<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1729-519X</journal-id>
<journal-title><![CDATA[Revista Habanera de Ciencias Médicas]]></journal-title>
<abbrev-journal-title><![CDATA[Rev haban cienc méd]]></abbrev-journal-title>
<issn>1729-519X</issn>
<publisher>
<publisher-name><![CDATA[Universidad de Ciencias Médicas de la Habana]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1729-519X2021000600008</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Biomodulina T® como alternativa de tratamiento en el shock séptico en pediatría]]></article-title>
<article-title xml:lang="en"><![CDATA[Biomodulina T® as an alternative to the treatment of septic shock in pediatrics]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Reyes Zamora]]></surname>
<given-names><![CDATA[Mary Carmen]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Acevedo Rodríguez]]></surname>
<given-names><![CDATA[Yoandra]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez Chávez]]></surname>
<given-names><![CDATA[Suset]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Nacional de Biopreparados  ]]></institution>
<addr-line><![CDATA[La Habana ]]></addr-line>
<country>Cuba</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de Ciencias Médicas de La Habana Instituto de Ciencias Básicas y Preclínicas &#8220;Victoria de Girón&#8221; ]]></institution>
<addr-line><![CDATA[La Habana ]]></addr-line>
<country>Cuba</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital Pediátrico Universitario &#8220;José Luis Miranda&#8221;  ]]></institution>
<addr-line><![CDATA[Villa Clara ]]></addr-line>
<country>Cuba</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Universidad de Ciencias Médicas de Villa Clara  ]]></institution>
<addr-line><![CDATA[Villa Clara ]]></addr-line>
<country>Cuba</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2021</year>
</pub-date>
<volume>20</volume>
<numero>6</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_arttext&amp;pid=S1729-519X2021000600008&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_abstract&amp;pid=S1729-519X2021000600008&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_pdf&amp;pid=S1729-519X2021000600008&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción:  La sepsis y el shock séptico se encuentran entre las principales causas de morbilidad y mortalidad en la población pediátrica a nivel mundial. Encontrar soluciones alternativas para combatirlas, mediante el desarrollo de agentes inmunomoduladores, ha atraído el interés de investigadores en los últimos 20 años; Cuba cuenta con Biomodulina T®, un potente inmunomodulador.  Objetivo:  Demostrar que existe evidencia científica que avale la realización de ensayos clínicos controlados para la incorporación de la Biomodulina T® en las pautas de tratamientos de la sepsis en las terapias intensivas pediátricas.  Material y Métodos:  Se realizó una búsqueda en las bases de datos Medline, PubMed, SciELO, Lilacs, Cochrane Library y Web of Science, entre marzo de 2019 y marzo de 2020; se seleccionaron los 47 artículos de mayor relevancia para esta investigación.  Desarrollo: La inmunopatogenia del shock se centra en un fenotipo complejo y alteraciones funcionales, tanto del sistema inmune innato como del sistema adaptativo, con disminución del número de células efectoras, aumento de subpoblaciones de linfocitos inmunosupresores y agotamiento de células T. Biomodulina T® estimula la producción de linfocitos T y robustece la diferenciación de las células linfoblastoides del timo. La práctica médica sugiere que su administración podría ser una estrategia prometedora para la restauración inmune en pacientes pediátricos con shock séptico.  Conclusiones:  Existe evidencia científica que respalda el uso de Biomodulina T® en pacientes con shock séptico, lo cual sustenta la fiabilidad de realizar ensayos clínicos controlados en población pediátrica para su posterior incorporación en las pautas de tratamientos en las terapias intensivas.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction:  Sepsis and septic shock are among the main causes of morbidity and mortality in the pediatric population worldwide. Finding alternative solutions to combat them through the development of immunomodulatory agents has attracted the interest of researchers in the last 20 years; Cuba has Biomodulina T®, a powerful immunomodulator.  Objective:  To demonstrate that there is scientific evidence that supports the conduction of controlled clinical trials for the incorporation of Biomodulina T® into the treatment guidelines for sepsis in pediatric intensive care therapies.  Material and Methods:  A search was carried out in the Medline, PubMed, SciELO, Lilacs, the Cochrane Library and the Web of Science databases between March 2019 and March 2020; the 47 most relevant articlesfor this research were selected.  Development:  The immunopathogenesis of shock focuses on a complex phenotype and functional alterations of both the innate and adaptive immune systems with a decrease in the number of effector cells, an increase in subpopulations of immunosuppressive lymphocytes, and depletion of T cells. Biomodulina T® stimulates the production of T lymphocytes and strengthens the differentiation of lymphoblastoid cells of the thymus; medical practice suggests that its administration could be a promising strategy for immune restoration in pediatric patients with septic shock.  Conclusions:  There is scientific evidence that supports the use of Biomodulina T® in patients with septic shock, which supports the reliability of conducting controlled clinical trials in the pediatric population for its subsequent incorporation into treatment guidelines in intensive care therapies.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[choque séptico]]></kwd>
