COVID-19 and the Nervous System from a Cuban Experience.

Neuropsychiatric manifestations of viral infections (both per se and secondary to the neuroinflammatory reaction of the host) are mainly attributed to immunological reactions, so many aspects of their pathogenesis are still nuclear. Some novel therapeutic strategies are progressively emerging in which a vaccination may be having a particular impact on recovery and reduction of death. In this context, it is accepted that the SARS-CoV-2 virus is profoundly neurotropic and neuroinvasive, with various effects on the nervous system, although there is no complete understanding of the mechanism of neuroinvasion, brain injury, or short- or long-term neuropsychiatric sequelae. Therefore, it is necessary to understand the post-infectious manifestations of COVID-19 to guide the management of neuropsychiatric diseases. Thus, based on different research groups focused on this field, in this manuscript we summarize papers on COVID-19 and the nervous system (NS) published in a series of articles by Cuban authors. This review focuses on cognitive and affective emotional states, pathogenesis, biomarkers, clinical manifestations, and intervention strategies.

A multivariate spatio-temporal model for the incidence of imported COVID-19 cases and COVID-19 deaths in Cuba.

To monitor the COVID-19 epidemic in Cuba, data on several epidemiological indicators have been collected on a daily basis for each municipality. Studying the spatio-temporal dynamics in these indicators, and how they behave similarly, can help us better understand how COVID-19 spread across Cuba. Therefore, spatio-temporal models can be used to analyze these indicators. Univariate spatio-temporal models have been thoroughly studied, but when interest lies in studying the association between multiple outcomes, a joint model that allows for association between the spatial and temporal patterns is necessary. The purpose of our study was to develop a multivariate spatio-temporal model to study the association between the weekly number of COVID-19 deaths and the weekly number of imported COVID-19 cases in Cuba during 2021. To allow for correlation between the spatial patterns, a multivariate conditional autoregressive prior (MCAR) was used. Correlation between the temporal patterns was taken into account by using two approaches; either a multivariate random walk prior was used or a multivariate conditional autoregressive prior (MCAR) was used. All models were fitted within a Bayesian framework.

Estrés, burnout y emociones en personal de salud ante la emergencia por COVID-19 / Stress, burnout and emotions in health workers´ emergency conditions due to the COVID-19

La situación epidemiológica originada por la COVID-19 provocó nuevas demandas a las ya existentes en el personal de salud. Objetivos: Describir las dimensiones del síndrome de burnout: agotamiento emocional, despersonalización y falta de realización profesional en el personal del área de salud, determinar los niveles de estrés, explorar el ambiente emocional en sus dimensiones de afectividad positiva y negativa y delimitar la relación entre estas variables. Estudio cuantitativo con un diseño descriptivo de corte transversal, en un Policlínico durante el mes de diciembre del 2021. En personal médico (n=23) y de enfermería (n=16), se aplica el Inventario de burnout de Maslach, la Escala sintomática de estrés y la Escala de afectividad positiva y negativa. Resultados: Se obtiene agotamiento emocional alto en el 30,8%, medio en 33,3%; despersonalización, en un sujeto fue alto, y en 6 medio; la eficacia profesional en 9 sujetos fue medio y en 1 bajo; el nivel de estrés fue patológico en 41%, la afectividad positiva es alta en 53,8%, la negativa en el 5,1%. No existen diferencias respecto al sexo, ocupación y haber padecido o no COVID-19, se constata relación inversa entre la despersonalización y la edad. Conclusiones: La relación directa entre el estrés, agotamiento emocional y afectividad negativa son expresión de un desgaste producto de las respuestas fisiológicas y emocionales a situaciones mantenidas de movilización de recursos en el entorno laboral, lo cual se manifiesta en el grupo estudiado. Se recomiendan acciones dirigidas a intervenir de modo participativo y prevenir el ambiente emocional negativo(AU)

The epidemiological situation originated by COVID-19 caused new demands to those already existing in health personnel. Objectives: Describe the dimensions of the burnout syndrome, determine the levels of stress explore the emotional environment in its positive and negative affectivity dimensions and define the relationship between these variables. Quantitative study with crosssectional design, in a polyclinic during the month of December 2021. In medical (n=23) and nursing (n=16) staff the Scale of Positive and Negative Affect -PANAS- the Symptomatic Scales of Stress and the Maslach Burnout Inventory were applied. Measures of central tendency, absolutes and relative frequencies, measures of association and correlation coefficients with a reliability of 95% were used. Results: High emotional exhaustion is obtained in 30.8%, medium in 33.3%, depersonalization in one subject was high and in 6 medium, professional efficacy in 9 subjects was medium and in 1 low; the level of pathological stress in 41%, the positive affectivity is high in 53,8%, the negative in the 5.1%. There are no differences regarding sex, occupation and having suffered or not COVID-19. An inverse relationship between depersonalization and age is verified. Conclusions: The direct relationship between stress, emotional exhaustion and negative affectivity are expressions of a wear due to the physiological and emotional response to chronic situations of mobilization of resource at work. Actions aimed at intervening in a participatory way and preventing the negative emotional environment is recommended(AU)

Leadership, teamwork and technology enabling the largest free and accessible event worldwide on COVID-19 management.

OBJECTIVE: To report the experience of technology-enabling organisation and deployment of a large-scale free online scientific event about COVID-19, and to share leadership lessons learnt. METHODS: The 'First Brazilian Congress of Clinical Evidence on COVID-19' took place between 3 May and 7 May 2021 and was hosted by the Universidade Federal de Minas Gerais, one of Brazil's top federal universities. Online platforms and a website were used for registration, as well as live transmission of the event, such as Zoom, YouTube and Even. A Situational Leadership framework was used to lead the team. Participants' satisfaction was evaluated through an online questionnaire. RESULTS: There were overall 27 000 registrations. The transmission reached over 97 100 views, from Brazil, Cuba, Mexico and the UK. Conference's topics included the whole COVID-19 'system of care'. Speakers and moderators from all over Brazil and abroad were chosen according to their expertise on COVID-19 and on evidence-based medicine. Video testimonies were presented between sessions from people who could not work from home about what touched their heart during the pandemic. Accessibility was ensured through simultaneous translation to Brazilian sign language. From 2228 respondents of the satisfaction assessment questionnaire, 97.4% reported their expectations to be exceeded and 86.8% reported acquiring new knowledge about COVID-19. CONCLUSION: This experience showed that leadership, teamwork, motivation and technology enabled the dissemination of accessible scientific evidence on COVID-19 to a large audience through a free online event. Lessons learnt may be useful for the post-pandemic, for new-waves, as well as recovery.

