Medicc Review最新文献

{"title":"Caution Ahead: Traffic Accidents in Cuba.","authors":"Conner Gorry","doi":"10.37757/MR2022.V24.N1.6","DOIUrl":"https://doi.org/10.37757/MR2022.V24.N1.6","url":null,"abstract":"","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":"24 1","pages":"77"},"PeriodicalIF":2.1,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39779057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccines and Public Trust: Containing COVID-19 in Cuba.","authors":"Conner Gorry","doi":"10.37757/MR2022.V24.N1.11","DOIUrl":"https://doi.org/10.37757/MR2022.V24.N1.11","url":null,"abstract":"<p><p>As 2021 drew to a close, Cuba struggled to contain the highly transmissible omicron variant of SARS-CoV-2, braced for a new wave of infections and kept a close eye on other variants of concern popping up around the world-a common experience to countries everywhere as we head into the second year of the pandemic. In Cuba, however, there is one marked difference making all the difference: by early January, 87% of the population was fully vaccinated using a three-dose schedule of vaccines developed and produced on the island.[1] This massive vaccination campaign is complemented by a rapid booster rollout-also using Cuban vaccines-that began in December 2021 and was ongoing as we finalized this issue. The island nation was able to achieve the third highest COVID-19 vaccination rate in the world[2] after decades of scientific investment, research, discovery and innovation; regulatory oversight and compliance; professional training; and increased production capacity. But a vaccine is only as effective as the health system charged with administering it-in a safe and timely manner, to as many people as possible. Here too, Cuba has decades of experience, including a national pediatric immunization program where 98% of children under 5 are immunized against 13 diseases,[3] an annual polio vaccination campaign (both launched in 1962 and uninterrupted since) and campaigns to contain epidemics such as H1N1. When the first COVID-19 cases were detected on the island in March 2020, Cuba harnessed this vaccine experience, making a hard tack towards developing its own vaccines. Two of the main protagonists in the country's biotechnology development, the Finlay Vaccine Institute (IFV) and the Genetic Engineering and Biotechnology Center (CIGB), both with several groundbreaking preventive and therapeutic vaccines in their portfolios, led the search for a vaccine. Today, Cuba has three vaccines authorized for emergency use-Soberana 02 and Soberana Plus developed by IFV, and Abdala, developed by CIGB. Schedules with these vaccines have demonstrated more than 90% efficacy in clinical trials,[4] and after regulatory approval for emergency use, became the backbone of Cuban COVID-19 vaccination efforts. A fourth vaccine, Mambisa (CIGB), administered nasally, and a fifth, Soberana 01 (IFV) are still in clinical trials. For this installment in MEDICC Review's series spotlighting leading women of Cuban science, we sat down with Dr Verena Muzio, Director of Clinical Research at CIGB. A pioneer of Cuba's biotechnology sector, she is an immunologist with a doctorate in biological sciences. Her professional trajectory began researching the genetically engineered hepatitis B surface antigen that led to the development of Cuba's recombinant hepatitis B vaccine in 1989. The same technological platform used in this vaccine was used to develop CIGB's Abdala vaccine against SARS-CoV-2-part of the reason Cuba was able to secure a vaccine so quickly. A phase 3 clinical trial deter","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":"24 1","pages":"9-13"},"PeriodicalIF":2.1,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39917723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Physical Exercise on Burnout Syndrome in University Students.","authors":"Yury Rosales-Ricardo,&nbsp;José P Ferreira","doi":"10.37757/MR2022.V24.N1.7","DOIUrl":"https://doi.org/10.37757/MR2022.V24.N1.7","url":null,"abstract":"<p><strong>Introduction: </strong>Burnout syndrome has a negative impact on university students' health worldwide. Global prevalence of each dimension of the syndrome is estimated at 55.4% for emotional exhaustion, 31.6% for cynicism and 30.9% for academic inefficacy.</p><p><strong>Objective: </strong>Evaluate the efficacy of physical exercise in reducing burnout levels in university students.