CAMAGÜEY.- Upon entering the context of immunology, Dr. Maricela Velázquez Hernández, specialist in Immunology and Comprehensive General Medicine (MGI), Instructor Professor and Master in Infectious Diseases, from the Eduardo Agramonte Piña Pediatric Hospital, in this city, unveiled its main features.

"It is a branch of biomedical science, one of the most modern and very broad. Its fundamental role is the study of the immune response in human beings and lies in the ability of the immune system to maintain the balance between the internal environment and known as homeostasis, which is a property of organisms consisting of their ability to maintain a stable internal condition by compensating for changes in their environment, eliminating microbes, aged cells, tumor cells and participating in the repair of damaged tissues".

And she added: "We have cells that circulate through the body and are responsible for looking for harmful substances, whether from the external environment or produced internally, and eliminating them. They play their role of defense against the microorganisms that surround us and their main function is maintaining that balance.

—How does the specialty of Immunology deal with children?

—We have a history in our Pediatric hospital of about 15 years since the consultation was opened and it has not been easy because it is a first world specialty that requires very expensive resources; however, with the resources available to the country we have carried out this science.

—What are the main conditions that children have to attend this consultation?

—We treat many with autoimmune diseases, such as: juvenile rheumatic arthritis, lupus erythematosus, nephritis, hemolytic anemia of autoimmune causes, through multidisciplinary consultations in direct connection with other specialties such as rheumatology, hematology, nephrology, among others, but those who reach us the most are children with secondary immune-deficiencies.

"The primary is generally associated with genetic defects, both in the structure and function of the immune system; while the secondary is related to other processes, such as the use of medications; maternal alcoholism or the consumption of drugs or toxic substances, the habit of smoking.

"Also within the secondary ones we find those immune-deficiencies associated with endocrine diseases such as: diabetes mellitus, thyroid, adrenals, and secondary to oncological disorders and the intensive treatment that is applied with radio or chemotherapy and once their disease is cured are sent to our office with a depressed immune system, so we take care of stabilizing it".

—How are they followed up in dependency if it is primary or secondary?

—In both one and the other we follow the disease in time. There are children who have been in this consultation for years because they suffer from a primary immunodeficiency and are treated here practically until they reach adulthood. Those with some genetic component are consulted with specialists in genetics and from these consultations patients also come to us and when they are studied we direct them to tertiary care and they are treated at the national institutes of Hematology and Immunology where their research is completed.

"In the case of secondary immune-deficiencies, they are treated here when that condition is suspected and there is warning or danger signs. First, if we know of a family history of important primary immunodeficiency, if they suffer from eight or more serious sinusitis in a year, the one that faces an infectious process, they order different antibiotics and do not resolve or need parenteral antibiotics (intravenous or intramuscular), the one that has deep or severe infections, and is the one that develops community pneumonia and gets complicated, for example, with a pleural effusion or severe sepsis.

"Also those who, after dengue or COVID-19, start with other recurrent viral diseases. Those who have serious infections with rare germs or who have poly-microbial infections, with high resistance to broad-spectrum antibiotics.

"As well those children who show persistent diarrhea or associated with weight loss, without apparent causes, or that reflect episodes of autoimmune diseases. There are children who are brought because they do not gain weight and do not grow in correspondence with age."

—Faced with these warning signs, what should parents do?

—It is important that they take their children to their family doctor or pediatrician in the health area to be referred to the immunology clinic. We are four specialists and shifts are offered throughout the year, we consult from Monday to Thursday, and even, we treat children who are hospitalized in the hospital itself at the request of the attending physician and then go to the outpatient clinic.

—Could there be any relationship between the COVID-19 pandemic and your specialty?

—Yes, we know that it has been a challenge for our scientists to create Cuban vaccines in record time to avoid serious forms of the disease and deaths, and it is known that post-COVID-19 autoimmune diseases can occur, since this virus is capable of causing an imbalance of the immune system and it is possible that they arise from immune-deficiencies to autoimmune diseases after going through this condition.

"We have dealt with cases, which it is another challenge we have. We only see the tip of the iceberg, but the trail of complications and sequels it leaves are innumerable and there are transcendences that are not yet known, but we are certain that Cuban science will know how to face them.

—What age are the children who come to the consultation the most?

—There is a phenomenon that arises after nine months and it is transient hypogammaglobulinemia of infancy. It is that little boy who begins to walk and the parents tell us that he did not get sick until the child began in the day care center. It must be taken into account that around this age coincides that the antibodies that passed to that baby through the placenta have already consumed them and then he begins to make his own, which is why he needs time to achieve balance and it is physiological, too. That child begins to walk and touch everything, to put objects in his mouth to interact with other children and other people and it is something that sometimes the family does not understand and they have to explain it, it is normal for it to happen. Other children go through this stage very well because they have a more robust immune system and genetic predisposition also depends on it.

—If we take these criteria into account, can you tell me what would be more effective, taking the children to the so-called care homes or to the daycare center?

—I bet on the daycare center for many reasons. First, because education is personalized by age groups; and second, and very important, because the bacterial flora is more or less the same within each age group. On the other hand, if the child was in the bubble of his house without being exposed to other microenvironments by coming into contact with others who suffer from recurrent respiratory infections, parasites, among other conditions, this makes him develop antibodies and cells with protective capacity because the immune system needs these contacts to learn to face them and sometimes parents don't see it that way and want to avoid it.

"However, in those care homes that we know have been an alternative due to the lack of capacity in our daycare centers and due to the increasing number of working mothers, there are some behaviors that are not appropriate due to lack of preparation of who are in charge, the groups are made up of children of different ages with different learning needs, with psychomotor development at different levels and, on the other hand, with different bacterial flora according to their age. They are suspended when they are sick. Anyway, we know that some nursing homes do an incredible job and really solve a social problem; I respect those people who do this work with a lot of love and seriousness.

—Does the sex of the little ones determine when they attend these consultations?

—There are no big differences; it is similar in both sexes.

-Any advice for parents?

—Go to their doctor at any alarm sign, never remain in doubt. The family doctor will know how to identify these signs, guide them and send them to our consultations.

Translated by Linet Acuña Quilez