El mosquito del dengue en la Ciudad de México. Invasión incipiente de Aedes aegypti y sus potenciales riesgos / Aedes aegypti, the dengue fever mosquito in Mexico City. Early invasion and its potential risks

Resumen Introducción: La Ciudad de México no tiene presencia endémica de Aedes aegypti, por lo que está libre de enfermedades transmitidas por vector como dengue, Zika y chikunguña. Sin embargo, existe evidencia de la presencia de huevecillos en la urbe desde 2015. Objetivo: Reportar la presencia constante y en aumento de huevecillos de Aedes aegypti en la Ciudad de México de 2015 a 2018. Método: Se realizó vigilancia a través de ovitrampas; se contabilizaron y eclosionaron huevecillos para determinar la especie. Resultados: De 2015 a 2018 fueron identificados 378 organismos como Aedes aegypti. En total fueron colectadas 76 ovitrampas positivas a Aedes aegypti en 50 sitios distintos de 11 alcaldías. El noreste de la Ciudad de México fue el área con mayor positividad. Conclusiones: Los resultados pueden estar indicando un periodo de colonización incipiente y la probable la existencia de colonias crípticas del mosquito, por lo que la Ciudad de México podría estar en riesgo de presentar epidemias de enfermedades transmitidas por vector.

Abstract Introduction: Mexico City has no endemic presence of Aedes aegypti, and it is therefore free of vector-borne diseases, such as dengue fever, Zika and chikungunya. However, evidence has shown the presence of Aedes aegypti eggs in the city since 2015. Objective: To report the constant and increasing presence of Aedes aegypti eggs in Mexico City from 2015 to 2018. Methods: Surveillance was carried out using ovitraps. Eggs were counted and hatched in order to determine the species. Results: From 2015 to 2018, 378 organisms were identified as Ae. aegypti. In total, 76 Aedes aegypti-positive ovitraps were collected at 50 different places in 11 boroughs of the city. Northeastern Mexico City was the area with the highest number of positive traps. Conclusions: The results may be indicating a period of early colonization and the probable existence of cryptic colonies of the mosquito, and Mexico City could be therefore at risk of experiencing vector-borne epidemics.

Caracterización de los hallazgos electrocardiográficos y su relación con la mortalidad en la enfermedad cerebrovascular aguda / Characterization of electrocardiographic findings and their relationship with mortality in acute cerebrovascular disease

RESUMEN Introducción: En Cuba, los estudios descriptivos y experimentales que exploran los trastornos cardiovasculares secundarios a enfermedades neurológicas son escasos, tanto en el campo de la clínica como de la neurocardiología. Objetivos: Caracterizar los hallazgos electrocardiográficos en las primeras 72 horas de evolución de la enfermedad cerebrovascular y su relación con la mortalidad. Método: Se realizó un estudio observacional, descriptivo, de corte longitudinal prospectivo, en 166 pacientes ingresados en el Hospital Clínico-Quirúrgico Joaquín Albarrán, con el diagnóstico de enfermedad cerebrovascular de cualquier etiología y forma de presentación, durante el período de enero de 2015 a diciembre de 2016. Resultados: Los hallazgos electrocardiográficos estuvieron presentes en el 32,5% de los pacientes, fundamentalmente la taquicardia sinusal (27,7 %), la inversión de la onda T y las extrasístoles auriculares (13,3% cada uno). Se encontró una frecuencia significativamente mayor de cambios electrocardiográficos en los pacientes con hemorragia subaracnoidea (33,3% frente a 5,4%), menor puntuación en la escala de coma de Glasgow (29,7% frente a 5,4%) y localización a nivel de los ganglios basales (50,0%). La presencia de nuevos hallazgos electrocardiográficos se relacionó con una probabilidad 7,2 veces mayor de muerte intrahospitalaria (40,7% frente a 7,1%). Conclusiones: La presencia de nuevas alteraciones electrocardiográficas en pacientes con enfermedad cerebrovascular puede ser empleado como un marcador de riesgo de mortalidad intrahospitalaria.

ABSTRACT Introduction: In Cuba, descriptive and experimental studies that explore cardiovascular disorders secondary to neurological diseases are scarce, both in the clinical and neurocardiology fields. Objectives: To characterize the electrocardiographic findings in the first 72 hours of evolution of the cerebrovascular disease and its relation to mortality. Method: An observational, descriptive, longitudinal prospective study was carried out in 166 patients admitted to the Hospital Clínico-Quirúrgico Joaquín Albarrán, with the diagnosis of cerebrovascular disease of any etiology and form of presentation, during the period of January 2015 to December 2016. Results: Electrocardiographic findings were present in 32.5% of patients, mainly sinus tachycardia (27.7%), T wave inversion and premature atrial contractions (13.3% each). A significantly higher frequency of electrocardiographic changes was found in patients with subarachnoid hemorrhage (33.3% vs. 5.4%), lower score on the Glasgow coma scale (29.7% vs. 5.4%) and location at the level of the basal ganglia (50.0%). The presence of new electrocardiographic findings was related to a 7.2 times greater probability of in-hospital death (40.7% vs. 7.1%). Conclusions: The presence of new electrocardiographic alterations in patients with cerebrovascular disease can be used as a marker of risk of in-hospital mortality.

