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1.
Mol Phylogenet Evol ; 174: 107548, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35690377

RESUMO

The genus Cyclura includes nine extant species and six subspecies of West Indian Rock Iguanas and is one of the most imperiled genera of squamate reptiles globally. An understanding of species diversity, evolutionary relationships, diversification, and historical biogeography in this group is crucial for implementing sound long-term conservation strategies. We collected DNA samples from 1 to 10 individuals per taxon from all Cyclura taxa (n = 70 ingroup individuals), focusing where possible on incorporating individuals from different populations of each species. We also collected 1-2 individuals from each of seven outgroup species of iguanas (Iguana delicatissima; five Ctenosaura species) and Anolis sagrei (n = 12 total outgroup individuals). We used targeted genomic sequence capture to isolate and to sequence 1,872 loci comprising of 687,308 base pairs (bp) from each of the 82 individuals from across the nuclear genome. We extracted mitochondrial reads and assembled and annotated mitogenomes for all Cyclura taxa plus outgroup species. We present well-supported phylogenomic gene tree/species tree analyses for all extant species of Cyclura using ASTRAL-III, SVDQuartets, and StarBEAST2 methods, and discuss the taxonomic, biogeographic, and conservation implications of these data. We find a most recent common ancestor of the genus 9.91 million years ago. The earliest divergence within Cyclura separates C. pinguis from a clade comprising all other Cyclura. Within the latter group, a clade comprising C. carinata from the southern Lucayan Islands and C. ricordii from Hispaniola is the sister taxon to a clade comprising the other Cyclura. Among the other Cyclura, the species C. cornuta and C. stejnegeri (from Hispaniola and Isla Mona) form the sister taxon to a clade of species from Jamaica (C. collei), Cuba and Cayman Islands (C. nubila and C. lewisi), and the eastern (C. rileyi) and western (C. cychlura) Lucayan Islands. Cyclura cychlura and C. rileyi form a clade whose sister taxa are C. nubila and C. lewisi. Cyclura collei is the sister taxon to these four species combined.


Assuntos
Iguanas , Lagartos , Animais , Cuba , Humanos , Iguanas/genética , Lagartos/genética , Filogenia , Análise de Sequência de DNA , Índias Ocidentais
2.
Rev. urug. enferm ; 17(1): 1-13, jun. 2022.
Artigo em Espanhol | LILACS, BDENF - Enfermagem | ID: biblio-1363018

RESUMO

Introducción: En la investigación desarrollada en el servicio de neonatología del hospital Docente Ginecobstétrico "Eusebio Hernández", se pudo constatar que para el personal de enfermería el cuidado del recién nacido que se encuentra en recuperación nutricional es un elemento importante para el progreso de la atención del neonato en las salas de cuidados intensivos neonatales. Objetivo: Identificar las competencias específicas de enfermería para el cuidado del recién nacido en recuperación nutricional. Métodos: Investigación de desarrollo tecnológico en el Hospital Ginecobstétrico Eusebio Hernández en La Habana durante 2020. El universo lo constituyeron 50 profesionales de enfermería que laboran en el servicio de neonatología. Para el desarrollo de la investigación se utilizó el método DACUM (desarrollo del currículum laboral), se confeccionó las funciones y tareas, con la participación de expertos, se construyó el mapa DACUM. Resultados: Se identificaron 6 competencias específicas en relación con 6 funciones y sus tareas en lo que la totalidad de los expertos estuvieron de acuerdo por tener un alto nivel científico. Conclusiones: Se identificaron las competencias específicas de enfermería para el cuidado de neo-natos en recuperación nutricional, lo que permitió mejorar la calidad de la atención a estos recién nacidos y el perfeccionamiento de los profesionales.


Introduction: In the research carried out in the neonatology service of the Eusebio Hernández Gyneco-Obstetric Teaching Hospital, it was found that for the nursing staff the care of the newborn who is in nutritional recovery is an important element for the progress of care of the neonate in neonatal intensive care wards. Objective: To identify the specific nursing competencies for the care of the newborn in nutritional recovery. Methods: Technological development research at the Eusebio Hernández Gyneco-Obstetric Hospital in Havana during 2020. The universe was made up of 50 nursing professionals working in the neonatology service. For the development of the research, the DACUM method (development of the work curriculum) was used, the functions and tasks were prepared, with the participation of experts, the DACUM map was constructed. Results: 6 specific competences were identified in relation to 6 functions and their tasks, in which all the experts agreed due to having a high scientific level. Conclusions: Specific nursing competencies for the care of neonates in nutritional recovery were identified, which allowed improving the quality of care for these newborns and the improvement of professionals.


