#Mambisa y #Abdala. Rescatando vidas del #COVID19

#Mambisa (CIGB-669) vía intranasal y #Abdala (CIGB-66) vía intramuscular, son los candidatos obtenidos por el CIGB que componen la lista de 4 de nuestra #CienciaCubana para combatir la #COVID19. Reportaje del #NTV y #Caribe para que usted se informe con nosotros!!

Un paso más para #SALVARVIDAS. Laboratorio de Biología Molecular del CIGB llega a más de 50 mil PCR

En el CIGB, desde abril de 2020, puesta en marcha de un Laboratorio de Biología Molecular para prestación de servicio de pruebas confirmatorias de SARS-CoV-2 por PCR en tiempo real al sistema de salud y como parte del aseguramiento de evaluación de muestras de pacientes de ensayos clínicos con productos novedosos. Se han procesado más de 50,000 muestras por PCR. 

#HeberprotP. SIGUE TUS PASOS. Testimonio de VIDA

Conozca la historia de una cubana que apesar de recibir los fuertes azotes de la #COVID19, se siente sumamente dichosa de las atenciones y resultados de la salud cubana y además es doblemente beneficiada con el producto #HeberprotP para salvar su pierna de una amputación.

  

 

#QUIEROQUESEPAS sobre #NASALFERON

El #Nasalferón resulta un inmunomodulador, evita la replicación del virus y modifica la cantidad de colonias presentes en el organismo, explica el Dr. Hugo Nodarse Cuní, investigador del Centro de Ingeniería Genética y Biotecnología. Una de las 29 medidas recomendadas por el Grupo de Ciencia del Ministerio de Salud Pública para contener la propagación de la #COVID19 en #CiegoDeÁvila es la aplicación del antiviral #Nasalferón. El fármaco ya se sumisnitra a trabajadores, pacientes y acompañantes de todos los centros asistenciales de la provincia.

 

Maíz híbrido transgénico. ¿Conoces acerca del tema?

#SABÍASQUÉ

Agricultores de Sancti Spíritus, Matanzas y Ciego de Ávila cultivan por primera vez un maíz híbrido transgénico de alto potencial productivo, desarrollado por el Centro de Ingeniería Genética y Biotecnología.
La cosecha de las primeras plantaciones confirma que su rendimiento agrícola es mucho mayor que el de las variedades tradicionales que se emplean en la elaboración de piensos para la alimentación animal.

¿Qué es el CIGB 2020? ¿A qué llamamos "respuesta inmune innata" en tiempo de COVID19?

#CIGBQUIEREQUESEPAS 

Dr. Gerardo Guillén, Director de Investigaciones Biomédicas del CIGB, explica sobre el proyecto CIGB-2020 que desarrolla una vacuna contra la #COVID19 que busca la respuesta inmune innata ante el virus. ¿QUIERES CONOCER AL RESPECTO?

Leading by Example: Cuba in the Covid-19 Pandemic

by Helen Yaffe 

https://www.counterpunch.org/2020/06/04/leading-by-example-cuba-in-the-covid-19-pandemic/  

The response of socialist Cuba to the global SARS-CoV2 pandemic has been outstanding both domestically and for its international contribution. That a small island nation, subjected to hundreds of years of colonialism and imperialism and, since the Revolution of 1959, six decades of the criminal United States blockade, can play such an exemplary role is due to Cuba’s socialist system. The central plan directs national resources according to a development strategy which prioritises human welfare and community participation, not private profit. 

Cuban authorities reacted quickly to Chinese information about SARS-CoV2 at the start of the year. In January, authorities established a National Intersectoral Commission for COVID-19, updated their National Action Plan for Epidemics, initiated surveillance at ports, airports and marines, gave COVID-19 response training for border and immigration officials and drafted a ‘prevention and control’ plan. Cuban specialists travelled to China to learn about the new coronavirus’ behaviour and commissions of the government’s Scientific Council began to work on combating the coronavirus. Throughout February, medical facilities were reorganised, and staff trained to control the spread of the virus domestically. In early March a science and biotechnology group was created to develop COVID-19 treatments, tests, vaccines, diagnostics and other innovations. From 10 March inbound travellers were tested for COVID-19. All of this was before the virus was detected on the island.  

