ABSTRACT The COVID-19 pandemic exhibits different characteristics in each country, related to the extent of SARS-CoV-2 local transmission, as well as the speed and effectiveness of epidemic response implemented by authorities. This study presents a descriptive epidemiological analysis of the daily and cumulative incidence of confirmed cases and deaths in Cuba from COVID-19 in the first 110 days after first-case confirmation on March 11, 2020. During this period, 2340 cases (20.7 x 100,000 population) were confirmed, of which 86 patients died (case fatality 3.67%; 52 men and 34 women). Mean age of the deceased was 73.6 years (with a minimum of 35 years and a maximum of 101), with the average age of men lower than that of women. More than 70% of all deceased had associated noncommunicable diseases. The incidence curve ascended for five weeks and then descended steadily. The average number of confirmed cases and deaths for the last week included (June 23–28, 2020) were 25 and 1 respectively; the curve always moved within the most favorable forecast zone of available mathematical models and the effective reproductive number fell below 1 after the fifth week following the onset of the epidemic. We present the prevention and control measures implemented during this period—some unique to Cuba—and assess their effectiveness using two analytical tools: comparison of observed deaths and confirmed cases with those predicted by mathematical models; and estimation of the effective reproductive rate of SARS-CoV-2. Some distinctive features of this strategy include nationwide door-to-door active screening for individuals with fever and/or symptoms of respiratory distress, isolation of cases and quarantine of contacts of confirmed cases and of persons suspected of having the virus. During this period, Cuba’s response to the epidemic was successful in flattening the curve and limiting transmission, resulting in fewer cases and a lower number of subsequent deaths.

ABSTRACT INTRODUCTION Reference values for liver stiffness for healthy individuals vary worldwide. Different optimal cutoff values correspond to the stages of fibrosis in chronic liver disease. OBJECTIVES Characterize the distribution of liver stiffness in Cuban adults without liver disease and its association with age, serum uric acid and body mass index. METHODS A cross-sectional study was performed of 110 plasma donors recruited from the Havana Province Blood Bank January 2016 through February 2017. Measurements of liver stiffness were performed using a FibroScan elastography device on the same day of laboratory analyses and abdominal ultrasound. The Pearson coefficient was used to assess correlations, and the reference range was calculated using the mean and its 95% confidence interval. RESULTS Liver stiffness values observed ranged from 2.2–6.3 kPa. The reference range (95% CI) for the 110 subjects without known liver disease was 4.2–4.6 kPa (mean 4.4). A positive correlation was observed between liver stiffness measurements and body mass index (r = 0.255, p <0.01) and serum uric acid (r = 0.266, p <0.01). There was no correlation between liver stiffness and age. Liver stiffness in women was similar to that of men, 4.3 (2.4–6.1) and 4.5 (2.2–6.3) kPa, respectively (p = 0.086). CONCLUSIONS Liver stiffness in Cuban adults without liver disease ranges from 2.2–6.3 kPa. The reference range is 4.2–4.6 kPa. Body mass index and serum uric acid levels are positively associated with liver stiffness. CONTRIBUTION OF THIS RESEARCH This is the first Cuban study using FibroScan to measure liver stiffness; its results will enable better assessment of liver disease in clinical practice.

The colorectal carcinoma (CLC) is one of the more frequent neoplasia in our practice, in past years there was a significant advance in the knowledge of mechanisms implicated in its development and progression. Such advance embraces from the identification of different genetic factors or molecular involved in its genesis. A case-control study was conducted on the CLC risk factors in adult patients (92 cases and 184 controls), diagnosed in the Institute of Gastroenterology. A survey was applied to collect these possible factors and to determine its relation to CLC. Analysis of these results showed that the risk factors with a great solid causality are: smoking, hip-waist index, vegetable consumption, physical inactivity and personal pathologic backgrounds of polyps and of other malignant tumors. There was predominance to left colon (descending, sigmoid and rectum) in both sexes. There was also predominance of the ulcerated type in both sexes, and the more frequent histological type was the adenocarcinoma.

El cáncer colorrectal (CCR) es una de las neoplasias más frecuentes en nuestro medio, en los últimos años hemos asistido a un avance muy significativo en el conocimiento de los mecanismos que participan en su desarrollo y progresión. Ese avance abarca desde la identificación de diversos factores genéticos o moleculares implicados en la fisiopatología de esta neoplasia, hasta la caracterización de múltiples aspectos epidemiológicos involucrados en su génesis. Se realizó un estudio de casos y controles sobre factores de riesgo del CCR, en pacientes adultos (92 casos y 184 controles), diagnosticados en el Instituto de Gastroenterología. Se aplicó una encuesta para recoger estos posibles factores y determinar su relación con el CCR. El análisis de estos resultados demostró que los factores de riesgo de más sólida causalidad son: hábito de fumar, índice cintura-cadera, consumo de vegetales, inactividad física y antecedentes patológicos personales de pólipos y de otros tumores malignos. Predominó la localización hacia colon izquierdo (descendente, sigmoide y recto) en ambos sexos. Se observó predominio del tipo ulcerado, en ambos sexos y el tipo histológico más frecuente fue el adenocarcinoma.

