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1.
Lancet Reg Health Am ; 16: 100366, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36185968

RESUMO

Background: COVID-19 vaccines have proven safe and efficacious in reducing severe illness and death. Cuban protein subunit vaccine Abdala has shown safety, tolerability and efficacy (92·3% [95% CI: 85·7‒95·8]) against SARS-CoV-2 in clinical trials. This study aimed to estimate Abdala's real-world vaccine effectiveness (VE). Methods: This retrospective cohort study in Havana analyzed Cuban Ministry of Public Health databases (May 12-August 31, 2021) to assess VE in preventing severe illness and death from COVID-19 (primary outcomes). Cox models accounting for time-varying vaccination status and adjusting by demographics were used to estimate hazard ratios. A subgroup analysis by age group and a sensitivity analysis including a subgroup of tested persons (qRT-PCR) were conducted. Daily cases and deaths were modelled accounting for different VE. Findings: The study included 1 355 638 persons (Mean age: 49·5 years [SD: 18·2]; 704 932 female [52·0%]; ethnicity data unavailable): 1 324 vaccinated (partially/fully) and 31 433 unvaccinated. Estimated VE against severe illness was 93·3% (95% CI: 92·1-94·3) in partially- vaccinated and 98·2% (95% CI: 97·9-98·5) in fully-vaccinated and against death was 94·1% (95% CI: 92·5-95·4) in partially-vaccinated and 98·7% (95% CI: 98·3-99·0) in fully-vaccinated. VE exceeded 92·0% in all age groups. Daily cases and deaths during the study period corresponded to a VE above 90%, as predicted by models. Interpretation: The Cuban Abdala protein subunit vaccine was highly effective in preventing severe illness and death from COVID-19 under real-life conditions. Funding: Cuban Ministry of Public Health. Genetic Engineering and Biotechnology Centre.

2.
Washington, D.C.; OPS; 2022-08-10. (OPS/FPL/IM/22-0020).
em Espanhol | PAHO-IRIS | ID: phr-56232

RESUMO

EN ESTA EDICIÓN: Semana de Vacunación en las Américas 2022: “¿Estás protegido? Ponte todas tus vacunas” | Lo que he aprendido…Ana Elena Chévez, Asesora Técnica Sénior del Fondo Rotatorio para la Compra de Vacunas | Estudio sobre la reticencia a la vacunación contra la COVID-19 en el Caribe | Las vacunas sin jeringas podrían tener numerosos beneficios pero requieren más inversión | Aumento del número de materiales de comunicación publicados por IM, 2018-2021 | Inmunización, curso de vida y salud mental: cooperación técnica en Cuba para hacer frente a la pandemia | Los esfuerzos de colaboración con las autoridades ancestrales como clave para avanzar en la cobertura de la vacunación contra la COVID-19 en Guatemala | Introducción de la vigilancia activa de los ESAVI tras la vacunación contra la COVID-19 en mujeres embarazadas en Guatemala | Clasificación final de casos en la Región de las Américas, 2022.


Assuntos
Imunização , Programas de Imunização , Doenças Preveníveis por Vacina , Vacinas contra COVID-19 , Cuba , Guatemala , América , Região do Caribe
3.
Washington, D.C.; PAHO; 2022-08-10. (PAHO/FPL/IM/22-0020).
em Inglês | PAHO-IRIS | ID: phr-56231

RESUMO

IN THIS EDITION: Vaccination Week in the Americas 2022: “Are You Fully Vaccinated? Get All Your Shots” | What I Have Learned… Ana Elena Chévez, Senior Technical Advisor, Revolving Fund for Access to Vaccines | Studying COVID-19 Vaccine Hesitancy in the Caribbean | Vaccines without Needles Could Have Numerous Benefits but Require Further Investment | Increase in Number of Communications Materials Published by IM, 2018–20211 | Immunization, life course, and mental health: technical cooperation in Cuba to respond to the pandemic | Collaborative Efforts with Ancestral Authorities as a Key to Advancing COVID-19 Vaccination Coverage in Guatemala | Implementing Active ESAVI Surveillance following COVID-19 Vaccination among Pregnant Women in Guatemala | Final Classification of Cases in the Region of the Americas, 2021.