Introdução: Na pesquisa realizada no serviço de neonatologia do Hospital Universitário Gineco-Obstétrico "Eusebio Hernández", constatou-se que para a equipe de enfermagem o cuidado ao recém-nascido em recuperação nutricional é um elemento importante para o andamento da assistência do recém-nascido em enfermarias de terapia intensiva neonatal. Objetivo: Identificar as competências específicas de enfermagem para o cuidado ao recém-nascido em recuperação nutricional. Métodos: Pesquisa de desenvolvimento tecnológico no Hospital "Eusebio Hernández" Gyneco-Obstétrico de Havana em 2020. O universo era formado por 50 profissionais de enfermagem que atuavam no serviço de neonatologia. Para o desenvolvimento da pesquisa, foi utilizado o método DACUM (elaboração do currículo do trabalho), foram elaboradas as funções e tarefas, com a participação de especialistas, foi construído o mapa DACUM. Resultados: identificaram-se 6 competências específicas em relação a 6 funções e respetivas tarefas, em que todos os peritos concordaram por possuírem um elevado nível científico. Conclusões: Foram identificadas competências específicas de enfermagem para o cuidado ao recém-nascido em recuperação nutricional, o que permitiu melhorar a qualidade da assistência a esses recém-nascidos e o aprimoramento dos profissionais.


Assuntos
Humanos , Recém-Nascido , Terapia Intensiva Neonatal , Enfermagem Neonatal , Cuba , Nutrição do Lactente , Enfermeiras Neonatologistas
3.
MEDICC Rev ; 24(2): 7-14, 2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35648057

RESUMO

INTRODUCTION: COVID-19 sequelae, or the short-, medium-, and long-term manifestations of the disease are under continuous study. There are currently few reports on the evolution of hematological variables following a demonstrated absence of SARS-CoV-2 after infection. OBJECTIVE: Identify hematological alterations in Cuban adults recovered from SARS-CoV-2 infection, and their relation with disease severity. METHODS: We selected 348 persons recovered from COVID-19 residing in Havana, Cuba with an RT-PCR study negative for SARS-CoV-2 performed two weeks after hospital discharge; a structured survey was administered to obtain clinical-epidemiological data. Three groups were established according to COVID-19 clinical criteria: asymptomatic, mild/moderately symptomatic, and severely symptomatic, which, in turn, were divided according to hospital discharge date and blood sample collection date. We performed hemograms with differential leukocyte counts and compared results among groups. We then measured the associations between hematological variables, personal medical history, and relevant lifestyle habits (smoking). RESULTS: All hematological variables were within normal reference limits, although men from the group of severely ill patients had increased total leukocytes, neutrophils and lymphocytes, and decreased hemoglobin and eosinophils, which was also evident in those with a recovery time of 31-90 days. CONCLUSIONS: The relation between hematological variables and degree of clinical severity offers evidence as to persistence of systemic alterations (possibly inflammatory) associated with viral infection. Their identification and characterization can facilitate personalized patient followup and rehabilitation.


Assuntos
COVID-19 , Adulto , Cuba/epidemiologia , Humanos , Masculino , RNA Viral/análise , SARS-CoV-2 , Índice de Gravidade de Doença
4.
MEDICC Rev ; 24(2): 15-19, 2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35648058

RESUMO

INTRODUCTION: The use of various diagnostic techniques is increasingly common in pandemic scenarios. It is important to update evaluations of their metric properties in different times and settings. OBJECTIVE: Evaluate metric properties of a SARS-CoV-2 rapid antigen test relative to a reference standard. METHODS: We carried out a prospective evaluation study of the SARS-CoV-2 rapid antigen test as compared to the RT-PCR test, which is considered the reference standard. Our sample was comprised of 778 individuals, and we calculated sensitiv- ity, specificity, predictive values, prevalence and validity indices. RESULTS: Of the total 778 samples, 70 were true positives, 658 were true negatives, and 27 were false negatives when compared to RT-PCR test results. We obtained a sensitivity of 75.3% (95% CI = 65.96-84.50); a specificity of 96.1% (95% CI = 94.53-97.59); 72.2% for positive predictive value, and 96.6% for negative predictive value. The estimated preva- lence was 11.9% and the validity index was 93.6%. CONCLUSIONS: The index values validate use of the SARS- CoV-2 rapid antigen test until prevalence falls below 2.5%, since as SARS-CoV-2 infection prevalence decreases, so does the predictive value of the PCR result. The use of the SARS-CoV-2 rapid antigen test on the Isle of Youth, Cuba, was decisive in the pandemic's clinical- epidemiological management.