<kwd lng="es"><![CDATA[niños]]></kwd>
<kwd lng="es"><![CDATA[sepsis]]></kwd>
<kwd lng="es"><![CDATA[factores inmunológicos]]></kwd>
<kwd lng="es"><![CDATA[ensayo clínico]]></kwd>
<kwd lng="es"><![CDATA[Biomodulina T®]]></kwd>
<kwd lng="en"><![CDATA[septic shock]]></kwd>
<kwd lng="en"><![CDATA[children]]></kwd>
<kwd lng="en"><![CDATA[sepsis]]></kwd>
<kwd lng="en"><![CDATA[immunologic factors]]></kwd>
<kwd lng="en"><![CDATA[clinical trial]]></kwd>
<kwd lng="en"><![CDATA[Biomodulina T®]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Davis]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
<name>
<surname><![CDATA[Carcillo]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Aneja]]></surname>
<given-names><![CDATA[RK]]></given-names>
</name>
<name>
<surname><![CDATA[Deymann]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Lin]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Nguyen]]></surname>
<given-names><![CDATA[TC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock]]></article-title>
<source><![CDATA[Crit Care Med]]></source>
<year>2017</year>
<volume>45</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>1061-93</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<collab>PubMed</collab>
<article-title xml:lang=""><![CDATA[Erratum: Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study]]></article-title>
<source><![CDATA[Am J Respir Crit Care Med]]></source>
<year>2016</year>
<volume>193</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>223-4</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="book">
<collab>Word Health Organization</collab>
<source><![CDATA[Improving the prevention, diagnosis and clinical management of sepsis]]></source>
<year>2018</year>
<publisher-loc><![CDATA[Geneva ]]></publisher-loc>
<publisher-name><![CDATA[WHO]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[ME]]></surname>
<given-names><![CDATA[Saeed MJ]]></given-names>
</name>
<name>
<surname><![CDATA[Powell KN]]></surname>
<given-names><![CDATA[Olsen MA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Comparative Epidemiology of Pediatric Severe Sepsis]]></article-title>
<source><![CDATA[J Intensive Care Med]]></source>
<year>2019</year>
<volume>34</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>472-9</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Watson]]></surname>
<given-names><![CDATA[RS]]></given-names>
</name>
<name>
<surname><![CDATA[Crow]]></surname>
<given-names><![CDATA[SS]]></given-names>
</name>
<name>
<surname><![CDATA[Hartman]]></surname>
<given-names><![CDATA[ME]]></given-names>
</name>
<name>
<surname><![CDATA[Lacroix]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Odetola]]></surname>
<given-names><![CDATA[FO]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Epidemiology and Outcomes of Pediatric Multiple Organ Dysfunction Syndrome]]></article-title>
<source><![CDATA[Pediatr Crit Care Med]]></source>
<year>2017</year>
<volume>18</volume>
<numero>^s3</numero>
<issue>^s3</issue>
<supplement>3</supplement>
<page-range>S4-S16</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hsu]]></surname>
<given-names><![CDATA[HE]]></given-names>
</name>
<name>
<surname><![CDATA[Abanyie]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Agus]]></surname>
<given-names><![CDATA[MSD]]></given-names>
</name>
<name>
<surname><![CDATA[Balamuth]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Brady]]></surname>
<given-names><![CDATA[PW]]></given-names>
</name>
<name>
<surname><![CDATA[Brilli]]></surname>
<given-names><![CDATA[RJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A National Approach to Pediatric Sepsis Surveillance]]></article-title>
<source><![CDATA[Pediatrics]]></source>
<year>2019</year>
<volume>144</volume>
<numero>6</numero>
<issue>6</issue>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="book">
<collab>MINSAP</collab>
<source><![CDATA[Dirección Nacional de Registros Médicos y Estadísticas de Salud. Anuario Estadístico de Salud 2019]]></source>
<year>2019</year>
<publisher-loc><![CDATA[La Habana ]]></publisher-loc>
<publisher-name><![CDATA[MINSAP]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[MINSAP]]></surname>
</name>
</person-group>
<source><![CDATA[Dirección Nacional de Registros Médicos y Estadísticas de Salud. Anuario Estadístico de Salud 2018]]></source>
<year>2018</year>
<publisher-loc><![CDATA[La Habana ]]></publisher-loc>
<publisher-name><![CDATA[MINSAP]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="book">
<collab>MINSAP</collab>
<source><![CDATA[Dirección Nacional de Registros Médicos y Estadísticas de Salud. Anuario Estadístico de Salud 2017]]></source>
<year>2017</year>
<publisher-loc><![CDATA[La Habana ]]></publisher-loc>
<publisher-name><![CDATA[MINSAP]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bordogna]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Bergna]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Guías de procedimientos institucionales. Sepsis, sepsis severa y shock séptico]]></article-title>
<source><![CDATA[Ludovica Pediátrica]]></source>
<year>2018</year>
