EDITORIAL / PDFGlobal COVID-19 Scorecard: Science, 1—Science Diplomacy and Equity, 0 PEER REVIEWERS 2022 / PDF LETTERS / PDF CUBA’S WOMEN OF SCIENCE – INTERVIEW Putting Science to Work: Cuba’s COVID-19 Pandemic ExperienceIleana Morales, Director, Science & Technological Innovation,Ministry of Public Health, CubaGail Reed MS / PDF INTERVIEWHealth Care is a Right, Not a Commodity: […]
Insights from Cuba’s COVID-19 Vaccine Enterprise: Report from a High Level Fact-Finding Delegation to Cuba July–October 2022, Vol 24, No 3–4
MEDICC Cuba COVID-19 Vaccine Full Report Download See also Executive Summary
2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the region of the Americas. Campbell NRC, Paccot Burnens M, Whelton PK, Angell SY, Jaffe MG, Cohn J, et al. Lancet Reg Health Am. 2022 May;9:None. https://doi.org/10.1016/j.lana.2022.100219 Cardiovascular disease (CVD) is the leading cause of death in the Americas and raised […]
Alina Artiles-Santana MDFamily physician and assistant professor, Prenatal Diagnostic Ultrasound Department, Chiqui Gómez Lubián Teaching Polyclinic, Santa Clara, Cuba. With more than three decades in public health services, Dr Artiles has taught residents in family medicine in courses on geriatrics, maternal and child health, and ultrasound diagnostics in primary health care. Anabel Fernández-Abreu MS PhDChemical […]
Deaths averted, doctors trained, clinics staffed, communities reached, minds changed, lives touched: the metrics for measuring the impact of the late Dr Paul Farmer (1959-2022) are impressive in themselves. As a physician, medical anthropologist, professor, author and public health activist, Dr Farmer’s commitment to advancing health equity is felt from Boston to Peru, Rwanda to […]
INTRODUCTION It would be useful to have diagnostic indices for obesity phenotypes in pregnant women based on morphological traits and the specific distribution of abdominal adipose tissue. This type of practical resource would allow for the classification of obesity phenotypes in normal-weight women in early pregnancy and would contribute to primary healthcare followup of pregnant women.
OBJECTIVES Validate a new diagnostic index for the metabolically unhealthy obese, normal-weight phenotype, as a determinant for cardiometabolic risk in normal-weight pregnant Cuban women in the first trimester of pregnancy.
METHODS A cross-sectional study of 526 pregnant women at a gestational age of 12 to 14 weeks seen at the ultrasound service of the Chiqui Gómez Lubián Teaching Polyclinic, Santa Clara municipality, Villa Clara province, Cuba, was conducted from January 2016 through July 2020. Subcutaneous, preperitoneal and visceral abdominal fats, as well as anthropometric and blood chemistry variables, were measured. The women were divided into three groups based on metabolic phenotypes, taking into account body mass index in the normal weight range, visceral adiposity index values and the lipid accumulation product starting at the 75th percentile.
The new index, called the abdominal adipose deposit index, was obtained by multiplying the subcutaneous fat thickness by visceral fat thickness, both measured by ultrasound. A cutoff point was established that facilitated discernment of an unhealthy phenotype: normal weight but metabolically obese, a cardiometabolic risk factor.
RESULTS Receiver operating characteristic (ROC) analysis of the abdominal adipose deposit index to distinguish the metabolically unhealthy obese, normal-weight phenotype in normal-weight pregnant women showed an area under the curve of 0.707 (95% CI: 0.62‒0.79, p <0.001), greater than that of the body fat index (0.630; 95% CI: 0.54‒0.72), the fat accumulation index (0.637; 95% CI: 0.55‒0.73) and other established ultrasound indices of abdominal adiposity, with a prevalence of 6.3%.
CONCLUSIONS The abdominal adipose deposit index is better than other traditional indicators at detecting the risk of metabolic obesity in early pregnancy in normal-weight women, facilitating early intervention in clinical practice to prevent or delay progression of cardiometabolic disease in these women.
