

El síndrome de Noonan es una enfermedad genética, poco conocida, producida por una mutación en el cromosoma 12q22. En Cuba existen pocos datos sobre esta afección, ya que no se han realizado estudios con una muestra significativa que demuestren la frecuencia real de la afección. Se presenta un paciente de ocho años de edad, natural de Banes, Holguín, al cual se le diagnosticó el síndrome a través de la técnica comparativa o de patrón, y considerando las características clínicas y radiológicas. Se tuvo en cuenta el consentimiento de los padres para realizar y divulgar este informe. El interés de este caso radica en la baja frecuencia de aparición del Síndrome de Noonan, de hecho, es el primero que se ha diagnosticado en el municipio.

Noonan’s syndrome is a genetic, little-known disease, produced for a mutation in the 12q22 chromosome. Few data on this affection exists in Cuba; since studies with a significant sample have not been conducted that demonstrate the real frequency of the affection. An eight year old patient’s case from Banes, Holguín, is presented, to whom the syndrome through comparative technique was diagnosed, and considering the clinics and radiological characteristics. The consent of parents to do and to divulge this report was taken into account. The interest of this case consists on the low frequency of appearing of Noonan’s syndrome, in fact, the first one that has been diagnosed at the municipality.

Hypocholesterolemia in patients with an amebic liver abscess.

BACKGROUND/AIMS: Many parasites induce changes in the lipid profiles of the host. Cholesterol increases the virulence of Entamoeba histolytica in animal models and in vitro culture. This study aimed to determine, in patients with an amebic liver abscess, the correlation between cholesterol and other features, such as the size and number of abscesses, standard hematological and serum chemistry profiles, liver tests, and duration of hospital stay. METHODS: A total of 108 patients with an amebic liver abscess and 140 clinically healthy volunteers were investigated. Cholesterol and triglycerides were measured in the sera. The data from medical observations and laboratory tests were obtained from the clinical records. RESULTS: A total of 93% of patients with an amebic liver abscess showed hypocholesterolemia not related to any of the studied parameters. Liver function tests correlated with the size of the abscess. The most severe cases of amebic liver disease or death were found in patients whose cholesterol levels continued to decrease despite receiving antiamebic treatment and hospital care. CONCLUSIONS: Our results show that the hypocholesterolemia observed in patients with an amebic liver abscess is not related to any of the clinical and laboratory features analyzed. This is the first study relating hypocholesterolemia to severity of hepatic amebiasis.

Evaluación del programa nacional de rabia, provincia Pinar del Río, 2010 / Evaluation of Rabies National Program, Pinar del Río Province (2010)

La evaluación está concebida como la actividad que permite emitir un juicio de valor, identificar las brechas existentes entre el cumplimiento de los objetivos y su comportamiento en un momento determinado, proponiendo posteriormente las medidas para su corrección. El objetivo fue evaluar los componentes estructura, proceso y resultados del mismo. Se realizó una investigación evaluativa del programa de rabia en la provincia Pinar del Río en el 2010 La información se obtuvo mediante la revisión de documentos, observaciones de proceso, entrevistas a los recursos humanos implicados en el programa; se utilizaron como medidas de resumen frecuencias absolutas, razones, proporciones o porcentajes, y tasas; se definieron los criterios, indicadores y estándares sobre la base de criterios normativos y de expertos. La dimensión estructura fue evaluada de inadecuada, no cumpliendo con el estándar propuesto. En la dimensión proceso, el 66,6 por ciento de los indicadores examinados resultaron regular o mal. El 66.6 por ciento de los indicadores en la dimensión resultado del programa se evaluaron de mal. El programa de rabia fue evaluado de inadecuado(AU)

