Medicc Review最新文献

Cristian Morales, an economist by training, has dedicated his career to improving health and health equity in the Americas through his work with PAHO/WHO. This has taken him from hurricanes, earthquakes and epidemics in Haiti to PAHO's Washington DC offi ces, where he was instrumental in achieving consensus on a resolution aiming for universal health-coverage plus access-approved by all governments in the Americas. In 2015, he was appointed PAHO/WHO Permanent Representative in Cuba, and in 2018 to the same post in Mexico.

The emerging SARS-CoV-2, a novel human coronavirus, caused the COVID-19 pandemic, with more than 9.5 million cases and 484 000 known fatalities to date (June 24th, 2020). In several regions, healthcare systems have collapsed whereas interventions applied to slow the viral spreading have had major social and economic impacts. After China, Europe, and the United States, Latin America has emerged as the new epicenter of the pandemic. By late-June, the region accounted for roughly 50% of global daily deaths (Gardner, 2020). The evolution of the COVID-19 pandemic in the region has been heterogenous as several countries are currently experiencing exponential growth of their daily cases and fatalities, while others have successfully controlled their corresponding outbreaks. Cuba confi rmed its fi rst COVID-19 cases in mid-March. After a three-month outbreak, the country recently began to move to a post-epidemic phase. This dispatch details some relevant aspects of the strategy deployed in Cuba to face the COVID-19 pandemic and to decrease the impact of this emerging disease in the country. In addition, it describes the evolution of some epidemiological variables which allowed the country to de-escalate some of the non-pharmaceutical interventions applied during the outbreak.

INTRODUCTION On March 11, 2020, WHO declared COVID-19 a pandemic and called on governments to impose drastic measures to fi ght it. It is vitally important for government health authorities and leaders to have reliable estimates of infected cases and deaths in order to apply the necessary measures with the resources at their disposal. OBJECTIVE Test the validity of the logistic regression and Gompertz curve to forecast peaks of confi rmed cases and deaths in Cuba, as well as total number of cases. METHODS An inferential, predictive study was conducted using lo-gistic and Gompertz growth curves, adjusted with the least squares method and informatics tools for analysis and prediction of growth in COVID-19 cases and deaths. Italy and Spain-countries that have passed the initial peak of infection rates-were studied, and it was inferred from the results of these countries that their models were ap-plicable to Cuba. This hypothesis was tested by applying goodness-of-fi t and signifi cance tests on its parameters.RESULTS Both models showed good fi t, low mean square errors, and all parameters were highly signifi cant. CONCLUSIONS The validity of models was confi rmed based on logis-tic regression and the Gompertz curve to forecast the dates of peak infections and deaths, as well as total number of cases in Cuba. KEYWORDS COVID-19, SARS-CoV-2, logistic models, pandemic, mortality, Cuba.

By June 2020, the cumulative cases and deaths related to COVID-19 in 16 East and Southern African (ESA) countries were still rising, with an average case fatality rate of 1.46%.[1] From its initial presence in cities and regional transport hubs, cases are spreading, including to rural areas, among health workers and as migrants cross borders to return home.[2].

Worldwide, there has been a progressive demographic shift over the past 50 years resulting in a larger proportion of older adults in the general population. Aging itself is a complex biological phenomenon characterized in part by changes in the immune system known as "immunosenescence", which makes older adults more susceptible to infectious, cardiovascular and autoimmune diseases, as well as cancers. Several strategies have been proposed in an attempt to reverse immunosenescence, including use of hormones, cytokines and thymic factors. A promising drug in the search to restore the thymic microenvironment (which plays an important role in the regulation and maintenance of the immune system) in older adults is Biomodulina T, a Cuban product registered for use in patients with recurrent respiratory infections. The administration of Biomodulina T increases the number of naïve T-lymphocyte, CD4-positive cells that have recently migrated from the thymus gland (recent thymic emigrants) and memory CD8-positive T lymphocytes, which have characteristics akin to stem cells (stem cell-like memory). Furthermore, the expression of programmed cell death 1 protein in CD4-positive T lymphocytes and CD4-positive T lymphocytes decreases, and the proliferative capacity of CD4-positive T lymphocytes increases, without changes in the frequency of regulatory T lymphocytes. These results suggest that the administration of Biomodulina T could be used to restore immunity in older adults and in other immunocompromised individuals, improve response to other immunotherapies in cancer patients, and increase the effi cacy of vaccinations in older adults. Its use has been approved in Cuba for immune system restoration.KEYWORDS Immunosenescence, aging, immunotherapy, immuno-modulation, antineoplastic protocols, Cuba.