KEYWORDS Abdominal adipose tissue, abdominal fat, pregnant woman, phenotype, metabolic syndrome, diagnostic ultrasound, Cuba
Ileana Morales Suárez MD MS July–October 2022, Vol 24, No 3–4
It was just before New Year’s Eve, 2019 when an emerging virus in China caught the attention of Dr Ileana Morales, director of Science and Technological Innovation in Cuba’s Ministry of Public Health. She had already participated in implementing Cuban protocols to prevent Ebola and address diseases such as Zika and dengue. But this was […]
July 1997–December 2019 July–October 2022, Vol 24, No 3–4
INTRODUCTION Vibrio cholerae is a microorganism that causes acute diarrheal diseases and cholera, one of the leading causes of global morbidity and mortality, especially in children under five years old. It is present in many regions and has been isolated from diverse sources such as water, soil and food. Surveillance of this microorganism in Cuba from 1985 through June 1997 showed circulation of non-epidemic non-O1/non-O139 serogroups, but surveillance continued to identify distribution of V. cholerae serotypes and serogroups in the different geographic regions of the country during the following years, due to the risk of introducing cholera-causing serogroups that provoked cholera epidemics in other countries of the region.
OBJECTIVES Describe the temporal‒spatial distribution of serogroups and serotypes of V. cholerae in Cuba.
METHODS A cross-sectional study was conducted that included isolates from passive surveillance of V. cholerae in 16 hygiene and epidemiology centers throughout Cuba from July 1997 through December 2019, submitted to the National Reference Laboratory for Acute Diarrheal Diseases of the Pedro Kourí Tropical Medicine Institute in Havana, Cuba. The timeline was subdivided into three five-year periods and one eight-year period. The centers submitting isolates were grouped into three geographical regions: western, central and eastern Cuba. A total of 1060 V. cholerae isolates were studied, from the 1438 samples sent from 15 Provincial Hygiene, Epidemiology and Microbiology Centers and the Municipal Hygiene, Epidemiology and Microbiology Center of the Isle of Youth Special Municipality. Genus, species and serotype of all specimens were studied and reviewed in the context of the outbreaks of acute diarrheal diseases reported in the country.
RESULTS All 1060 isolates were confirmed as V. cholerae. In the distribution by time period and region, the highest percentage occurred in the 2012‒2019 period, and the eastern region contributed the most isolates in all periods. Approximately 63.9% (677/1060) were from outbreaks, and in the 2012‒2019 period, the most epidemic-causing isolates came from the western region. Approximately 52.8% (560/1060) were identified as non-O1/non-O139 V. cholerae, and 47.2% (500/1060) as O1 V. cholerae; of these, 96.4% (482/500) corresponded to Ogawa serotype and 3.6% (18/500) to Inaba. Circulation of non-O1/non-O139 V. cholerae occurred throughout the entire period. The O1 serogroup began to circulate in 2012 and continued through 2016; however, since 2017, it has not been identified again. In the western region, there were smaller percentages of isolates of non-O1/non-O139 V. cholerae in all periods, except 2012‒2019. In that period, V. cholerae O1 was identified to a lesser degree in the central region.
CONCLUSIONS Vibrio cholerae circulated in all three Cuban regions during the years studied, with a higher percentage of isolates of the non-O1/non-O139 serogroup, which caused outbreaks or sporadic cases of diarrhea in the eastern region, with the exception of the 2012‒2019 period, when epidemic outbreaks of the O1 serogroup (which causes cholera) occurred in all three regions, with higher percentages in the western region.
KEYWORDS Vibrio cholerae; Vibrio cholerae O1; Vibrio cholerae non-O1; Vibrio cholerae O139; dysentery; cholera; epidemiological monitoring; infectious diarrheal disease; disease transmission, infectious; gastrointestinal diseases; Cuba
INTRODUCTION Polyserositis is described as inflammation with effusion of more than one serous membrane. There is very little published literature linking it to COVID-19 as a late complication.
OBJECTIVES Present and describe a case of post–COVID-19 polyserositis.
METHODS Data were collected from the medical record of a female patient admitted for fainting spells and marked weakness. The patient underwent a clinical evaluation, additional hematology, imaging and histopathology tests, and a surgical procedure.
The new index, called the abdominal adipose deposit index, was obtained by multiplying the subcutaneous fat thickness by visceral fat thickness, both measured by ultrasound. A cutoff point was established that facilitated discernment of an unhealthy phenotype: normal weight but metabolically obese, a cardiometabolic risk factor.