The evaluation is conceived as the activity permitting to deliver judgments of value, to identify the gaps existing between the achievement of the goals and its behavior in a certain time, and the further proposal of measures for correction. The objective was to evaluate its components structure, process, and results. An evaluative revision of the rabies program was made in Pinar del Río Province in 2010. The information was collected by papers research, observation of processes, interviews with the human resources involved in the program; as synthetic means we used absolute frequencies, rates, and percentages. The criteria, indicators and standards were defined under normative and expert criteria. The dimension structure was evaluated as inadequate, as it does not comply by the proposed standards. In the dimension process, the 66.6 percent of the examined indicators were evaluated as wrong or fair. The 66.6 percent of the indicators of the dimension results of the program were evaluated as wrong. The Rabies Program was evaluated as wrong(AU)

Evaluación del programa nacional de rabia, provincia Pinar del Río, 2010 / Evaluation of Rabies National Program, Pinar del Río Province (2010)

Introducción: la evaluación está concebida como la actividad que permite emitir un juicio de valor, identificar las brechas existentes entre el cumplimiento de los objetivos y su comportamiento en un momento determinado, proponiendo posteriormente las medidas para su corrección. Objetivo: evaluar los componentes estructura, proceso y resultados del mismo. Material y métodos: se realizó una investigación evaluativa del programa de rabia en la provincia Pinar del Río en el 2010 La información se obtuvo mediante la revisión de documentos, observaciones de proceso, entrevistas a los recursos humanos implicados en el programa; se utilizaron como medidas de resumen frecuencias absolutas, razones, proporciones o porcentajes, y tasas; se definieron los criterios, indicadores y estándares sobre la base de criterios normativos y de expertos. Resultados: la dimensión estructura fue evaluada de inadecuada, no cumpliendo con el estándar propuesto. En la dimensión proceso, el 66,6% de los indicadores examinados resultaron regular o mal. El 66.6% de los indicadores en la dimensión resultado del programa se evaluaron de mal. Conclusiones: el programa de rabia fue evaluado de inadecuado.

Introduction: the evaluation is conceived as the activity permitting to deliver judgments of value, to identify the gaps existing between the achievement of the goals and its behavior in a certain time, and the further proposal of measures for correction. Objective: to evaluate its components structure, process, and results. Material and methods: an evaluative revision of the rabies program was made in Pinar del Río Province in 2010. The information was collected by papers research, observation of processes, interviews with the human resources involved in the program; as synthetic means we used absolute frequencies, rates, and percentages. The criteria, indicators and standards were defined under normative and expert criteria. Results: the dimension structure was evaluated as inadequate, as it does not comply by the proposed standards. In the dimension process, the 66.6% of the examined indicators were evaluated as wrong or fair. The 66.6% of the indicators of the dimension results of the program were evaluated as wrong. Conclusions: the Rabies Program was evaluated as wrong.

Factores de riesgo relacionado con la mortalidad en la cirugía multivalvular / Fatores de risco relacionados à mortalidade na cirurgia multivalvar / Risk factors related to multivalve surgey mortality

Las enfermedades cardiovasculares son las que afectan en mayor grado a los países desarrollados y a los países en vía de desarrollo. Cuba no está exenta de esto, y las enfermedades cardiovasculares son la primera causa de muerte en nuestro medio y, dentro de ellas, las lesiones valvulares siguensiendo una enfermedad cardiaca frecuente. Se realizó un estudio descriptivo y retrospectivo en 128 pacientes operados de 2 o más válvulas cardíacas en el Servicio de Cirugía Cardiovascular del Hospital Hermanos Ameijeiras, de enero del 2006 a diciembre del 2010. Se evaluaron las variables preoperatorias, transoperatorias y postoperatorias y su relación con la mortalidad. Predominóel sexo femenino y las edades entre 40 y 59 años. Todos los pacientes se encontraban en clase funcional III y IV. El 50% de los casos presentó el antecedente de fiebre reumática. La afectación valvular predominante fue mitro-aórtica, así como la doble sustitución valvular el procedimientoquirúrgico más realizado. La mortalidad global en este quinquenio de los pacientes operados de válvulas en nuestro servicio fue del 5,9%. Sin embargo en el subgrupo específico de operaciones realizadas sobre varias válvulas fue del 14,8 %, constatándose una asociación significativa de esta variable con: la presencia de fiebre reumática, el hecho de pertenecer a la clase funcional IV, tiempos de CEC por encima de 211 minutos y tiempo de paro anóxico superior a 150 minutos. La presencia de complicaciones como arritmias, anemia y trastornos de la coagulación, del tipo respiratorias, las complicaciones renales y la reintervención quirúrgica mostraron asociación significativa con la mortalidad...