On 11 March, three Italian tourists were confirmed as the first cases of COVID-19 in Cuba. Cuban healthcare authorities stepped into action, organising neighbourhood meetings, conducting door-to-door health checks, testing, contact tracing and quarantining. This has been accompanied by education programmes and daily information updates. The population went under ‘lockdown’ on 20 March, required to abide by social distancing rules and wear facemasks when leaving homes on essential business. Business taxes and domestic debts were suspended, those hospitalised had 50% of their salaries guaranteed and low-income households qualified for social assistance and family assistance schemes, with food, medicine and other goods delivered to their homes. Workshops nationwide began to produce masks, bolstered by a grassroots movement of home production, and community mutual aids groups organised to assist the vulnerable and elderly with shopping for food as long queues became the norm. On 24 March, Cuba closed its borders to all non-residents, a tough decision given the importance of tourism revenue to the state. Anyone entering the country was required to spend a fortnight in supervised quarantine, under a testing regime. Defence Councils in the Provinces and Municipalities were activated. 

Video: Cuba’s Isolation Centers  

In April payment of utility bills was suspended, likewise local and regional transport, while transport was guaranteed for medical staff and other essential workers. Havana and other cities were disinfected. 20 communities in six provinces were placed under total or partial quarantine. A Cuban-designed mobile phone app, ‘Virtual Screening’, went live with an opt-in application allowing users to submit an epidemiological survey for statistical analysis by the Ministry of Public Health (MINSAP). Measures were taken to keep the virus out of prisons, with active screening twice daily and no reported cases by 23 April. 

By 24 May, a Cuban population of 11.2 million had reported 82 deaths and fewer than 2,000 confirmed cases; 173 confirmed cases per million people, compared to 3,907 per million in Britain. Not one healthcare worker had died, although 92 had been infected by mid-April. 

Cuba’s exemplary response is based on five features of its socialist development. First, its single, universal, free public healthcare system which seeks prevention over cure, with a network of family doctors responsible for community health who live among their patients. Second, Cuba’s biopharma industry which is driven by public health needs, produces nearly 70% of the medicines consumed domestically and exports to 50 countries.[1] Third, the island’s experience in civil defence and disaster risk reduction, usually in response to climate-related and natural disasters. Its internationally applauded capacity to mobilise national resources to protect human life is achieved by a network of grassroots organisations which facilitate communication and community action. Fourth, the island’s experience in operating infectious disease (border) controls. For decades, Cuba has sent healthcare professionals to countries which have infectious diseases long-since eradicated on the island and has invited tens of thousands of foreigners from those countries to study in Cuba. It has well-developed procedures for quarantining people (re)entering the island. Fifth, Cuban medical internationalism, which has seen 400,000 healthcare professionals providing free healthcare for underserved populations in 164 countries; some 28,000 medical personnel were serving in 59 countries when the pandemic began. By late May, an additional 2,300 healthcare specialists from Cuba’s Henry Reeve medical brigades, specialists in epidemiological and disaster response, had gone to 24 countries to treat patients with COVID-19. 

A commitment to high-standard public healthcare  

In 1959, Cuba had some 6,000 doctors but half of them soon left; only 12 of the 250 Cuban teachers at the University of Havana’s Medical School stayed. There was only one rural hospital. The revolutionary government faced the challenge of providing a high-standard public healthcare system almost from scratch. To that end, in 1960, the Rural Medical Service (RMS) was established and over the next decade hundreds of newly graduated doctors were posted in remote areas.[2] RMS physicians served as health educators as well as clinicians. National programmes were established for infectious disease control and prevention. From 1962 a national immunisation programme provided all Cubans with eight vaccinations free of charge. Infectious diseases were rapidly reduced, then eliminated. By 1970, the number of rural hospitals had reached 53. Not until 1976 was the pre-revolutionary ratio of doctors to citizens restored. By then, health services were available nationwide and indicators had improved significantly. A new model of community-based polyclinics was established in 1974 giving Cuban communities local access to primary care specialists. Training and policy emphasised the impact of biological, social, cultural, economic and environmental factors on patients. National programmes focused on maternal and child health, infectious diseases, chronic non-communicable diseases, and older adult health. 

In 1983, the Family Doctor and Nurse Plan was introduced nationwide. Under this system, family doctor practices were set up in neighbourhoods, with either the doctor or the nurse living with their family above the practice, so medical attention is available 24 hours a day. Family doctors coordinate medical care and lead health promotion efforts, emphasising prevention and epidemiological analysis. They rely on history-taking and clinical skills, reserving costly high-tech procedures for patients requiring them, holding patient appointments in the mornings and making house calls in the afternoons. The teams carry out neighbourhood health diagnosis, melding clinical medicine with public health, and individualised ‘Continuous Assessment and Risk Evaluation’ (CARE) for their patients. Family doctors and nurses are also employed in large workplaces and schools, child day-care centres, homes for senior citizens and so on. 

By 2005, Cubans had one doctor for every 167 people, the highest ratio in the world. Cuba now has 449 policlinics, each attending to 20,000 to 40,000 people and serving as a hub for 15 to 40 family doctors. There are more than 10,000 family doctors spread evenly throughout the island. 