Portal integrador para la gestión de la información en la Universidad Virtual de Salud de Santiago de Cuba / Integrative portal for information management in the Health Virtual University of Santiago de Cuba i: en

Los avances en las tecnologías de la información y la comunicación han posibilitado trazar estrategias para el reordenamiento del proceso docente-educativo en estos tiempos de crisis sanitaria por la pandemia de COVID-19, que ha limitado la presencialidad en las aulas. En la Universidad de Ciencias Médicas de Santiago de Cuba, la Universidad Virtual de Salud integra varias plataformas para la enseñanza-aprendizaje de pregrado y posgrado, tales como el aula y la clínica virtuales, el repositorio, el directorio de cursos y humanidades; sin embargo, se observa un insuficiente aprovechamiento de estas potencialidades. Por tal razón, en el presente artículo se enfatiza en la necesidad de incrementar el uso del portal integrador para la gestión de la información en la Universidad Virtual de Salud.

The advances in technologies of information and communication have facilitated to trace strategies for the reorganization of the teaching-educational process in these times of sanitary crisis due to the pandemic of COVID-19 that has limited the presence in classrooms. In the University of Medical Sciences in Santiago de Cuba, the Health Virtual University integrates several platforms for the predegree and postdegree teaching-learning, such as classroom and virtual clinic, repository, courses and humanities directory; however, an insufficient use of these potentialities is observed. For such a reason, in this work the necessity of increasing the use of the integrative portal for information management in Health Virtual University is emphasized.

Effects of lockdown by COVID-19 on glycemic control of Cuban children and adolescents with type 1 diabetes mellitus / Efectos del confinamiento por COVID-19 sobre el control glucémico de niños y adolescentes con diabetes mellitus tipo 1 / Efeitos do confinamento COVID-19 no controle glicêmico de crianças e adolescentes com diabetes mellitus tipo 1

Introduction: The purpose of this study was to determine the impact of confinement due to COVID-19 on glycemic control in children and adolescents with type 1 diabetes mellitus. Material and methods: An observational, descriptive study with a prospective design was carried out in Cuba, between November 2020 and May 2021. The sample consisted of 41 children and adolescents from a Provincial Center for Care and Education for Diabetic Patients. Anthropometric measurements (weight, height, and BMI) were obtained from the patients' medical records at the time of debut and at the time of the follow-up visit during the study period. Glycemic control was determined from the value of glycosylated hemoglobin (HbA1c). The comparison of the means between independent groups of variables was carried out using the ANOVA analysis of variance of a Kruskal-Wallis factor when quantitative variables were brought, and Pearson's Chi square in the case of categorical variables. Results: It was shown that during confinement, 78.05% of the patients had poor glycemic control. In addition, the requirements for higher total doses of insulin (p=0.005), both fast-acting (p=0.011) and slow-acting (p=0.008), and the highest dosage by weight in kilograms (p=0.003), and the highest evolution time (p=0.011) were significantly related to poor glycemic control. Most of the variables that were associated with poor glycemic control during confinement were also associated before said period. Conclusions: The confinement had a negative impact on the glycemic control of children and adolescents with type 1 diabetes mellitus in Cuba, since during this period the patients required higher doses of insulin and showed higher HbA1c figures.

Introducción: El propósito de este estudio fue determinar el impacto del confinamiento por COVID-19 en el control glucémico de niños y adolescentes con diabetes mellitus tipo 1. Material y métodos: Se realizó un estudio observacional, descriptivo con diseño prospectivo en Cuba, entre noviembre de 2020 y mayo de 2021. La muestra estuvo constituida por 41 niños y adolescentes de un Centro Provincial de Atención y Educación al Paciente Diabético. Las mediciones antropométricas (peso, talla e IMC) fueron obtenidas de las historias clínicas de los pacientes al momento del debut y al momento de la consulta de seguimiento durante el periodo del estudio. El control glucémico fue determinado a partir del valor de la hemoglobina glucosilada (HbA1c). La comparación de las medias entre grupos de variables independientes fue llevada a cabo mediante el análisis de varianza ANOVA de un factor de Kruskal-Wallis cuando se trataba de variables cuantitativas, y Chi cuadrado de Pearson en el caso de las variables categóricas. Resultados: Se observó que durante el confinamiento el 78,05 % de los pacientes presentaban un mal control glucémico. Además, los requerimientos de mayores dosis totales de insulina (p=0,005), tanto de acción rápida (p=0,011) como lenta (p=0,008), y la mayor dosificación por peso en kilogramos (p=0,003), y el mayor tiempo de evolución (p=0,011) se relacionaron significativamente con el mal control glucémico. La mayoría las variables que se asociaron a un mal control glucémico durante el confinamiento, también lo hacían antes de dicho período. Conclusiones: El confinamiento tuvo un impacto negativo sobre el control glucémico de niños y adolescentes con diabetes mellitus tipo 1 en Cuba, ya que durante este período los pacientes requirieron mayores dosis de insulina y mostraron mayores cifras de HbA1c.