As doenças cardiovasculares são as mais comuns nos países desenvolvidos e nos países em via de desenvolvimento. Cuba também não está isenta e as doenças cardiovasculares são a primeiracausa de morte em nosso meio e, como sabemos, as lesões valvares continuam sendo uma doença cardíaca frequente. Realizou-se um estudo descritivo e retrospectivo em 128 pacientes operados de 2 ou mais valvas cardíacas no Serviço de Cirurgia Cardiovascular do Hospital Hermanos Ameijeiras,de janeiro de 2006 a dezembro de 2010. Avaliaram-se as variáveis pré operatórias, transoperatóriase pós operatórias e sua relação com a mortalidade. O predomínio foi do sexo feminino e as idades predominantes foram de 40 a 59 anos. Todos os pacientes se encontravam em classe funcional III e IV. 50% dos casos apresentou febre reumática como antecedente. A valva mais afetada foi amitro-aórtica, e a dupla troca valvar foi o procedimento cirúrgico mais realizado.A mortalidade global dos pacientes operados de válvulas em nosso serviço neste quinquênio, foi de 5,9%, entretanto, no subgrupo específico de operações realizadas sobre várias válvulas, foi de 14,8%, constatando-se uma associação significativa desta variável com a presença de febrereumática, o fato de pertenecer à classe funcional IV, tempos de CEC acima de 211 minutos e tempo de parada anóxica superior a 150 minutos. A presença de complicações como arritmias, anemia e trastornos de coagulação, de tiporespiratórias, as complicações renais e a reintervenção cirúrgica, mostraram associação significativa com a mortalidade...

Cardiovascular diseases affect both developed and developing countries. Cuba is not an exception and cardiovascular diseases are the first cause of death in our country and, in them, valve lesions still continue being a frequent heart disease. A descriptive and retrospective analysis of 128 patients operated of two or more cardiac valves was carried out at the Department of Cardiovascular Surgery at the Hermanos Ameijeiras Hospital from January 2006 to December 2010. Preoperative, intraoperative and postoperative variables were assessed and how they related to mortality. There was a prevalence of the female gender and ages ranged from 40 to 59 years. Allpatients were in functional Class III and IV. 50% of the cases had preexisting rheumatic fever. The predominant valve disease was mitral aortic, and the procedure mostly carried out was double valve replacement. Overall mortality of patients undergoing valve surgery in our Department during these five years was 5.9%. Nevertheless, in the specific subgroup of surgeries of several valves mortality was 14.8%, thus reporting a significant relationship of this variable with: presence of rheumatic fever, belonging to functional Class IV, by-pass time over 211 minutes and time of anoxic arrest over 150minutes. The presence of complications such as arrhythmia, anemia, coagulation, respiratory and renaldisorders and surgical re-interventions were statistically significantly related to mortality...