<volume>21</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>21-32</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Torrealba]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Carnevale]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Factores de riesgo de pacientes con sepsis ingresados en la Unidad de Cuidados Intensivos Pediátricos. Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga]]></article-title>
<source><![CDATA[Boletín Médico De Postgrado]]></source>
<year>2018</year>
<volume>34</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cartaya]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Rovira]]></surname>
<given-names><![CDATA[LE]]></given-names>
</name>
<name>
<surname><![CDATA[Segredo]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Álvarez]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Acevedo]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Moya]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Implementing ACCM critical care guidelines for septic shock management in a Cuban pediatric intensive care unit]]></article-title>
<source><![CDATA[MEDICC Review]]></source>
<year>2014</year>
<volume>16</volume>
<numero>3-4</numero>
<issue>3-4</issue>
<page-range>47-54</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="book">
<collab>CECMED</collab>
<source><![CDATA[Resumen de las características del producto. Biomodulina T]]></source>
<year>2020</year>
<publisher-loc><![CDATA[La Habana ]]></publisher-loc>
<publisher-name><![CDATA[CECMED]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ferrer Vázquez]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<source><![CDATA[Las patologías infantiles en la medicina greco helenística. Estudio y análisis historiográfico desde la práctica de la pediatría moderna]]></source>
<year>2017</year>
<publisher-loc><![CDATA[España ]]></publisher-loc>
<publisher-name><![CDATA[Universitat Jaume I]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[McSherry]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Thucydides' syndrome]]></article-title>
<source><![CDATA[CMAJ]]></source>
<year>1998</year>
<volume>159</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>21-2</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nishida]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Ogura]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Egi]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Fujishima]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Hayashi]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Iba]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016)]]></article-title>
<source><![CDATA[J Intensive Care]]></source>
<year>2018</year>
<volume>6</volume>
</nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Weiss]]></surname>
<given-names><![CDATA[SL]]></given-names>
</name>
<name>
<surname><![CDATA[Peters]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
<name>
<surname><![CDATA[Alhazzani]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Agus]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
<name>
<surname><![CDATA[Flori]]></surname>
<given-names><![CDATA[HR]]></given-names>
</name>
<name>
<surname><![CDATA[Inwald]]></surname>
<given-names><![CDATA[DP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children]]></article-title>
<source><![CDATA[Intensive Care Med]]></source>
<year>2020</year>
<volume>46</volume>
<numero>^s1</numero>
<issue>^s1</issue>
<supplement>1</supplement>
<page-range>10-67</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Esteban]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Revisión de las nuevas definiciones sobre la sepsis y su aplicación en Pediatría]]></article-title>
<source><![CDATA[Rev Esp Pediatr]]></source>
<year>2017</year>
<volume>73</volume>
<numero>^s1</numero>
<issue>^s1</issue>
<supplement>1</supplement>
<page-range>21-2</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Obonyo]]></surname>
<given-names><![CDATA[NG]]></given-names>
</name>
<name>
<surname><![CDATA[Schlapbach]]></surname>
<given-names><![CDATA[LJ]]></given-names>
</name>
<name>
<surname><![CDATA[Fraser]]></surname>
<given-names><![CDATA[JF]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Corrigendum Sepsis: Changing Definitions, Unchanging Treatment]]></article-title>
<source><![CDATA[Front Pediatr]]></source>
<year>2020</year>
<volume>7</volume>
<page-range>538</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[De Souza]]></surname>
<given-names><![CDATA[DC]]></given-names>
</name>
<name>
<surname><![CDATA[Barciela Brandão]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Piva]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[From the International Pediatric Sepsis Conference 2005 to the Sepsis-3 Consensus]]></article-title>
<source><![CDATA[Rev Bras Ter Intensiva]]></source>
<year>2018</year>
<volume>30</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>1-5</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Singer]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Deutschman]]></surname>
<given-names><![CDATA[CS]]></given-names>
</name>
<name>
<surname><![CDATA[Seymour]]></surname>
<given-names><![CDATA[CW]]></given-names>
</name>
<name>
<surname><![CDATA[Shankar Hari]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Annane]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Bauer]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2016</year>
