Chemical and C and N stable isotope compositions of three species of epiphytic Tillandsia in a Caribbean coastal zone: air pollution sources and biomonitoring implications

We characterized the elemental and C and N stable isotope compositions of Tillandsia fasciculata Sw., Tillandsia balbisiana Schult. & Schult.f. and Tillandsia recurvata (L.) L. samples collected in Cienfuegos (Cuba). Results showed high enrichment factors for S, Hg, Cd, Pb, P, Zn, Cu, Mo, Sb and Ca in all Tillandsia species, indicating inputs from local anthropogenic activities (road traffic, industries and cement production). Carbon concentrations and δ13C varied from 38.3-47.7 % and -20.4 to -13.4 ‰ within the three species, respectively. δ13C showed seasonal dependence with the dry and wet periods and more 13C-depleted values in urban/industrial areas, coherent with the input of anthropogenic emissions. Nitrogen concentrations (0.4-1.3 %) and δ15N values (-9.9-4.4 ‰) exhibit larger variations and are positively correlated in the three species. The most positive δ15N in T. recurvata (-0.2-4.4 ‰) are attributed to contributions from industrial activities and road traffic. In fact, both δ15N and total nitrogen (TN) values increase in sites with higher road traffic and show significant correlations with typical road traffic and industrial tracers. Finally, we calculate an average total nitrogen deposition rate of 4.4 ± 2.3 kg ha-1 a-1 from N content in T. recurvata, similar to the existing values determined in the region by field measurements, but higher than the global terrestrial average.

Prevalence of intestinal parasites and associated risk factors among schoolchildren from Unión de Reyes municipality, Matanzas Province, Cuba

Intestinal parasites are widely distributed around the world and children are the most common affected group. The prevalence of intestinal parasites and associated risk factors by a cross-sectional study among children at a primary school in the Union de Reyes municipality, Matanzas province, Cuba, was carried out during April-May, 2022. Blastocystis spp. and Giardia intestinalis were the most common parasites found.

An island 'endemic' born out of hybridization between introduced lineages

Humans have profoundly impacted the distribution of plant and animal species over thousands of years. The most direct example of these effects is human-mediated movement of individuals, either through translocation of individuals within their range or through the introduction of species to new habitats. While human involvement may be suspected in species with obvious range disjunctions, it can be difficult to detect natural versus human-mediated dispersal events for populations at the edge of a species' range, and this uncertainty muddles how we understand the evolutionary history of populations and broad biogeographical patterns. Studies combining genetic data with archaeological, linguistic and historical evidence have confirmed prehistoric examples of human-mediated dispersal; however, it is unclear whether these methods can disentangle recent dispersal events, such as species translocated by European colonizers during the past 500 years. We use genomic DNA from historical museum specimens and historical records to evaluate three hypotheses regarding the timing and origin of Northern Bobwhites (Colinus virginianus) in Cuba, whose status as an endemic or introduced population has long been debated. We discovered that bobwhites from southern Mexico arrived in Cuba between the 12th and 16th centuries, followed by the subsequent introduction of bobwhites from the southeastern USA to Cuba between the 18th and 20th centuries. These dates suggest the introduction of bobwhites to Cuba was human-mediated and concomitant with Spanish colonial shipping routes between Veracruz, Mexico and Havana, Cuba during this period. Our results identify endemic Cuban bobwhites as a genetically distinct population born of hybridization between divergent, introduced lineages.

Assessing greenhouse gas emissions in Cuban agricultural soils: Implications for climate change and rice (Oryza sativa L.) production

Assessing the impact of greenhouse gas (GHG) emissions on agricultural soils is crucial for ensuring food production sustainability in the global effort to combat climate change. The present study delves to comprehensively assess GHG emissions in Cuba's agricultural soil and analyze its implications for rice production and climate change because of its rich agriculture cultivation tradition and diverse agro-ecological zones from the period of 1990-2022. In this research, based on Autoregressive Distributed Lag (ARDL) approach the empirical findings depicts that in short run, a positive and significant impact of 1.60 percent % in Cuba's rice production. The higher amount of atmospheric carbon dioxide (CO2) levels improves photosynthesis, and stimulates the growth of rice plants, resulting in greater grain yields. On the other hand, rice production index raising GHG emissions from agriculture by 0.35 % in the short run. Furthermore, a significant and positive impact on rice production is found in relation to the farm machinery i.e., 3.1 %. Conversely, an adverse and significant impact of land quality was observed on rice production i.e., -5.5 %. The reliability of models was confirmed by CUSUM and CUSUM square plot. Diagnostic tests ensure the absence of serial correlation and heteroscedasticity in the models. Additionally, the forecasting results are obtained from the three machine learning models i.e. feed forward neural network (FFNN), support vector machines (SVM) and adaptive boosting technique (Adaboost). Through the % MAPE criterion, it is evident that FFNN has achieved high precision (91 %). Based on the empirical findings, the study proposed the adoption of sustainable agricultural practices and incentives should be given to the farmers so that future generations inherit a world that is sustainable, and healthy.

A collaborative approach to develop indicators for quality of care for ST segment Elevation Myocardial Infarction in networks without coronary intervention: A position paper

BACKGROUND

Data about performance measures (PM) in patients with ST segment Elevation Myocardial Infarction (STEMI) in low- and middle-income countries is really scarce. One of the reasons is the lack of appropriate measures for these scenarios where coronary intervention is not the standard treatment.

OBJECTIVE

This study aimed to develop a set of PM and quality markers for patients with STEMI in these countries.

METHODS

Two investigators systematically reviewed existing guidelines and scientific literature to identify potential PM by referring to documents searched through PubMed from 2010 through 2019, using terms "Myocardial Infarction", "STEMI", "quality indicator", and "performance measure". A modified Delphi technique, involving multidisciplinary panel interview, was used. A 15-member multidisciplinary expert panel individually rated each potential indicator on a scale of 1 (lowest) to 5 (highest) during three rounds. All indicators that received a median score ≥4.5, in final round without significant disagreement were included as PM.

RESULTS

Through the consensus-building process, 84 potential indicators were found, of which 10 were proposed as performance measures and 2 as quality metrics, as follows: Pre-Hospital Electrocardiogram; Patients with reperfusion therapy; Pre-hospital Reperfusion; Ischemic time less than 120 minutes; System delay time less than 90 minutes; In-hospital Mortality; Complete in-hospital Treatment; Complete in-hospital Treatment in patients with Heart Failure; 30 day-Re-admissions; 30 day-mortality; Patients with in-hospital stress test performed; and, Patients included in rehabilitation programs.

CONCLUSION

This document provides the official set of PM of attention in ST segment Elevation Myocardial Infarction of the Cuban Society of Cardiology and Cuban National Group of Cardiology.

Mechanisms and Challenges

Cuba faces a dilemma between continuing its current portfolio of biotechnology drugs and vaccines with lower profitability or renewing its product portfolio with the associated costs and risks.

Chlamydia trachomatis infection in Cuban adolescent and young populations

BACKGROUND

In Cuba, little is known regarding the prevalence of Chlamydia trachomatis (CT) infection in adolescents and young people. We study the frequency of CT infection in these populations, and its association with clinical-epidemiological variables.

METHODS

A total of 496 individuals aged 12 to 24 were recruited from November 2018 to November 2019. Of them, 302 were patients attending at sexually transmitted infections (STI) services and 194 were young volunteers. CT detections were carried out by real-time PCR and IgG serology.

RESULTS

The prevalence of CT using PCR was 9.1% (45/496); 12.3% (37/302) for subjects attending STI service and 4.1% (8/194) for young volunteers, being significantly higher in the first group (OR=3.25; p=.001). CT IgG antibodies was detected in 38.6% (81/210). Individuals from 12 to 17 years old were more likely infected with CT (OR=2.21; p=.010). Infection was associated with the early onset of sexual intercourse, the frequent changing of sexual partners and black ethnicity.

