Rafael Rangel-Aldao, Editor
From the start in May 1st, 2020, the Portal of the National Academy of Medicine of Venezuela, (NAMV) linked its contents to the metrics of Google Analytics, and now, at the end of this pandemic and the scary year, it is now possible to glance back and determine what were the facts that attracted the most attention to our readers worldwide. In these eight months, we have had the fortune and privilege to attract the interest of 32,138 views from close to 12,000 readers, from 958 cities of 81 countries in the five continents. As expected, most matters of inquiry from such readers were related to Covid-19, but also to peer-reviewed research papers and editorials published by CientMed, an electronic journal of open access that started operations on August 5th, 2020, and that so far captured attention because of its speed of publication and high-impact authors. But the Portal is more than that, it contains all the publications of NAMV, that is, the emblematic journal, Gaceta Médica de Caracas (GMC), Colección Razetti, Monthly Bulletin, Dissertations, Proceeding of its weekly Sessions, News, and all information pertaining to the life, structure, and history of NAMV. The Portal, therefore, contains a wealth of knowledge that this year can now share worldwide with the appearance of a new addition, The Electronic Annals.
The top contenders, from May 1st to December 22nd.
To the surprise of many, including this editor, the post that attracted the most attention of the year was our editorial note in response to a «new anti-Covid-19 drug, DR10, announced by the national government on October 26th, 2020. To this date, this note received up to 3.401 views, with an average duration of 5:48 minutes as compared with the average time of 2:38 minutes of the Portal. But the fact that gave us the most surprising was the extent of the duration of such visits, which to this date spanned almost two months, as shown below:
The page views almost doubled in 24 hours, from October 26th (538) to the following day (859) to reach a lower number on October 31st (75). Since then, a renewed interest in the matter surfaced back and forth till the actual date. To have an idea of the relative length of such a long period of interest to this single note on the scientific response to DR10, let us look at the duration of other publications and pages of the Portal throughout the year, since its first edition of the Portal on May 1st, 2020:
It is obvious from this graph, how transient is the interest of the viewers on any type of publication of our Portal, and that includes papers and citations from the leading journals of biomedicine and basic biology. Each peak corresponds to a new development except that they do not last long.
The other aspect of the DR10 note that was interesting, was the content of the comments it received (16 so far). Such observations spanned from science to politics, including nationalistic or even irrational views. Before going to the details it is important to note that most opinions were addressed no to the «discovery» itself, but in response to the scientific and clinical facts explained by this editor. That is, the successive and rigorous path of utmost transparency, that any candidate of the medicinal drug must follow to be approved by regulatory agencies upon compliance of all requisites of safety and efficacy, as it is the case of antiviral drugs and vaccines assayed so far, or for that matter applicable to any other disease. Here is a selection of some of the most noteworthy comments:
Secrecy in an investigation may be illegal, but if the results obtained are for the collective benefit, then they must be validated. (El secreto en una investigación podrá ser ilegal, pero si los resultados obtenidos son del provecho colectivo, entonces deberán serán validados).
Knowing the standard testing methodology does not mean that there is evidence that it does not work. (El conocer la metodología de estandar de pruebas no significa que se tengan pruebas de que no funciona.)
I do not understand, how they want to equate a laboratory result, in vitro, with a clinical investigation… let’s wait for the clinical trials and do not presage the failure of the investigation, as was done with Sputnik V. (No entiendo, como quieren equiparar un resultado de laboratorio, in vitro con una investigación clínica.. esperemos los ensayos clínicos y no presagiemos del fracaso de la investigación, como se hizo con la Sputnik V).
There is no limit to fraud and the design of opinion matrices that «convince» a defenseless majority of the population. (No hay límite para el fraude y el diseño de matrices de opinión que «convencen» a una mayoría poblacional indefensa.).
This complements the excellent description of what a clinical trial is… All study protocols in clinical epidemiology must be registered in platforms such as Clinicaltrials.gov or WHO, etc.
