Medicc Review最新文献

If all physicians are detectives, using their skills to track down what ails body and mind, then epidemiologists are medicine's social detectives, using their training to understand the great calamities of population health. For over 30 years, Dr José Moya has worked in the fi eld since his initial position as head of epidemiology in Ayacucho, in his home country of Peru. His journey into global health began with Doctors Without Borders in Guatemala, Mozambique and Nigeria. Later at PAHO, he was Permanent Representative in Venezuela, after earlier postings as an epidemiologist in Haiti, Mexico, Brazil, the Dominican Republic and Argentina.

Belén Gopegui (Madrid, 1963) Licenciada en Derecho en la Universidad Autónoma de Madrid. Novelista y guionista española. Con su ópera prima La escala de los mapas, (1993) recibió varios premios y su tercera obra, La conquista del aire, fue adaptada al cine. Belén Gopegui fue descrita como la mejor de su generación por el escritor y ensayista español Francisco Umbral. Sus novelas han sido traducidas a varios idiomas. En 2019 se publica su conferencia Ella pisó la Luna, ellas pisaron la luna, un poderoso texto que reivindica a todas las mujeres cuyos logros no han visto la luz.

INTRODUCTION The scales available to predict death and complica-tions after acute coronary syndrome include angiographic studies and serum biomarkers that are not within reach of services with limited resources. Such services need specifi c and sensitive instruments to evaluate risk using accessible resources and information. OBJECTIVE Develop a scale to estimate and stratify the risk of intra-hospital death in patients with acute ST-segment elevation myocardial infarction. METHODS An analytical observational study was conducted in a universe of 769 patients with acute ST-segment elevation myocardial infarction who were admitted consecutively to the Camilo Cienfuegos Provincial Hospital in Sancti Spíritus Province, Cuba, from January 2013 to March 2018. The fi nal study cohort included 667 patients, ex-cluding 102 due to branch blocks, atrial fi brillation, drugs that prolong the QT interval, low life expectancy or history of myocardial infarction. The demographic variables of age, sex, skin color, classic cardiovas-cular risk factors, blood pressure, heart rate, blood glucose level, in addition to duration and dispersion of the QT interval with and without correction, left ventricular ejection fraction, and glomerular fi ltration rate were included in the analysis. Patients were categorized according to the Killip-Kimball Classifi cation for degree of heart failure. A risk scale was constructed, the predictive ability of which was evaluated using the detectability index associated with an receiver-operator curve.RESULTS Seventy-seven patients died (11.5%). Mean blood glucose levels were higher among the deceased, while their systolic and dia-stolic blood pressure, left ventricular ejection fraction, and glomerular fi ltration rate were lower than those participants discharged alive. Rel-evant variables included in the scale were systolic blood pressure, Killip-Kimball class, cardiorespiratory arrest, glomerular fi ltration rate, corrected QT interval dispersion, left ventricular ejection fraction, and blood glucose levels. The variable with the best predictive ability was cardiorespiratory arrest, followed by a blood glucose level higher than 11.1 mmol/L. The scale demonstrated a great predictive ability with a detectability index of 0.92. CONCLUSIONS The numeric scale we designed estimates and strati-fi es risk of death during hospitalization for patients with ST-segment elevation myocardial infarction and has good metric properties for predictive ability and calibration. KEYWORDS ST-segment elevation myocardial infarction, mortality, risk assessment, Cuba.

In their MEDICC Review Perspective, Galindo-Santana and colleagues highlight the challenges presented by anti-vaccination groups, stressing that immunization is an essential cost-effective preventive measure that promotes population health.[1] In 2019, WHO identifi ed vaccine hesitancy, fragile and vulnerable settings and weak primary health care as 3 of 10 main global health threats. Close attention to these threats can detect potential areas of missed opportunities for immunization across populations and mitigate risk of preventable diseases.