CONCLUSIONS

The results suggest that Cuban adolescents and young populations are at highest risk of acquiring CT infection and developing reproductive complications. The data obtained advise the needs of implementation of a routine CT screening strategy, for timely diagnosis, detection and treatment at the earliest ages.

First molecular characterization of Dirofilaria Immitis in Cuba

BACKGROUND

Dirofilarioses are widespread diseases caused by mosquito-borne nematodes of the family Onchocercidae, genus Dirofilaria. The major etiologic agent of canine dirofilariosis in the American continent is the zoonotic parasite Dirofilaria immitis. Existing reports of filarioid nematodes in Cuba are based solely on morphological and immunological analysis which do not allow unambiguous identification and/or direct detection of causal agents.

RESULTS

Here we present the molecular characterization of filarioid nematodes found in a dog in Cuba. Based on the molecular and phylogenetic analysis of the 5.8S-ITS2-28S region and cox1 gene fragments, the worms were unambiguously classified as D. immitis. Sequence analysis showed high identity of the gene fragments in this study with others previously obtained from D. immitis found in dogs, wolfs and jackals but also from mosquito vectors of D. immitis.

CONCLUSIONS

Further studies are guarantee to better understand the epidemiological impact of canine dirofilariosis in Cuba as well as the competence of different species of culicid mosquitoes as vectors of Dirofilaria in the country.

Transforming food systems: a gendered perspective on local agricultural innovation in Cuba

Compared to many countries, Cuba has made significant progress in advancing women's rights and gender equity; however, disparities remain. In the country's rural communities and agricultural sector, women continue to face barriers to equal participation and recognition for the value of their work. This case study shares the story of gender equity efforts that have been conducted within the framework of a broader development project-the Project to Strengthen a System of Innovation in Local Agricultural Development (PIAL, for its initials in Spanish). PIAL began in 2001 as a participatory plant-breeding initiative aimed at increasing the genetic diversity of key crops such as maize and beans. Over the course of two decades, the project's goals expanded to include an emphasis on increasing women's participation. In the beginning, those efforts focused on including women in the participatory plant-breeding activities, which enabled them to prioritize traits they cared about such as grain texture, cooking speed, and taste in the selection process. Over time, the participatory nature of the PIAL methodology empowered women to identify and pursue capacity-building in other areas of local agricultural innovation. While PPB remained central to PIAL, women also chose to pursue opportunities in seed bank management, leadership training, and small-scale farm-based entrepreneurship. The results of the PIAL work on gender have included not just more inclusive plant breeding, but also important economic improvements for rural women as they have been able to diversify their livelihoods, and social change as they have gained confidence and recognition as leaders in their households, communities, and beyond.

A decade of study on the condition of western Cuban coral reefs, with low human impact

Background

The long-time study of coral reefs with low human impacts can provide information on the effects of regional pressures like climate change, and is an opportunity to document how these pressures are reflected in coral communities. An example of minimal local anthropogenic impacts are the Guanahacabibes coral reefs, located in the westernmost region of Cuba. The objectives of this study were: to evaluate the temporal variability of six benthic biological indicators of coral reefs, and to explore the possible relationship between predictive abiotic variables and biological response variables.

Methods

Four coral reef sites were sampled between 2008 and 2017, to analyze biological indicators (living coral cover, fleshy algae index, coral species richness, coral species abundance, coral trait groups species abundance, Functional Reef Index). Seven abiotic variables (wave exposure, sea surface temperature, degree heating week, chlorophyll-a concentration, particulate organic carbon, photosynthetically available radiation, and the diffuse attenuation coefficient) were compiled between 2007 and 2016, from remote sensing datasets, to analyze their relationship with the biological indicators. Permanova statistical analysis was used to evaluate trends in biological variables between sites and years, and Routine Analysis Based on Linear Distances (DISTLM) was used to explore some dependencies between biotic and abiotic variables.

Results

We found significant variability in the temporal analysis, with a decrease in living coral cover, a decline in the predominance of the branching and massive framework reef-building species, a decline in Orbicella species abundance, and an increase in the fleshy algae index. Some abiotic variables (average of degree heating weeks, standard deviation of the diffuse attenuation coefficient, average of the sea surface temperature, among others) significantly explained the variability of biological indicators; however, determination coefficients were low.

Conclusions

Certain decrease in the functionality of the coral reef was appreciated, taking into account the predominance of secondary and nom-massive framework reef-building species in the last years. A weak association between abiotic and biological variables was found in the temporal analysis. The current scenario of the condition of the coral reefs seems to be regulated by the global effects of climate change, weakly associated effects, and in longer terms.

The Potential of Surveillance Data for Dengue Risk Mapping: An Evaluation of Different Approaches in Cuba

To better guide dengue prevention and control efforts, the use of routinely collected data to develop risk maps is proposed. For this purpose, dengue experts identified indicators representative of entomological, epidemiological and demographic risks, hereafter called components, by using surveillance data aggregated at the level of Consejos Populares (CPs) in two municipalities of Cuba (Santiago de Cuba and Cienfuegos) in the period of 2010-2015. Two vulnerability models (one with equally weighted components and one with data-derived weights using Principal Component Analysis), and three incidence-based risk models were built to construct risk maps. The correlation between the two vulnerability models was high (tau > 0.89). The single-component and multicomponent incidence-based models were also highly correlated (tau ≥ 0.9). However, the agreement between the vulnerability- and the incidence-based risk maps was below 0.6 in the setting with a prolonged history of dengue transmission. This may suggest that an incidence-based approach does not fully reflect the complexity of vulnerability for future transmission. The small difference between single- and multicomponent incidence maps indicates that in a setting with a narrow availability of data, simpler models can be used. Nevertheless, the generalized linear mixed multicomponent model provides information of covariate-adjusted and spatially smoothed relative risks of disease transmission, which can be important for the prospective evaluation of an intervention strategy. In conclusion, caution is needed when interpreting risk maps, as the results vary depending on the importance given to the components involved in disease transmission. The multicomponent vulnerability mapping needs to be prospectively validated based on an intervention trial targeting high-risk areas.

Aedes albopictus (Skuse) dispersion in Havana City, Cuba, 1995-2018

Various arboviruses are transmitted to humans by mosquitoes, particularly Aedes aegypti and Aedes albopictus, two invasive and frequently sympatric species. The objective of this study was to evaluate the dispersion and the behavior of Ae. albopictus in relation to houses and its association with other mosquitoes in the province of Havana, Cuba. All water-containing deposits in the houses or vacant lots in urban and peri‑urban municipalities of the province of Havana were sampled during the two study periods: 1995-1999 and 2010-2018. The following patterns in the presence of Ae. albopictus in the study area were observed: a persistent absence of Ae. albopictus in one of the municipalities; a rapid dispersion in the second period, staring from the absence of vector in the first period, in tow other municipalities; and a sustained decrease in the dispersion of Ae.albopictus in two other municipalities. The peripheral municipalities noted the highest presence of Ae. albopictus, but few associations with other mosquitoes. However, overall, we found an increase in this association when comparing the period 2010-2018 with the first period. Ae. albopictus was present in 8% (2016) to 21.5% (2013) inside the houses with an average of 15%, which evidences an initial domiciliation of the species. The results obtained in this work show an initiation of domiciliation of Ae. albopictus in the urban area of the province of Havana. This is important to alert the National Control Program to strengthen the entomological monitoring of Ae. albopictus, and not only Ae. aegypti. The follow-up of this domiciliation is important to guide control efforts, knowing its role as a vector of different arboviruses.