Introdução: O objetivo deste estudo foi determinar o impacto do confinamento devido ao COVID-19 no controle glicêmico em crianças e adolescentes com diabetes mellitus tipo 1. Material e métodos: Estudo observacional, descritivo, com desenho prospectivo, realizado em Cuba, entre novembro de 2020 e maio de 2021. A amostra foi composta por 41 crianças e adolescentes de um Centro Provincial de Atenção e Educação para Diabéticos. As medidas antropométricas (peso, altura e IMC) foram obtidas dos prontuários dos pacientes no momento da estreia e no momento da consulta de acompanhamento durante o período do estudo. O controle glicêmico foi determinado a partir do valor da hemoglobina glicosilada (HbA1c). A comparação das médias entre grupos de variáveis ​​independentes foi realizada por meio da análise de variância ANOVA de um fator de Kruskal-Wallis no caso de variáveis ​​quantitativas e do Qui-quadrado de Pearson no caso de variáveis ​​categóricas. Resultados: Observou-se que durante o confinamento, 78,05% dos pacientes apresentaram mau controle glicêmico. Além disso, as necessidades de maiores doses totais de insulina (p=0,005), tanto de ação rápida (p=0,011) quanto de ação lenta (p=0,008), e a maior dosagem por peso em quilogramas (p=0,003), e o maior tempo de evolução (p=0,011) relacionaram-se significativamente com o mau controle glicêmico. A maioria das variáveis ​​que se associaram ao mau controle glicêmico durante o confinamento também se associaram antes desse período. Conclusões: O confinamento teve um impacto negativo no controle glicêmico de crianças e adolescentes com diabetes mellitus tipo 1 em Cuba, pois durante esse período os pacientes necessitaram de doses mais altas de insulina e apresentaram valores de HbA1c mais elevados.

Identification of patients with very low risk of transition to severity in confirmed covid-19. Cuba. March 2020-May 2021 / Identificación de pacientes de muy bajo riesgo de transición a la severidad en confirmados de covid-19. Cuba. 2020- 2021 / Identificação de pacientes com baixíssimo risco de transição para gravidade em casos confirmados de covid-19. Cuba. 2020-2021

Introduction: Covid-19 pandemic, threatened health worldwide, and overhelmed systemshealthcare in many countries. Performing and adequate identification of subjects with verylow risk to develop a severe form of the disease must result very cost-effective.Objective: To identify patients with very low risk of transition to severity in subjectsconfirmed with Covid-19 in Cuba.Methods: An environmental study was carried out based on the Cuban National Registerof confirmed Subjects covid-19. Between march 11th, 2020 and may 31st 2021, 10600persons were recorded. Admission in ICU and mortality related to covid-19, both measured30 days after disease confirmation, were the variables analyzed. As predictors, age and comorbidities were chosen. A classification tree ­ algorithm was applied to identify risk strata. To every stratum, its volume, the risk of transition to severity and the explained risk were calculated.Results: Subjects less than 65 years with no comorbidities (85,8% of the total) had a verylow risk (0,2%) of admission in ICU and death. Adjusted models showed a good calibration and discriminant ability.Conclusions: The study allowed the identification of subjects with very low risk of transition to severity. They could be followed by primary health care units with home surveillance and symptomatic treatment. The approaches used, permit the improvement of assigning admissions to different health care units' optimizing limited health resources.

Introducción: La pandemia de covid-19, amenaza para la salud mundial, desbordó los sistemas de salud en muchos países. Realizar una adecuada clasificación del riesgo de transmisión resulta de vital importancia. Objetivo: Identificar pacientes con muy bajo riesgo de transición a la severidad en pacientes  confirmados de covid-19 en Cuba. Métodos: Se realizó un estudio ecológico  que tuvo como base el registro nacional de pacientes confirmados de covid-19.  Se analizaron  10600 individuos entre el 11 de marzo de 2020 y el 31 de mayo de 2021. Las variables de respuesta seleccionadas fueron admisión en UCI y mortalidad, ambas medidas a los 30 días de la confirmación de la enfermedad. Los predictores fueron la edad  y la presencia de comorbilidades.  Se aplicó  un algoritmo de árboles de clasificación para identificar estratos de riego. Se determinó para cada estrato, su volumen, el riesgo de transición a la severidad y el riesgo explicado. Resultados: Se comprobó que los pacientes con  edad menor de 65 años y sin comorbilidades, que concentraba el 86,8% de la muestra, tenían muy bajo riesgo (0,2%)  de  admisión en UCI y de muerte. Los modelos demostraron una buena calibración y discriminación. Conclusiones: El estudio permitió identificar individuos con muy bajo riesgo de transición a la severidad seguidos desde la atención primaria de salud con  ingreso en el hogar y tratamiento sintomático. La metodología propuesta basado en la evidencia permitió perfeccionar los procedimientos de derivación hacia los distintos escenarios  y priorizar recursos de salud limitados. 

Introdução: A pandemia de covid-19, uma ameaça global à saúde, sobrecarregou os sistemas de saúde de muitos países. A realização de uma classificação adequada do risco de transmissão é de vital importância. Objetivo: Identificar pacientes com baixíssimo risco de transição para gravidade em pacientes confirmados com covid-19 em Cuba. Métodos: Foi realizado um estudo ecológico com base no registro nacional de pacientes confirmados com covid-19. Foram analisados ​​10.600 indivíduos entre 11 de março de 2020 e 31 de maio de 2021. As variáveis ​​de resposta selecionadas foram admissão na UTI e mortalidade, ambas medidas 30 dias após a confirmação da doença. Os preditores foram idade e presença de comorbidades. Um algoritmo de árvore de classificação foi aplicado para identificar os estratos de irrigação. Foi determinado para cada estrato, o seu volume, o risco de transição para gravidade e o risco explicado.Resultados: Verificou-se que os pacientes com menos de 65 anos e sem comorbidades, que perfizeram 86,8% da amostra, apresentaram risco muito baixo (0,2%) de internação em UTI e óbito. Os modelos demonstraram boa calibração e discriminação.Conclusões: O estudo permitiu identificar indivíduos com baixíssimo risco de transição para a gravidade seguidos de cuidados de saúde primários com internamento domiciliário e tratamento sintomático. A metodologia baseada em evidências proposta permitiu refinar os procedimentos de encaminhamento para os diferentes cenários e priorizar os recursos de saúde limitados.