<volume>315</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>801-10</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Giamarellos Bourboulis]]></surname>
<given-names><![CDATA[EJ]]></given-names>
</name>
<name>
<surname><![CDATA[Tsaganos]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Tsangaris]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Lada]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Routsi]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Sinapidis]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Validation of the new Sepsis-3 definitions: proposal for improvement in early risk identification]]></article-title>
<source><![CDATA[Clinical Microbiology Infection]]></source>
<year>2017</year>
<volume>23</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>104-9</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Weiss]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Peters]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Alhazzani]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Agus]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Flori]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Inwald]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Guías Internacionales de la Campaña para Sobrevivir a la Sepsis para el tratamiento en niños del shock/choqueséptico y la disfunción orgánica asociada a la sepsis]]></article-title>
<source><![CDATA[Intensive Care Med]]></source>
<year>2020</year>
<volume>46</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>23-7</page-range></nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Davis]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
<name>
<surname><![CDATA[Carcillo]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Aneja]]></surname>
<given-names><![CDATA[RK]]></given-names>
</name>
<name>
<surname><![CDATA[Deymann]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Lin]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Nguyen]]></surname>
<given-names><![CDATA[TC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock: Erratum]]></article-title>
<source><![CDATA[Crit Care Med]]></source>
<year>2017</year>
<volume>45</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>1061-93</page-range></nlm-citation>
</ref>
<ref id="B25">
<label>25</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Matics]]></surname>
<given-names><![CDATA[TJ]]></given-names>
</name>
<name>
<surname><![CDATA[Sánchez Pinto]]></surname>
<given-names><![CDATA[LN]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Adaptation and Validation of a Pediatric Sequential Organ Failure Assessment Score and Evaluation of the Sepsis-3 Definitions in Critically Ill Children]]></article-title>
<source><![CDATA[JAMA Pediatr]]></source>
<year>2017</year>
<volume>171</volume>
<numero>10</numero>
<issue>10</issue>
</nlm-citation>
</ref>
<ref id="B26">
<label>26</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hotchkiss]]></surname>
<given-names><![CDATA[RS]]></given-names>
</name>
<name>
<surname><![CDATA[Coopersmith]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
<name>
<surname><![CDATA[McDunn]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Ferguson]]></surname>
<given-names><![CDATA[TA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The sepsis seesaw: tilting toward immunosuppression]]></article-title>
<source><![CDATA[Nat Med]]></source>
<year>2009</year>
<volume>15</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>496-7</page-range></nlm-citation>
</ref>
<ref id="B27">
<label>27</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Weiss]]></surname>
<given-names><![CDATA[SL]]></given-names>
</name>
<name>
<surname><![CDATA[Peters]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
<name>
<surname><![CDATA[Alhazzani]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Agus]]></surname>
<given-names><![CDATA[MSD]]></given-names>
</name>
<name>
<surname><![CDATA[Flori]]></surname>
<given-names><![CDATA[HR]]></given-names>
</name>
<name>
<surname><![CDATA[Inwald]]></surname>
<given-names><![CDATA[DP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children]]></article-title>
<source><![CDATA[Intensive Care Med]]></source>
<year>2020</year>
<volume>46</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>10-67</page-range></nlm-citation>
</ref>
<ref id="B28">
<label>28</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Arens]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Bajwa]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
<name>
<surname><![CDATA[Koch]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Siegler]]></surname>
<given-names><![CDATA[BH]]></given-names>
</name>
<name>
<surname><![CDATA[Schneck]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Hecker]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Sepsis-induced long-term immune paralysis--results of a descriptive, explorative study]]></article-title>
<source><![CDATA[Crit Care]]></source>
<year>2016</year>
<volume>20</volume>
<page-range>93</page-range></nlm-citation>
</ref>
<ref id="B29">
<label>29</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Davies]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[O'Dea]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Gordon]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Immune therapy in sepsis: Are we ready to try again?]]></article-title>
<source><![CDATA[J Intensive Care Soc]]></source>
<year>2018</year>