Precisiones teórico-metodológicas para la comprensión de la ética y la bioética médica / Theoretical-methodological precisions for understanding the ethics and the medical bioethics

El pensamiento ético y bioético es una de las áreas de conocimiento recurrentes en el ejercicio reflexivo del profesional de la salud en Cuba; sin embargo, se detectan insuficiencias relacionadas con imprecisiones y falta de claridad en el pensamiento ético-moral por parte de este personal, según se observa en materiales evaluados para su publicación, en los ejercicios para el proceso de obtención de categorías docentes y en la presentación de las evaluaciones de posgrados. El artículo tiene el objetivo de argumentar precisiones teórico- metodológicas para la elaboración de trabajos en ética y bioética.

The ethical and bioethical thought is one of the recurrent areas of knowledge in the reflexive exercise of health professionals in Cuba. However, according to the observations of evaluated materials for their publication, in the exercises for the process of obtaining educational categories and in the presentation of postgraduate evaluations, inadequacies related with imprecision and lack of clarity are detected in the ethical-moral thought on the part of health professionals. The article has the objective of arguing theoretical- methodological precisions for the elaboration of works in ethics and bioethics.

La Medicina Interna en el ambiente hospitalario / The Internal Medicine in the hospitable environment

Introducción: los cambios del contexto de trabajo en los hospitales para los internistas exigen perfeccionar el funcionamiento de sus servicios. Objetivos: identificar problemas que afectan a la especialidad Medicina Interna y los cambios organizativos necesarios para su solución, en un hospital clínico-quirúrgico. Material y Métodos: se realizó investigación cualitativa, basada en la actividad de un grupo nominal que dio salida a tareas propias de la dirección estratégica. Resultados: se definió la misión, visión y líneas estratégicas de trabajo del Servicio de Medicina Interna, se caracterizó el contexto y definieron como problemas en orden de prioridad: Deterioro del método clínico; práctica de una Medicina biologicista; insuficiente disponibilidad de camas; limitaciones en los recursos humanos, materiales y financieros para la máxima calidad de la atención y sobrecarga de los servicios clínicos. Se definieron las fortalezas, debilidades, amenazas y oportunidades. De ellas se derivaron propuestas de acciones ofensivas, adaptativas, defensivas y de supervivencia para lograr un cambio positivo en el trabajo de esta especialidad. Conclusiones: la gestión del capital humano en Medicina Interna implica una estructura colaborativa más eficiente para el hospital, que depare mejor utilización de los internistas como médico generalista e integrador, lo que contribuiría a disminuir las fronteras físicas de las salas y centrar el trabajo en los enfermos.

Introduction: the work context changes of the internists demand to make perfect the functioning of their services. Objectives: identify problems that affect the Internal Medicine and the necessary organizative changes to solve them, at a clinical-surgical hospital. Material and Methods: it was a qualitative research based on the activity of a nominal group that gave vent to own tasks of the strategic direction. Results: the mission, vision and the Internal Medicine service's strategic lines of work were defined; the context was assigned priority to its problems: Deterioration of the clinical method; the practice of a biologist medicine; insufficient availability of beds; Limitations in human, materials and financiers resources for the maximum quality of attention; Overload of the clinical services. It was defined fortresses, weaknesses, threats and opportunities. The offensive, adjustatives, defensives and survival actions to achieve a positive change were derived. Conclusions: the management of the human capital in internal medicine implies a collaborative structure more efficient for the hospital, that better utilization of the internists like generalist and integrative doctor that would contribute to diminish the physical frontiers of the wards and centering the work in the sick persons.