Assuntos
COVID-19 , SARS-CoV-2 , Adolescente , COVID-19/diagnóstico , COVID-19/epidemiologia , Cuba/epidemiologia , Humanos
5.
MEDICC Rev ; 24(2): 26-34, 2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35648060

RESUMO

INTRODUCTION: Immunity in cancer patients is modified both by the cancer itself and by oncospecific treatments. Whether a patient's adaptive immunity is impaired depends on their levels of naive lymphocytes and other cell populations. During the COVID-19 pandemic, cancer patients are at greater risk of progressing to severe forms of the disease and have higher mortality rates than individuals without cancer, particularly while they are receiving cancer-specific therapies. An individual's protection against infection, their response to vaccines, and even the tests that determine the humoral immune response to SARS-CoV-2, depend on lymphocyte populations, meriting their study. OBJECTIVE: Estimate blood concentrations of lymphocytes involved in the immune response to new pathogens in cancer patients. METHODS: We carried out an analytical study of 218 cancer patients; 124 women and 94 men, 26-93 years of age, who were treated at the National Oncology and Radiobiology Institute in Havana, Cuba, March-June, 2020. Patients were divided into five groups: (1) those with controlled disease who were not undergoing cancer-specific treatment; (2) those undergoing debulking surgery; (3) patients undergoing chemotherapy; (4) patients undergoing radiation therapy and (5) patients currently battling infection. We evaluated the following peripheral blood lymphocyte subpopulations via flow cytometry: B lymphocytes (total, naive, transitional, memory, plasmablasts and plasma cells); T lymphocytes (total, helper, cytotoxic and their respective naive, activated, central memory and effector memory subsets); and total, secretory and cytotoxic natural killer cells and T natural killer cells. We also estimated neutrophil/lymphocyte ratios. Lymphocyte concentrations were associated with controlled disease and standard cancer therapy. For variables that did not fall within a normal distribution, ranges were set by medians and 2.5-97.5 percentiles. The two-tailed Mann-Whitney U test was used to measure the effect of sex and to compare lymphocyte populations. We calculated odds ratios to estimate lymphopenia risk. RESULTS: All cancer patients had lower values of naive helper and cytotoxic T lymphocyte populations, naive B lymphocytes, and natural killer cells than normal reference medians. Naive helper T cells were the most affected subpopulation. Memory B cells, plasmablasts, plasma cells, activated T helper cells, and cytotoxic central memory T cells were increased. Patients undergoing treatment had lower levels of naive lymphocytes than untreated patients, particularly during radiation therapy. The risk of B lymphopenia was higher in patients in treatment. The odds ratio for B lymphopenia was 8.0 in patients who underwent surgery, 12.9 in those undergoing chemotherapy, and 13.9 in patients in radiotherapy. CONCLUSIONS: Cancer and conventional cancer therapies significantly affect peripheral blood B lymphocyte levels, particularly transitional T helper lymphocytes, reducing the immune system's ability to trigger primary immune responses against new antigens.


Assuntos
COVID-19 , Linfopenia , Neoplasias , Cuba , Feminino , Humanos , Subpopulações de Linfócitos , Masculino , Neoplasias/terapia , Pandemias , SARS-CoV-2
6.
MEDICC Rev ; 24(2): 35-42, 2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35648061