O diagnóstico e o tratamento corretos e precoces da sífilis são essenciais para o seu controle. Os testes diagnósticos tradicionais dependem de equipamentos, instalações e recursos humanos especializados. Na busca de testes de execução simplificada e rápida, realizou-se projeto de validação e da reprodutibilidade de quatro diferentes testes anteriormente avaliados pelos laboratórios de referência da Organização Mundial da Saúde. Verificaram-se também as características operacionais e aceitabilidade dos pacientes e dos profissionais de saúde. As amostras obtidas numa clínica de DST constaram de 541 e 248 pacientes com 51 e 52 positivos no FTA-Abs (padrão ouro) nos estudos 1 e 2, respectivamente. A sensibilidade variou entre 84 e 96%, especificidade superior a 98% e valor preditivo positivo > 90%. A reprodutibilidade foi superior a 97% e 0,94 no índice de kappa, comparando-se os resultados obtidos pelos diferentes profissionais. A execução dos testes foi de menos de vinte minutos, e mais de 90% dos pacientes concordaram em esperar o seu resultado até duas horas. Os testes apresentaram requisitos necessários para serem empregados no diagnóstico da sífilis, dando assim mais uma opção para o controle desta infecção.

Correct, early diagnosis and treatment of syphilis are essential for its control. Traditional diagnostic tests depend on specialized equipment, installations, and human resources. In the search for quick, simple tests, a project was conducted on the validation and reproducibility of four different tests, previously assessed by WHO reference laboratories. The study also verified the operational characteristics and acceptance by patients and health professionals. Samples obtained at an STD clinic were from 541 and 248 patients with 51 and 52 positive results according to FTA-Abs (gold standard) in studies 1 and 2, respectively. The sensitivity varied from 84 to 96%, specificity was greater than 98%, and PPV was > 90%. Reproducibility was > 97% and kappa index 0.94, comparing the results obtained by different health workers. The tests took less than 20 minutes to perform, and more than 90% of patients agreed to wait up to two hours for the results. The tests presented the necessary requirements for use in diagnosis of syphilis, thus providing an additional option for controlling this disease.

O diagnóstico e o tratamento corretos e precoces da sífilis são essenciais para o seu controle. Os testes diagnósticos tradicionais dependem de equipamentos, instalações e recursos humanos especializados. Na busca de testes de execução simplificada e rápida, realizou-se projeto de validação e da reprodutibilidade de quatro diferentes testes anteriormente avaliados pelos laboratórios de referência da Organização Mundial da Saúde. Verificaram-se também as características operacionais e aceitabilidade dos pacientes e dos profissionais de saúde. As amostras obtidas numa clínica de DST constaram de 541 e 248 pacientes com 51 e 52 positivos no FTA-Abs (padrão ouro) nos estudos 1 e 2, respectivamente. A sensibilidade variou entre 84 e 96%, especificidade superior a 98% e valor preditivo positivo > 90%. A reprodutibilidade foi superior a 97% e 0,94 no índice de kappa, comparando-se os resultados obtidos pelos diferentes profissionais. A execução dos testes foi de menos de vinte minutos, e mais de 90% dos pacientes concordaram em esperar o seu resultado até duas horas. Os testes apresentaram requisitos necessários para serem empregados no diagnóstico da sífilis, dando assim mais uma opção para o controle desta infecção.

Correct, early diagnosis and treatment of syphilis are essential for its control. Traditional diagnostic tests depend on specialized equipment, installations, and human resources. In the search for quick, simple tests, a project was conducted on the validation and reproducibility of four different tests, previously assessed by WHO reference laboratories. The study also verified the operational characteristics and acceptance by patients and health professionals. Samples obtained at an STD clinic were from 541 and 248 patients with 51 and 52 positive results according to FTA-Abs (gold standard) in studies 1 and 2, respectively. The sensitivity varied from 84 to 96%, specificity was greater than 98%, and PPV was > 90%. Reproducibility was > 97% and kappa index 0.94, comparing the results obtained by different health workers. The tests took less than 20 minutes to perform, and more than 90% of patients agreed to wait up to two hours for the results. The tests presented the necessary requirements for use in diagnosis of syphilis, thus providing an additional option for controlling this disease.