Primary Health Care as the backbone of Cuba’s response  

An article in April 2020 Medicc Review describes Cuba’s primary health care system as a ‘powerful weapon’ against COVID-19.[3] ‘Without early access to rapid tests, massive testing was clearly not in the cards as a first strategic option. However, primary health care was.’ Cuban authorities ensured that everyone in the healthcare system, including support staff, received COVID-19 training before the virus was detected. Senior medics from each province were trained at Cuba’s world-famous hospital for tropical diseases, Instituto Pedro Kourí. On returning to their provinces they then trained colleagues in the second tier – hospital and polyclinics directors. ‘Then they went on to the third tier: training for family doctors and nurses themselves, lab and radiology technicians, administrative personnel, and also housekeeping staff, ambulance drivers and orderlies. Anyone who might come into contact with a patient’, explained a polyclinic director, Dr Mayra Garcia, who is cited in the Medicc article. 

Each polyclinic also trained non-health sector people in their geographical area, in workplaces, small business owners, people renting homes, especially to foreigners, or managing childcare facilities, telling them how to recognise symptoms and take protective measures. Senior medical professionals in the polyclinics were sent to family doctors’ offices as reinforcement. Medical staff were posted in local hotels to provide 24-hour detection and health care to foreigners residing there. Walk-in emergency services were re-organised to separate anyone with respiratory symptoms and to provide 24-hour assessment. Non-COVID-19 related appointments were postponed where possible or shifted to home visits for priority groups. 

The Medicc article underscores the importance of the CARE model for combating COVID-19. All Cubans are already categorised into four groups: apparently healthy, with risk factors for disease, ill, and in recovery or rehabilitation. Doctors know the health characteristics and needs of the community they serve. ‘The CARE model also automatically alerts us to people who are more susceptible to respiratory infections, the people whose chronic diseases are the risk factors most commonly associated with complications in COVID-19 patients’ explained Dr Alejandro Fadragas. 

Throughout Cuba, CDRs, or street committees, organised public health information meetings for family doctors and nurses to advise neighbourhoods about the pandemic. Once the first cases were confirmed, the family doctors daily house visits were extended and became the ‘single most important tool’ for active case detection, to get ahead of the virus.[4] Some 28,000 medical students joined them going door to door to detect symptoms. This procedure means the whole population can be surveyed. 

Video: Cuba’s Door-to-Door Doctors 

People with symptoms are remitted to their local polyclinic for rapid evaluation. Those suspected of having COVID-19 are sent on to one of the new municipal isolation centres established throughout the island. They must remain for a minimum of 14 days, receiving testing and medical attention. If the case appears to be another respiratory illness, they return home but must stay indoors for at least 14 days, followed up in primary care. Hospitals are reserved for patients who really need them. Primary healthcare professionals are also responsible for rapid contact tracing for all suspected cases; those contacts are tested and must isolate at home. In addition, the homes and communal entrances of patients sent to isolation centres are disinfected by ‘rapid response’ teams consisting of polyclinic directors and vice directors, alongside family members. Family doctors’ offices are also disinfected daily. Meanwhile, workers in hotels where foreigners are lodged are checked daily by medical staff. The polyclinic provides them with PPE and disinfectants. Polyclinics and family doctors are also responsible for 14 days follow-up for COVID-19 patients discharged from hospitals. 

Home-grown medicine  

The Cuban treatment protocol for COVID-19 patients includes 22 drugs, most produced domestically. The focus has been placed on prevention, with measures to improve innate immunity. Early on the potential of Cuba’s anti-viral drug Heberon, an interferon Alfa 2b human recombinant (IFNrec), was identified. The biotech product has proven effective for viral diseases including hepatitis types B and C, shingles, HIV-AIDS, and dengue. Produced in Cuba since 1986 and in China since 2003 through a Cuban-Chinese joint venture, ChangHeber, in January 2020 it was selected by the Chinese National Health Commission among 30 treatments for COVID-19 patients. It soon topped their list of anti-viral drugs, having demonstrated good results. 

The drug has most efficacy when used preventatively and at early stages of infection. In Wuhan, China, nearly 3,000 medical personnel received Heberon as a preventative measure to boast their immune response; none of them contracted the virus. Meanwhile, 50% of another 3,300 medics who were not given the drug did get COVID-19. Cuba’s IFNrec is recommended in the medical protocols of several countries, by the World Health Organisation (WHO), Johns Hopkins Medical Centre and the World Journal of Paediatrics among others. The product was already registered in Algeria, Argentina, Chile, Ecuador, Jamaica, Thailand, Venezuela, Vietnam, Yemen and Uruguay. By mid-April requests for its use had been received from some 80 countries and it was being administered by Cuba’s Henry Reeve medical brigades treating COVID-19 patients overseas. On 14 April it was reported that 93.4% of COVID-19 patients in Cuba had been treated with Heberon and only 5.5% of those had reached a serious state. The mortality rate reported by that date was 2.7% but for patients treated with Heberon it was just 0.9%. 

