Ciencia: la experiencia de la biotecnología cubana

En este artículo se intenta resumir las conclusiones provisionales más generales que pudieran extraerse de la práctica de más de veinte años de construcción de lo que hoy se reconoce como un nuevo sector de la economía cubana: la economía del conocimiento, el sector de la Biotecnología. Pero este análisis no se limita al campo de la Biotecnología, sino que concierne esencialmente al proceso de inserción de la investigación científica como parte y componente primario de la cadena de creación de valor para la economía. Estas conclusiones también tocarán aspectos como la financiación de la actividad científica, las especificidades de la gestión de los recursos humanos en los sectores de alta tecnología, los componentes de I+D en la estructura y los esquemas financieros de las empresas, las formas de administración adecuadas a este nuevo nivel de desarrollo de las fuerzas productivas, la estrategia de negociación exterior sobre las tecnologías propias, etc

La ciencia no es un lujo (Monografìa)

En su discurso al inaugurar el Centro de Inmunología Mo­lecular el 5 de diciembre de 1994 Fidel dijo: «Es un orgullo en pleno periodo especial inaugurar este Centro que no es un lujo, es una promesa de salud para nuestro pueblo y es una promesa de ingresos para nuestra economía». Lo dijo con un énfasis muy evidente, y lo escuchamos muy de cerca. Esa advertencia enfática nos hacía ver que existían (y aún existen) compañeros que piensan que la ciencia es un lujo, un gasto improductivo, o al menos no inmediatamente productivo, que solo pueden permitirse las sociedades opulentas del norte, o los diletantes del sur; o quizá algo relacionado con un distante futuro de lo que podemos ocuparnos «después». Son muchos de ellos buenos cuadros, empeñados en defender la Revolución y en hacerle frente con gran esfuerzo, a las presiones económicas de la vida cotidiana. Las urgencias económicas llevan a algunos (por suerte para Cuba, no a sus grandes líderes) a desarrollar una visión de corto plazo. Siempre hemos vivido bajo presiones económicas urgentes, primero por la economía dependiente, y pobre que heredamos del capitalismo periférico, a lo que se sumó luego el feroz bloqueo norteamericano contra Cuba, después la desaparición de la URSS y el periodo especial, y finalmente las tendencias actuales de la globalización neoliberal. Pocos países han vivido bajo presiones económicas de tal magnitud y duración. Y como dicen algunos compañeros con visión cortoplacista, para tener un futuro, primero hay que trabajar para llegar hasta ese futuro. Se les puede comprender, pero esa comprensión no nos exonera de decir que están equivocados, y de explicar porqué

Una publicación doble necesaria: Desafíos del desarrollo. El problema de las nuevas funciones de la investigación en la sociedad, visto desde la perspectiva de un hombre de laboratorio y en un país en desarrollo

Hace 20 años, el Dr. Agustín Lage Dávila, amigo, eminente médico y científico cubano, escribió un artículo que tituló "Desafíos del desarrollo. El problema de las nuevas funciones de la investigación en la sociedad, visto desde la perspectiva de un hombre de laboratorio y en un país en desarrollo". Este trabajo fue publicado en la revista Ciencia, Innovación y Desarrollo (La Habana); en su volumen 1, número 1, de 1995. Después de obtener la aprobación del Dr. Lage para su reproducción en Medisur -lo cual agradecemos mucho-, hemos considerado ponerlo a disposición de nuestros lectores, por su calidad y por la actualidad que mantienen las ideas que aquí se exponen. DR. C. Alfredo Darío Espinosa Brito

LA CIENCIA, LA CONSTITUCIÓN Y EL MODELO ECONÓMICO

The year 2019 has been very active in the critical analysis and improvement of our Science, Technology and Innovation System, and has produced a good harvest of proposals and results. All of this has been widely reported by our press these days, and we can then not use this small space to celebrate (precisely) what has been done, but to reflect on what to do from now on. Anniversaries are cause for celebration but also for reflection. What has been done is a starting point.El año 2019 ha sido muy activo en el análisis crítico y perfeccionamiento de nuestro Sistema de Ciencia, Tecnología e Innovación, y ha producido una buena cosecha de propuestas y resultados. De todo ello ha informado nuestra prensa ampliamente en estos días, y podemos entonces no utilizar este pequeño espacio para celebrar (justamente) lo realizado, sino para reflexionar sobre lo que hay que hacer a partir de ahora. Los aniversarios son motivo de celebración pero también de reflexión. Lo realizado es un punto de partida

Rehabilitation with implant-supported overdentures in total edentulous patients: a review