</p><p><strong>Methods: </strong>We carried out an investigation in students from the Technical University of Ambato, Ecuador. Students were in different career tracks, randomly selected, and were assigned to three different groups with pre-test and post-test measurements: two intervention groups (aerobic and strength exercise) and one control group (no exercise). The evaluation instrument was the Maslach Burnout Inventory-Student Survey, whose dimensions are exhaustion, cynicism and academic inefficacy. We also evaluated heart rate variability.</p><p><strong>Results: </strong>The aerobic exercise group reduced cynicism by 21.1% (d = 0.252), inefficacy 13.1% (d = 0.397) and exhaustion by 31.0% (d = 0.532). The strength exercise group reduced cynicism by 27.4% (d = 0.315), inefficacy by 21.7% (d = 0.704) and exhaustion by 19.6% (d = 0.299). In the control group, exhaustion and inefficacy increased by 10.1% (d = 0.128) and 4.4% (d = 0.129) respectively; instead, cynicism was reduced by 7.3% (d = 0.062).The aerobic exercise group had the greatest increase in heart rate variability (at 16.8%), followed by the strength group (16.6%) and the control group (5.2%).</p><p><strong>Conclusions: </strong>Physical exercise (both aerobic and strength) was effective in reducing burnout levels in university students.</p>","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":"24 1","pages":"36-39"},"PeriodicalIF":2.1,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39779054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Hemodynamic Reserve Abnormalities Detected Via Transcranial Doppler Ultrasound in Recovered COVID-19 Patients.","authors":"Anselmo Antonio Abdo-Cuza,&nbsp;Charles Hall-Smith,&nbsp;Juliette Suárez-López,&nbsp;Roberto Castellanos-Gutiérrez,&nbsp;Miguel Ángel Blanco-González,&nbsp;Rafael Machado-Martínez,&nbsp;Jonathan Pi-Ávila,&nbsp;Francisco Gómez-Peire,&nbsp;Namibia Espinosa-Nodarse,&nbsp;Juan C López-González","doi":"10.37757/MR2022.V24.N1.3","DOIUrl":"https://doi.org/10.37757/MR2022.V24.N1.3","url":null,"abstract":"<p><strong>Introduction: </strong>SARS-CoV-2 infection can produce endothelial injury and microvascular damage, one cause of the multiorgan failure associated with COVID-19. Cerebrovascular endothelial damage increases the risk of stroke in COVID-19 patients, which makes prompt diagnosis important. Endothelial dysfunction can be evaluated by using transcranial Doppler ultrasound to study cerebral hemodynamic reserve, but there are few of these studies in patients with COVID-19, and the technique is not included in COVID-19 action and follow-up guidelines nationally or internationally.</p><p><strong>Objective: </strong>Estimate baseline cerebral hemodynamic patterns, cerebral hemodynamic reserve, and breath-holding index in recovered COVID-19 patients.</p><p><strong>Method: </strong>We conducted an exploratory study in 51 people; 27 men and 24 women 20-78 years of age, divided into two groups. One group comprised 25 recovered COVID-19 patients, following clinical and epidemiological discharge, who suffered differing degrees of disease severity, and who had no neurological symptoms or disease at the time they were incorporated into the study. The second group comprised 26 people who had not been diagnosed with COVID-19 and who tested negative by RT-PCR at the time of study enrollment. Recovered patients were further divided into two groups: those who had been asymptomatic or had mild disease, and those who had severe or critical disease. We performed transcranial Doppler ultrasounds to obtain baseline and post-apnea tests of cerebral hemodynamic patterns to evaluate cerebral hemodynamic reserve and breath-holding indices. We characterized the recovered patient group and the control group through simple descriptive statistics (means and standard deviations).</p><p><strong>Results: </strong>There were no measurable differences in baseline cerebral hemodynamics between the groups. However, cerebral hemodynamic reserve and breath-holding index were lower in those who had COVID-19 than among control participants (19.9% vs. 36.8% and 0.7 vs. 1.2 respectively). These variables were similar for patients who had asymptomatic or mild disease (19.9% vs.19.8%) and for those who had severe or critical disease (0.7 vs. 0.7).</p><p><strong>Conclusions: </strong>Patients recovered from SARS-CoV-2 infection showed decreased cerebral hemodynamic reserve and breath-holding index regardless of the disease's clinical severity or presence of neurological symptoms. These abnormalities may be associated with endothelial damage caused by COVID-19. It would be useful to include transcranial Doppler ultrasound in evaluation and follow-up protocols for patients with COVID-19.