Other Cuban medicines reporting promising results include: 

+ Biomodulina T, a immunomodulator which stimulates the immune systems of vulnerable individuals and has been used in Cuba for 12 years, principally to treat recurrent respiratory infections in the elderly. 

+ The monoclonal antibody Itolizumab (Anti-CD6), used to treat lymphomas and leukemia, administered to COVID-19 patients in a severe or critical condition to reduce the secretion of inflammatory cytokines, which cause the massive flow of substances and liquid in the lungs. 

+ CIGB-258, a new immunomodulatory peptide designed to reduce inflammatory processes. By 22 May, 52 COVID-19 patients had been treated with CIGB-258; among those in a severe stage, the survival rate was 92%, against a global average of 20%. For those in a critical condition the survival rate was 78%. 

+ Blood plasma from recovered patients. 

Cuban medical scientists are producing their own version of Kaletra, an antiretroviral combination of Lopinavir and Ritonavir, used to treat HIV/AIDS. Domestic production will eliminate costly imports from capitalist big pharma and subject to the US blockade. Meanwhile, the homeopathic medicine, Prevengho-Vir, which is believed to strengthen the immune system has been distributed for free to everyone on the island. Medical scientists are evaluating two vaccines to stimulate the immune system and four candidates for specific preventative vaccine for COVID-19 are under design. 

By early May, Cuban scientists had adapted SUMA, a Cuban computerised diagnostic system, to detect antibodies for COVID-19 rapidly, allowing for mass testing at low cost. ‘The objective is to find new cases and then intervene, isolate, seek contacts, and take all possible measures to ensure that Cuba continues as it is now’, said Cuba’s top epidemiologist, Francisco Durán during his daily televised update on 11 May. This means the island no longer relies on donated tests or expensive ones purchased internationally. Cuba’s comparatively high rate of testing is set to soar. 

BioCubaFarma is mass producing facemasks, personal protective equipment (PPE) and medical and sanitary products, as well as coordinating state enterprises and self-employed workers to repair vital equipment, such as breathing ventilators. Cuban efforts to purchase new ventilators have been obstructed by the US blockade which, for almost 60 years, has included food and medicines among its prohibitions. 

Leading the global fight  

On 18 March, Cuba allowed the cruise ship MS Braemar, with 684 mostly British passengers and 5 confirmed COVID-19 cases, to dock in Havana after a week stranded at sea, having been refused entry by Curacao, Barbados, Bahamas, Dominican Republic and the United States. Cuban authorities facilitated their safe transfer to charter flights for repatriation. Three days later, a 53-strong Cuban medical brigade arrived in Lombardy, Italy, at that time the epicentre of the pandemic, to assist local healthcare authorities. The medics were members of Cuba’s Henry Reeve Contingent, which received a World Health Organisation (WHO) Public Health Prize in 2017 in recognition for providing free emergency medical aid. It was the first Cuban medical mission to Europe. By 21 May, over 2,300 Cuban healthcare professionals had gone to 24 countries to treat COVID-19 patients, including a second brigade in northern Italy and another to the European principality Andorra. 

The threat of a good example  

Cuban medical internationalism began in 1960, but the export of healthcare professionals was not a source of state revenue until the mid-2000s with the famous ‘oil for doctors’ programme under which 30,000 Cuban healthcare workers served in Venezuela. US President Bush’s administration responded by attempting sabotage Cuba’s medical export earnings with the Cuban Medical Parole Programme. This induced Cuban professionals, who had paid no tuition costs, graduated debt free and voluntarily signed contracts to work abroad assisting underserved populations, to abandon missions in return for US citizenship. President Obama kept the Programme, even while praising Cuban medics combating Ebola in West Africa. It was ended in his last days in office in January 2017. 

Video: Doctors speak (Cuban medical internationalists) 

The Trump administration has renewed attacks on Cuban medical missions, fuelling their expulsion from Brazil, Ecuador and Bolivia, and leaving millions of people in those countries without healthcare. The motivation was the same; to block revenues to a nation which has survived 60 years of US hostility. In the context of the pandemic, when the US government’s wilful failures have resulted in tens of thousands of unnecessary deaths, socialist Cuba’s global leadership has represented the threat of a good example. Lashing out, the US State Department has labelled Cuban medics as ‘slaves’, claiming that the Cuban government seeks revenues and political influence. It has pressured beneficiary countries to reject Cuban assistance in their time of urgent need. These attacks are particularly vile; it is likely that Cuba is receiving no payment, beyond costs, for this assistance. 