Assuntos
Imunização , Programas de Imunização , Doenças Preveníveis por Vacina , Vacinas contra COVID-19 , Cuba , Guatemala , América , Região do Caribe
4.
Washington, D.C.; Organisation panaméricaine de la Santé; 2022-08-10. (OPS/FPL/IM/22-0020).
em Francês | PAHO-IRIS | ID: phr-56230

RESUMO

DANS CE NUMÉRO: Semaine de la vaccination dans les Amériques 2022 : « Es-tu protégé ? Prends tous tes vaccins » | Ce que j’ai appris... Ana Elena Chévez, Conseillère technique principale du Fonds renouvelable pour l’accès aux vaccins | Étude de la réticence à la vaccination anti-COVID-19 dans les Caraïbes | Les vaccins sans aiguilles pourraient avoir de nombreux avantages, mais nécessitent des investissements supplémentaires | Augmentation du nombre de documents de communication publiés par IM, 2018-2021 | Vaccination, cycle de vie et santé mentale : coopération technique à Cuba pour faire face à la pandémie | Efforts de collaboration avec les autorités ancestrales : un facteur clé de progression de la couverture vaccinale anti-COVID-19 au Guatemala | Mise en oeuvre d’une surveillance active des ESAVI après la vaccination anti-COVID-19 de femmes enceintes au Guatemala | Classement final des cas, Région des Amériques, 2021.


Assuntos
Imunização , Programas de Imunização , Doenças Preveníveis por Vacina , Vacinas contra COVID-19 , Cuba , Guatemala , América , Região do Caribe
5.
Washington, D.C.; OPAS; 2022-08-10. (OPAS/FPL/IM/22-0020).
em Português | PAHO-IRIS | ID: phr-56229

RESUMO

NESTA EDIÇÃO: Semana de Vacinação nas Américas 2022: “Você está protegido? Tome todas as vacinas | O que aprendi... Ana Elena Chévez, Assessora Técnica Sênior do Fundo Rotativo para Acesso a Vacinas | Estudo sobre a hesitação à vacina contra COVID-19 no Caribe | Vacinas sem agulhas podem ter inúmeros benefícios, mas exigem mais investimentos | Aumento do número de materiais de comunicação publicados pela IM, 2018 a 2021 | Imunização curso de vida e saúde mental: cooperação técnica em Cuba para enfrentar a pandemia | Esforços de colaboração com autoridades ancestrais como chave para o avanço da cobertura da vacinação contra COVID-19 na Guatemala | Implementação de vigilância ativa de ESAVI após a vacinação de gestantes contra COVID-19 na Guatemala | Classificação final dos casos na Região das Américas, 2021.


Assuntos
Imunização , Programas de Imunização , Doenças Preveníveis por Vacina , Vacinas contra COVID-19 , Cuba , Guatemala , América , Região do Caribe
6.
J Lat Am Caribb Anthropol ; 27(1-2): 16-36, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35935183

RESUMO

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


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

7.
J Clin Virol Plus ; 2(4): 100104, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36034515

RESUMO

The SARS CoV-2 D614G variant circulated in Cuba in 2020. New viral variants were detected after the opening of the border in November 2020. We show the results of the genomic surveillance in Cuba from December 28, 2020, to September 28, 2021 and their relationship to the epidemiological situation in the country. A total of 1,406 nasopharyngeal exudates from COVID-19 patients were processed for RNA extraction and the 1836 bp fragment of the spike gene was amplified and sequenced. The mutations present were determined using the GISAID database. Prevalence ratios were estimated by fitting Poisson univariate and multivariate regression models to investigate associations between SARS-CoV-2 variant group (VOC, non-VOC) and disease outcome. Seventeen genetic variants were detected including VOC Alpha, Beta, Gamma and Delta, one variant of interest (VOI) (Lambda) and two previous VOI (A.2.5.1 and Zeta/P.2). Beta (34.77%), Delta (24.89%) and D614G (19%) variants were the most frequently detected. By June, Delta increased in frequency, displacing Beta. Disease severity increased significantly with age and VOC (PR =1.98, IC 95%: 1.33-3.05, p <0.05). Genomic surveillance allowed us to identify the upsurge of novel variants. Coinciding with the higher epidemic period, multiple variants were co-circulating. Although we cannot rule out that failure in the transmission containment measures occurred, the increase in the number of cases associated with the circulation of several variants, particularly the Beta and Delta variants is highly suggestive. A greater association of Beta variant with clinical severity and Delta variant with a greater transmissibility was observed.