Older adult Cubans moving to the Canary Islands (Spain): Migrants' strategies in later life

The research on migration to Spain of Cuban citizens in later life proposes to overcome the lack of academic knowledge from these analytical perspectives: migrations of older adult people beyond the issue of lifestyle mobility; the transnational diasporic nexus favoring migrations; and the Cuban community residing abroad, outside the United States of America. The combination of these elements in this case study shows the agency of older adult Cuban citizens who move to the Canary Islands, trying to achieve a greater level of material well-being and taking advantage of the diasporic ties between the Canary Islands and Cuba; but this is a process that brings out, simultaneously, feelings of dislocation and nostalgia in the stage of old age. The development of a mixed methodology and the focus on the life course of migrants offer an opportunity to reflect on the cultural and social construction of ageing in migration studies. Consequently, this research allows a deepening of knowledge on human mobility from the perspective of ageing in a counter-diasporic migration, showing the relationship between emigration and life cycle and demonstrating the strength and spirit of achievement of those individuals who decide to emigrate despite their advanced age.

Seroprevalence and genetic characterization of Toxoplasma gondii in domestic pigs intended for human consumption in Cuba

Domestic pigs are considered as one of the main intermediate hosts in the zoonotic transmission of Toxoplasma gondii in many countries. Serological and molecular studies are warranted to better understand the epidemiology and transmission patterns of this parasite worldwide. To date, seroepidemiological information on T. gondii in domestic pigs in Cuba is very scarce and there are no reports of T. gondii genotypes circulating in this country. Here, we aimed to estimate the seroprevalence of T. gondii and provide genetic characterization of the strains circulating in slaughtered pigs intended for human consumption in Central Cuba. Seroprevalence was determined in 450 serum samples from slaughtered pigs in Villa Clara province using ELISA. Anti-Toxoplasma gondii IgG antibodies were detected in 100 animals (22.2%, 95% CI: 18.5-26.2). Conventional PCR of the 529-bp marker of T. gondii was performed in hearts and diaphragm tissues of all ELISA-seropositive pigs. Toxoplasma gondii DNA was detected in four animals. Further genetic characterization of the positive DNA samples was performed by multilocus PCR-RFLP and PCR-sequencing typing tools. Molecular analysis revealed four different genetic profiles that were combinations of type I, II, III and u-1 alleles, suggesting the circulation of non-clonal genotypes of T. gondii in domestic pigs in Cuba. Our results indicate that T. gondii is widely distributed in slaughtered pigs in this country, which might have important implications for public health. To the best of our knowledge, this is the first report on genetic characterization of T. gondii in Cuba. Although preliminary, the results suggest a high genetic diversity of T. gondii in the study region. Further studies based on parasite isolation are needed to definitively identify the genotypes circulating and characterize the virulence of strains detected in pigs in Cuba, and to assess the risk of zoonotic transmission from pork products in this country.

Effectiveness of a provider and patient-focused intervention to improve hypertension management and control in the primary health care setting in Cuba: a controlled before-after study

BACKGROUND

Implementation research to improve hypertension control is scarce in Latin America. We assessed the effectiveness of an intervention aimed at primary care practitioners and hypertensive patients in a setting that provides integrated care through an accessible network of family practices.

METHODS

We conducted in Cardenas and Santiago, Cuba, a controlled before-after study in 122 family practices, which are staffed with a doctor and a nurse. The intervention comprised a control arm (usual care), an arm with a component targeting providers (hypertension management workshops), and an arm with, on top of the latter, a component targeting patients (hypertension schools). To evaluate the effect, we undertook a baseline survey before the intervention and an endline survey sixteen months after its start. In each survey, we randomly included 1400 hypertensive patients. Controlled hypertension, defined as a mean systolic and diastolic blood pressure below 140 and 90 mmHg, respectively, was the primary endpoint assessed. We performed linear and logistic regression with a Generalized Estimating Equations approach to determine if the proportion of patients with controlled hypertension changed following the intervention.

RESULTS

Seventy-three doctors, including substitutes, and 54 nurses from the 61 intervention family practices attended the provider workshops, and 3308 patients -51.6% of the eligible ones- participated in the hypertension schools. Adherence to anti-hypertensive medication improved from 42% at baseline to 63% at the endline in the intervention arms. Under the provider intervention, the proportion of patients with controlled hypertension increased by 18.9%, from 48.7% at baseline to 67.6% at endline. However, adding the component that targeted hypertensive patients did not augment the effect. Compared to patients in the control arm, the adjusted OR of having controlled hypertension was 2.36 (95% CI, 1.73-3.22) in the provider and 2.00 (95% CI, 1.68-2.37) in the provider plus patient intervention arm.

CONCLUSIONS

The intervention's patient component remains to be fine-tuned. Still, we demonstrate that it is feasible to substantially improve hypertension outcomes by intervention at the primary care level, despite an already relatively high control rate.

Is there added value from using three serial samples when surveying the occurrence of intestinal parasites in children?

BACKGROUND

Surveys for intestinal parasitic infections (IPIs) often involve samples from three sampling dates analysed by various microscopy techniques. However, analysis of three samples per individual is a huge burden on time and resources. We compared the value from analysing three or fewer samples.

METHODS

In this cross-sectional study, three faecal samples were collected every other day from 332 children from two locations in Guantanamo province, Cuba. Samples were analysed by wet mount with Lugol stain, Willis flotation method and Kato-Katz thick smear.

RESULTS

Most parasites were detected by wet mount, although helminth eggs not found by wet smear were detected by the Willis flotation method (in particular) and Kato-Katz smear. Blastocystis spp. was the most commonly detected parasite (about 65%), then Giardia duodenalis and then Entamoeba spp. Although analysis of two stool samples significantly increased occurrence data for Blastocystis, this was not so for the other parasites. For none of the protozoan parasites were results from analysing three samples significantly higher than results from analysing just two samples.

CONCLUSIONS

Analysing two faecal samples by wet mount and the Willis flotation method provides useful data for estimating the prevalence of IPIs in relatively high prevalence settings. Analysing further samples provides limited additional information and adds an extra burden in terms of time and resources.

A stakeholder-engaged approach to evaluating spawning aggregation management as a strategy for conserving bonefish (Albula vulpes) in Cuba

Animals that congregate in large numbers to reproduce in spatially and temporally distinct locations are particularly susceptible to overexploitation. Many fishes form spawning aggregations that are intentionally targeted given ease of capture. Bonefish (Albula spp.) species aggregate to spawn and are culturally and economically important, but generally lack management such as spawning area protections to ensure that fisheries are sustainable. Here, we use Cuba as a case study to inform the development and refinement of management strategies for bonefish. Recommendations for the management of bonefish pre-spawning aggregations were based on international experiences, which have been adapted to the Cuban context from results of surveys and interviews with Cuban fisheries professionals and fishing guides. The achievability and feasibility of recommendations were further reviewed by additional experts in the field of fisheries, management and Cuban policy. The process revealed extensive data-limitations for bonefish fisheries and underscored the importance of including fishing guides, local ecological knowledge and the context of marine protected areas in Cuba for bonefish management. Recommendations include (1) initiating information exchange between Cuban management agencies and third-party institutions related to bonefish management; (2) utilizing local ecological knowledge to gather information, formulate management strategies and enforce regulations; (3) implementing spatial and temporal management measures for bonefish spawning sites; (4) using what is already in place, by protecting spawning sites in the context of existing marine protected areas; (5) collaborating with all stakeholders to manage bonefish spawning sites; and (6) reducing the commercial harvest of the species.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10641-022-01355-0.

Genetic and Morphological Identification of Spirometra decipiens in Snakes and Domestic Dog Found in Cuba

Spirometra (Cestoda: Diphyllobothriidea) affects humans and some species of domestic and wild animals which eventually interact with humans. In this article, we report three new cases of Spirometra decipiens (Diesing, 1850) infection observed in two intermediate hosts and one definitive host, in Cuba. Genetic and morphological identification of S. decipiens in two snakes and a domestic dog were carried out by molecular means and routine histological study using hematoxylin-eosin staining, respectively. Taken together, the anatomical location, the host species infected with the specimens and their morphological and genetic features, all the samples were identified as S. decipiens. In each of the three cases, PCR assays using specific primers amplified bands that corresponded to S. decipiens species. To our knowledge, this paper is the first report of S. decipiens in species of Cuban endemic fauna and in the Caribbean islands. These species constitute a real or potential risk of transmission of Spirometra to humans in Cuba.