Producción científica de la Universidad de Ciencias Médicas de La Habana en revistas estudiantiles cubanas / The scientific production of the University of Medical Sciences of Havana published in student scientific journals

Introducción: Se desconocen las características de la ciencia generada por la Universidad de Ciencias Médicas de La Habana, publicada en revistas científicas estudiantiles nacionales. Los estudios métricos constituyen herramientas idóneas para abordar problemáticas de esta naturaleza. Objetivo: Caracterizar la producción científica de la Universidad de Ciencias Médicas de La Habana en revistas estudiantiles cubanas. Métodos: Se realizó un estudio métrico, descriptivo y transversal en 121 artículos publicados en 12 revistas entre 2017 y 2021. Resultados: Los artículos alcanzaron 149 citas y 65,8 citas corregidas. Hubo un alto índice de Subramanyan (0,76) y un bajo índice de colaboración entre facultades (0,16). Se registraron 207 autores; 2 de ellos fueron líderes. Predominaron los artículos originales (38,8 por ciento). HolCien ostentó el mayor índice de Price (0,87), mientras que 16 de abril y Universidad Médica Pinareña lideraron, respectivamente, en cuanto a número de citas (71) y de citas corregidas (32,5). La Facultad Manuel Fajardo resultó la más productiva (n = 29); y la Facultad Calixto García, la más citada (54 citas). En 2020 se alcanzó el mayor número de publicaciones (n = 51) y de citas (88), probablemente como consecuencia de la COVID-19, que constituyó el principal foco temático emergente de investigación. Conclusiones: La producción se caracterizó por ser baja, mostrar una tendencia al ascenso cuantitativo, ostentar altos índices de coautoría y originalidad científica, y contar con autores líderes. Fue débil en cuanto a la colaboración entre facultades, la publicación en inglés y la actualización de las referencias bibliográficas (AU)

Introduction: The characteristics of the science produced by the University of Medical Sciences of Havana, published in national student scientific journals, are unknown. Metric studies are ideal tools for approaching problem situations of this nature. Objective: To characterize the scientific production of the University of Medical Sciences of Havana published in Cuban student journals. Methods: A metric, descriptive and cross-sectional study was carried out with 121 articles published in twelve journals between 2017 and 2021. Results: The articles reached 149 citations and 65.8 corrected citations. There was a high Subramanyan index (0.76) and a low index of collaboration between schools (0.16). There were 207 reported authors; two of them were leaders. Original articles predominated (38.8 percent). HolCien had the highest Price index (0.87), while the journals 16 de Abril and Universidad Médica Pinareña led, respectively, in number of citations (71) and corrected citations (32.5). The Manuel Fajardo Medical School was the most productive (n=29), while the Calixto García Medical School was the most cited (54 citations). In 2020, the highest number of publications (n=51) and citations (88) was reached, probably as a consequence of COVID-19, which became the main emerging thematic focus of research. Conclusions: The production was characterized by being low, showing a quantitative upward trend, as well as high rates of coauthorship and scientific originality, and by having leading authors. It was weak in terms of collaboration between schools, publication in English and updating of bibliographic references(AU)

Cardiovascular Complications in Patients Hospitalized for COVID-19: A Cohort Study in Havana, Cuba.

INTRODUCTION AND OBJECTIVE: At least one in ten patients infected with COVID develop cardiovascular complications during hospitalization, increasing the number of deaths from this cause. However, the determinants of risk are not clearly elucidated. This study aims to determine whether there is a relationship between in-hospital cardiac complications and cardiovascular history and hospital evolution. METHODS: Prospective cohort study of 373 patients with a positive diagnosis of SARS-CoV-2 admitted to an Intensive Care Unit between March and October 2021. RESULTS: Median age was 69 (IQR: 57-77), 29.2 % of patients presented cardiovascular complications: 21.2 % electrical, 5.9 % acute coronary syndrome and 1.9 % pulmonary thromboembolism. Age RR: 1.02 (95 % CI: 1.00-1.04; p = 0.020) and history of ischemic heart disease RR: 2.23 (95 % CI: 1.27-3.92; p = 0.005) were identified as independent predictors of in-hospital cardiac complications. CONCLUSIONS: Age and history of ischemic heart disease were identified as independent predictor variables of cardiovascular complications in patients admitted with severe COVID-19 involvement; being significantly associated with lower survival.

Boletín de la Cooperación Técnica Cuba: "Andar la salud", Septiembre-Diciembre 2022

[Introducción] “Andar la salud” es un boletín elaborado en la Oficina de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) en Cuba. Su propósito fundamental es compartir lo más relevante de la cooperación técnica de esta Representación con el Ministerio de Salud Pública (MINSAP) y otras instituciones y organismos en el país. Entre los artículos del presente número, destacan los relacionados con: la 30a Conferencia Sanitaria Panamericana y sus resultados más relevantes; la presencia de una delegación de OPS en la IV Convención Internacional “Cuba Salud 2022”, así como la sesión especial que, en el marco de este evento, se les dedicó a los 120 años de la Organización regional; y el cierre del proyecto que se impulsó con la Unión Europea para fortalecer la respuesta del sistema de salud a la COVID-19. Además, es posible encontrar una infografía que muestra los títulos y una sinopsis de los cinco libros preparados con el MINSAP como celebración del aniversario 120 de la OPS, donde se recogen hitos de esta Organización y temas de salud pública relevantes en el contexto cubano.

Adverse Drug Reactions during COVID-19 Treatment: A Comprehensive Analysis Focused on Hospitalized Patients, with the Use of a Survey in Cuba in 2020.