</p>","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":"24 1","pages":"28-31"},"PeriodicalIF":2.1,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39779052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Without Accessible Primary Care, We Are \"Dangerously Unprepared\" for the Next Pandemic.","authors":"","doi":"10.37757/MR2022.V24.N1.13","DOIUrl":"https://doi.org/10.37757/MR2022.V24.N1.13","url":null,"abstract":"","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":"24 1","pages":"4-5"},"PeriodicalIF":2.1,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39917721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymptomatic SARS-CoV-2 Infection in Havana, Cuba, March-June 2020: Epidemiological Implications.","authors":"Elba Cruz-Rodríguez,&nbsp;Waldemar Baldoquín-Rodríguez,&nbsp;Niurka Molina-Águila,&nbsp;Belkys M Galindo-Santana,&nbsp;Manuel Romero-Placeres,&nbsp;Tania M González-Gross,&nbsp;Isabela Morgado-Vega,&nbsp;Yadira Olivera-Nodarse,&nbsp;María Guadalupe-Guzmán","doi":"10.37757/MR2022.V24.N1.4","DOIUrl":"https://doi.org/10.37757/MR2022.V24.N1.4","url":null,"abstract":"<p><strong>Introduction: </strong>The percentage of asymptomatic COVID-19 cases worldwide is estimated at 18-50%; 53% in Cuba specifically, and 58% in Havana, the Cuban capital and the 2020 epicenter of the country's COVID-19 epidemic. These figures, however, do not represent the transmission capacity or behavior of asymptomatic cases. Understanding asymptomatic transmission's contribution to SARS-CoV-2 spread is of great importance to disease control and prevention.</p><p><strong>Objective: </strong>Identify the epidemiological implications of asymptomatic SARS-CoV-2 infection in Havana, Cuba, during the first wave of the epidemic in 2020.</p><p><strong>Methods: </strong>We carried out a cross-sectional study of all confirmed COVID-19 cases diagnosed in Havana, Cuba, from March 16 through June 30, 2020. The information was obtained through review of the standardized form for investigation of suspected and confirmed cases. Examined variables included age, sex, occupation, case type and source of infection. Cases were divided into asymptomatic and symptomatic groups, and transmission was characterized through the creation of a contact matrix. Analysis was carried out in Epidat and R.</p><p><strong>Results: </strong>We studied 1287 confirmed cases, of which 57.7% (743) were asymptomatic, and 42.3% (544) were symptomatic. Symptomatic presentation was the most common for both imported and introduced cases, while asymptomatic presentation was more common in autochthonic cases and infections from an undetermined source. Asymptomatic infection was more common in groups aged &#10216;20 and 20-59 years, while symptomatic infection was more common in those aged &#10217;60 years. In the contact matrix, 34.6% of cases (445/1287) were not tied to other cases, and 65.4% (842/1287) were infectious-infected dyads, with symptomatic-symptomatic being the most common combination. The majority of primary cases (78.5%; 1002/1276) did not generate secondary cases, and 85.6% (658/743) of asymptomatic cases did not lead to other cases (although one asymptomatic superspreader led to 90 cases in a single event). However, 63.2% (344/544) of symptomatic primary cases generated secondary cases, and 11 symptomatic superspreaders spawned 100 secondary cases in different events.</p><p><strong>Conclusions: </strong>Asymptomatic SARS-CoV-2 infection was the most common form of COVID-19 in Havana during the study period, but its capacity for contagion was lower than that of symptomatic individuals. Superspreader events under specific conditions played an important role in sustaining the epidemic.