RESUMO

INTRODUCTION: Most previous studies have examined the effects of acute psychological stress in humans based on select gene panels. The genomic approach may help identify novel genes that underline biological mechanisms of acute psychological stress responses. OBJECTIVE: This exploratory study aimed to investigate genome-wide transcriptional activity changes in response to acute psychological stress. METHODS: The sample included 40 healthy women (mean age 31.4 ± 11.6 years). Twenty-two participants had a stress experience induced by the Trier Social Stress Test (experimental group) and 18 did not (control group). Psychological stress levels and hemodynamic changes were assessed before and after the Trier Social Stress Test. Peripheral blood samples obtained before and after the Trier Social Stress Test were processed for mRNA sequencing. RESULTS: Psychological and hemodynamic stress parameters indicated that the Trier Social Stress Test induced moderate levels of stress in the experimental group. Six genes (HCG26, HCP5, HLA-F, HLA-F-AS1, LOC1019287, and SLC22A16) were up-regulated, and fi ve genes (CA1, FBXO9, SNCA, STRADB, and TRMT12) were down-regulated among those who experienced stress induction, compared with the control group. Nine genes of eleven were linked to endocrine system disorders, neurological disease, and organismal injury and abnormalities. CONCLUSIONS: Of the genes identifi ed in this study, HCP5, SLC22A16, and SNCA genes have previously been proposed as therapeutic targets for cancer and Parkinson disease. Further studies are needed to examine pathological mechanisms through which these genes mediate eff ects of psychological stress on adverse health outcomes. Such studies may ultimately identify therapeutic targets that enhance biological resilience to adverse eff ects of psychological stress.


Assuntos
Hidrocortisona , Estresse Psicológico , Adulto , Cuba , Feminino , Humanos , Hidrocortisona/análise , Hidrocortisona/metabolismo , RNA Mensageiro , Estresse Psicológico/genética , Estresse Psicológico/metabolismo , Estresse Psicológico/psicologia , Adulto Jovem
7.
MEDICC Rev ; 24(2): 3-5, 2022 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-35648056

Assuntos
Pandemias , Política , Cuba , Humanos
9.
MEDICC Rev ; 24(2): 20-25, 2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35648059

RESUMO

INTRODUCTION: Urinary tract infection is the second-leading reason for consults in primary health care. Bacterial urinary tract infections are the most common, of which Escherichia coli is the main etiologic agent. Antimicrobial resistance and multidrug resistance complicate effective community treatment, especially if resistance is caused by extended-spectrum beta-lactamase production. WHO recommends that antimicrobial susceptibility be evaluated in different regions of the world at different times. Community-acquired E. coli's susceptibility to colistin has not yet been studied in Cuba, and mcr-1 gene screening is necessary. OBJECTIVE: Evaluate community-acquired uropathogenic E. coli isolates' susceptibility to antibiotics, including colistin, and identify extended-spectrum beta-lactamase-producing bacteria. METHODS: We conducted a descriptive cross-sectional study that included 281 community-acquired uropathogenic E. coli isolates (153 from the Isle of Youth Special Municipality's Hygiene, Epidemiology, and Microbiology Center and 128 from Microbiology Laboratories of 7 institutions in Havana) from June 2016 through July 2018. We used the disk diffusion method to determine susceptibility to ampicillin, ampicillin/sulbactam, cefazolin, trimethoprim/sulfamethoxazole, ciprofloxacin, nitrofurantoin and fosfomycin. The disk elution method was used to determine susceptibility to colistin. The combined disk method was used to identify extended-spectrum beta-lactamases. Estimates were made regarding the frequency and percentages of antimicrobial susceptibility and resistance, as well as multidrug-resistance patterns. RESULTS: Of the 281 isolates, 68.3% (192/281) were resistant to ampicillin, 54.8% (154/281) were resistant to ciprofloxacin, and 49.5% (139/281) were resistant to trimethoprim/sulfamethoxazole. Resistance to colistin was not detected. On the other hand, 14.2% (40/281) were susceptible to the 8 antibiotics we evaluated, 22.1% (62/281) showed resistance to only 1 antibiotic, and 63.7% (179/281) were resistant to 2 or more antibiotics. In the extended-spectrum beta-lactamase determination, 34.5% (97/281) had inhibition zones ≤14 mm with cefazolin. Of those with inhibition zones, 64.9% (63/97) were positive in the phenotype test, and 35.1% (34/97) were negative. In extended-spectrum beta-lactamase-producing bacteria, 1.6% (1/63) were resistant to fosfomycin, and 3.2% (2/63) were resistant to nitrofurantoin. The most common multidrug-resistance pattern (22.9%; 30/131) was to ampicillin/sulbactam, ampicillin, cefazolin, ciprofloxacin, and trimethoprim/sulfamethoxazole. CONCLUSIONS: Uropathogenic E. coli resistance to the antibiotics most frequently used in community medical practice is quite common, and extended-spectrum beta-lactamase-producing bacteria is the mechanism for beta-lactam antibiotic resistance. Multidrug-resistance patterns include resistance to the antibiotics most used in community-acquired infections. Fosfomycin and nitrofurantoin are the most active in extended-spectrum beta-lactamase producing bacteria. All the isolates were susceptible to colistin.