RESULTS We present the case of a 57-year-old female patient admitted to hospital for fainting spells and marked weakness, four months after COVID-19 infection. She also had a history of obesity, asthma, type 2 diabetes mellitus and a cholecystectomy in December 1992 for gallstones. Clinical assessment revealed pericardial effusion and bilateral pleural effusion, in addition to a tumor-like lesion outside the pericardium, proximal to the right ventricular wall. A surgical procedure and findings from additional tests led to diagnoses of thymic remnants and polyserositis.
CONCLUSIONS This is a case of polyserositis in a post–COVID-19 patient. After other causes of polyserositis were ruled out, and since there is a likely physiological and pathogenic mechanism operating between the two diseases, the polyserositis was determined to be a late complication of COVID-19. To date, it is the second case reported in the world and the first reported in Cuba.
KEYWORDS COVID-19, SARS-CoV-2, colchicine, pericardial effusion, pleural effusion, pericarditis, thoracoscopy, Cuba
Insights from Cuba’s COVID-19 Vaccine Enterprise: Report from a High Level Fact-Finding Delegation to Cuba July–October 2022, Vol 24, No 3–4
MEDICC-Cuba-COVID-19-Vaccine-Executive-Summary_2022 Download See also full Technical Report
Wherever you may be reading this: thank science. As you dress your children for school, commute, commune, worship or workout: thank science. As you plan a wedding, year-end celebrations, a trip, surgery, or dental cleaning: thank science. Our very survival is thanks to collaborative research and science that delivered safe, effective COVID-19 vaccines in record […]
To the Editors:COVID-19 pandemic continues testing the stamina of both societies and health care services. Until now, we have focused on the acute effects of SARS-CoV-2 but, as more people convalesce from the infection, our attention is drawn to its more long-term effects. With increasing frequency, we examine outpatients with cognitive dysfunction after COVID-19 infection. […]
INTRODUCTION In inflammatory respiratory diseases, the imbalance between proteases and endogenous protease inhibitors leads to an exacerbated activity of human neutrophil elastase (a protease that destroys the extracellular matrix and stimulates proinflammatory cytokine release). Elastase is considered a target in the search for therapeutic treatments for inflammatory respiratory diseases. Pulmonary surfactant is a promising product for this purpose, because in addition to its biophysical function, it has anti-inflammatory properties.
OBJECTIVES Evaluate effect of the Cuban porcine pulmonary surfactant (Surfacen), the rCmPI-II elastase inhibitor, and the Surfacen/rCmPI-II combination on activated neutrophil elastase activity in vitro, and determine if Surfacen’s interface property changes in the presence of the inhibitor.
METHODS The anti-elastase effect of Surfacen, rCmPI-II and the Surfacen/rCmPI-II combination was evaluated in an in vitro model of activated neutrophils, previously purified from the blood of healthy subjects. The cells were stimulated with LPS/fMLP and were incubated with different concentrations of Surfacen, rCmPI-II and the Surfacen/rCmPI-II combination. Elastase activity was measured. The interface property was determined on a Langmuir surface balance.
The new index, called the abdominal adipose deposit index, was obtained by multiplying the subcutaneous fat thickness by visceral fat thickness, both measured by ultrasound. A cutoff point was established that facilitated discernment of an unhealthy phenotype: normal weight but metabolically obese, a cardiometabolic risk factor.
RESULTS Surfacen at 10 mg/mL inhibited 71% of stimulated neutrophil elastase activity. rCmPI-II at 0.1 μM reduced 20% of elastase activity; at 200 μM—the maximum concentration evaluated—inhibition was 68%. Both products had a dose-dependent effect. The Surfacen/inhibitor combination (0.5 mg/mL/80 µM) did not affect the surfactant interface property or the inhibitory activity of rCmPI-II against human neutrophil elastase.
CONCLUSIONS Surfacen and the rCmPI-II inhibitor have an anti-elastase effect on an activated neutrophil model. rCmPI-II does not affect Surfacen’s interface property and, therefore, both can be evaluated for combined use in treating inflammatory lung diseases.