Cuban Abdala vaccine: Effectiveness in preventing severe disease and death from COVID-19 in Havana, Cuba; A cohort study

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.

Emergence and evolution of SARS-CoV-2 genetic variants during the Cuban epidemic

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.

Effect of Cuban Porcine Pulmonary Surfactant (Surfacen) and rCmPI-II Protease Inhibitor on Neutrophil Elastase Activity

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.

OBJECTIVE

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.

Lessons from Building a Sustainable Healthcare Exchange between the Netherlands and Cuba

Over the past ten years, seven Dutch Universities have built a sustainable exchange with seven institutes in Cuban healthcare. The exchange was initiated by the Leiden University Medical Centre and the University of Medical Sciences of Havana. Cooperation with Cuba was chosen as Cuba has excellent primary healthcare and has a strong focus on prevention and public health. These were considered important due to the major contribution of non-communicable diseases to morbidity and mortality in the Netherlands. Exchanges have occurred with Dutch health professionals and students visiting Cuban healthcare institutions and Cuban postgraduate students studying in the Netherlands. There has been an increased awareness of the importance of public health and prevention in Dutch professional organizations following the exchange. The exchange has also helped to break the scientific and economic US blockade of Cuba and resulted in joint publications. In this review we described the process, key aspects, results and lessons learned in this process. Collaboration between Cuba (a middle income) and the Netherlands (a high-income country) is possible.

'I did not get this disease on the street; it was brought home as a gift': Gender, violence and HIV vulnerability among Cuban women

While gay, bisexual and other men who have sex with men are most affected by HIV in Cuba, infections among women have increased over time, but there has been little research to contextualise their vulnerability to HIV. The purpose of this study was to explore the role of gender and violence in shaping vulnerability to HIV among Cuban women. Qualitative in-depth interviews were conducted with women living with HIV at an outpatient HIV clinic in Havana. Narrative and thematic technique were used to systematically analyse the data. Participants described negotiating sexual relationships in a context where traditional gender norms merge with the paradox of increasing professional opportunities for women alongside growing economic precarity. Interconnected economic and emotional dependence along with violence influenced the acceptance of certain behaviours that heightened vulnerability to HIV, including inconsistent condom use and infidelity. Gender transformative approaches that recognise the complex interplay between gender norms, economic precarity and violence are needed to address women's vulnerability to HIV in the Cuban context. Such efforts can reinforce existing strategies to promote behaviourally focused prevention while creating an enabling environment for the integration and expansion of biomedical innovation in HIV prevention.

A Retrospective Study of Risk Factors, Mortality, and Treatment Outcomes for Infections with Carbapenemase-Producing Enterobacterales in a Tertiary Hospital in Havana, Cuba

(1) Background: The spread of carbapenem-resistant Enterobacterales in hospitals constitutes an important epidemiological and therapeutic problem that especially affects vulnerable patients such as perioperative patients. (2) Methods: We conducted a descriptive, observational, retrospective case-control study of patients infected with carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) and carbapenem-susceptible Enterobacterales during the perioperative period in a tertiary hospital. (3) Results: Metallo-β-lactamase was detected in all 124 CRE isolates, with NDM-type carbapenemase being dominant, while 3 isolates coproduced KPC-type enzyme and showed high resistance rates against all antibiotics except colistin (25.2%). By analyzing the risk factors for infection, steroid use (OR: 3.22, p < 0.01), prior use of two or more antibiotics (OR: 4.04, p = 0.01), prior use of broad-spectrum cephalosporins (OR: 2.40, p = 0.04), and prior use of carbapenem (OR: 4.77, p = 0.03) were found to be independent risk factors for CP-CRE infection. In addition, in this study, we observed that the clinical outcomes of bloodstream infections and pneumonia associated with CP-CRE posed higher mortality risks. However, by analyzing the associations between treatment options and mortality, it was found that, in bloodstream infections caused by CP-CRE, colistin-based regimens showed a significant advantage (PR = 0.40, p = 0.03). (4) Conclusions: High mortality is associated with nosocomial infections in the perioperative period caused by carbapenemase-producing Enterobacterales, the dissemination of which in health care settings in Cuba remains a public health challenge.

Child Neurology Care in Latin America: Challenges and Potential Solutions

BACKGROUND

The current practice of child neurology in Latin America has been impacted by the waves of sociopolitical unrest that in the last decades have swept the region.

METHODS

We searched the available literature referring to the situation of child neurology in Latin America and conditions that specifically impact the region.

RESULTS

In lower-middle-income countries, the number of child neurologists is inadequate. Child neurologists working in large public hospitals can only afford to do so on a part-time basis as these institutions are chronically underfunded. Several circumstances are particularly relevant to Latin America: Spanish is the main language spoken, something that limits the opportunity to keep local child neurologists up to date. The structure of health care systems in Latin America varies significantly. Some countries have fragmented systems with inadequate capacity to offer equitable access to medical care. Latin America has been impacted by epidemics of arthropod-borne viruses: zika, chikungunya, and dengue. It stands to reason that the COVID-19 pandemic will affect the distribution of resources for chronic neurological conditions.

CONCLUSIONS

The virtual platforms such as Zoom, expanded during the COVID-19 pandemic, are useful not only to improve access to care through telemedicine but also for educational purposes. Collaborative efforts to support educational courses and symposia in Spanish are ongoing. It is necessary to set short- and long-term priorities to improve child neurology care in the region. Immediate priorities should focus on improving the diagnosis of neurological conditions, making emphasis on locally available resources.

Type 1 neurodegeneration with brain iron accumulation: a case report

BACKGROUND

Type 1 neurodegeneration with brain iron accumulation is a rare neurological disorder with estimated prevalence of one to two per million persons worldwide, characterized by progressive degeneration of basal ganglia, globus pallidus, and reticular part of substantia nigra, produced by brain iron accumulation due to a defect in the gene producing pantothenate kinase 2. Clinical presentations include dystonia, dysarthria, dysphagia, dementia, severe mental retardation, and severe movement disability at later stages. The characteristic pattern on brain magnetic resonance imaging shows the "eye of the tiger" sign. Treatment in late stages is mainly symptomatic. We report the case of a Cuban boy with high-severity brain iron accumulation, with positive clinical and imaging findings diagnosed in a late stage of the illness. This degree of severity has never been reported in Cuba and is rarely reported worldwide.

CASE PRESENTATION

We present the case of a 19-year-old male white Cuban boy who presented to our department with features of spasticity, dystonia, gait difficulty, dysarthria, dysphagia, aggressiveness, and sleep disorders. He was diagnosed with pantothenate kinase-associated neurodegeneration on the basis of clinical findings and typical "eye of the tiger" pattern on brain magnetic resonance imaging. Detailed evaluation was carried out, and symptomatic treatment and physiotherapy were started with trihexyphenidyl, cabergoline, baclofen, and intramuscular botulinum neurotoxin as well as daily home sessions of passive stretching, weight bearing, and muscle massaging. At 3 months reevaluation, the patient showed a great improvement of motor function, with a decrease of dystonic symptoms, although language, cognition, and functional independence showed no improvement. The prognosis of the patient remains reserved.

CONCLUSION

The diagnosis can be made based on the presence of clinical and imaging features. The presence of "eye-of-the-tiger" sign on magnetic resonance imaging must be considered a nearly pathognomonic sign of neurodegeneration with brain iron accumulation presence. Treatment after high-severity presentation remains directed toward symptomatic findings. Both dopamine agonists and anticholinergic agents are useful to treat motor symptoms, but there is not yet an effective treatment to stop the underlying degeneration. New therapeutic approaches are needed to counteract late stages of the disease and improve prognosis.