Lower-extremity diabetic ulcers are responsible for 80% of annual worldwide nontraumatic amputations. Epidermal growth factor (EGF) reduction is one of the molecular pillars of diabetic ulcer chronicity, thus EGF administration may be considered a type of replacement therapy. Topical EGF ad-ministration to improve and speed wound healing began in 1989 on burn patients as part of an acute-healing therapy. Further clinical studies based on topically administering EGF to different chronic wounds resulted in disappointing out-comes. An analysis of the literature on unsuccessful clinical trials identifi ed a lack of knowledge concerning: (I) molecular and cellular foundations of wound chronicity and (II) the phar-macodynamic requisites governing EGF interaction with its receptor to promote cell response. Yet, EGF intra- and perile-sional infi ltration were shown to circumvent the pharmacody-namic limitations of topical application. Since the fi rst studies, the following decades of basic and clinical research on EGF therapy for problem wounds have shed light on potential uses of growth factors in regenerative medicine. EGF's molecular and biochemical effects at both local and systemic levels are diverse: (1) downregulation of genes encoding infl ammation mediators and increased expression of genes involved in cell proliferation, angiogenesis and matrix secretion; (2) EGF in-tervention positively impacts both mesenchymal and epithelial cells, reducing infl ammation and stimulating the recruitment of precursor circulating cells that promote the formation of new blood vessels; (3) at the subcellular level, upregulation of the EGF receptor with subsequent intracellular traffi cking, includ-ing mitochondrial allocation along with restored morphology of multiple organelles; and (4) local EGF infi ltration resulting in a systemic, organismal repercussion, thus contributing to attenuation of circulating infl ammatory and catabolic reac-tants, restored reduction-oxidation balance, and decreased toxic glycation products and soluble apoptogenic effectors. It is likely that EGF treatment may rearrange critical epigenetic drivers of diabetic metabolic memory. KEYWORDS Epidermal Growth Factor, diabetes, diabetes complications, wound healing, diabetic foot, amputation, ulcer, Cuba.

Several territorial governments in Spain are considering inviting Cuban doctors to participate in the fi ght against the coronavirus epidemic, just as they have done in Italy and Andorra...Cuba's healthcare culture is different from Europe's, and the response to the epidemic likely would have been different if criteria were used similar to those followed in Cuba.

Analyzing any bio-psycho-social paradigm is complex and requires a comprehensive, integrative approach. Parsing the health picture of individuals, as well as whole populations, is no exception. Considering masculinity as a factor may shed light on health status, especially since traditional ideas of 'manhood' work against health promotion and prevention, as revealed in studies worldwide. In fact, these studies show a direct association between traditional understandings of masculinity and risks, vulnerabilities and the construction of health. In the last decade, such observations have received a bit more attention from international agencies.

This MEDICC Review roundtable brings you specialists from Havana's Pedro Kourí Tropical Medicine Institute (IPK), who are working directly with testing, research and patient care during the COVID-19 pandemic. Founded in 1937 by its namesake, the Institute has gained considerable worldwide prestige. Today, it is a PAHO-WHO Collaborating Center for the Study of Dengue and Its Vector, and for the Elimination of Tuberculosis. Its main role within Cuba's health system is as the national reference center for prevention, control, management and elimination of infectious diseases, including epidemics. Its 479 workers staff 32 departments, including laboratories, research and teach-ing facilities, a hospital and isolation center. The IPK's hospital treats later-stage AIDS patients, while the Institute is the nation-al reference center for attention to all HIV-positive patients and maintains the national HIV/AIDS registry, as well as registries for other infectious diseases. The institution was responsible for training the Cuban doctors who served in West Africa during the 2014-2016 Ebola outbreaks and for those going abroad to assist in the COVID-19 response today, and its professionals offer an internationally-recognized biennial course on dengue.

The days are long and arduous, with end-less patients to attend, often in a foreign language, always on foreign shores. Far from family and the familiar. Sleep is fi tful at best for health profession-als serving in emergency situations-when sickness obeys no clock and patients' pain haunts even the quiet moments. The crisis scenario varies: post-earthquake, hurricane or tsunami; amid a cholera or Ebola epidemic. The countries vary: Haiti, Pakistan, Guatemala, Mozambique, Sierra Leone. What does not vary is the answer to the calls for help and Cuban professionals' commitment to care for the most vulner-able. These aren't armchair musings or a political pat on the back: they are my own conclusions after living for weeks in close-quarter tents with Cuban doctors, nurses and biomedical engineers in post-earth-quake Pakistan and Haiti, and witnessing their work.