Assuntos
Fosfomicina , Infecções Urinárias , Escherichia coli Uropatogênica , Ampicilina/uso terapêutico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Cefazolina/uso terapêutico , Ciprofloxacina/uso terapêutico , Colistina/farmacologia , Colistina/uso terapêutico , Estudos Transversais , Cuba , Proteínas de Escherichia coli , Fosfomicina/farmacologia , Fosfomicina/uso terapêutico , Humanos , Testes de Sensibilidade Microbiana , Nitrofurantoína/uso terapêutico , Sulbactam/uso terapêutico , Sulfametoxazol/uso terapêutico , Trimetoprima/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , beta-Lactamases/uso terapêutico
10.
Environ Monit Assess ; 194(6): 441, 2022 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-35596091

RESUMO

Cuba is a country with considerable potential for economic growth, and special efforts are made to increase the agricultural output. As food production depends on the quality of soils, heavy metal concentrations were measured in 39 soils in the province of Mayabeque, Cuba, and interpreted in light of anthropogenic activities and pedogenic conditions (soil type and properties). With median concentrations of 1.8 Cd, 60.3 Cr, 48.1 Cu, 36.2 Ni, 16.7 Pb, 55.0 Zn, and 0.1 mg/kg Hg, soils of Mayabeque were mostly below Cuban quality reference values (QRV) representing benchmarks of quality standards but no official threshold values. Only Cd concentrations were in many cases above the QRV of 0.6 mg/kg and some Cu concentrations above the one of 83 mg/kg. While Cd, Cr, and Ni concentrations were rather pedogenically driven, Cu, Pb, Zn, and Hg contents were rather anthropogenically influenced. When evaluated statistically, Cd and Cr showed most times a significant influence of both sources. In contrast, Ni and Zn could not be significantly related with the origins investigated in this study. Hence, the allocation of heavy metal concentrations to pedogenic or anthropogenic contamination or pollution sources is tentative and needs further investigations. Nevertheless, the present data adds information on soil heavy metal concentrations in the Caribbean region, serves as reference before further industrial development, and sets the ground for adaptation of the QRV for Cd and possibly future national environmental standards.


Assuntos
Mercúrio , Metais Pesados , Poluentes do Solo , Cádmio , China , Cuba , Monitoramento Ambiental , Chumbo , Metais Pesados/análise , Medição de Risco , Solo , Poluentes do Solo/análise
11.
J Health Care Poor Underserved ; 33(2): 790-805, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35574877

RESUMO

OBJECTIVES: Determine if United States graduates of the Latin American Medical School in Cuba: 1) provide primary health care to disadvantaged populations; 2) complete licensing exams and obtain residencies; and 3) accrue additional debt during their medical education. METHODS: A Qualtrics secure web-based survey was provided to 158 graduates via email, completed anonymously. Responses were compiled and descriptive statistics generated. RESULTS: Fifty-six valid surveys were returned, for a response rate of 35.4%. Chi-square analysis showed no statistically significant differences between survey respondents and the sampling frame. Most graduates are people of color; 68% work in clinical medicine; of these, 90% are in primary care, with 100% serving disadvantaged populations. Most accrued no further educational loan debt. CONCLUSIONS: United States graduates of the Latin American Medical School work in primary care with disadvantaged populations. Graduates accrue little additional student loan debt.


Assuntos
Escolha da Profissão , Faculdades de Medicina , Cuba , Humanos , América Latina , Apoio ao Desenvolvimento de Recursos Humanos , Estados Unidos
12.
Dokl Biol Sci ; 503(1): 54-57, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35437735

RESUMO

The dynamics of the taxonomic diversity of the birds of Cuba during the Late Pleistocene-Holocene is assessed for the first time using material from El Abrón Cave in the western part of the island. The Upper Pleistocene beds of the locality are characterized by a rich taxonomic diversity of birds, including an abundance of waterbirds and open-landscape inhabitants. For the Holocene, a general decrease in taxonomic diversity and a significant increase in the number of remains belonging to representatives of forest faunas (Picidae) are recorded. Our data indicate a significant transformation of landscapes of western Cuba and the faunistic associations of birds at the end of the Quaternary, which is consistent with paleoclimatic data.