Heavy metals in soils of Mayabeque, Cuba: multifaceted and hardly discernable contributions from pedogenic and anthropogenic sources

Cuba is a country with considerable potential for economic growth, and special efforts are made to increase the agricultural output. As food production depends on the quality of soils, heavy metal concentrations were measured in 39 soils in the province of Mayabeque, Cuba, and interpreted in light of anthropogenic activities and pedogenic conditions (soil type and properties). With median concentrations of 1.8 Cd, 60.3 Cr, 48.1 Cu, 36.2 Ni, 16.7 Pb, 55.0 Zn, and 0.1 mg/kg Hg, soils of Mayabeque were mostly below Cuban quality reference values (QRV) representing benchmarks of quality standards but no official threshold values. Only Cd concentrations were in many cases above the QRV of 0.6 mg/kg and some Cu concentrations above the one of 83 mg/kg. While Cd, Cr, and Ni concentrations were rather pedogenically driven, Cu, Pb, Zn, and Hg contents were rather anthropogenically influenced. When evaluated statistically, Cd and Cr showed most times a significant influence of both sources. In contrast, Ni and Zn could not be significantly related with the origins investigated in this study. Hence, the allocation of heavy metal concentrations to pedogenic or anthropogenic contamination or pollution sources is tentative and needs further investigations. Nevertheless, the present data adds information on soil heavy metal concentrations in the Caribbean region, serves as reference before further industrial development, and sets the ground for adaptation of the QRV for Cd and possibly future national environmental standards.

10-Years assessment of 7Be and 210Pb in atmospheric bulk depositions in Cienfuegos (Cuba)

10-years records of monthly bulk atmospheric fluxes of ⁷Be and ²¹⁰Pb (wet + dry, n = 119 samples) at a coastal station in Cienfuegos (Cuba) between 2010 and 2019 were reported and assessed in function of their temporal variability and meteorological influence. Fluxes of ⁷Be and ²¹⁰Pb ranged from 120 to 15617 and from 29 to 911 mBq m^-2 day^-1, respectively. Both radionuclides exhibited a similar seasonal trend with highest values during wet months and minimum values during dry months. The removal of ⁷Be and ²¹⁰Pb from the atmosphere was mainly controlled by wet depositions, while dry deposition was estimated to be more important for ²¹⁰Pb (29% of the total bulk deposition) than for ⁷Be (12%). The ²¹⁰Pb/⁷Be ratios (average of 0.10) showed low variability during wet months with abrupt peaks in the driest months with low temperatures and the highest wind speed and pressure, which was mainly attributed to contributions from soil resuspension. The calculated total deposition velocity of aerosols derived from ⁷Be (average of 0.48 cm s^-1) and ²¹⁰Pb (average of 0.47 cm s^-1) was in agreement with values reported in the literature. Multiple linear regression models for the monthly fluxes of ⁷Be and ²¹⁰Pb based on precipitation, temperature and pressure and explaining about 60% of their variances were derived, highlighting the preponderant role of the local and regional conditions on the variability of these radionuclides. The annual fluxes of ⁷Be (209-1901 Bq m^-2 y^-1) and ²¹⁰Pb (35-123 Bq m^-2 y^-1) were in the range of variations observed in other coastal stations worldwide, showing fluctuations affected by changes in the amount of precipitation during the wet periods. ⁷Be annual variability also evidenced a significant modulation with the solar activity.

Repeat-dose and local tolerance toxicity of SARS-CoV-2 FINLAY-FR-02 vaccine candidate in Sprague Dawley rats

This study evaluates safety of FINLAY-FR-02, a vaccine candidate against SARS-CoV-2 based on the recombinant receptor binding domain conjugated to tetanus toxoid, in a preclinical, repeat-dose toxicity and local tolerance study. Sprague Dawley rats were randomly allocated to three experimental groups: control (receiving physiological saline solution); placebo (receiving all vaccine components except antigens) and vaccine group (receiving three doses of the vaccine candidate, 37.5 µg of RBD) administered intramuscularly in hind limbs at 24 h intervals during three days. We evaluated physiological condition, pain, food and water consumption, body temperature, dermal irritability, injection site temperature and inflammation, immunological response, blood chemistry, relative organ weight, histopathology and immunotoxicology. The product was well tolerated; no clinically relevant changes, pain, local effects or adverse systemic toxicological changes or deaths were observed. These preliminary results permitted the Cuban regulatory authorities to authorize clinical trials in humans.

Vaccinal chronicity: immunotherapy, primary care, and the temporal remaking of lung cancer's patienthood in Cuba

The Cuban biotechnology industry is producing cancer immunotherapy, in particular, therapeutic vaccines that actively stimulate the immune system to stabilise the tumour. These products aim to transform metastatic malignancies into a chronic disease. Since 2010, this therapeutic concept has been integrated within a public health experiment, consisting of the large distribution of immunotherapies, including in primary healthcare centres, to enhance access and assess its effectiveness on a wider population of patients. Such experimental intervention, consisting of post-marketing clinical trials, has focused only on lung cancer, one of the most widespread and lethal cancers on the island. Combining interviews with ethnographic observations focusing on care performed by professionals, patients, and their relatives, this paper analyses the experience of lung cancer chronicity under this type of immunotherapy in Cuba. It shows how a certain form of continuity is made between prophylactic and therapeutic vaccination to shape a new temporality of cancer care, through the integration within primary care, constant access to biotechnology, and multiple care practices directed to strengthen the immunotherapy's efficacy. If vaccinal chronicity remains fragile due to its experimental dimension and the fact that long-term survivorship is still an exceptional phenomenon, lung cancer patienthood is deeply transformed through a shared effort of the people and the state to provide more stable, meaningful, and inclusive care.

TaqI polymorphism of the VDR gene: aspects related to the clinical behavior of COVID-19 in Cuban patients

Purpose

To determine the relationship between the genotypes of the TaqI polymorphism of VDR gene and the clinical forms of COVID-19 in Cuban patients.

Methods

TaqI polymorphism was determined by the PCR in 104 Cuban patients, who suffered different clinical forms of COVID-19.

Results

There was a greater possibility of presenting symptomatic forms [OR = 2.081, 95% CI: 0.243-17.842], even severe [OR = 1.200, 95% CI: 0.217-6.638], related to the tt genotype.

Conclusion

There are signs of association between the risk of developing COVID-19 and the genotypes of the TaqI polymorphism of the VDR gene in the studied Cuban patients.

Professional experiences in the transition of Cuban-trained South African medical graduates

BACKGROUND

Medical educators have been tasked to provide Cuban-trained Foreign Medical Graduates (FMGs) with adequate learning exposures to become integrated into the South African healthcare workforce. International research suggests that FMGs face multiple challenges during the transition from practising medicine in countries other than where they had been trained. The transitional experiences of international FMGs are well documented, but little is known about the challenges faced by Cuban-trained graduates upon reintegration into South Africa. An improved understanding of the challenges will provide insight into how medical educators can best support Cuban trained graduates in their final phase of training in the South African context.This study explored the challenges experienced during the professional transition of Cuban-trained FMGs with reference to Schlossberg's transitional theory.

METHODS

A qualitative case study was used to interview a purposive sample of 20 Cuban-trained FMGs who studied between January 1997 and December 2007. Data were collected through audio-recorded, semi-structured interviews, which were analysed thematically.

RESULTS

The findings indicate that FMGs' experienced educational and social stress, which was linked to the transitional situation itself. Challenges during reintegration included bias and discrimination, language, educational differences, and becoming familiar with patients from diverse educational and cultural backgrounds. They drew on peer and institutional support that was mainly informal and varied across disciplines and the medical schools.

CONCLUSION

Recommendations include a national multidisciplinary consolidated approach to provide personal and professional support at national, institutional, and departmental levels. The creation of mentoring networks will optimise Cuban-trained FMGs' transitional experiences for returning students.