Aims: To evaluate the prevalence and type of adverse drug reactions (ADRs), together with associated risk factors, among Cuban COVID-19 patients treated with chloroquine (CQ), lopinavir/ritonavir (LPV/r), or interferon α2b (IFN α2b), according to the Cuban protocol. Materials and Methods: A prospective descriptive analysis of ADRs was performed on 200 COVID-19 patients who were admitted consecutively to three hospitals in Havana and Pinar del Río from April to July 2020. Information on demographics, ADRs, outcomes, behavioral, and health-related factors was collected using a validated questionnaire and clinical records. Each potential ADR case was assessed for causality based on the WHO-UMC algorithm, concomitant drug influences, and the presence of any drug-drug interactions (DDI). Results: The total frequency of ADRs was 55%, with predominantly gastrointestinal disorders and general symptoms (23% vs 20%). 95.1% of ADRs occurred within 10 days after treatment and 42 potential DDI in 55.5% of patients (61/110) were observed. The prevalence of ADRs was: 44%, 30.4%, and 26.4% for IFN α2b, LPV/r, and CQ, respectively. Sex (odds ratio (OR): 0.40 (95% confidence interval (CI): 0.211-0.742), age (OR: 2.36 (95% CI: 1.02-5.44)), and underlying diseases (OR: 0.12 (95% CI: 0.06-0.23)) were independently associated factors for ADRs (P < 0.05). Conclusions: The frequency of ADRs and potential DDI was high compared to their use during nonpandemic times (e.g., for malaria, HIV, or inflammatory diseases). The safety profile of these drugs when used for COVID-19 treatment showed similar characteristics. Comorbidities, age >37 years old, and female sex were associated with ADRs.

Correction to "Cuban Abdala vaccine: Effectiveness in preventing severe disease and death from COVID-19 in Havana, Cuba; A cohort study" [The Lancet Regional Health - Americas 2022; 16: 100366] https://doi.org/10.1016/j.lana.2022.100366.

[This corrects the article DOI: 10.1016/j.lana.2022.100366.].

Seguridad de las vacunas SOBERANAS® en niños, hijos de trabajadores de una institución de BioCubaFarma / Safety of SOBERANAS® vaccines in children of workers of a BioCubaFarma institution

En un complejo contexto epidemiológico nacional e internacional, de trasmisión y hospitalización por COVID-19 en población pediátrica, Cuba decidió realizar una campaña de vacunación masiva contra esta enfermedad en niños y adolescentes. El objetivo de este trabajo fue evaluar la seguridad del esquema heterólogo de dos dosis de SOBERANA®02 más una dosis de SOBERANA®Plus con 28 días entre ellas en niños y adolescentes, hijos de los trabajadores del Centro Nacional de Biopreparados, que pertenece a BioCubaFarma, Grupo Empresarial de las Industrias Biotecnológica y Farmacéutica de Cuba. La seguridad de las vacunas se evaluó mediante la identificación y clasificación de los eventos adversos por farmacovigilancia activa y pasiva. Se evaluaron 237 niños de ambos sexos, siendo incluidos 200 (130 con edades de 2 a 10 años y 70, de 11 a 18). Ciento noventa niños de los incluidos (95 por ciento) recibieron el esquema completo de vacunación. Se registraron un total de 121 eventos adversos, en su mayoría por farmacovigilancia pasiva, de intensidad leve y de causalidad A1 (relacionados). No ocurrieron eventos adversos graves relacionados. Las vacunas SOBERANA®02 y SOBERANA®PLUS evidenciaron un perfil de seguridad muy favorable durante su administración a niños y adolescentes, hijos de los trabajadores del Centro Nacional de Biopreparados(AU)

In a complex national and international epidemiological context of transmission and hospitalization by COVID-19 in the pediatric population, Cuba decided to carry out a massive vaccination campaign against this disease in children and adolescents. The aim of this work was to evaluate the safety of the heterologous scheme of two doses of SOBERANA®02 and one dose of SOBERANA®PLUS with 28 days between them, in children and adolescents who are sons of workers of the Centro Nacional de Biopreparados which belongs to BioCubaFarma, the Business Group of the Biotechnological and Pharmaceutical Industries of Cuba. The safety of the vaccines was evaluated through the identification and classification of adverse events by active and passive pharmacovigilance. A quantity of 237 children of both sexes was evaluated, and 200 were included (130 from 2 to 10 years, and 70 from 11 to 18 years). Of those included, 190 children (95percent) received the complete vaccination schedule. A total of 121 adverse events were recorded, mostly due to passive pharmacovigilance, of mild intensity and A1 (related) causality. No related serious adverse events occurred. The SOBERANA®02 and SOBERANA®PLUS vaccines showed a very favorable safety profile during their administration to children and adolescents who are sons of workers at the Centro Nacional de Biopreparados(AU)

Farmacovigilancia intensiva de vacunas SOBERANA®02 y Soberana®Plus en población pediátrica en el Centro de Inmunología Molecular / Intensive pharmacovigilance of SOBERANA®02 and Soberana®Plus vaccines in pediatric population at the Center for Molecular Immunology

Las vacunas SOBERANA®02 y SOBERANA® Plus contra el coronavirus tipo 2 causante del síndrome respiratorio agudo severo, recibieron autorización de uso en emergencia por la autoridad reguladora de Cuba, y de inmediato aconteció una campaña de vacunación masiva en población pediátrica, lo que devino en una inminente movilización de centros de vacunación y vigilancia de sus eventos adversos. El Centro de Inmunología Molecular realizó un estudio de farmacovigilancia intensiva que evalúo el cumplimiento del esquema heterólogo con ambas vacunas, su seguridad y la incidencia de casos positivos a COVID-19 en niños y adolescentes después de completar el esquema de inmunización. Desde el 15 de septiembre al 31 de diciembre del 2021, participaron 529 sujetos entre 2 y 18 años de edad, de ambos sexos, sin antecedentes de infección por coronavirus tipo 2 del síndrome respiratorio agudo severo, procedentes de 35 municipios y 12 provincias cubanas, quienes recibieron vacuna SOBERANA®02 (dos dosis) y SOBERANA®Plus (una dosis). Se realizó vigilancia de eventos adversos hasta 30 días después de la última dosis recibida. Se consultó la plataforma informática nacional Higia Andariego para identificar los casos positivos al virus del síndrome respiratorio agudo severo coronavirus 2, hasta 3 meses de haber completado la vacunación. El 98,5 por ciento de los participantes completó el esquema de vacunación y en el 6,6 por ciento se notificó algún evento adverso con relación consistente a la vacunación. Predominaron las reacciones locales (dolor, eritema, inflamación), sobre las reacciones sistémicas (fatiga y febrícula), de intensidad ligera o moderada. Se logró un elevado cumplimiento del esquema de inmunización, con un perfil de seguridad favorable, los sujetos con esquema completo de inmunización no enfermaron de COVID-19(AU)