In second place was the opening menu of the NAMV, with 3,348 views, a page that attracted the everyday reader to the Portal, with an average of 1:45 minutes. The third and fourth places were a close tie of the main menus of GMC (1,285 views) and the new section Covid-19 (1,279 views), both of short duration each (00:56 and 1:17, respectively), and with a pattern that followed the peaks and throughs of the Academy´s page views. It is noteworthy, however, the performance of Supplement 2, of GMC, just published this month, on December 15th, 2020. Supplement 2, with a content of 22 articles, was a true bestseller until it reached a minimum number of views, a week after, on December 22th, with a total of 199 page views accrued during that period:
The editorial piece on DR10 and Supplement 2 of GMC, shared two common features that may explain their popularity, one is the obvious subject of Covid-19, but equally important was the fact that both pages addressed the matter of Covid-19 with clear scientific explanations that shed light on the nature of the pandemic, as well as its social implications. This pattern of attraction was also common to the rest of the most successful notes of the Portal. To complete the top five of the ranking, there was the post, «Impact of pandemic Covid-19, a Vision of the Academies«, a video from YouTube, posted on our Portal on May 13th, 2020. This was a multi-author and multi-disciplinary conference, with interventions of our current President, Enrique López Loyo, and other distinguished personalities of the other national academies, such as Drs. Carole Leal, Flor Pujol, Francisco Javier Pérez, Reogelio Pérez, Carlos Ayala Corao, Sary Levy, and Werner Corrales. This important conference accrued 956 views as shown below, with an average duration of 03:51 minutes:
The new variant of SARS-CoV-2 of the United Kingdom
At the very last minute of this edition, two communications came regarding this VUI 202012/01 variant; one from the Centers for Disease Control and Prevention (CDC), on 12/22/2020; and the other on 12/23/2020, a letter to the editor of CientMed, from Drs. Flor Pujol and José Esparza, two Venezuelan renowned virologists. Both pieces shared the common agreement that more studies and evidence are necessary to reach a conclusion on the possible effects of this variant:
It is still very early in the identification of this variant, so we have a great deal to learn. More studies on the new variant are needed to understand: 1) How widely the new variant has spread in the UK and potentially around the world; 2) How the new variant differs from earlier variants; 3) How the disease caused by this variant differs from the disease caused by other variants that are currently circulating. (CDC)
In conclusion, the VUI 202012/01 variant was identified in the United Kingdom thanks to a powerful genomic surveillance system (they have sequenced close to 5% of COVID-19 cases on the island). The variant seems to be more transmissible, but there is no evidence at the moment that it is more serious or that it will affect the success of vaccination programs that have just started. However, the World Health Organization (WHO) recommends redoubling surveillance both in terms of molecular screening of infections and of circulating genomic variants in each country. Pujol and Esparza.
The effect of CientMed and Covid-19, from August 5th to December 22nd, 2020.
CientMed as Connector and Catalyst of NAMV Publications and Sessions
CientMed, the electronic and peer-reviewed journal, of open access, issued its first scientific publication on August 5th, 2020, and since then, in just four months reached the top of the Portal´s page views, as shown in the above graph, with data from Google Analytics. The journal, however, must be looked at as a connector to both Venezuelan physicians and scientists, as well as to several matters of utmost interest to our medical community, published or referenced by the Portal. For such reasons, the publications of CientMed are usually linked to the section on Covid-19, and the GMC when deemed necessary. Examples of linked editions are Synopsis Covid-19 and Synopsis 20, as well as several editorials referred to Supplement 1 and Supplement 2, respectively, of GMC. To this date, CientMed has published 21 Synopsis with a total of 1,490 views from active users of 76 countries. As an example of the editorials of CientMed linked to GMC, the most recent piece was Strategies of Public Policies in Latin America. published on December 16th, 2020, which highlighted some of the articles of Supplement 2 of GMC, issued the day before, on December 15th, 2020, and both publications, CientMed and GMC, shared the top ten positions of the corresponding Google Analytics ranking that week, as pinpointed by Synopsis 20.
In a similar fashion, CientMed published two editions of the new section, Webinars of the National Academy of Medicine, to highlight some of the Zoom Sessions of NAM with contents of immediate interest to our audience. The idea here was to resemble some of the conferences and discussions of the very early days of GMC, where our founder, Dr. Luis Razetti, stimulated this journal to publish details of questions and answers of the speakers. The two webinars published as an innovation of CientMed were very well received by our audience, being the most recent one, on 12/03/2020, a thorough review of the Zoom conference by Dr. Carlos Hernández Rivero, Teleconsultation in Venezuela in times of Covid-19. Before that, the Webinars NAMV published on 11/19/2020, the conference of Dr. Maritza Durán, on the Post Covid-19 Syndrome. Both webinars made the top ten rankings of their corresponding weeks, with the latter at position No. 7 in Synopsis 17 and the former at No 5, as shown by Synopsis 18. CientMed has also active links to other academic institutions, and for that purpose, it teamed with both AsoVAC and Universidad Central de Venezuela, as co-hosts of the Annual Assembly of AsoVAC this year, as well as the Symposium Frontiers of Science, which received 212 views from November 19th to December 20th.