<volume>19</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>326-44</page-range></nlm-citation>
</ref>
<ref id="B30">
<label>30</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ding]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Meng]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Ma]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Central Role of the Inflammatory Response in Understanding the Heterogeneity of Sepsis-3]]></article-title>
<source><![CDATA[Biomed Res Int]]></source>
<year>2018</year>
<volume>2018</volume>
</nlm-citation>
</ref>
<ref id="B31">
<label>31</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Liu]]></surname>
<given-names><![CDATA[Q]]></given-names>
</name>
<name>
<surname><![CDATA[Li]]></surname>
<given-names><![CDATA[CS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Programmed Cell Death-1/Programmed Death-ligand 1 Pathway: A New Target for Sepsis]]></article-title>
<source><![CDATA[Chin Med J (Engl)]]></source>
<year>2017</year>
<volume>130</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>986-92</page-range></nlm-citation>
</ref>
<ref id="B32">
<label>32</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Watson]]></surname>
<given-names><![CDATA[RS]]></given-names>
</name>
<name>
<surname><![CDATA[Crow]]></surname>
<given-names><![CDATA[SS]]></given-names>
</name>
<name>
<surname><![CDATA[Hartman]]></surname>
<given-names><![CDATA[ME]]></given-names>
</name>
<name>
<surname><![CDATA[Lacroix]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Odetola]]></surname>
<given-names><![CDATA[FO]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Epidemiology and Outcomes of Pediatric Multiple Organ Dysfunction Syndrome]]></article-title>
<source><![CDATA[Pediatr Crit Care Med]]></source>
<year>2017</year>
<volume>18</volume>
<numero>^s1</numero>
<issue>^s1</issue>
<supplement>1</supplement>
<page-range>S4-S16</page-range></nlm-citation>
</ref>
<ref id="B33">
<label>33</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Manzanares Arévalo]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
</person-group>
<source><![CDATA[Comportamiento clínico de la sepsis grave / shock séptico en pacientes ingresados a la Unidad de Cuidados Intensivos Pediátrica, del Hospital Alemán Nicaragüense, del 1 de enero al 31 de diciembre de 2016]]></source>
<year>2017</year>
<publisher-loc><![CDATA[Managua ]]></publisher-loc>
<publisher-name><![CDATA[Universidad Nacional Autónoma de Nicaragua]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B34">
<label>34</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Peters van Ton]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Kox]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Abdo]]></surname>
<given-names><![CDATA[WF]]></given-names>
</name>
<name>
<surname><![CDATA[Pickkers]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Precision Immunotherapy for Sepsis]]></article-title>
<source><![CDATA[Front Immunol]]></source>
<year>2018</year>
<volume>9</volume>
<page-range>1926</page-range></nlm-citation>
</ref>
<ref id="B35">
<label>35</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sims]]></surname>
<given-names><![CDATA[CR]]></given-names>
</name>
<name>
<surname><![CDATA[Nguyen]]></surname>
<given-names><![CDATA[TC]]></given-names>
</name>
<name>
<surname><![CDATA[Mayeux]]></surname>
<given-names><![CDATA[PR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Could Biomarkers Direct Therapy for the Septic Patient?]]></article-title>
<source><![CDATA[J Pharmacol Exp Ther]]></source>
<year>2016</year>
<volume>357</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>228-39</page-range></nlm-citation>
</ref>
<ref id="B36">
<label>36</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Winkler]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
<name>
<surname><![CDATA[Rissiek]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Priefler]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Schwedhelm]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Robbe]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Bauer]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Human leucocyte antigen (HLA-DR) gene expression is reduced in sepsis and correlates with impaired TNFa response: A diagnostic tool for immunosuppression?]]></article-title>
<source><![CDATA[PLoS One]]></source>
<year>2017</year>
<volume>12</volume>
<numero>8</numero>
<issue>8</issue>
</nlm-citation>
</ref>
<ref id="B37">
<label>37</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dueñas Castell]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Ortiz Ruiz]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Borré Naranjo]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Sepsis: A Definition Under Construction]]></article-title>
<person-group person-group-type="editor">
<name>
<surname><![CDATA[Ortiz Ruiz]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Dueñas Castell]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<source><![CDATA[Sepsis]]></source>
<year>2018</year>
<publisher-loc><![CDATA[New York ]]></publisher-loc>
<publisher-name><![CDATA[Springer]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B38">
<label>38</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Liu]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[HM]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Zhang]]></surname>
<given-names><![CDATA[YM]]></given-names>
</name>
<name>