Meanwhile, the criminal US blockade, which has been punitively tightened under Trump, is preventing the purchase of urgently needed ventilators for Cuba’s own COVID-19 patients. A Chinese donation to Cuba of medical equipment was blocked because the airline carrying the goods would not travel to Cuba for fear of US fines. There is now a growing international demand for an end to all sanctions, not least against Cuba which has shown global leadership in combating the SARS-CoV2 pandemic. We must all add our voices to this demand. There are also calls from organisations and individuals worldwide to nominate Cuba’s Henry Reeve Contingents for a Nobel Peace Prize. What is clear from its history of principled medical internationalism is that, with recognition or without, revolutionary Cuba will continue to fight for global healthcare wherever its citizens, and its example, can reach. 

For more detail about Cuba’s response to Coovid-19 see: Medicc Review, April 2020.  

Notes. 

1) See Helen Yaffe, ‘Cuban medical science in the service of humanity’, www.counterpunch.org/2020/04/10/cuban-medical-science-in-the-service-of-humanity/ 

↑2) See C. William Keck and Gail A. Reed, ‘The Curious Case of Cuba’, American Journal of Public Health, 2012. 

↑ 3) Tania L. Aguilar-Guerra and Gail Reed, ‘Mobilizing Primary Health Care: Cuba’s Powerful Weapon against COVID-19’, Medicc Review, April 2020. https://mediccreview.org/wp-content/uploads/2020/05/MR-April2020-1.pdf 

↑ 4) Aguilar-Guerra and Reed, Mobilizing Primary Health Care. ↑ 

Originally published in Fight Racism! Fight Imperialism! No. 276, June/July 2020. 

Join the debate on Facebook More articles by:Helen Yaffe

BIOTECNOLOGÍA CUBANA ESTA DE ANIVERSARIO

Símbolo de un asombroso despegue Inaugurado por el Comandante en Jefe Fidel Castro el primero de julio de 1986, el Centro de Ingeniería Genética y Biotecnología devino en institución de referencia por sus notables aportes a la salud de la población y las crecientes exportaciones a más de 30 países. ¿SABÍAS QUE?... 

El 28 de mayo de 1981 lograron producir a partir de glóbulos blancos el primer interferón cubano en menos de 45 días, hecho considerado una verdadera proeza científica. En opinión de los estudiosos del tema el hecho marcó el punto de partida del desarrollo de la biotecnología nacional. 

Orgullosos de que en la lucha contra la COVID19, en pleno siglo XXI y a 39 años del hecho, esta obra de nuestro Comandante Fidel se mantenga en la primera trinchera del deber.

#CIGB258 o #Jusvinza, producto del CIGB para enfrentamiento a la pandemia de la #COVID19

CIGB-258 o Jusvinza, péptido diseñado para disminuir los procesos inflamatorios, producido por el Centro de Ingeniería Genética y Biotecnología (CIGB), mostrado gran efectividad para la sobrevida de pacientes de la COVID-19 críticos y graves en Cuba, y que la sobrevida de los pacientes en estado crítico fue del 78%.

BUSCAMOS respuestas, ofrecemos SOLUCIONES

Entrevista Dr Santiago Dueñas, subgerente empresa Changheber

Continuamos en la batalla contra el #Coronavirus: Entrevista al Dr. Santiago Dueñas, subgerente de la empresa mixta chino-cubana Changheber que produce el Interferon Cubano.

#QuedateEnCasa

Entrevista Dr.Gerardo Guillén sobre la COVID 2019 y el Interferón

En la batalla contra el #Coronavirus: ¿Por qué el #Interferón Alfa 2B Recombinante es efectivo en el tratamiento del #COVID2019? Les dejamos con la explicación del doctor Gerardo Guillén, director de investigaciones biomédicas del CIGB, en entrevista a Cubavisión Internacional 