Objectives: The main aim of this review article is to discuss implant-supported overdentures (ISOs) as treatment in edentulous patients. Besides, we will try to discuss among the different treatment options in such patients and to analyze their validity when ISOs are compared with other clinical modalities. At the same time, we will try to suggest clinical guidelines supported by current clinical studies. Material and methods: We performed a Medline search and review of pertinent articles on the mentioned subject from 1986 to 2011. As a searching strategy, we used the following words: implant-supported overdentures, attachment systems, Locator attachment, cantilever, fixed prosthesis. Results and conclusions: Implant-supported overdentures constitute an accurate and predictable treatment option and achieve a higher patient's satisfaction. This type of treatment constitutes a cheaper treatment than fixed prostheses and in some patients, with loss of lip support or with an interoclusal space larger than 15 mm, the choice of implant-supported overdentures seems to prevent future aesthetic or phonetic problems

Is there a subgroup of long-term evolution among patients with advanced lung cancer?: Hints from the analysis of survival curves from cancer registry data

Background: Recently, with the access of low toxicity biological and targeted therapies, evidence of the existence of a long-term survival subpopulation of cancer patients is appearing. We have studied an unselected population with advanced lung cancer to look for evidence of multimodality in survival distribution, and estimate the proportion of long-term survivors. Methods: We used survival data of 4944 patients with non-small-cell lung cancer (NSCLC) stages IIIb-IV at diagnostic, registered in the National Cancer Registry of Cuba (NCRC) between January 1998 and December 2006. We fitted one-component survival model and two-component mixture models to identify short-and long-term survivors. Bayesian information criterion was used for model selection. Results: For all of the selected parametric distributions the two components model presented the best fit. The population with short-term survival (almost 4 months median survival) represented 64% of patients. The population of long-term survival included 35% of patients, and showed a median survival around 12 months. None of the patients of short-term survival was still alive at month 24, while 10% of the patients of long-term survival died afterwards. Conclusions: There is a subgroup showing long-term evolution among patients with advanced lung cancer. As survival rates continue to improve with the new generation of therapies, prognostic models considering short-and long-term survival subpopulations should be considered in clinical research.LS, PL, CV, TC, AL were funded by their employer the Center of Molecular Immunology. YG is funded by the Ministry of Health. JB received no funding. We thank Dr. Camilo Rodriguez for their contribution to this work and for facilitate literature needed for manuscript writing

Modelo de evaluación de la gestión organizacional del ciclo I+D+I en empresa biofarmacéutica de alta tecnología (MEGO-EBAT): caso Centro de Inmunología Molecular

The innovation management models in the traditional sector are different from those of high technology, and in the biopharmaceutical sector, fragmented studies of the closed R&D&i cycle are reported that do not respond to the transit of a science-technology entity. and innovation (ECTI) to a high technology company (EAT). The article aims to propose a Model for the evaluation of the organizational management of the R&D&i cycle in a high-tech biopharmaceutical company (MEGO-EBAT), with the purpose of assessing its transition from an ECTI to EAT. The MEGO-EBAT Procedure is applied at the Molecular Immunology Center (CIM), as a case study, which has 28 years of experience in obtaining and producing monoclonal antibodies, has transitioned to an EAT and belongs to the BioCubaFarma business group.Los modelos de gestión de la innovación en el sector tradicional son diferentes a los de la alta tecnología, y en el sector biofarmacéutico se reportan estudios fragmentados del ciclo cerrado de I+D+i que no dan respuesta al tránsito de una entidad de ciencia tecnología e innovación (ECTI) a una empresa de alta tecnología (EAT). El artículo tiene como objetivo proponer un Modelo de evaluación de la gestión organizacional del ciclo de I+D+i en empresa biofarmacéutica de alta tecnología (MEGO-EBAT), con el propósito de valorar su tránsito de una ECTI a EAT. El Procedimiento MEGO-EBAT se aplica en el Centro de Inmunología Molecular (CIM), como caso de estudio, que cuenta con una experiencia de 28 años de obtención y producción de anticuerpos monoclonales, ha transitado a una EAT y pertenece al Grupo empresarial BioCubaFarma

The impact of inter-clinician electronic consultation in patients diagnosed with atrial fibrillation in primary care