<surname><![CDATA[Zhu]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The efficacy of thymosin a1 as immunomodulatory treatment for sepsis: a systematic review of randomized controlled trials]]></article-title>
<source><![CDATA[BMC Infectious Diseases]]></source>
<year>2016</year>
<volume>16</volume>
</nlm-citation>
</ref>
<ref id="B39">
<label>39</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dominari]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Hathaway Iii]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Pandav]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Matos]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Biswas]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Reddy]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Thymosin alpha 1: A comprehensive review of the literature]]></article-title>
<source><![CDATA[World J Virol]]></source>
<year>2020</year>
<volume>9</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>67-78</page-range></nlm-citation>
</ref>
<ref id="B40">
<label>40</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rodríguez Martín]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Vega Sánchez]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Peláez Borges]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Biomoduladores tímicos]]></article-title>
<source><![CDATA[Revista Cub Farm]]></source>
<year>1988</year>
<volume>22</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>72-83</page-range></nlm-citation>
</ref>
<ref id="B41">
<label>41</label><nlm-citation citation-type="book">
<collab>MINSAP</collab>
<source><![CDATA[Formulario Nacional de Medicamentos.]]></source>
<year>2019</year>
<publisher-loc><![CDATA[La Habana ]]></publisher-loc>
<publisher-name><![CDATA[MINSAP]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B42">
<label>42</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Suárez Formigo]]></surname>
<given-names><![CDATA[GM]]></given-names>
</name>
<name>
<surname><![CDATA[Saavedra Hernández]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Biomodulina T May Restore Immunity in Older Adults]]></article-title>
<source><![CDATA[MEDICC Rev]]></source>
<year>2020</year>
<volume>22</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>54-6</page-range></nlm-citation>
</ref>
<ref id="B43">
<label>43</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Saavedra]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Fuertes]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
<name>
<surname><![CDATA[Suárez]]></surname>
<given-names><![CDATA[GM]]></given-names>
</name>
<name>
<surname><![CDATA[González]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Lorenzo Luaces]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[García]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Biomodulina T partially restores immunosenescent CD4 and CD8 T cell compartments in the elderly]]></article-title>
<source><![CDATA[Exp Gerontol]]></source>
<year>2019</year>
<volume>124</volume>
</nlm-citation>
</ref>
<ref id="B44">
<label>44</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mollineda Tocoronte]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Martínez González]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Rabaza Perez]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Hernández Fernández]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Romero del So]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Respuesta al tratamiento en niños desnutridos menores de 1 año de edad]]></article-title>
<source><![CDATA[Rev Cubana Pediatr]]></source>
<year>1999</year>
<volume>71</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>191-6</page-range></nlm-citation>
</ref>
<ref id="B45">
<label>45</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Christian]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Rabassa]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Santamaría]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Romero]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hormonas Tímicas solas o combinadas. Su efecto sobre el Timo en niños con infecciones recurrentes]]></article-title>
<source><![CDATA[IV Congreso Nacional y VI Jornada Latinoamericana de Hematología, Inmunología y Medicina Transfusional; 2001 may 14-18; La Habana]]></source>
<year>2001</year>
<publisher-loc><![CDATA[La Habana ]]></publisher-loc>
<publisher-name><![CDATA[Sociedad Cubana De Hematología]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B46">
<label>46</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Christian]]></surname>
<given-names><![CDATA[LR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Biomodulina T Cruzada por la vida]]></article-title>
<source><![CDATA[Revista Ciencia para la Vida]]></source>
<year>2003</year>
<volume>8</volume>
<page-range>30-1</page-range></nlm-citation>
</ref>
<ref id="B47">
<label>47</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hernández]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Marín]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Martínez]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<source><![CDATA[Efecto de la Biomodulina T en el tratamiento de la Uveítis Anterior]]></source>
<year>1997</year>
<publisher-loc><![CDATA[La Habana ]]></publisher-loc>
<publisher-name><![CDATA[Hospital Calixto García]]></publisher-name>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