Bioactive Essential Oils from Cuban Plants: An Inspiration to Drug Development

Aromatic plants and essential oils are important agents as complementary and alternative medicines in many cultures and geographical locations. In this review, a literature search on essential oils from Cuba, their chemical compositions, and their pharmacological properties was carried out. Out of 171 published scientific articles on essential oils of Cuban plants, a total of 31 documents, focused on both chemical composition and pharmacological properties, were considered for this review. In general, an increase in articles published in the last decade was noted, particularly in recognized international journals in English. Myrtaceae and Piperaceae were the most representative families collected in the occidental area of the country. Leaves and aerial parts were predominantly used, while a wide and variable number of components were identified, including terpenes, aliphatic derivatives, sulfur-containing compounds, phenylpropanoids, alkaloids and amine-type compounds. Finally, different biological activities were reported such as antiprotozoal, antibacterial, antifungal, cytotoxic, anthelmintic, larvicidal and insecticidal. In conclusion, we encourage further studies that would promote the use of essential oils from Cuban plants in new pharmaceutical products.

in Cuban patients: what does molecular analysis tell us?

Taeniosis is a neglected disease, particularly in developing countries, and is caused by infection with the adult tapeworm of either Taenia solium, Taenia saginata, and Taenia asiatica. Of these, T. solium is of primary concern due to the potential for cysticercosis should T. solium eggs be ingested. In Cuba, all cases of taeniosis are assumed to be caused by T. saginata, although some cases of cysticercosis have been documented. It is therefore important to gain further insights regarding the species causing taeniosis in Cuba, especially as diagnostic records indicate an increasing incidence, with the highest number of cases reported in 2020. In this study, we analysed 37 Taenia-positive faecal samples (or proglottids isolated from faecal samples) from the period 2001 until 2020 from all regions of the country. Genomic DNA was extracted from the samples, which had been stored in 10% formalin, using the QIAamp Tissue Kit. Species identification was carried out by duplex real-time PCR targeting the mitochondrial DNA. All cases were found to be T. saginata, and sequence analysis of three isolates confirmed the identification of this species. Our data do not provide any evidence that T. solium currently occurs in Cuba. However, given the relatively low number of samples analysed here, that the parasite may be imported with visitors or travellers who have been in endemic countries, and that taeniosis has relatively mild symptoms and thus infected patients may not seek medical attention, we recommend species determination for all taeniosis cases reported in Cuba.

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The incidence of taeniosis cases in Cuba is rising, with 2020 being a peak year

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Although assumed to be Taenia saginata, this has not been confirmed

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We investigated 37 samples from 2001 until 2020 that had been stored in formalin

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Duplex real-time PCR indicated T. saginata; 3 cases were confirmed by sequencing

Visibility, collaboration and impact of the Cuban scientific output on COVID-19 in Scopus

INTRODUCTION

COVID-19 is a disease with worldwide impact that has fully caught attention of researchers. The Cuban scientific output, after one year of confronting this pandemic, has not been studied from a bibliometric perspective.

OBJECTIVE

To characterize the output of original scientific articles and review articles on COVID-19 published by Cuban authors in the journals included in the Scopus bibliographic database, the collaborations in these publications and their impact, according to the citation of the research in the world literature.

MATERIALS AND METHODS

A cross-sectional, descriptive and observational study was performed, using a bibliometric approach. A search strategy was used to retrieve articles on the subject and bibliometric indicators of output, visibility, leadership, collaboration and impact were studied.

RESULTS

Cuba contributed 2.5% of the Latin American output and 0.2% of the world output. Of the national scientific output (133 articles, 111 original and 22 reviews), 84.2% were authored by a Cuban corresponding author (Cuban leadership). However, the majority (n = 20; 71.4%) of articles with international collaboration (n = 28; 21.1%) had foreign corresponding authors. Of the total, 33.8% (n = 45) corresponded to articles without collaboration. Only 13.5% of the articles (n = 18) were published in journals with high visibility (Q1). Of all the output, 68.4% (n = 91) was in Cuban journals. The output in English represented 29.3% (n = 39) and achieved greater impact than the articles in Spanish in terms of citations. As the visibility of the journals increased according to the quartiles where they are, the percentage of articles published in English and cited articles increased too, but Cuban scientific leadership decreased.

CONCLUSIONS

The greater the leadership in Cuban research, the lower its impact, and the lower the indexes of international collaboration. Cuban researchers are not yet able to systematically generate research that has a significant impact on the international scientific community.

Molecular study of a large cohort of 109 haemophilia patients from Cuba using a gene panel with next generation sequencing-based technology

INTRODUCTION

In several countries, molecular diagnosis of haemophilia A (HA) and B (HB) is hampered by a lack of resources for DNA analysis. The advent of next-generation sequencing (NGS) has enabled gene analysis at a reasonable cost.

AIM

Describe a collaboration between Cuban and Spanish researchers to identify candidate variants and investigate the molecular epidemiology of 106 Cuban haemophilia patients using NGS.

PATIENTS/METHODS

The molecular analysis protocol included well-established LR-PCR procedures to detect F8 inversions, NGS with a 30-gene panel to sequence F8 and F9, and multiplex ligation-dependent probe amplification to identify large structural variants.

RESULTS

One-hundred and thirty-one candidate variants were identified along F8, F9, and VWF; 72 were unique and 28 (39%) had not been previously recorded. Putative variants were identified in 105/106 patients. Molecular characterization enabled confirmation and reclassification of: 90 HA (85%), 15 HB (14%), and one type 2N VWD (1%). Null variants leading to non-production of FVIII or FIX were common in severe HA (64%), moderate HA (74%), and severe HB (60%), whereas missense variants were frequent in mild HA (57%) and moderate or mild HB (83%). Additional variants in VWF were identified in 16 patients.

CONCLUSION

This is the first description of the molecular epidemiology of HA and HB in Cuba. Variants identified in index cases will be of value for local implementation of familial studies and prenatal diagnosis using the molecular approaches available in Cuba. The results of this protocolled genetic study improved the accuracy of the clinical diagnosis and will facilitate management of these patients.

Subtype-Dependent Co-receptor Tropism in Cuban HIV-1-Infected Patients: Implications for Maraviroc Treatment

INTRODUCTION

Unlike most high-income countries where subtype B viruses predominate, the Cuban HIV-1 epidemic is characterized by a great diversity of subtypes and circulating recombinant forms. Some studies have shown that HIV variants exhibiting a preference for the CXCR4 co-receptor (X4-tropic) could have impacts on disease pathogenesis, with clinical implications for antiviral treatment plans. Determination of HIV co-receptor tropism is crucial for clinicians in deciding whether maraviroc is an appropriate antiviral.

OBJECTIVE

Characterize V3 sequence variability and its relation to viral tropism across different subtypes circulating in Cuba and explore how this may affect treatment success with maraviroc.

METHODS

We designed a cross-sectional study that included 72 plasma samples obtained at the Pedro Kourí Tropical Medicine Institute in Havana, Cuba. We sequenced the C2V3 env region and assessed subtype based both on env and pol sequences; tropism was predicted by Geno2pheno analysis. Additionally, 35 V3-loop Cuban sequences, obtained from a previous study, were incorporated into the analysis. Statistical associations among virological, clinical and epidemiological variables were assessed by a chi-square test.

RESULTS

Tropism prediction for 72 variants revealed that CRF19_cpx was associated with dual-tropic R5X4 viruses (p = 0.034). Moreover, when 35 sequences from a former study were added, the association was significant not only for R5X4 (p = 0.019) but also for X4-tropic variants (p = 0.044). Alignment of 107 V3-loop sequences showed wide diversity among the different HIV-1 subtypes circulating in Cuba.

CONCLUSIONS

In accordance with G2P, CRF19_cpx is a genetic variant with a high proportion of X4 and R5X4-tropic viruses. The results from the present study suggest that the Cuban recombinant could be a more pathogenic variant and that maraviroc may not be suitable for patients infected with CRF19_cpx.