Background An early diagnosis and early initiation of oral anticoagulants (OAC) are main determinants for outcomes in patients with atrial fibrillation (AF). Inter-clinician electronic consultations (e-consultations) program for the general practitioner referrals to cardiologist may improve health care access by reducing the elapsed time for cardiology care. Objective To evaluate the effect of a reduced elapsed time to care after a inter-clinician e-consultations program implementation (2013–2019) in comparison with previous in-person consultation (2010–2012) in the outpatient health care management in a Cardiology Department. Methodology We included 10,488 patients with AF from 1 January 2010, to 31 December 2019. Until 2012, all patients attended an in-person consultation (2010–2012). In 2013, we instituted an e-consult program (2013–2019) for all primary care referrals to cardiologists that preceded patient's in-person consultation when considered. The shared electronic patient dossier (EPD) was available between GP and cardiologist, and any change in therapy advice from cardiologist was directly implemented in this EPD. Results During the e-consultation period (2013–2019) were referred 6627 patients by GPs to cardiology versus 3861 during the in-person consultation (2010–2012). The e-consultation implementation was associated with a reduction in the elapsed time to anticoagulation prescription (177.6 ± 8.9 vs. 22.5 ± 8.1 days, p < .001), and an increase of OAC use (61% [95% IC: 19.6%–102.4%], p < .001). The e-consult program implementation was associated with a reduction in the 1-year CV mortality (.48 [95% CI: .30–.75]) and all-cause mortality (.42 [95% CI: .29–.62]). The OAC reduces the stroke mortality (.15 [95% CI: .06–.39]) and CV mortality (.43 [95% CI: .29–.62]) and all-cause mortality (.23 [95% CI: .17–.31]). Conclusion A shared EPD-based inter-clinician e-consultation program significantly reduced the elapsed time for cardiology consultation and initiation of OAC. The implementation of this program was associated with a lower risk of stroke and cardiovascular/all-cause mortalityS

Aging and chronic inflammation: highlights from a multidisciplinary workshop

: Aging is a gradual, continuous series of natural changes in biological, physiological, immunological, environmental, psychological, behavioral, and social processes. Aging entails changes in the immune system characterized by a decrease in thymic output of naïve lymphocytes, an accumulated chronic antigenic stress notably caused by chronic infections such as cytomegalovirus (CMV), and immune cell senescence with acquisition of an inflammatory senescence-associated secretory phenotype (SASP). For this reason, and due to the SASP originating from other tissues, aging is commonly accompanied by low-grade chronic inflammation, termed "inflammaging". After decades of accumulating evidence regarding age-related processes and chronic inflammation, the domain now appears mature enough to allow an integrative reinterpretation of old data. Here, we provide an overview of the topics discussed in a recent workshop "Aging and Chronic Inflammation" to which many of the major players in the field contributed. We highlight advances in systematic measurement and interpretation of biological markers of aging, as well as their implications for human health and longevity and the interventions that can be envisaged to maintain or improve immune function in older people

Plasma Aβ42/40 ratio alone or combined with FDG-PET can accurately predict amyloid-PET positivity: a cross-sectional analysis from the AB255 Study

Background: To facilitate population screening and clinical trials of disease-modifying therapies for Alzheimer’s disease, supportive biomarker information is necessary. This study was aimed to investigate the association of plasma amyloid-beta (Aβ) levels with the presence of pathological accumulation of Aβ in the brain measured by amyloid-PET. Both plasma Aβ42/40 ratio alone or combined with an FDG-PET-based biomarker of neurodegeneration were assessed as potential AD biomarkers. Methods: We included 39 cognitively normal subjects and 20 patients with mild cognitive impairment from the AB255 Study who had undergone PiB-PET scans. Total Aβ40 and Aβ42 levels in plasma (TP42/40) were quantified using ABtest kits. Subjects were dichotomized as Aβ-PET positive or negative, and the ability of TP42/40 to detect Aβ-PET positivity was assessed by logistic regression and receiver operating characteristic analyses. Combination of plasma Aβ biomarkers and FDG-PET was further assessed as an improvement for brain amyloidosis detection and diagnosis classification. Results: Eighteen (30.5%) subjects were Aβ-PET positive. TP42/40 ratio alone identified Aβ-PET status with an area under the curve (AUC) of 0.881 (95% confidence interval [CI] = 0.779–0.982). Discriminating performance of TP42/40 to detect Aβ-PET-positive subjects yielded sensitivity and specificity values at Youden’s cutoff of 77.8% and 87.5%, respectively, with a positive predictive value of 0.732 and negative predictive value of 0.900. All these parameters improved after adjusting the model for significant covariates. Applying TP42/40 as the first screening tool in a sequential diagnostic work-up would reduce the number of Aβ-PET scans by 64%. Combination of both FDG-PET scores and plasma Aβ biomarkers was found to be the most accurate Aβ-PET predictor, with an AUC of 0.965 (95% CI = 0.913–0.100). Conclusions: Plasma TP42/40 ratio showed a relevant and significant potential as a screening tool to identify brain Aβ positivity in preclinical and prodromal stages of Alzheimer’s disease