8.
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
9.
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
10.
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
11.
Artigo em Espanhol | PAHO-IRIS | ID: phr2-55969

RESUMO

[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. Desde que comenzó la pandemia provocada por el SARS-CoV-2 en la isla, esta publicación se ha dedicado, fundamentalmente, a compilar y dar a conocer aspectos destacados de la respuesta en el territorio nacional. Sin embargo, en el presente número, la mayoría de los artículos recoge un balance de los resultados de la colaboración en las diferentes áreas técnicas entre 2020 y 2021. De tal forma, aunque se hace referencia a lo relacionado con el enfrentamiento a la COVID-19, también se reflejan esfuerzos encaminados a otros programas y prioridades dentro del sector sanitario. De igual forma, es posible leer una entrevista con la investigadora Marta Ayala Ávila, así como trabajo dedicados a la labor de médicos rurales cubanos y de la Unidad Nacional de Promoción de Salud y Prevención de Enfermedades (PROSALUD).


Assuntos
Vacinação , SARS-CoV-2 , COVID-19 , Epidemiologia , Promoção da Saúde , Doenças Transmissíveis , Imunização , Saúde Mental , Cooperação Técnica , Sistemas de Saúde
13.
MEDICC Rev ; 24(1): 14-18, 2022 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-35157634

RESUMO

Cuba's decision in September 2021 to launch a massive vaccination campaign against COVID-19 for children as young as two years old turned heads around the world-of clinicians, immunologists, public health experts, governments and regulatory authorities alike. Since then-and just as pediatric COVID-19 hospitalizations reached record numbers globally-some two million Cuban children and adolescents have received the Cuban Soberana vaccines (1.7 million, or 81.3% of that population through December 16, 2021).[1] Why did Cuban health authorities decide to vaccinate children? What clinical trials provided the evidence for such a course of action, especially for the youngest? And what have been the results thus far? To answer these and other questions, MEDICC Review spoke with Dr Rinaldo Puga, principal investigator for the completed phase 1/2 clinical trials of the Finlay Vaccine Institute's Soberana 02 and Soberana Plus vaccines in pediatric ages. Dr Puga's 30 years as a practicing pediatrician have been accompanied by teaching and research, the latter earning him awards from the Cuban Academy of Sciences, among others. He is currently chief of pediatrics and chair of the Scientific Council at the Cira García Clinic in Havana, which granted him leave to lead the pediatric vaccine trials.


Assuntos
Vacinas contra COVID-19 , Pediatria , Adolescente , COVID-19 , Criança , Pré-Escolar , Ensaios Clínicos como Assunto , Cuba , Humanos , Masculino , SARS-CoV-2
14.
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
15.
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
16.
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
17.
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
18.
MEDICC Rev ; 24(1): 70-75, 2022 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-35157641

RESUMO

We discuss the suitability of innate immune stimulation in acute respiratory infection post-exposure prophylaxis. The induction of innate immunity can be used to reduce susceptibility to immune-evasive pathogens (coronavirus, influenza virus, respiratory syncytial virus and rhinovirus). After the emergence of multiple SARS-CoV-2 variants, scientists are debating whether new variants could affect vaccine efficacy and how antigens could be redesigned to compensate. In addition, there is insufficient vaccine production to cover universal demand, and equitable vaccine distribution is a global challenge. Given these factors, non-specific immune stimulators may be suitable for a quick first response in the case of a suspected or early respiratory infection. Our group completed several HeberNasvac studies in healthy volunteers and patients with respiratory infections, and is currently starting large clinical trials in patients with early SARS-CoV-2 infections. This nasal formulation of hepatitis B vaccine has demonstrated its capacity to stimulate innate immunity markers (TLR3, TLR7 and TLR8 in tonsils) at the virus' entry site, in systemic compartments (HLA class II in monocytes and lymphocytes) and in the activation of dendritic cells, lymphocytes and other cell lines in vitro and ex vivo. In addition, research generated by the current pandemic may obtain results useful for treating other acute respiratory infections, which have long been main drivers of mortality among older adults and in early childhood.


Assuntos
COVID-19 , SARS-CoV-2 , Idoso , Pré-Escolar , Cuba , Humanos , Imunidade Inata , Profilaxia Pós-Exposição , Prevenção Secundária
19.
O.F.I.L ; 32(1): 83-86, enero 2022.
Artigo em Espanhol | IBECS | ID: ibc-205737