Interferón alfa 2b humano recombinante Seguridad máxima a nivel de célula

#SiemprePorLaVida

EFFECT OF INTERFERON ALFA AGAINST CORONAVIRUS

• Due to its known mechanism of action, Interferon has being commonly used against viral infections for which there are no specific therapies available. 
•  The antiviral effect of interferon has been extensively demonstrated being the first line of antiviral defense, activating both the innate immune response against the virus, as well as the mechanism of inhibition of viral replication due to the Interferon inducer genes (W.M. Schneider, et al. Annual Review of Immunology. 2014; 32:513-545). 
• It has been reported that SARS-CoV (Coronavirus associated to 2002 outbreak) reduces IFN expression, avoiding the activation of IFN inducer genes like STAT1 and MyD88 and the possibility for the antiviral defense mechanisms to detect the presence of the virus. (M.J. Cameron, et al. PLoS ONE 2012, 7 (9): e45842). 
• The papain-like protease of the coronavirus has shown antagonistic activity to Interferon. Interferon Antagonism Activities of Coronavirus Papain-Like Proteases. J Virol. 2010;84(9):4619–29. 
• Both SARS and MERS are antagonistic to interferon. Advances in Virus Research. 2016. p. 219–43. It has been demonstrated that Interferon’s induction protects against infection caused by MERS-CoV (coronavirus associated to 2012 outbreak). Blockage of Interferon prolongs virus clearance, increases the inflammatory response and decreases the T-cell mediated cellular response. 
• Demonstration of the sensitivity of SARS / MERS CoV to Interferon and other drugs based on hyper immune serum in man. Infect Disord – Drug Targets [Internet]. 2014 Sep 11 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25019238 
• Has been shown that the induction of NF-kB (associated mechanism with the increase of proinflammatory cytokines) is increased in adult monkeys associated with lung damage, and consequently the inflammatory response mediated by cytosines IL-6 and IL-8. In young monkeys where IFN early expression is elevated this does not happen. (S.L. Smits, et al. PLoS Pathogens, 6 (2010), p. e100075).
The administration of IFN during the first day after inoculating mice with the virus (before the viral multiplication peak is reached), prevented the death of the mice by producing a subclinical infection. A late administration of IFN did not achieve the same effects. R. Channappanavar, et al. J Clin Invest. 2019;129(9):3625-3639. https://doi.org/10.1172/JCI126363.). 
• Recent articles have also shown that early IFN expression enhance the rapid induction of the neutralizing antibody response. (Marco de Giovani, et al. Nature Immunology 2020). 
• It is recommended the use of Interferon in pregnant women using nebulization through the respiratory tract. Review Acta Obstet Gynecol Scand. 2020;00:1-4., article “Novel corona virus disease (COVID-19) in pregnancy: What clinical recommendations to follow?”. 
• Recommended use of nebulized Interferon Alfa 2B in children. World Journal of Pediatrics, February 2020, articles “Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts’ consensus statement” and “Pharmaceutical care recommendations for antiviral treatments in children with coronavirus disease 2019”.

These evidences and previous studies suggest the possible use of Interferon as a preventive therapy in a vulnerable population and in early stages of infection. In addition, the use of Interferon in the current pandemic continues to be published and is recommended in Patient Treatment Protocols by different countries and organizations.

Given the urgency to stop the spread of this pandemic, not only interferon, but different drugs are being used as therapeutic tools, even though their efficacy has not been demonstrated for the treatment of SARSCOV-2.

Recommendations on the clinical use of Interferon issued in guidelines by WHO, China, Singapore, South Korea and Spain

• Chinese Society of Pharmacology Experts Consensus issued on February 6, 2020: Interferon-alpha (adults: 5 MIU diluted in 2ml water for injection and nebulized twice a day)
• Listed on the indications of “Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia” (Trial Version 7) issued by the National Health Commission & State Administration of Traditional Chinese Medicine on March 3, 2020).
• Listed on the Guidelines issued by the John Hopkins Medical Center in Baltimore.
• Listed on the Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID 19), February 16th to 24th. Page 32/33 quote: “There are no specific antiviral or immune modulating agents proven (or recommended) to improve outcomes. All patients are monitored by regular pulse oximetry. The guidelines include supportive care by clinical category (mild, moderate, severe and critical), as well as the role of investigational treatments such as chloroquine, phosphate, lopinavir/ritonavir, alpha interferon, ribavirin, arbidol. The application of intubation/invasive ventilation and ECMO in critically ill patients can improve survival”
• The Interferon was also recommended by the Experts Committee for the Treatment and Prevention of COVID-19 in a recent article published on January 29th in the World Journal of Pediatrics. The Committee was formed by representatives from the Group of Respirology, Chinese Pediatric Society, Chinese Medical Association, Chinese Medical Doctor Association Committee on Respirology Pediatrics, China Medicine Education Association Committee on Pediatrics, Chinese Research Hospital Association, Committee on Pediatrics, Chinese Non-government Medical Institutions Association, Committee on Pediatrics, China Association of Traditional Chinese Medicine, Committee on Children’s Health and Medicine Research, China News of Drug Information Association, Committee on Children’s Safety Medication, Global Pediatric Pulmonology Alliance, https://doi.org/10.1007/s12519-020-00343-7 