INTRODUCTION Antimicrobial drug resistance constitutes a health risk of increasing concern worldwide. One of the most common av-enues for the acquisition of clinically-relevant antimicrobial resistance can be traced back to the food supply, where resistance is acquired through the ingestion of antimicrobial resistant microorganisms pres-ent in food. Antimicrobial resistance constitutes a health risk, leading to production losses and negative consequences for livelihood and food safety. OBJECTIVE Determine whether resistant bacteria are present in foods in Cuba. METHODS A descriptive observational study was conducted in theMicrobiology Laboratory of Cuba's National Institute of Hygiene, Epi-demiology and Microbiology from September 2004 through Decem-ber 2018. Researchers analyzed 1178 bacterial isolates from food samples. The isolates were identifi ed as Escherichia coli, Salmonella, Vibrio cholerae and coagulase-positive Staphylococcus. The antimi-crobial susceptibility study was performed using the Bauer-Kirby disk diffusion method, following procedures outlined by the Clinical and Laboratory Standards Institute. The data were analyzed using WHO-NET version 5.6. RESULTS Of the total isolates, 62.1% were resistant to at least one antibiotic. Within each group, >50% of isolates showed some type of resistance. E. coli and V. cholerae exceeded 50% resistance to tetracycline and ampicillin, respectively. Staphylococcus showed the highest resistance to penicillin, and Salmonella to tetracycline, nali-dixic acid and ampicillin. The highest percentages of non-susceptible microorganisms were identifi ed in meats and meat products. CONCLUSIONS These results serve as an alert to the dangers of acquiring antibiotic-resistant bacteria from food and demonstrate the need to establish a surveillance system and institute measures bacte-rial control in food products.KEYWORDS Microbial drug resistance, bacteria, food, foodborne disease, Cuba.

Four months after COVID-19 was declared a pandemic, it has found a new epicenter: the Americas. With over four million cases and nearly half a million deaths at this writing, the United States is providing the best example of a failed response to a crisis in which GDP is not proving the best predictor of success. Zero coordinat-ed national strategy combined with unnecessary delays in testing, confusing and often contradictory messaging, and politicization of even the most elementary measures to combat the virus have led some US states to surpass infection and death rates in even the most hard-hit countries. Brazil, where government fi nally resumed reporting, is second only to the USA, its authorities admitting 2.4 million cases and over 300,000 deaths thus far. And by all counts, as in many countries, numbers are vastly underestimated.

MEDICC Review continues documentation of Cuba's COVID-19 Prevention and Control Plan and its implementation, begun with our April issue (see https://mediccreview.org/cubas-covid-19-strategy-main-actions-through-april-23-2020). This time, we present two tables: the first refers to measures taken to confront the epidemic, and the second, to the phased recovery process that is expected to lead to changes in many, if not all, sectors of Cuban society. In both cases, we have indicated the source of the information provided.

Science journalism was little known in Cuba when Iramis Alonso wrote her the-sis on the specialized fi eld in 1990. That year, journalism degree from the Uni-versity of Havana in hand, she set off to Cuba's eastern countryside to complete two years of social service reporting for local, regional and national print media. Living in the mountains of Holguín, a typical day for the cub reporter took her to caves, forests and fi elds for stories on the intersection of science, culture and the environment. Alonso credits this formative experience with igniting her passion for investigative and sci-ence journalism, setting her on a unique career path as a journalist and editor specializing in the sciences writ large: climate change, astronomy, mathemat-ics and other hard sciences, engineer-ing, information technologies and social sciences, among others.

Dr Héctor Javier Sánchez specializes in public health and research methodology and holds a master's degree in epidemiology. He is a senior researcher in the Society, Culture and Health Department at El Colegio de la Frontera Sur, Mexico. The Colegio is a public research institu-tion concentrating on environmental, economic and social issues related to a sustainable future for Mexico's southern border area, and belongs to the National Council of Science and Technol-ogy (CONACYT). In Chiapas State, the country's poorest region and home to many indigenous peoples, Dr Sánchez has carried out studies on TB, poverty and health, domestic violence, hu-man rights, maternal-child health and the effect of agrochemicals on human health.