Reacción en la lepra: presentación de un caso clínico / Reactional leprosy: a case report

La reacción en la lepra es una modalidad clínica de presentación aguda o subaguda, de orden local o general, expresión de un fenómeno inmunológico, que ocurre en el curso evolutivo de la enfermedad. Puede suceder en alrededor del 30 por ciento de los pacientes multibacilares: lepromatosos y dimorfos. En la actual investigación se hace la presentación de un caso clínico, paciente masculino, de 44 años, con diagnóstico de lepra lepromatosa, que comenzó con exacerbación del cuadro clínico, con nódulos diseminados e infiltrados, que se correspondió con una reacción leprosa tipo 2, eritema nudoso leproso(AU)

Reactional leprosy is a clinical modality of acute and sub-acute presentation which is local or general, expression of an immunological phenomenon that occurs in the natural history of the disease. It can arise in almost the 30 per cent of the multibacillary, lepromatous and dimorphous patients. In this current study a case of forty four-year-old male patient diagnosed as lepromatous leprosy was reported. The patient presented an exacerbated presentation of the clinical chart with disseminated and infiltrated nodules corresponding to a type-2 reactional leprosy and erythema nodosum leprosum(AU)

Reacción en la lepra. Presentación de un caso clínico / Reactional leprosy. A case report

La reacción en la lepra es una modalidad clínica de presentación aguda o subaguda, de orden local o general, expresión de un fenómeno inmunológico, que ocurre en el curso evolutivo de la enfermedad. Puede suceder en alrededor del 30% de los pacientes multibacilares: lepromatosos y dimorfos. En la actual investigación se hace la presentación de un caso clínico, paciente masculino, de 44 años, con diagnóstico de lepra lepromatosa, que comenzó con exacerbación del cuadro clínico, con nódulos diseminados e infiltrados, que se correspondió con una reacción leprosa tipo 2, eritema nudoso leproso.

Reactional leprosy is a clinical modality of acute and sub-acute presentation which is local or general, expression of an immunological phenomenon that occurs in the natural history of the disease. It can arise in almost the 30% of the multibacillary, lepromatous and dimorphous patients. In this current study a case of forty four-year-old male patient diagnosed as lepromatous leprosy was reported. The patient presented an exacerbated presentation of the clinical chart with disseminated and infiltrated nodules corresponding to a type-2 reactional leprosy and erythema nodosum leprosum.

Factores de riesgo del intento suicida en adolescentes, Pinar del Río / Risk factors of suicide attempt in adolescents, Pinar del Río

Se realizó un estudio observacional analítico de caso y control, con el objetivo de identificar los factores de riesgo relacionados con el intento suicida en los adolescentes del municipio Pinar del Río, en el período comprendido de enero a junio del 2009. El universo del estudio estuvo constituido por la población de 10 a 19 años con intento suicida, quedando conformada la muestra por 36 casos contra 72 controles, seleccionados por un pareo de 1:2, se analizaron los factores de riesgo individuales y familiares asociados al intento suicida. Los datos se obtuvieron mediante la aplicación de un cuestionario diseñado por la autora de la investigación, se determinó la asociación entre los factores de riesgo y el intento suicida, a través de la prueba de Chi cuadrado y la razón de productos cruzados (OR) con estimación puntual y por intervalos de confianza; entre los principales resultados se encontró asociación estadística significativa al intento suicida, de los siguientes factores de riesgo: la presencia de adolescentes con desordenes mentales como depresión y retraso mental, dificultades escolares e internamiento invo luntario y el antecedente de suicidio por otro miembro del hogar...(AU)

An observational, analytical case-control study was carried out with the purpose of identifying the risk factors related to suicide attempt in adolescents in Pinar del Rio municipality from January to June 2009. The target group was comprised of the total population from 10 to 19 years old with suicide attempts; the sample consisted of 36 cases vs. 72 controls, chosen by a matching of 1:2, individual and familial risks factors associated with suicide attempt were analyzed as well. Data were obtained by means of the application of a questionnaire designed by the author of the study, the association between the risk factors and suicide attempt was determined using chi square test and the reason of crossed products ratio by punctual estimation and by confidence intervals; among the main results a significant statistical association to suicide attempt was found and the following risk factors: presence of mental disorders in adolescents (depression), mental retardation, schooling difficulties, involuntary boarding school and history of suicide attempt in other family members...(AU)