The above mentioned article recommends the following treatments:

1. Interferon-α nebulization: interferon-α 200,000–400,000 IU/kg or 2–4 μg/kg in 2 mL sterile water, nebulization two times per day for 5–7 days 
2. Interferon-α2b spray: applied for high-risk populations with a close contact with suspected 2019-nCoV infected patients or those in the early phase with only upper respiratory tract symptoms. Patients should use 1–2 sprays on each side of the nasal cavity, 8–10 sprays on the oropharynx, and the dose of interferon-α2b per injection is 8000 IU, once every 1–2 hours, 8–10 sprays/day for a course of 5–7 days.

• The Spanish Guides issued on the 3rd of March, 2020 on its recommendation section refer the Chinese experience using interferon α2b nebulization with the following dosage: 100.000–200.000 UI/kg for mild cases, and 200.000–400.000 UI/kg for severe cases, twice a day during 5 to 7 days. 
•  The National University of Singapore (NUS) on its indications issued March 12, 2020, also refers the Chinese experience of the use of interferon in combination with Kaletra (lopinavir/ritonavir)

EFECTO DEL INTERFERON alfa CONTRA EL CORONAVIRUS

• Es común que por su conocido mecanismo de acción se emplee el Interferón (IFN) contra infecciones virales para las que no se disponen de terapias específicas. Está ampliamente demostrado el efecto antiviral del interferón, siendo la primera línea de defensa antiviral, activando tanto la respuesta inmune innata contra el virus, como el mecanismo de inhibición de la replicación viral, mediado por los genes inductores de interferón (W.M. Schneider, et al. Annual Review of Immunology. 2014; 32:513-545). 
• Se ha reportado que el SARS-CoV (coronavirus asociado a la epidemia de 2002) reduce la expresión de IFN, impidiendo que se activen los genes inductores de IFN como STAT1 y MyD88, y que los mecanismos de defensa antiviral puedan detectar la presencia del virus. (M.J. Cameron, et al. PLoS ONE 2012, 7 (9): e45842) . 
• La proteasa tipo Papaína del coronavirus ha mostrado actividad antagónica al interferón. Interferon Antagonism Activities of Coronavirus Papain-Like Proteases. J Virol. 2010;84(9):4619–29. 
• Tanto el SARS como el MERS tienen acción antagónicas con el interferón. Advances in Virus Research. 2016. p. 219–43. Se ha demostrado que la inducción de IFN protege contra la infección por MERS-CoV (coronavirus asociado a la epidemia de 2012). 
• El bloqueo del IFN prolonga la eliminación del virus e incrementa la respuesta inflamatoria y disminuye la respuesta celular mediada por células T. 
•  Demostración de la sensibilidad de SARS/MERS CoV al interferón y a otras drogas basadas en sueros hiperinmunes en el hombre. Infect Disord – Drug Targets [Internet]. 2014 Sep 11 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25019238 
• Demostrado que la inducción de NF-kB (mecanismo asociado al incremento de citocinas proinflamatorias) se incrementa en monos adultos asociado con el daño pulmonar, y en consecuencia la respuesta inflamatoria mediada por citosinas IL-6 e IL-8. En monos jóvenes donde es elevada expresión temprana de IFN esto no sucede (S.L. Smits, et al. PLoS Pathogens, 6 (2010), p. e100075).
• La administración de IFN durante el primer día después de inocular ratones con el virus (antes de que se llegue al pico de multiplicación viral), evitó la muerte de los ratones produciendo una infección subclínica. Una administración tardía del IFN no logró los mismos efectos (R. Channappanavar, et al. J Clin Invest. 2019;129(9):3625-3639. https://doi.org/10.1172/JCI126363.). 
• Artículos recientes también han demostrado que una expresión temprana del IFN favorece la rápida inducción de la respuesta de anticuerpos neutralizantes (Marco de Giovani, et al. Nature Immunology 2020). 
• Se recomienda el uso del Interferón nebulizado en embarazadas según la revista Acta Obstet Gynecol Scand. 2020;00:1–4., en su artículo “Novel corona virus disease (COVID-19) in pregnancy: What clinical recommendations to follow?”. 
• Recomiendan el uso nebulizado del interferón Alfa 2B en niños según la revista World Journal of Pediatrics, Feb 2020, en sus artículos “Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts’ consensus statement” y “Pharmaceutical care recommendations for antiviral treatments in children with coronavirus disease 2019”.