</p>","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":"24 1","pages":"21-27"},"PeriodicalIF":2.1,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39779051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wound Chronicity, Impaired Immunity and Infection in Diabetic Patients.","authors":"Nadia Rodríguez-Rodríguez, Indira Martínez-Jiménez, Ariana García-Ojalvo, Yssel Mendoza-Mari, Gerardo Guillén-Nieto, David George Armstrong, Jorge Berlanga-Acosta","doi":"10.37757/MR2021.V23.N3.8","DOIUrl":"10.37757/MR2021.V23.N3.8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Diabetic foot ulcers are a common diabetic complication leading to alarming figures of amputation, disability, and early mortality. The diabetic glucooxidative environment impairs the healing response, promoting the onset of a 'wound chronicity phenotype'. In 50% of ulcers, these non-healing wounds act as an open door for developing infections, a process facilitated by diabetic patients' dysimmunity. Infection can elicit biofilm formation that worsens wound prognosis. How this microorganism community is able to take advantage of underlying diabetic conditions and thrive both within the wound and the diabetic host is an expanding research field.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;1) Offer an overview of the major cellular and molecular derangements of the diabetic healing process versus physiological cascades in a non-diabetic host. 2) Describe the main immunopathological aspects of diabetics' immune response and explore how these contribute to wound infection susceptibility. 3) Conceptualize infection and biofilim in diabetic foot ulcers and analyze their dynamic interactions with wound bed cells and matrices, and their systemic effects at the organism level. 4) Offer an integrative conceptual framework of wound-dysimmunity-infection-organism damage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Evidence aquisition: &lt;/strong&gt;We retrieved 683 articles indexed in Medline/PubMed, SciELO, Bioline International and Google Scholar. 280 articles were selected for discussion under four major subheadings: 1) normal healing processes, 2) impaired healing processes in the diabetic population, 3) diabetic dysimmunity and 4) diabetic foot infection and its interaction with the host.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Development: &lt;/strong&gt;The diabetic healing response is heterogeneous, torpid and asynchronous, leading to wound chronicity. The accumulation of senescent cells and a protracted inflammatory profile with a pro-catabolic balance hinder the proliferative response and delay re-epithelialization. Diabetes reduces the immune system's abilities to orchestrate an appropriate antimicrobial response and offers ideal conditions for microbiota establishment and biofilm formation. Biofilm-microbial entrenchment hinders antimicrobial therapy effectiveness, amplifies the host's pre-existing immunodepression, arrests the wound's proliferative phase, increases localized catabolism, prolongs pathogenic inflammation and perpetuates wound chronicity. In such circumstances the infected wound may act as a proinflammatory and pro-oxidant organ superimposed onto the host, which eventually intensifies peripheral insulin resistance and disrupts homeostasis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The number of lower-limb amputations remains high worldwide despite continued research efforts on diabetic foot ulcers. Identifying and manipulating the molecular drivers underlying diabetic wound healing failure, and dysimmunity-driven susceptibility to infection will offer more effective therapeutic to","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":"24 1","pages":"44-58"},"PeriodicalIF":2.1,"publicationDate":"2021-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39523740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Haiti, Cubans Among First Responders, Again: Luis Orlando Oliveros-Serrano MD Coordinator, Cuban Medical Team in Haiti.","authors":"Conner Gorry","doi":"10.37757/MR2022.V24.N1.1","DOIUrl":"https://doi.org/10.37757/MR2022.V24.N1.1","url":null,"abstract":"<p><p>Soaring summer temperatures, systematic urban and political violence, unreliable infrastructure-power outages, water shortages, sporadic transportation and interruption of other basic services-plus the illness, death and economic straits wrought by COVID-19, are what Haitians awake to every day. On the morning of August 14, 2021, they also woke to the earth in the throes of violent, lethal convulsions caused by a 7.2-magnitude earthquake, along the same fault line responsible for the devastating 2010 disaster and stronger still. As if this weren't enough, Tropical Storm Grace was bearing down on the nation, about to dump biblical amounts of rain on the heels of Tropical Storm Fred. When the Haitian President was assassinated on July 7, Haiti still had not received a single dose of any COVID-19 vaccine-indeed, it was the last country in the Americas to receive vaccines. Later that month, 500,000 doses arrived in the country, donated by the United States via COVAX, the WHO-led initiative to assure at least some vaccines reached low- and middle-income countries. In Haiti, getting those vaccines into the arms of the population is beset by cold chain, distribution and bureaucratic problems, and compounded by widespread vaccine hesitancy; when the earthquake struck, only 14,074 of those doses had been administered.