RESUMO

Introducción: La infestación y mortalidad ocasionada por el coronavirus Sarv-Cov-2 (COVID-19) generó que los sistemas de salud desarrollaran acciones para promover nuevas investigaciones clínicas encaminadas a contar con esquemas de tratamientos efectivos, para un mejor manejo de esta enfermedad.En Cuba, con la existencia antes de la pandemia, de un plan de ensayos clínicos y la necesidad de promover nuevos, para hacer frente a la COVID-19; se propuso la elaboración de un sistema de acciones encaminadas a preservar la calidad de los mismos.Objetivo: Describir las principales acciones desarrolladas, por el Sistema Nacional de Salud cubano, para el desarrollo de las investigaciones clínicas durante la pandemia.Métodos: Se realizó una revisión bibliográfica en los principales sitios web regulatorios y vinculados con el tema de investigaciones clínicas en etapa de pandemia por la COVID-19. Los resultados alcanzados se tuvieron en cuenta para proponer un sistema de acciones propio, encaminado a respaldar los ensayos clínicos.Resultados: Se establecieron acciones en tres líneas de trabajo: el respaldo ético, los requerimientos regulatorios para las modificaciones a los estudios en curso y nuevos y para el control de los ensayos clínicos. El sistema de trabajo quedó conformado por 29 acciones encaminadas a que los ensayos clínicos tuvieran un respaldado ético, cumplieran con los requerimientos regulatorios en cuanto a los aspectos metodológicos, de diseño y de control para garantizar el cumplimiento de las Buenas Prácticas Clínicas. (AU)


Introduction: The infestation and mortality caused by the Sarv-Cov-2 (COVID-19) coronavirus led health systems to develop actions to promote new clinical research aimed at having effective treatment schemes for better management of this disease.In Cuba, with the existence before the pandemic, of a clinical trial plan and the need to promote new ones, to deal with COVID-19; it was proposed to develop a system of actions aimed at preserving their quality.Objective: Describe the main actions developed by the Cuban National Health System for the development of clinical research during the pandemic.Methods: A bibliographic review was carried out on the main regulatory websites and those related to the topic of clinical research in the pandemic stage of COVID-19. The results achieved were taken into account to propose an own action system, aimed at supporting clinical trials.Results: Actions were established in three lines of work: ethical support, regulatory requirements for modifications to ongoing and new studies, and the control of clinical trials. The work system was made up of 29 actions aimed at ensuring that clinical trials have ethical support, comply with regulatory requirements in terms of methodological, design aspects and their control to guarantee compliance with Good Clinical Practices. (AU)


Assuntos
Humanos , Sistemas de Saúde , Coronavirus , Pandemias , Estágio Clínico , Patologia
20.
Curr Ther Res Clin Exp ; 96: 100662, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35039686

RESUMO

BACKGROUND: The ongoing coronavirus disease 2019 (COVID-19) pandemic is a worldwide public health threat. Millions of people are at risk and older adults are more susceptible to developing the most serious manifestations of the disease, in part because of the effects of ageing on the immune system. Biomodulina T is an injectable immune modulator that has been licensed for use in Cuba for many years. OBJECTIVE: An open-label, uncontrolled trial was conducted to investigate whether or not it might be useful to prevent or modulate the serious effects of severe acute respiratory syndrome coronavirus 2 infections in older Cuban adults before the availability of vaccinations. METHODS: From April 12 to August 31, 2021, 1239 adults aged 60 years and older, unvaccinated against COVID-19 were recruited from the José Luis Dubrocq polyclinics, to receive Biomodulina T, 1 intramuscular 3 mL dose weekly for 6 weeks. Each person was visited at home weekly to be administered Biomodulina T. Once daily patients were seen by a medical student to collect information on any possible adverse events related to the medication as well as any symptoms of COVID-19. The possible usefulness of the intervention and its potential adverse events were assessed based on the number of older adults who became infected with COVID-19, and the severity of any symptoms reported or noted both during the 6-week treatment period and during an additional 6-week posttreatment observation period. RESULTS: Sixteen patients were diagnosed with symptomatic COVID-19 during the intervention using a specific reverse transcription polymerase chain reaction test. One patient died because of COVID-19. The most common preexisting diagnoses in treated patients included high blood pressure in 64.8%, diabetes mellitus in 19.85%, and ischemic cardiopathy in 13.88%. Biomodulina T was well tolerated. Only infrequent, mild, transient, and self-limited adverse events were identified. Both the incidence of COVID-19 infections and the overall mortality rate were lower in the treated patients than what was observed in the untreated general population of this Cuban province during the same time period. CONCLUSIONS: Although further, confirmatory, double-blind, controlled clinical trials are needed, Biomodulina T injections were well tolerated, and the results of this open, uncontrolled study suggest that it may have been useful to decrease the incidence and severity of symptomatic COVID-19 infection in these older Cuban adults. (Curr Ther Res Clin Exp. 2022; 82:XXX-XXX) © 2022 Elsevier HS Journals, Inc.

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