Assuntos
Aves , Fósseis , Animais , Cuba , Florestas
14.
Toxins (Basel) ; 14(3)2022 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-35324706

RESUMO

The factors related to cyanotoxin occurrence and its social impact, with comprehension and risk perception being the most important issues, are not yet completely understood in the Cuban context. The objectives of this research were to determine the risk extension and microcystin-LR levels, and to identify the environmental factors that trigger the toxic cyanobacteria growth and microcystin-LR occurrence in 24 water reservoirs in eastern Cuba. Samplings were performed in the early morning hours, with in situ determination and physicochemical analysis carried out in the laboratory. Microcystin-LR were determined in water and within the cells (intracellular toxins) using UPLC-MS analysis after solid phase extraction. The reservoirs studied were found to be affected by eutrophication, with high levels of TN:TP ratio and phytoplankton cell concentrations, high water temperatures and low transparency, which cause collateral effect such as cyanobacterial bloom and microcystin-LR occurrence. In Hatillo, Chalóns, Parada, Mícara, Baraguá, Cautillo, La Yaya, Guisa and Jaibo reservoirs, concentrations of MC-LR higher than the WHO limits for drinking water (1 µg·L-1), were detected.


Assuntos
Cianobactérias , Água Potável , Cromatografia Líquida , Cuba , Água Potável/análise , Toxinas Marinhas , Microcistinas/análise , Espectrometria de Massas em Tandem
15.
Anthropol Med ; 29(1): 45-60, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35306938

RESUMO

The Cuban biotechnology industry is producing cancer immunotherapy, in particular, therapeutic vaccines that actively stimulate the immune system to stabilise the tumour. These products aim to transform metastatic malignancies into a chronic disease. Since 2010, this therapeutic concept has been integrated within a public health experiment, consisting of the large distribution of immunotherapies, including in primary healthcare centres, to enhance access and assess its effectiveness on a wider population of patients. Such experimental intervention, consisting of post-marketing clinical trials, has focused only on lung cancer, one of the most widespread and lethal cancers on the island. Combining interviews with ethnographic observations focusing on care performed by professionals, patients, and their relatives, this paper analyses the experience of lung cancer chronicity under this type of immunotherapy in Cuba. It shows how a certain form of continuity is made between prophylactic and therapeutic vaccination to shape a new temporality of cancer care, through the integration within primary care, constant access to biotechnology, and multiple care practices directed to strengthen the immunotherapy's efficacy. If vaccinal chronicity remains fragile due to its experimental dimension and the fact that long-term survivorship is still an exceptional phenomenon, lung cancer patienthood is deeply transformed through a shared effort of the people and the state to provide more stable, meaningful, and inclusive care.


Assuntos
Neoplasias Pulmonares , Vacinas , Antropologia Médica , Cuba/epidemiologia , Humanos , Imunoterapia , Neoplasias Pulmonares/terapia , Atenção Primária à Saúde
16.
MEDICC Rev ; 24(1): 9-13, 2022 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-35157633