[1,2] Suddenly there was a new, more urgent tragedy, the earthquake leaving thousands of dead, injured and displaced-perhaps hundreds of thousands once the real tally emerges. As in the 2010 quake, the doctors, nurses and technicians comprising Cuba's medical team in Haiti-a commitment Cuba has maintained with its Caribbean neighbor since 1998-were among the first responders. The 2010 relief effort included an additional 1500 health professionals and specialists from Cuba's Henry Reeve Emergency Medical Contingent. Just 24 hours after the August 14th quake, MEDICC Review spoke by phone with Dr Luis Orlando Oliveros-Serrano in Port-au-Prince, where he coordinates Cuba's medical team in Haiti. His disaster response experience had already taken him to Haiti twice before and to Pakistan, Bolivia and beyond.</p>","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":"24 1","pages":"19-20"},"PeriodicalIF":2.1,"publicationDate":"2021-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39520816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved Recovery Protocols in Cardiac Surgery: A Systematic Review and Meta-Analysis of Observational and Quasi-Experimental Studies.","authors":"María O Agüero-Martínez,&nbsp;Víctor M Tapia-Figueroa,&nbsp;Tania Hidalgo-Costa","doi":"10.37757/MR2021.V23.N3.9","DOIUrl":"https://doi.org/10.37757/MR2021.V23.N3.9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Estimate the effectiveness of improved recovery protocols in the perioperative evolution of patients undergoing cardiac surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We selected 15 studies (a total of 5059 patients: study group, n = 1706; control group, ","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":"23 3-4","pages":"46-53"},"PeriodicalIF":2.1,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9939117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Multiple Cause-of-Death Analysis to Estimate Systemic Autoimmune Disease Mortality Burden in Low- and Middle-Income Countries.","authors":"Halbert Hernández-Negrín,&nbsp;Yeniver Roque-Dapresa,&nbsp;Onan Martínez-Morales,&nbsp;Anabel Mederos-Portal","doi":"10.37757/MR2021.V23.N2.12","DOIUrl":"https://doi.org/10.37757/MR2021.V23.N2.12","url":null,"abstract":"<p><p>Autoimmune diseases are not always recognized as urgent health issues, despite a worldwide prevalence of 4%-5%. Most estimates come from high-income countries, as low- and middle-income countries face more issues of under-reporting. Despite this and the lack of recognition under current reporting practices, the role these diseases play in mortality must be acknowledged. In particular, considering multiple causes of death as opposed to a single cause of death results in a 1.5-4.2-fold increase in deaths classified as relating to autoimmune diseases, evidence of their share in overall mortality burden, a factor important for patient care and healthcare policy decision making. However, formulating such policies and programs for timely, appropriate diagnoses and care is stymied in low- and middle-income countries by the shortage of methodologically sound studies on mortality from systemic autoimmune diseases. This limitation exacerbates inequalities and health gaps among patients in different countries and localities. Multiple cause-of-death methodology has been validated for research on other diseases and demonstrates the mortality burden of these illnesses in countries where traditional methodological approaches, primarily based on prospective cohort studies, are not feasible. Studying mortality from systemic autoimmune diseases by analyzing multiple causes of death with data from national mortality registries is a low-cost alternative to traditional mortality analysis. The objective of this paper is to demonstrate and defend the usefulness of this approach to estimate mortality burden.</p>","PeriodicalId":49835,"journal":{"name":"Medicc Review","volume":"23 2","pages":"69"},"PeriodicalIF":2.1,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38900845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}