KEYWORDS Pulmonary surfactants, elastase inhibitor, drug carriers, neutrophils, Cuba
Cuban Abdala vaccine: Effectiveness in preventing severe disease and death from COVID-19 in Havana, Cuba; A cohort study. Más-Bermejo PI, Dickinson-Meneses FO, Almenares-Rodríguez K, Sánchez-Valdés L, Guinovart-Díaz R, Vidal-Ledo M, et al. Lancet Reg Health Am. 2022 Dec;16:100366. Epub 2022 Sep 24. https://doi.org/10.1016/j.lana.2022.100366 Background COVID-19 vaccines have proven safe and efficacious in reducing severe illness and […]
Variant in Cuba July–October 2022, Vol 24, No 3–4
INTRODUCTION In November 2021, omicron—a new SARS-CoV-2 variant—was identified in South Africa and almost immediately, WHO declared it a ‘variant of concern’. In view of its rapid worldwide spread and its imminent introduction in Cuba, genomic surveillance was strengthened.
OBJECTIVES Describe cases during the first eight epidemiological weeks (epiweeks) of SARS-CoV-2 infection attributable to omicron variant in Cuba by clinical and epidemiological variables.
METHODS From epiweek 48, 2021 to epiweek 4, 2022, 288 nasopharyngeal swabs were processed for sequencing of a 1836 bp fragment of the S gene. Variants were identified according to GISAID database and confirmed by phylogenetic analysis. Variants’ association with clinical and epidemiological outcomes was assessed.
RESULTS The first cases of omicron variant were imported, mostly from African countries and the United States. During the period studied, omicron was detected in 83.0% (239/288) of cases processed, while the delta variant was found in 17.0% (49/288). Most persons infected with omicron were symptomatic (63.2%; 151/239) and fully vaccinated (65.3%; 156/239); severe cases and deaths occurred mainly among patients aged ≥65 years (92.9%; 13/14), and 12 of these deaths occurred in fully vaccinated persons (92.3%; 12/13). Omicron spread rapidly throughout the country (from 10% of cases in epiweek 48, 2021, to 100% by epiweek 4, 2022), displacing the formerly predominant delta variant.
CONCLUSIONS Omicron’s rapid expansion in Cuba was associated with increased incidence but not with a higher case fatality rate. The relatively milder disease in those infected with this variant could be influenced by the high vaccination coverage, along with the natural immunity acquired as a consequence of previous virus infection.
KEYWORDS Pandemics, epidemiology, epidemiological monitoring, COVID-19 testing, COVID-19, SARS-CoV-2, COVID-19 vaccines, Cuba
Might Explain Different Clinical Outcomes July–October 2022, Vol 24, No 3–4
Globally, SARS CoV-2 omicron variant has led to a notable increase of COVID-19 diagnoses, although with less severe clinical manifestations and decreased hospitalizations. The omicron wave swelled faster than previous waves, completely displacing the delta variant within weeks, and creating worldwide concern about final, successful pandemic control. Some authors contend that symptoms associated to omicron differ from ‘traditional’ symptoms and more closely resemble those of the common cold.
One major COVID-19 symptom frequent with other variants—loss of taste and smell—is rarely present with omicron. This may be of interest, since it has also been suggested that direct SARS-CoV-2 invasion into the brainstem through the olfactory nerves by transsynaptic pathways could provide one explanation for the acute respiratory distress syndrome refractory to treatment. Brainstem infection by SARS-CoV-2 can severely damage the respiratory center, triggering functional deviations that affect involuntary respiration, leading to acute respiratory distress syndrome refractory to treatment, the main cause of death in COVID-19 patients. A shift in the omicron SARS-CoV-2 entry pathway from cell-surface fusion, triggered by TMPRSS2, to cathepsin-dependent fusion within the endosome, may affect transmission, cellular tropism and pathogenesis. Therefore, we can hypothesize that this entrance modification may impact transmission from the olfactory nerve to the brainstem through transsynaptic pathways. A decrement of the virus’s direct invasion into the brainstem could diminish respiratory center dysfunction, reducing acute respiratory distress syndrome and the need for mechanical ventilation.
KEYWORDS SARS-CoV-2, COVID-19, olfactory nerve, COVID-19 pandemics, respiratory center, smell, anosmia, taste, ageusia, brain stem, cathepsins, endosomes