<?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>S1729-519X2020000300004</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[COVID-19. De la patogenia a la elevada mortalidad en el adulto mayor y con comorbilidades]]></article-title>
<article-title xml:lang="en"><![CDATA[COVID-19. From pathogenesis to high mortality in elderly patients with comorbidities]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Serra Valdes]]></surname>
<given-names><![CDATA[Miguel Ángel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital General Docente &#8220;Dr. Enrique Cabrera&#8221;  ]]></institution>
<addr-line><![CDATA[La Habana ]]></addr-line>
<country>Cuba</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de Ciencias Médicas de La Habana  ]]></institution>
<addr-line><![CDATA[La Habana ]]></addr-line>
<country>Cuba</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2020</year>
</pub-date>
<volume>19</volume>
<numero>3</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_arttext&amp;pid=S1729-519X2020000300004&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_abstract&amp;pid=S1729-519X2020000300004&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_pdf&amp;pid=S1729-519X2020000300004&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción: La COVID-19 y el Síndrome Respiratorio Agudo Severo o SARS-CoV-2 por el nuevo coronavirus está causando una pandemia con alta mortalidad. Aunque aún quedan incógnitas por definir como enfermedad infecciosa viral nueva se ha avanzado en los conocimientos en relación con el comportamiento clínico y la patogenia.  Objetivo: Revisar las evidencias científicas más actuales sobre la patogenia de la enfermedad y su vínculo con la elevada mortalidad en adultos mayores afectados con comorbilidades.  Material y Métodos:  Se realizó una revisión de la literatura existente hasta la fecha en publicaciones de revistas indexadas en MEDLINE, LILACS, SciELO, LATINDEX, MEDIGRAPHY, MEDSCAPE, Science Direct Elsevier y PubMed y noticias divulgadas en boletines de la OMS/OPS, el Portal de INFOMED y otras agencias de noticias con buenas evidencias científicas.  Desarrollo: Se realiza el análisis de los conocimientos actuales en la patogenia y el proceso inflamatorio pulmonar de no ser una simple neumonía viral sino un proceso inflamatorio local y sistémico que involucra diferentes órganos, trastornos de la coagulación y alteraciones en la inmunidad y hace más vulnerables sobre todo al adulto mayor con comorbilidades, al ocasionar gravedad y elevar la mortalidad.  Conclusiones:  La patogenia de esta enfermedad, mejor conocida en la actualidad, explica las implicaciones en los casos críticos y graves con elevada mortalidad, sobre todo en los más vulnerables. El SARS y sus complicaciones evolutivas no son explicables solo por la inflamación pulmonar. Intervienen otros factores involucrados en la conocida patogenia de mucha mayor gravedad que conducen a un desenlace fatal.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction:  Coronavirus disease-2019 (COVID-19) and the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) are causing a pandemic associated with high mortality. Although many uncertainties still remain because it is a new viral infectious disease, knowledge of clinical behavior and pathogenesis has advanced.  Objective:  To review the most current scientific evidence on the pathogenesis of the disease and its association with high mortality in elderly patients with comorbidities.  Material and Methods:  A literature review of the information published to date on this respect was carried out. Databases such as MEDLINE, LILACS, SCIELO, LATINDEX, MEDIGRAPHIC, MEDSCAPE, Science Direct, Elsevier and PubMed were searched; important data were also obtained from WHO / PAHO bulletins, the Cuban National Health Care Telecommunications Network and Portal (infomed) and other news agencies that present good scientific evidence.  Development:  An analysis of the current knowledge about the pathogenesis and the pulmonary inflammatory process is carried out while observing that this process does not respond to a simple viral pneumonia but to a local and systemic inflammatory process that involves different organs, coagulation disorders and alterations of immunity that make elderly patients with comorbidities more vulnerable, causing severity and increasing mortality.  Conclusions:  The pathogenesis of this disease, which is better known at present, explains the implications in critical and severe cases with high mortality, especially the most vulnerable ones. SARS and its evolutive complications are not explained by lung inflammation only. Other factors are involved in the well-known pathogenesis of a much greater severity that leads to the fatal outcome.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[COVID-19]]></kwd>
<kwd lng="es"><![CDATA[SARS-CoV-2]]></kwd>
<kwd lng="es"><![CDATA[patogenia]]></kwd>
<kwd lng="es"><![CDATA[comorbilidades]]></kwd>
<kwd lng="es"><![CDATA[adulto mayor]]></kwd>
<kwd lng="es"><![CDATA[mortalidad]]></kwd>
<kwd lng="en"><![CDATA[COVID-19]]></kwd>
<kwd lng="en"><![CDATA[SARS-CoV-2]]></kwd>
<kwd lng="en"><![CDATA[pathogenesis]]></kwd>
<kwd lng="en"><![CDATA[comorbidities]]></kwd>
<kwd lng="en"><![CDATA[elderly]]></kwd>
<kwd lng="en"><![CDATA[mortality]]></kwd>
</kwd-group>
</article-meta>
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