The severe acute respiratory syndrome coronavirus 2 vaccines, SOBERANA®02 and SOBERANA®Plus, received authorization for emergency use by the Cuban regulatory authority; a massive vaccination campaign was immediately launched in the pediatric population, which led to an imminent mobilization of vaccination centers and surveillance of adverse events. The Molecular Immunology Center conducted an intensive pharmacovigilance study to evaluate compliance of the heterologous scheme with both vaccines, their safety, and the incidence of COVID-19 positive cases in children and adolescents after completing the immunization schedule. From September 15 to December 31, 2021, a total of 529 subjects between 2 and 18 years of age, of both sexes, without a history of infection by severe acute respiratory syndrome coronavirus type 2, from 35 municipalities and 12 Cuban provinces, who received SOBERANA®02 (two doses) and SOBERANA®Plus (one dose) vaccines, were included in the study. Surveillance for adverse events was performed up to 30 days after the last dose received. The national computer platform Higia Andariego was consulted to identify positive cases for severe acute respiratory syndrome coronavirus 2 up to 3 months after completing vaccination. According to the report, 98.5percent of the participants completed the vaccination schedule and 6.6percent of them reported some adverse event consistently related to vaccination. Local reactions (pain, erythema, inflammation) prevailed over systemic reactions (fatigue and fever), of light or moderate intensity. High compliance with the immunization schedule was achieved, with a favorable safety profile; subjects with a complete immunization schedule did not become ill with COVID-19(AU)

Impact of the COVID-19 on the epidemiology of maxillofacial fractures surgically treated in a Cuban university hospital

Introduction: COVID-19 pandemic has had a significant impact on people's behavior. Aim: To evaluate the impact of the COVID-19 on the epidemiology of maxillofacial fractures surgically treated in a Cuban university hospital. Methods: This research involved a 4-year descriptive, comparative, retrospective and cross-sectional study. Patients surgically treated between March 1 and December 31, 2020 (COVID-19 period) were compared with those who had undergone surgery between the same date in the years 2017-2019 (non-pandemic period). Age, sex, residence, year, month, alcohol consumption at the time of trauma, etiology, fractures types, and number of fractures per patient were recorded. Results: A decline in patients with maxillofacial fractures in 2020 (n=25) was observed when compared to equivalent periods in the three previous years (2017: n=37; 2018: n=31; 2019: n=41), respectively, with an annual average reduction of 31.19 %. Interpersonal violence was found to be the paramount etiological factor for maxillofacial fractures during the comparison periods (2017-2019); however, road traffic accident prevailed in the 2020 (n=12; 48%). There was a small increase in the number of alcohol-related fractures (56% in 2020 vs 46.34%, 41.94%, and 51.35% in 2019, 2018, and 2017, respectively). Conclusion: COVID-19 impacted on the epidemiology maxillofacial fractures surgically treated in this Cuban university hospital.

Introducción: La pandemia de la COVID-19 ha tenido un impacto significativo en el comportamiento de la población. Objetivo: Evaluar el impacto de la COVID-19 en la epidemiología de las fracturas maxilofaciales tratadas quirúrgicamente en un hospital universitario cubano. Métodos: Esta investigación consistió en un estudio descriptivo, comparativo, retrospectivo y transversal de 4 años de duración. Se compararon los pacientes intervenidos quirúrgicamente entre el 1 de marzo y el 31 de diciembre de 2020 (periodo COVID-19) con los intervenidos entre la misma fecha en los años 2017-2019 (periodo no pandémico). Se registraron edad, sexo, residencia, año, mes, consumo de alcohol en el momento del traumatismo, etiología, tipos de fracturas y número de fracturas por paciente. Resultados: Se observó un descenso de pacientes con fracturas maxilofaciales en 2020 (n=25) en comparación con periodos equivalentes de los tres años anteriores (2017: n=37; 2018: n=31; 2019: n=41), respectivamente, con una reducción media anual del 31,19 %. Se observó que la violencia interpersonal fue el factor etiológico primordial de las fracturas maxilofaciales durante los periodos de comparación (2017-2019); sin embargo, el accidente de tráfico prevaleció en el 2020 (n=12; 48 %). Hubo un pequeño aumento en el número de fracturas relacionadas con el alcohol (56 % en 2020 frente a 46,34 %, 41,94 % y 51,35 % en 2019, 2018 y 2017, respectivamente). Conclusiones: La COVID-19 impactó en la epidemiología de fracturas maxilofaciales atendidas quirúrgicamente en este hospital universitario cubano.

La pediatría social. Herramienta necesaria para combatir la pandemia de COVID-19 en Cuba

Introducción: La pediatría social se orienta hacia la atención integral del niño. Estudia las causas sociales que alteran su salud y también los problemas de esta índole que repercuten en su entorno social. En el contexto de la actual pandemia, caracterizada por alta morbilidad y mortalidad, se produjeron significativas consecuencias psicosociales. Objetivo: Describir el impacto de la pediatría social sobre la salud infanto-juvenil durante la pandemia de COVID-19. Métodos: Se realizó una revisión en las bases de datos bibliográficas PubMed y BVS. Se empleó el Google Académico como motor de búsqueda. Se utilizaron, en español y en inglés, los siguientes descriptores: pediatría social, pandemia COVID-19, aislamiento social, bienestar psicológico, salud mental y población pediátrica. Análisis y síntesis de la información: Se expusieron argumentos desde la mirada psicosocial del pediatra, relacionados con el desarrollo y el bienestar socioemocional de los niños, y la repercusión sobre ellos del aislamiento social; además, se describió el impacto de la pandemia en la infancia, y el papel desempeñado por el especialista y otros profesionales vinculados con la atención pediátrica. Conclusiones: La pandemia se caracterizó por afectar todas las esferas de la vida del niño. La pediatría social resultó indispensable en el enfrentamiento de las consecuencias médico-biológicas, psicológicasy sociales que ocasionó el azote de la COVID-19, por lo que su rol influyó en el restablecimiento del equilibrio biopsicosocial de la población infantil.