Racotumomab in Non-Small Cell Lung Cancer as Maintenance and Second-Line Treatment

INTRODUCTION

Racotumomab is a therapeutic vaccine based on a monoclonal anti-idiotypic antibody developed by the Molecular Immunology Center in Havana, Cuba, that is registered in Cuba and Argentina for treatment of non-small cell lung cancer. It induces a specific humoral and cellular immune response against the N-glycolyl GM3 (NeuGcGM3) ganglioside present in tumor cells, thereby provoking the death of these cells.

OBJECTIVE

Evaluate racotumomab vaccine use as switch maintenance and second-line therapy for patients with inoperable non-small cell lung cancer in routine clinical practice, outside the framework of clinical studies, and assess the overall survival, stage-specific survival and safety in these patients.

METHODS

A descriptive, retrospective study was carried out in patients diagnosed with non-small cell lung cancer not suitable for surgical treatment, who received racotumomab as a part of switch maintenance or second-line treatments. Overall survival was defined from diagnosis and from the first immunization, until death.

RESULTS

We included 71 patients treated with racotumomab, 57.7% (41/71) of whom were in stages IIIB and IV of non-small cell lung cancer. Of the patients, 84.5% (60/71) had no adverse events, and 15.5% (11/71) had mild adverse reactions. The median overall survival was 24.5 months, calculated from the first immunization, 17.2 months for those who received racotumomab as switch maintenance and 6.8 months for patients who had progressed after the first line of treatment.

CONCLUSIONS

Racotumomab in routine clinical practice prolonged overall survival in patients with non-small cell lung cancer treated in switch maintenance, and in stage IV patients who received the treatment as second-line therapy. The vaccine was well tolerated.

Improved Recovery Protocols in Cardiac Surgery: A Systematic Review and Meta-Analysis of Observational and Quasi-Experimental Studies

INTRODUCTION

Improved recovery protocols were implemented in surgical specialties over the last decade, which decreased anesthetic and surgical stress and the incidence of perioperative complications. However, these recovery protocols were introduced more slowly for cardiac surgeries. The most frequent complications in cardiac surgery are related to patient clinical status and the characteristics of the surgical procedures involved, which are becoming more varied and complex every day. The first version of the enhanced recovery program for cardiac surgery was published in 2019, but its recommendations were based on only a few studies, and scant research has evaluated its implementation. Randomized and controlled clinical trials for these protocols are scarce, so research that summarizes the results of studies with other methodological designs are useful in demonstrating their benefits in cardiovascular surgery services in Cuba and in other limited-resource settings.

OBJECTIVE

Estimate the effectiveness of improved recovery protocols in the perioperative evolution of patients undergoing cardiac surgery.

METHODS

We performed a systematic review and meta-analysis according to the guidelines of manual 5.1.0 for reviews of the Cochrane library. We included observational and quasi-experimental studies published from January 2015 through May 2020 that compared enhanced recovery protocols with conventional treatments in patients older than 18 years, and used a quality score to evaluate them. We used the following sources: the Cochrane Library, PubMed, LILACS, SciELO, EBSCO, Google Scholar, Web of Science, Clinical Key, ResearchGate and HINARI. The following keywords were used for the database searches in English: ERAS, protocols and cardiac surgery, enhanced recovery after cardiac surgery, ERACS, clinical pathway recovery and cardiac surgery, perioperative care and cardiac surgery. We used the following search terms for databases in Spanish: protocolos de recuperación precoz and cirugía cardiaca, protocolos de recuperación mejorada and cirugía cardiaca, cuidados perioperatorios and cirugía cardiaca, programas de recuperación precoz and cirugía cardiovascular. Methodological quality of included investigations was evaluated using the surgical research methodology scale. Meta-analyses were performed for perioperative complications, intensive care unit and hospital stays, and hospital readmission within 30 days of surgery. We calculated effect sizes of the interventions and the corresponding 95% confidence intervals. We used mean differences and confidence intervals for continuous variables, and for qualitative variables we calculated relative risk (RR). Random effects analysis was used. Heterogeneity of the studies was assessed using the Q statistic and the I2 statistic.

RESULTS

We selected 15 studies (a total of 5059 patients: study group, n = 1706; control group, n = 3353). The average quality score for the 15 articles included was 18.9 (out of a maximum of 36 according to the scale) and 66.6% had a score =18. With improved recovery protocols in cardiac surgery, the incidence of perioperative complications decreased (RR = 0.73; 95% CI 0.52-0.98) as did hospital readmission within 30 days after surgery (RR = 0.51; 95% CI 95% CI: 0.31-0.86). Differences in extubation time, hospital stay and length of stay in intensive care units were less marked, but always favored the group in which the enhanced protocols were implemented.

CONCLUSIONS

Improved recovery protocols in cardiac surgery increase quality of care evidenced by reductions in perioperative complications and decreased incidence of hospital readmission in the month following surgery.

Influence of Inflammation on Assessing Iron-Deficiency Anemia in Cuban Preschool Children

INTRODUCTION

Anemia is a public health problem worldwide and is most prevalent in preschool children, for whom it is the most frequent cause of nutritional deficits. In turn, iron deficiency is the main cause of anemia, affecting 43% of children globally. Previous studies in Cuba show rates of iron deficiency in preschool children between 38.6% and 57.6%, higher in infants (71.2% to 81.1%). WHO recommends using serum ferritin as an indicator of iron deficiency accompanied by acute (C-reactive protein) and chronic (a1-acid glycoprotein) inflammation biomarkers.

OBJECTIVE

Assess how inflammation affects measuring and reporting of iron-deficiency anemia rates in Cuban preschool children.

METHODS

Data were obtained from serum samples contained in the National Anemia and Iron Deficiency Survey, and included presumably healthy preschool Cuban children (aged 6-59 months). Serum samples were collected from 1375 children from randomly selected provinces in 4 regions of the country from 2014 through 2018. We examined the association between ferritin and two inflammatory biomarkers: C-reactive protein and a1-acid glycoprotein. Individual inflammation-adjusted ferritin concentrations were calculated using four approaches: 1) a higher ferritin cut-off point (⟨30 g/L); 2) exclusion of subjects showing inflammation (C-reactive protein ⟩5 mg/L or a1-acid glycoprotein ⟩1 g/L); 3) mathematical correction factor based on C-reactive protein or a1-acid glycoprotein; and 4) correction by regression with the method proposed by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia Group. We estimated confidence intervals of differences between unadjusted prevalence and prevalence adjusted for inflammation by each method.

RESULTS

The proportion of children with inflammation according to C-reactive protein concentrations >5 mg/L was lower (11.1%, 153/1375) than the proportion measured according to the concentrations of a1-acid glycoprotein, at >1 g/L (30.8%, 424/1375). The percentage of children with high concentrations of at least one of the aforementioned biomarkers was 32.7% (450/1375). Thus, each correction method increased the observed prevalence of iron deficiency compared to unadjusted estimates (23%, 316/1375). This increase was more pronounced when using the internal regression correction method (based only on C-reactive protein) or the method based on a higher cut-off point. Adjustment using all four methods changed estimated iron deficiency prevalence, increasing it from 0.1% to 8.8%, compared to unadjusted values.

CONCLUSIONS

One-third of preschool children had biomarkers indicating elevated inflammation levels. Without adjusting for inflammation, iron deficiency prevalence was underestimated. The significant disparity between unadjusted and inflammation-adjusted ferritin when using some approaches highlights the importance of selecting the right approach for accurate, corrected measurement. The internal regression correction approach is appropriate for epidemiological studies because it takes into account inflammation severity. However, other models should be explored that account for inflammation and also provide better adjusted ferritin concentrations.

A Year in the COVID-19 Epidemic: Cuba and Uruguay in the Latin American Context

INTRODUCTION

One year after WHO declared COVID-19 a pandemic, we found it useful to carry out a diagnosis of the situation in Latin America.