RESUMO

As 2021 drew to a close, Cuba struggled to contain the highly transmissible omicron variant of SARS-CoV-2, braced for a new wave of infections and kept a close eye on other variants of concern popping up around the world-a common experience to countries everywhere as we head into the second year of the pandemic. In Cuba, however, there is one marked difference making all the difference: by early January, 87% of the population was fully vaccinated using a three-dose schedule of vaccines developed and produced on the island.[1] This massive vaccination campaign is complemented by a rapid booster rollout-also using Cuban vaccines-that began in December 2021 and was ongoing as we finalized this issue. The island nation was able to achieve the third highest COVID-19 vaccination rate in the world[2] after decades of scientific investment, research, discovery and innovation; regulatory oversight and compliance; professional training; and increased production capacity. But a vaccine is only as effective as the health system charged with administering it-in a safe and timely manner, to as many people as possible. Here too, Cuba has decades of experience, including a national pediatric immunization program where 98% of children under 5 are immunized against 13 diseases,[3] an annual polio vaccination campaign (both launched in 1962 and uninterrupted since) and campaigns to contain epidemics such as H1N1. When the first COVID-19 cases were detected on the island in March 2020, Cuba harnessed this vaccine experience, making a hard tack towards developing its own vaccines. Two of the main protagonists in the country's biotechnology development, the Finlay Vaccine Institute (IFV) and the Genetic Engineering and Biotechnology Center (CIGB), both with several groundbreaking preventive and therapeutic vaccines in their portfolios, led the search for a vaccine. Today, Cuba has three vaccines authorized for emergency use-Soberana 02 and Soberana Plus developed by IFV, and Abdala, developed by CIGB. Schedules with these vaccines have demonstrated more than 90% efficacy in clinical trials,[4] and after regulatory approval for emergency use, became the backbone of Cuban COVID-19 vaccination efforts. A fourth vaccine, Mambisa (CIGB), administered nasally, and a fifth, Soberana 01 (IFV) are still in clinical trials. For this installment in MEDICC Review's series spotlighting leading women of Cuban science, we sat down with Dr Verena Muzio, Director of Clinical Research at CIGB. A pioneer of Cuba's biotechnology sector, she is an immunologist with a doctorate in biological sciences. Her professional trajectory began researching the genetically engineered hepatitis B surface antigen that led to the development of Cuba's recombinant hepatitis B vaccine in 1989. The same technological platform used in this vaccine was used to develop CIGB's Abdala vaccine against SARS-CoV-2-part of the reason Cuba was able to secure a vaccine so quickly. A phase 3 clinical trial determined a 92.28% efficacy rate for Abdala, with results to appear in forthcoming publications.


Assuntos
COVID-19 , Vírus da Influenza A Subtipo H1N1 , Vacinas contra COVID-19 , Criança , Cuba , Feminino , Humanos , Pandemias , SARS-CoV-2 , Confiança
17.
MEDICC Rev ; 24(1): 21-27, 2022 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-35157635

RESUMO

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.


Assuntos
COVID-19 , Idoso , Infecções Assintomáticas/epidemiologia , Estudos Transversais , Cuba/epidemiologia , Humanos , SARS-CoV-2
18.
MEDICC Rev ; 24(1): 28-31, 2022 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-35157636

RESUMO

INTRODUCTION: SARS-CoV-2 infection can produce endothelial injury and microvascular damage, one cause of the multiorgan failure associated with COVID-19. Cerebrovascular endothelial damage increases the risk of stroke in COVID-19 patients, which makes prompt diagnosis important. Endothelial dysfunction can be evaluated by using transcranial Doppler ultrasound to study cerebral hemodynamic reserve, but there are few of these studies in patients with COVID-19, and the technique is not included in COVID-19 action and follow-up guidelines nationally or internationally. OBJECTIVE: Estimate baseline cerebral hemodynamic patterns, cerebral hemodynamic reserve, and breath-holding index in recovered COVID-19 patients. METHOD: We conducted an exploratory study in 51 people; 27 men and 24 women 20-78 years of age, divided into two groups. One group comprised 25 recovered COVID-19 patients, following clinical and epidemiological discharge, who suffered differing degrees of disease severity, and who had no neurological symptoms or disease at the time they were incorporated into the study. The second group comprised 26 people who had not been diagnosed with COVID-19 and who tested negative by RT-PCR at the time of study enrollment. Recovered patients were further divided into two groups: those who had been asymptomatic or had mild disease, and those who had severe or critical disease. We performed transcranial Doppler ultrasounds to obtain baseline and post-apnea tests of cerebral hemodynamic patterns to evaluate cerebral hemodynamic reserve and breath-holding indices. We characterized the recovered patient group and the control group through simple descriptive statistics (means and standard deviations). RESULTS: There were no measurable differences in baseline cerebral hemodynamics between the groups. However, cerebral hemodynamic reserve and breath-holding index were lower in those who had COVID-19 than among control participants (19.9% vs. 36.8% and 0.7 vs. 1.2 respectively). These variables were similar for patients who had asymptomatic or mild disease (19.9% vs.19.8%) and for those who had severe or critical disease (0.7 vs. 0.7). CONCLUSIONS: Patients recovered from SARS-CoV-2 infection showed decreased cerebral hemodynamic reserve and breath-holding index regardless of the disease's clinical severity or presence of neurological symptoms. These abnormalities may be associated with endothelial damage caused by COVID-19. It would be useful to include transcranial Doppler ultrasound in evaluation and follow-up protocols for patients with COVID-19.