Introduction: Social pediatrics is oriented towards the comprehensive care of children. It studies the social causes that alter their health, and also the problems of this nature that affect their social environment. In the context of the current pandemic, characterized by high morbidity and mortality, there were significant psychosocial consequences. Objective: To describe the impact of social pediatrics on children and adolescents health during the COVID-19 pandemic. Methods: A review was conducted in the bibliographic databases PubMed and VHL. Google Scholar was used as a search engine. The following descriptors were used in Spanish and English: social pediatrics, COVID-19 pandemic, social isolation, psychological well-being, mental health and pediatric population. Analysis and synthesis of information: Arguments were presented from the psychosocial perspective of the pediatrician, related to the development and socio-emotional well-being of children, and the impact on them of social isolation. In addition, the impact of the pandemic on children was described, and the role played by the specialists and other professionals linked to pediatric care. Conclusions: The pandemic was characterized by affecting all spheres of the child's life. Social pediatrics was indispensable in confronting the medical-biological, psychological and social consequences caused by the scourge of COVID-19, so its role influenced the restoration of the biopsychosocial balance of the children population.

Huellas históricas de la COVID-19 en la asistencia médica de los habitantes de Manicaragua, Cuba / Historical traces of COVID-19 in the medical care of the inhabitants of Manicaragua, Cuba

Fundamento: la pandemia de COVID-19 ha tenido un efecto socioeconómico disruptivo en el mundo; pero ha dejado huellas que constituyen lecciones aprendidas entre la población de numerosos países. Objetivo: describir las huellas históricas de la COVID-19 en el municipio de Manicaragua, Villa Clara, Cuba, como expresión de la reorganización y regionalización de los servicios de salud que demandaba el enfrentamiento a la pandemia. Métodos: se realizó un estudio descriptivo longitudinal cuantitativo sobre el comportamiento de la COVID-19 en Manicaragua desde el inicio de la pandemia, abril 2020 hasta el 2022. Se emplearon métodos teóricos: análitico-sintético e histórico-lógico; empíricos: análisis documental; y matemático-estadísticos: para los valores absolutos y relativos. Resultados: fue analizado el impacto de la COVID-19 a partir de los casos diagnosticados y sus tasas de incidencia por habitantes en las distintas áreas de salud. Se destacan cifras predominantes: el poblado de Manicaragua y el grupo etario de 19 a 64 años como los de mayor presencia de contagiados, la fuente de infección superior fue la intradomiciliaria y Estados Unidos como el país que aportó la mayor cifra de contaminados. Se argumentan algunas formas de indisciplinas sociales como causas de los rebrotes epidemiológicos. Conclusiones: la COVID-19 dejó huellas que pueden considerarse históricas en Manicaragua, pues representó una pausa en su desarrollo social y un reordenamiento de los servicios médicos asistenciales. El incumplimiento de los protocolos y la actuación comunitaria frente a las indisciplinas sociales hoy se consideran lecciones aprendidas frente a próximos eventos epidemiológicos.

Background: the COVID-19 pandemic has had a disruptive socioeconomic effect on the world; but it has left traces that constitute lessons learned among the population of many countries. Objective: to describe the historical traces of COVID-19 in the municipality of Manicaragua, Villa Clara, Cuba, as an expression of the reorganization and regionalization of health services that the confrontation with the pandemic demanded. Methods: a quantitative longitudinal descriptive study was carried out on the behavior of COVID-19 in Manicaragua from the beginning of the pandemic, April 2020 to 2022. Theoretical methods were used: analytical-synthetic and historical-logical; empirical ones: documentary analysis; and mathematical-statistical: for absolute and relative values. Results: the impact of COVID-19 was analyzed based on the diagnosed cases and their incidence rates per population in the different health areas. Predominant figures stand out: the town of Manicaragua and the age group from 19 to 64 years as the ones with the highest presence of infected people, the highest source of infection was intra-domiciliary and the United States as the country that contributed the highest number of infected people. Some forms of social indiscipline are argued as causes of epidemiological outbreaks. Conclusions: COVID-19 left traces that can be considered historical in Manicaragua, since it represented a pause in its social development and a reordering of medical care services. Failure to comply with the protocols and community action against social indiscipline today are considered lessons learned in the face of upcoming epidemiological events.

Respuesta de Cuba para enfrentar la COVID-19 y sus retos / Cuba's response to COVID-19 and its challenges

Conferencia Magistral del Ministro de Salud Pública de la República de Cuba, Dr. José Angel Portal Miranda, Dr. C., durante la Inauguración del xxvi Congreso de la Federación Latinoamericana de Parasitología (FLAP), xv Congreso Centroamericano y del Caribe de Parasitología y Medicina Tropical (ACACPMT), x Congreso Cubano de Microbiología y Parasitología, vii Congreso Nacional de Medicina Tropical, vii Seminario Internacional sobre la Infección por el VIH y el Sida en Cuba. La Habana, 1 de noviembre del 2022.

Keynote Address by the Minister of Public Health of the Republic of Cuba, Dr. José Angel Portal Miranda, PhD, during the Opening Session of the 25th Congress of the Latin American Federation of Parasitology (FLAP), 15th Central American and Caribbean Congress of Parasitology and Tropical Medicine (ACACPMT), 10th Cuban Congress of Microbiology and Parasitology, 7th National Congress of Tropical Medicine, and 7th International Symposium on HIV Infection and AIDS in Cuba.