OBJECTIVE

Examine the prevailing epidemiological panorama in mid-March 2021 in 16 countries in Latin America and the performance, over time, in the two countries with the best responses to their respective epidemics.

METHODS

Using morbidity and mortality data, we compared the relative performance of each country under review and identified the two countries with the most successful responses to the pandemic. We used five indicators to analyze the course of each country's performance during the pandemic throughout 2020: prevalence of active cases per million population; cumulative incidence rate in 7 days per 100,000 population; positivity rate over a 7-day period; percentage of recovered patients and crude mortality rate per 1,000,000 population.

RESULTS

According to the performance indicators, Cuba was ranked highest, followed by Uruguay. Although figures remained within acceptable margins, both nations experienced notable setbacks in the first weeks of 2021, especially sharp in Uruguay.

CONCLUSIONS

Any characterization of the situation is condemned to be short-lived due to the emergence of mutational variants; however, this analysis identified favorable sociodemographic characteristics in both nations, and in their health systems, which may offer possible explanations for the results we obtained.

Hypoxemia and Cytokine Storm in COVID-19: Clinical Implications

One of the most dreadful complications that can occur during the course of COVID-19 is the cytokine storm-also known as cytokine release syndrome-a form of systemic inflammatory response syndrome triggered by SARS-CoV-2 infection. The cytokine storm is an activation cascade of auto-amplifying cytokines, which leads to excessive activation of immune cells and generation of pro-inflammatory cytokines. It occurs when large numbers of white blood cells are activated and release inflammatory cytokines, in turn activating even more white blood cells, finally resulting in an exaggerated pro-inflammatory-mediated response and ineffective anti-inflammatory control, leading to tissue damage, multiorgan failure, acute respiratory distress syndrome and death. Although cytokine storm pathogenesis is multifactorial, we hypothesize there is a close association between hypoxemia and cytokine storms in COVID-19, although it is difficult to establish the direction of this relationship. Most probably they coexist and, given enough time, one triggers the other in a chain reaction. Careful analysis of the day-to-day clinical evolution of COVID-19 indicates that there are short and slight periods of hypoxemia (confirmed by pulse oximetry and arterial gasometry), even on the day of the onset of persistent cough and/or shortness of breath. We propose the use of continuous positive airway pressure in early stages of COVID-19, at the onset of respiratory symptoms. This non-invasive ventilation method may be useful in individualized treatments to prevent early hypoxemia in COVID-19 patients and thus avoid triggering a cytokine storm. We believe such an approach is relevant everywhere, and in Cuba in particular, since the country has initiated national production of mechanical ventilation systems, including non-invasive ventilators. Moreover, as Cuba's COVID-19 protocols ensure early patient admission to isolation centers or hospitals, clinicians can prescribe the early use of continuous positive airway pressure as soon as respiratory symptoms begin, averting early hypoxemia and its triggering effect on cytokine storm development, and consequently, avoiding acute respiratory distress syndrome, multi-organ failure, and death.

Characterization of two Cuban colonies of Rhipicephalus microplus ticks

Rhipicephalus microplus (Canestrini, 1888) is one of the species with medical and economic relevance that has been reported in the list of Cuban tick species. Some morphological characterizations about the R. microplus species in Cuba have been published; however, molecular studies are lacking. Molecular phylogenetic analyses have grouped R. annulatus, R. australis and three clades of R. microplus in a complex named R. microplus. The present study aimed to characterize two R. microplus tick isolates, established as colonies at the Cuban National Laboratory of Parasitology. Morphological characterization of adult specimens was carried out by using Scanning Electron Microscopy. The sequences of mitochondrial genes: 12S rRNA, 16S rRNA and the subunit I of cytochrome c oxidase (coxI) and one nuclear sequence: internal transcribed spacer 2 (its2) were used for phylogenetic analyses. The life cycle under laboratory conditions for both isolates was also characterized. Tick specimens of both colonies showed morphological characteristics comparable with those distinctive for the R. microplus species. Phylogenies based on mitochondrial gene sequences identified congruently the Cuban tick colonies within the clade A of R. microplus. The life cycle of both isolates under laboratory conditions lasted 65 ± 5 days and the reproductive performance of female ticks of each colony also were similar with approximately 2500 larvae obtained from fully engorged female ticks. This study constitutes the first molecular characterization of ticks from the R. microplus species in Cuba.

COVID-19 contagion concern scale (PRE-COVID-19): Validation in Cuban patients with type 2 diabetes

AIMS

It is important to have valid and reliable measures to determine the psychological impact of COVID-19 in patients with diabetes; however, few instruments have been developed and validated for this population. Therefore, the aim of this study was to validate the Scale of Worry for Contagion of COVID-19 (PRE-COVID-19) in a sample of patients with diabetes mellitus (DM).

MATERIALS AND METHODS

A total of 219 patients (66.2% female, mean age 58.5 SD = 18.2) participated, selected through non-probabilistic sampling. The PRE-COVID-19 and the Generalized Anxiety Disorder Scale-2 were applied. Reliability analysis was performed for internal consistency, structural equation modeling and item response theory modeling.

RESULTS

The results show that a unidimensional 5-item model presents satisfactory goodness-of-fit indices and excellent reliability values. Likewise, convergent validity between the PRE-COVID-19 and a measure of anxiety is evident. All items present adequate discrimination parameters, allowing for discerning between those patients with critical concern about COVID-19 contagion from those with severe concern.

CONCLUSION

It is concluded that the PRE-COVID-19 is an instrument with adequate psychometric properties to measure concern about COVID-19 infection and the emotional impact in patients with DM.

The X-ray fluorescence screening of multiple elements in herbarium specimens from the Neotropical region reveals new records of metal accumulation in plants

Plants have developed a diversity of strategies to take up and store essential metals in order to colonize various types of soils including mineralized soils. Yet, our knowledge of the capacity of plant species to accumulate metals is still fragmentary across the plant kingdom. In this study, we have used the X-Ray Fluorescence technology to analyze metal concentration in a wide diversity of species of the Neotropical flora that was not extensively investigated so far. In total, we screened more than 11 000 specimens representing about 5000 species from herbaria in Paris and Cuba. Our study provides a large overview of the accumulation of metals such as manganese, zinc and nickel in the Neotropical flora. We report 30 new nickel hyperaccumulating species from Cuba, including the first records in the families Connaraceae, Melastomataceae, Polygonaceae, Santalaceae and Urticaceae. We also identified the first species from this region of the world that can be considered as manganese hyperaccumulators in the genera Lomatia (Proteaceae), Calycogonium (Melastomataceae), Ilex (Aquifoliaceae), Morella (Myricaceae) and Pimenta (Myrtaceae). Finally, we report the first zinc hyperaccumulator, Rinorea multivenosa (Violaceae), from the Amazonas region. The identification of species able to accumulate high amounts of metals will become instrumental to support the development of phytotechnologies in order to limit the impact of soil metal pollution in this region of the world.

Seroprevalence of Toxoplasma gondii and associated risk factors in domestic pigs raised from Cuba

A cross-sectional study was carried out to determine the seroprevalence of Toxoplasma gondii and associated risk factors in pigs in the largest pork-producing region in Cuba. Serum samples from 420 pigs, including 210 sows and 210 post-weaning pigs, were tested for antibodies against T. gondii using a commercial indirect enzyme-linked immunosorbent assay. Anti-T. gondii antibodies were detected in 56 animals (13.3%, 95% CI: 10.1–16.6). A generalized estimating equations model revealed that the risk factors associated with higher seropositivity in pigs were altitude (higher in farm’s location < 250 m above sea level (masl) versus ≥ 250 masl) and age (higher in sows compared to post-weaning pigs). The results indicated that this protozoan parasite is widely distributed on pig farms in the study area, which is a public health concern since the consumption of raw or undercooked pork meat products containing tissue cysts is considered one of the main routes of T. gondii transmission worldwide. Control measures should be implemented to reduce the risk of exposure to T. gondii in pigs in Cuba.