Éstas evidencias y estudios previos sugieren la posible utilidad del interferón de forma preventiva en población vulnerable y en etapas tempranas de la infección, además de que continúa publicándose su uso en la actual pandemia y aparece recomendado en los protocolos de tratamientos de pacientes por diferentes países y organizaciones.

Ante la urgencia de esta pandemia, no sólo el interferón, sino diversas drogas están siendo utilizadas como herramientas terapéuticas, aún cuando la eficacia de las mismas no ha sido demostrada para el tratamiento del SARSCOV-2.

Recomendaciones de Guías Chinas, de OMS, Singapur, Sud Corea, España y de Instituciones de EE.UU. sobre el uso clínico del Interferón

• Consenso de Expertos de la Sociedad China de Farmacología, Emitida el 6 de Febrero está: Interferon-alpha (adultos: 5 millones UI en 2ml de agua estéril para inyección administrado de forma nebulizada, dos veces al día).
• El 3 de marzo en las orientaciones para “Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia” (Trial Version 7) emitidas por National Health Commission & State Administration of Traditional Chinese Medicine on March 3, 2020).
• En las Guías del Centro Médico John Hopkins en Baltimore.
• En el Reporte de la Comisión Conjunta de la OMS y China para el seguimiento de la Epidemia y recomendaciones, que sesionó del 16 al 24 de Febrero, se recoge en la página 33 que no existe ningún tratamiento específico que haya demostrado eficacia pero a la vez refleja que las guías chinas de manejo de la enfermedad recomiendan 5 tratamientos antivirales entre los que se encuentra el Interferón (chloroquine phosphate, lopinavir/ritonavir, alpha interferon, ribavirin, arbidol).
• El Interferón se recomienda también por un Comité de Expertos para el tratamiento y prevención de COVID-19. El Comité estuvo integrado por Group of Respirology, Chinese Pediatric Society, Chinese Medical Association, Chinese Medical Doctor Association Committee on Respirology Pediatrics, China Medicine Education Association Committee on Pediatrics, Chinese Research Hospital Association, Committee on Pediatrics • Chinese Non-government Medical Institutions Association Committee on Pediatrics, China Association of Traditional Chinese Medicine, Committee on Children’s Health and Medicine Research, China News of Drug Information Association, Committee on Children’s Safety Medication, Global Pediatric Pulmonology Alliance, en un reciente artículo en el World Journal of Pediatrics del 29 de Enero, https://doi.org/10.1007/s12519-020-00343-7 En este artículo se recomienda los siguientes tratamientos:

1. Interferon-α nebulization: interferon-α 200,000–400,000 IU/kg or 2–4 μg/kg in 2 mL sterile water, nebulization two times per day for 5–7 days 
2. Interferon-α2b spray: applied for high-risk populations with a close contact with suspected 2019-nCoV infected patients or those in the early phase with only upper respiratory tract symptoms. Patients should use 1–2 sprays on each side of the nasal cavity, 8–10 sprays on the oropharynx, the dose of interferon-α2b per injection is 8000 IU, once every 1–2 hours, 8–10 sprays/day for a course of 5–7 days.

• Las Guías españolas emitidas el 3 de marzo en sus recomendaciones reflejan la experiencia China de usar nebulización con interferón-α2b 100.000–200.000 UI/kg para casos leves, y 200.000–400.000 UI/kg para casos graves, dos veces/día durante 5–7 días. 
• La Universidad Nacional de Singapur (NUS) en sus indicaciones del 12 de marzo de 2020, también recoge la experiencia China en su uso combinado con Kaletra.

Prevención UPD. Complicaciones de una diabetes mal atendida

La prevención sobre las heridas en los pies en los pacientes diabéticos es primordial para evitar complicaciones. Las UPD son una de las varias complicaciones que tiene una diabetes mal controlada, que puede terminar con una amputación.
Cuide sus pies #SiemprePorLaVida

¿Qué es el “Huanglongbing” (HLB) en cítricos?

El “Huanglongbing” (HLB) producida por la bacteria Candidatus ‘Liberibacter asiaticus’ constituye la enfermedad más destructiva de los cítricos en todo el mundo por la severidad de los síntomas, la rapidez con que se dispersa y porque afecta a todas las especies comerciales de cítricos. 

También conocida como enverdecimiento de los cítricos, es una enfermedad bacteriana de las plantas que, aunque no es peligrosa para los humanos, destruye la producción, apariencia y valor económico de los árboles de cítricos, y el sabor de la fruta y su jugo. 

Al proporcionar un método eficaz para la estimulación de la defensa natural y la inducción de resistencia de las plantas de cítricos contra el HLB. La aplicación de un producto eficaz permitirá la reducción significativa de la bacteria agente causal de la enfermedad.