Assuntos
COVID-19 , Cuba , Feminino , Hemodinâmica , Humanos , Masculino , SARS-CoV-2 , Ultrassonografia Doppler Transcraniana
19.
MEDICC Rev ; 24(1): 32-35, 2022 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-35157637

RESUMO

INTRODUCTION: During the pandemic caused by the SARS-CoV-2 virus, some patients who develop severe forms of COVID-19 present thrombotic microangiopathy in the course of the disease's clinical progression. METHODS: Data came from direct patient observation and clinical records. We performed a kidney biopsy and used optical microscopy and immunofluorescence techniques. RESULTS: We present the case of a 78-year-old male patient, mestizo, overweight with a history of high blood pressure, ischemic cardiopathy and chronic obstructive pulmonary disease who was first admitted to the hospital due to respiratory symptoms and diarrhea related to COVID-19, from which he recovered. He was subsequently readmitted with symptoms of acute renal dysfunction accompanied by mild anemia and thrombocytopenia; at the same time, he resulted negative for COVID-19 via a real-time polymerase chain reaction test. A kidney biopsy revealed thrombi in glomerular capillaries, acute tubular necrosis, thickening of extraglomerular blood vessel walls, and C3 deposits in the glomerular tufts. CONCLUSIONS: We describe a case of thrombotic microangiopathy with kidney biopsy in a patient recovering from COVID-19. Acute renal dysfunction is a form of thrombotic microangiopathy that has been observed in patients recovering from COVID-19.


Assuntos
COVID-19 , Microangiopatias Trombóticas , Idoso , Cuba , Humanos , Rim , Masculino , SARS-CoV-2 , Microangiopatias Trombóticas/diagnóstico , Microangiopatias Trombóticas/etiologia
20.
MEDICC Rev ; 24(1): 40-43, 2022 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-35157639

RESUMO

INTRODUCTION: In Cuba, 29,939 deaths from ischemic heart disease were recorded in 2020. Myocardial revascularization surgery and percutaneous coronary intervention are well-established methods of treating patients with multivessel coronary artery disease. These methods can reduce overall deaths, but choosing the optimal strategy for treating left main coronary ischemia is a source of debate among specialists. OBJECTIVE: Estimate survival and major cardiac and cerebrovascular events in patients treated with percutaneous coronary intervention versus myocardial revascularization surgery and their relationships with pre-existing patients' clinical and angiographic characteristics. METHODS: We conducted a retrospective cohort study in 41 patients; 35 men and 6 women aged 40-85 years who had been diagnosed with multivessel coronary artery disease and treated with percutaneous coronary intervention (n = 17) or myocardial revascularization surgery (n = 24) at the Medical-Surgical Research Center in Havana, Cuba, in 2016. The main variable under consideration was the occurrence of major adverse cardiovascular events over a four-year period following these interventions. We collected clinical and angiographic characteristics, and used the Kaplan-Meier test to calculate survival curves. Survival probabilities were compared using the log-rank test. A value of p ⟨ 0.05 was considered statistically significant. The Cox proportional hazards model was used to estimate the hazard ratio, with 95% confidence intervals used for both procedures. RESULTS: There were a total of 20 major adverse cardiovascular events, 75% (15/20) of which occurred in patients who underwent percutaneous coronary intervention and 5% in patients who had myocardial revascularization surgery. The probability of survival was 70.6% in surgery and 37.5% in interventionism; p = 0.043; hazard ratio 1.58 (95% confidence interval 0.987-2.530), p = 0.047. The need to repeat a revascularization procedure was the only major cardiovascular event that showed significant differences between methods (log-rank p = 0.015), and was more frequent in percutaneous intervention. CONCLUSIONS: Myocardial revascularization surgery offers a better chance of survival than percutaneous coronary intervention. Major adverse cardiovascular events are more frequent in patients with coronary interventionism, due to the need to repeat revascularization.


Assuntos
Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Adulto , Idoso , Idoso de 80 Anos ou mais , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Cuba/epidemiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
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