CientMed as a Knowledge System
CientMed is a knowledge and information system based on the wealth of science of NAMV. In the case of Covid-19, for instance, these two sources, the journal and the section related to the pandemic, «interact» to give the reader several layers of information of the gradual and deeper level of expertise and detail of each subject matter. As an example, the weekly Synopses show an Executive Summary in plain language to report a very brief view of the science and social advances of the previous week; then it goes deeper with texts and graphs illustrating in more depth such developments, as well as a glimpse of the metrics of the worldwide impact as measured by readership from different audiences and locations. To make it easier for the user who wants to get more granular information on scientific details, there are multiples links of each Synopsis to leading journals such as NEJM, Lancet, BMJ, JAMA, Science, and Nature, among others. The reader can also access some of the more specialized institutions such as WHO, CDC, FDA, HHS, NIH, and so on. The subject matter is divided into four categories such as Containment and Mitigation, Diagnostics, Treatment, and Vaccines to facilitate each search. Thus, with a combination of CientMed and Covid-19 of the Portal, it becomes possible to span this vast panorama of Covid-19, from the most elementary subjects of the pandemic to the frontier science involved, with the aid of more summaries, graphs, and links to leading journals of medicine and advanced biology, as well as to other sources of supporting sciences and technologies of the physical, chemical, and mathematical realm.
As an example of synthetic knowledge from CientMed, Covid-19, GMC, and its references to leading journals, the following graph depicts some of the key advances against the pandemic and SARS-CoV-2, portrayed in the Portal of NAMV. The graph below shows a timeline of these salient developments of public policies and measures, as well as the scientific breakthroughs occurred during this ominous year for mankind, but at the same time a promising one to envision a future control of Covid-19 in 2021:
We observe above a sort of a divisive line to mark two virtual stages of the fight against the pandemic. Since the start of Covid-19 in Venezuela in March, most publications and public measures were focused on Containment and Mitigation, as well as on the realization that the pandemic was not just an acute respiratory ailment, but a multisystemic disease. At the same time, treatment was in chaos, with false starts of compounds such as anti-malarial’s, Hydroxychloroquine, and chloroquine. Diagnostic tests were all based on the gold standard, qPCR, and all measures of containment were totally centralized by the government of our country, and tests were even forbidden to be performed by universities and private hospitals. Underreporting of Covid-19 by the Government became a rule as denounced by Dr. Julio Castro. Candidates to vaccines, in the meantime, were in rapid development from design to phase 1/2 trials, in a matter of few weeks.
The second «stage» of the 2020 fight against the pandemic, from August on, was the big triumph of modern science, which accrued the use of monoclonal antibodies as antiviral agents, and the emergence of mRNA vaccines as powerful tools to the future control of the pandemic worldwide. There were mishaps or setbacks, as well, as the clinical trials of remdesivir failed to confirm this drug as effective for serious Covid-19. The appearance of reinfections with SARS-CoV-2 was a cause of concern. Genomics and deep immunology came to the rescue to demonstrate a genetic link of a locus in Chromosome 3 which may lead to catastrophic Covid-19. The application of a combination of biology, medicine, and physics showed that the virus could also be transmitted by aerosols. Containment and mitigation demonstrated to be a power to reduce the incidence of Covid-19 in many countries that showed social discipline and leadership. Masks were demonstrated to reduce up to 50% of transmission by SARS-CoV-2.