Conocimientos y prácticas de los médicos cubanos respecto a Enterobacterales resistentes a carbapenémicos / Knowledge and practice on carbapenem-resistant Enterobacterales in medical doctors from a tertiary hospital in Cuba

Introducción: En el contexto de la pandemia de COVID-19, la infección por Enterobacterales resistentes a carbapenémicos productores de carbapenemasas (ERC-PC) se convierte en un problema de salud pública desafiante a nivel mundial. Los médicos desempeñan un papel fundamental en el manejo clínico de las infecciones por patógenos resistentes a carbapenémicos a nivel hospitalario y por ende en el control de estas. Sin embargo, no existen estudios sobre el conocimiento y prácticas de estos sobre ERC-PC en Cuba. Objetivo: Abordar conocimientos y prácticas sobre las infecciones por ERC-PC, su manejo terapéutico, prevención y control en médicos cubanos en un hospital terciario. Métodos: Se realizó un estudio observacional (descriptivo, de corte transversal) y se aplicó un cuestionario específico elaborado a 70 médicos asistenciales. Resultados: Hubo variabilidad en las opiniones sobre las ERC-PC y un conocimiento medio sobre estas en la mayoría de los encuestados. El 58,6 % de los médicos tenía experiencia en el manejo clínico de la infección por ERC-PC. Las brechas de conocimiento encontradas estuvieron asociadas a la escasa experiencia práctica en el manejo de casos. Hubo diferencia estadísticamente significativa en el nivel de conocimientos sobre los ERC-PC en los médicos con experiencia en el manejo de los ERC-PC en comparación con los médicos sin experiencia (p = 0,039). Conclusiones: Es necesario establecer un plan de formación continua en la temática para mejorar el desempeño de los profesionales de la salud en el control de las infecciones por ERC-PC y en el uso optimizado de los antibióticos.

Introduction: In the context of COVID-19 pandemic, carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) infection becomes a global public health threat. Medical doctors play a fundamental role in the clinical management and control of infections caused by carbapenem-resistant pathogens. However, in Cuba there are not previous studies on the knowledge and practice of medical doctors about CR-CRE. Objective: To study the knowledge and practice of Cuban medical doctors in a tertiary hospital about CR-CRE infections, their clinical management, prevention and control. Methods: It was conducted an observational study (descriptive, cross-sectional) and an specific questionnaire to 70 medical doctors was applied. Results: There was variability on the opinions about CP-CRE and average knowledge in the majority of the respondents. 58.6% of the medical doctors had some experience in the clinical management of CP-CRE infections. Knowledge gaps were associated with the limited practical experience in the management of cases. There was statistically significant difference in the level of knowledge about CP-CRE of medical doctors with experience in the management of CP-CRE compared to inexperienced medical doctors (p = 0.039). Conclusions: It is necessary to establish a continuous training plan on this topic to improve the performance of health professionals in the control of CP-CRE infections and in the appropriate use of antibiotics.

Diferencias entre formas de contagio intra y extradomiciliaria en tres brotes epidémicos de COVID-19 en Santiago de Cuba / Differences between Forms of Intra- and Extra-Domiciliary Contagion in Three Epidemic Outbreaks of COVID-19 in Santiago de Cuba

Introducción: En la transmisión de la COVID-19 en Santiago de Cuba se distinguieron tres brotes epidémicos entre 2020 y 2021. Objetivo: Identificar las diferencias entre los contagios intra y extradomiciliarios en tres brotes epidémicos de COVID-19 en Santiago de Cuba entre marzo de 2020 y mayo de 2021. Métodos: Se realizó un estudio descriptivo transversal de los casos de COVID-19 del territorio y el período referidos, mediante las técnicas bivariadas habituales de la estadística y el análisis estadístico implicativo, con una muestra de 6408 que se eligió por muestreo aleatorio simple de la base de datos de casos confirmados. Resultados: El contagio extradomiciliario fue significativamente mayor que el intradomiciliario sin diferencias por sexo, pero sí según grupos de edades y municipios dentro y entre ambos grupos. Fue significativo el predominio de los adultos mayores en el contagio intradomiciliario y de los adultos jóvenes en el extradomiciliario. Primaron los sintomáticos en el intradomiciliario; y, los asintomáticos, en el extradomiciliario, sin diferencias significativas entre ambas formas. Los menores de 20 años de edad, adultos mayores, asintomáticos y el municipio Mella fueron las características que se asociaron con el contagio intradomiciliario, mientras, con el extradomiciliario, los adultos jóvenes sintomáticos. Conclusiones: Las formas de contagio intra y extradomiciliaria se modularon según la conducta de las personas y el aislamiento propio de cada grupo de edades. La extradomiciliaria predominó en edades intermedias de la vida, como expresión de la conducta mediada por su responsabilidad económica en el hogar, mientras las edades extremas, que permanecieron en casa por cumplir medidas de aislamiento, fueron más propensas a la intradomiciliaria(AU)

Introduction: In the transmission of COVID-19 in Santiago de Cuba province, three epidemic outbreaks were observed between 2020 and 2021. Objective: To identify the differences between intra- and extra-domiciliary infections in three epidemic outbreaks of COVID-19 in Santiago de Cuba between March 2020 and May 2021. Methods: A cross-sectional descriptive study of COVID-19 cases in the territory and period above mentioned was carried out, using the usual bivariate techniques of statistics and implicative statistical analysis, to a sample of 6408 cass that was chosen by simple random sampling from the database of confirmed cases. Results: Extra-domiciliary contagion was significantly higher than intra-domiciliary contagion without differences by sex, but according to age groups and municipalities within and between both groups. The predominance of older adults in intra-domiciliary contagion and of young adults in extra-domiciliary contagion was significant. Symptomatic patients prevailed in the intra-domiciliary; and, the asymptomatic, in the extra-domiciliary, without significant differences between both forms. Children under 20 years of age, older adults, asymptomatic and Mella municipality were the characteristics that were associated with intra-domiciliary contagion, while, with the extra-domiciliary were related symptomatic young adults. Conclusions: The forms of intra- and extra-domiciliary contagion were modulated according to the behavior of the people and the isolation of each age group. Extra-domiciliary predominated in intermediate ages of life, as an expression of the behavior mediated by their economic responsibility at home, while extreme ages, who remained at home to comply with isolation measures, were more prone to intra-domiciliary contagion(AU)