The graph above also illustrates how certain terms of highly sophisticated technologies became part of the popular language in the Covid-19 fight. Besides qPCR, mRNA, and cytokines, emerged the importance of molecular epidemiology as an essential tool to follow certain variants of the spike protein of SARS-CoV-2, such as D614G, that prevails in global strains. Cryo-electron tomography was another term that became well known, to name the powerful tool used to determine the structure of the spike protein at atomic resolution, and the use of that technology demonstrated the presence of hinges at the spike trimers allowing a certain degree of mobility to the virion crown, as it scans the target receptor on the surface of the cell. Systems medicine was the appropriate tool to study a multisystemic disease, that is, to investigate disease causality and mechanisms of action of infectious agents, with the aid of a combination of electronic medical records, deep immunology, flow cytometry, and machine learning. And, finally, there was the wonderful feat of the two mRNA vaccines of BioNTech/Pfizer and Moderna/NIH, respectively, with proven safety (so far) and efficacies above 95%. All of these developments can be easily accessed with the search engine of our Portal.
CientMed as a Scientific Journal
CientMed is a scientific journal in its own right, with full compliance of the law, both in Venezuela and elsewhere, with Depósito Legal Electrónico DC 2020000636, ISSN-e: 266-0479, and each article with its corresponding DOI, at no charge for the investigator. Research papers are by invitation only and later submitted to peer review for publication. Authors are all required to publish their ORCID. The journal publishes articles in the Medical Sciences, and Advanced Technologies, in the English language following the style manual of the Council of Science Editors.
CientMed publishes research articles and critical reviews with two main objectives this past year, one was to fill certain gaps of knowledge of our medical community, in particular those related to the massive number of papers on Covid-19, at the tune of 200,000 articles in PubMed this year. The second goal was to give notice of the wealth of Venezuelan science here and abroad, as generated by leaders of the frontier of biomedical research, as well as emerging technologies applied to medicine. The following table gives a glimpse of some of the most noteworthy articles published in 2020 by CientMed, on a host of themes of interest to our medical community.
The subjects included A critical view of CRISPR applications in Human Genetics, by Dr. José Luis Ramírez, from UCV and IDEA, on August 5th, 2020, just three months before the announcement of the Nobel Prize in Chemistry 2020 to the two authors of CRISPR. On September 1st, 2020, CientMed published, The emerging field of fecal microbiota transplantation by Dr. Monica Ganan, a graduate from USB and current researcher from Auckland Uniservices, New Zealand. Then, Dr. Janet Hoenicka, another graduate of USB, and a Venezuelan geneticist from Institut de Recerca Sant Joan de Déu, Barcelona, Spain, published, From the Clinic to the Laboratory and Back; Translational Research to Improve Diagnosis, on October 7th, 2020. From all of these advanced technologies applied to medicine, CientMed gave attention to Medical Sciences in Venezuela, with the article by Dr. Walter Mosca, from the Insitute of Biomedicine, UCV, with the title of Chagas Disease: The new realities revisit old paradigms, published on September 9th, 2020. On the same subject of Tropical Medicine, on August 26th, 2020, CientMed published Pregnancy as a risk factor to disease and the vertical transmission to the fetus, of a host of parasitic ailments, by Drs. Belkisyolé Alarcón de Noya, and Raiza Ruiz Guevara, from the Institute of Tropical Medicine, UCV.
CientMed as a Reporter of Clinical Studies
CientMed gives utmost importance to clinical research, in particular to those studies performed in our own country. To facilitate comprehension of such type of badly needed research in our universities and hospitals, in 2020, the journal published a series of papers by distinguished investigators of our country, that shed light on such important matters as meta-analysis and systematic reviews, as well as the description of unusual clinical cases and the possible epidemiologic implications to Venezuela, especially in the countryside. Here are the titles of such papers:
The first two papers were authored by Dr. Arturo Martí-Carvajal, from Universidad de Carabobo, Valencia, one of the best exponents in Venezuela, of the Cochrane Database of Systematic Reviews, the top most-cited journal of health care. These two papers by Dr. Martí-Carvajal deal with all the intricacies of systematic reviews and meta-analyses, with clear explanations and examples to offer the reader an understanding of the basic principles and tools of the trade, of such important means to clinical trials. The last two papers, by another renowned expert, Dr. Néstor Añez, from Universidad de Los Andes, illustrate how to overcome the difficulties of performing both clinical and epidemiological research, and get meaningful results even under the present conditions of our country.
And last but not least, CientMed and the weekly Synopsis, facilitated the publication of Electronic Annals of NAMV, a compendium comprising all the publications of this year contained on the Portal, with all the taxonomy, index, hyper-texts, and search engine to explore the wealth of knowledge produced by the Academy on 2020.