Clinical guideline for diagnosis and management of melioidosis

Melioidose é uma infecção emergente no Brasil e em países vizinhos da América do Sul. O amplo espectro de apresentação clínica inclui pneumonia adquirida na comunidade, septicemia, infecção do sistema nervoso central e infecção de partes moles de menor severidade. O diagnóstico depende essencialmente da identificação microbiológica. Burkholderia pseudomallei, a causa bacteriana da melioidose, é facilmente cultivada em sangue, escarro e em outras amostras clínicas. Entretanto, B. pseudomallei pode ser difícil de identificar com segurança e também ser confundido com outras bactérias Gram negativas. Os exames sorológicos podem dar suporte a um diagnóstico de melioidose, mas não fornece um diagnóstico definitivo por si só. A realização de investigação laboratorial seqüenciada pode ajudar a reduzir o risco de não reconhecer isolados incomuns de B. pseudomallei. O tratamento antibiótico recomendado para infecção severa é Ceftazidima ou Meropenem endovenosos por várias semanas, seguido por um tratamento oral com uma combinação de Sulfametoxazol-Trimetopim e Doxiciclina por até 20 semanas. O uso consistente do diagnóstico microbiológico e o tratamento rigoroso da infecção severa com antibióticos adequados nas duas etapas, aguda e de erradicação, contribuirão para a redução da mortalidade por melioidose.

Total plasma homocysteine concentrations in Puerto Rican patients with presumptive atherosclerotic coronary disease

BACKGROUND: In Puerto Rico, it has been established that although coronary heart disease is the leading cause of death, the population has a lower incidence of coronary disease than the continental United States. In addition, the severity of the disease is less aggressive in terms of a lower incidence of ventricular tachycardia and sudden death. A factor in the lower incidence of coronary disease in Puerto Rico could be a lower total plasma homocysteine concentration (tHcys) in our population. METHODS: We randomly measured tHcys concentrations in seventy-two Hispanic patients who were hospitalized for coronary angiography at the Cardiovascular Center of Puerto Rico and the Caribbean (UPR Division). RESULTS: The mean tHCys concentration in our patient population is similar than that reported for the Framingham study when adjusted by age (11.2 mumol/L vs. 11.8 mumol/L). In the Puerto Rican population, males had a higher tHcys concentration than females but this difference was not statistically significant (10.9 mumol/L vs. 9.4 mumol/L, p = 0.09). In addition, we did not see an increase of tHcys concentrations in diabetic patients when compared with nondiabetics (10.1 mumol/L vs. 10.3 mumol/L, p = 0.73). Neither we saw a direct correlation between tHcys concentrations and atherosclerosis as measured by coronary angiography (normal = 10.9 mumol/L, mild = 8.6 mumol/L, moderate = 10.9 mumol/L, severe = 10.5 mumol/L; ANOVA = 0.29). CONCLUSIONS: These results suggest that tHcys concentration is not a good predictor of atherosclerotic coronary disease in our patient population.

Vagotomía troncular o altamente selectiva en la úlcera péptica duodenal / Truncal or highly slective vagotomy in duodenal peptic ulcer

Se analizaron los resultados del tratamiento quirúrgico electivo de la úlcera duodenal con la vagotomía altamente selectiva (VAS) y la vagotomía troncular más piloroplastia (VT + P) en el Hospital Militar Central "Dr. Carlos J. Finlay", durante un período de 10 años. Se sometieron 36 pacientes a VAS y 67 a VT + P y se halló un mayor número de complicaciones trans y posoperatorias con esta última. Las recidivas se presentaron con pocas diferencias entre ambas técnicas (16,4 porciento para la VT + P y 13, 9 porciento para la VAS), pero en la VAS el 80 porciento resolvió con tratamiento médico, mientras que en la VT + P sólo el 36,4 porciento curó por esta vía. El costo por estadía fue menor en la VAS (80 porciento menos de 7 días) con una mejor aptitud para el trabajo en este mismo grupo (83,3 porciento) después de operados y con resultados finales satisfactorios superiores (80,6 porciento) a la VT + P(AU)

The results of the elective surgical treatment of duodenal ulcer with highly selective vagotomy (HSV) and truncal vagotomy plus pyloro-plasty (TV+P) at the Dr. "Carlos J. Finlay" Central Military Hospital during 10 years were analyzed. 36 patients underwent HSV and 67 TV+P. A higher number of transand postoperative complications were found in the latter. Relapses showed little differences between both techniques (16. 4 percent) for TV+P and 13. 9 percent for HSV). 80 percent of those who underwent HSV resolved with medical treatment, whereas only 36.4 percent of the patients that in HSV (80 percent less than 7 days) with a better aptitude for work in this same group (83.3 percent) after being operated on and with higher final satisfactory results ( 80. 6 percent) than TV+P(AU)

Plasma glutathione concentrations in non-infected infants born from HIV-infected mother: developmental profile

Glutathione (GSH) is the primary antioxidant in humans. Oxidative cellular injury is postulated to be centrally involved in diverse processes including ging, cancer, cardiovascular disease, and Human Immunodeficiency Virus (HIV) disease progression. Normal plasma GSH concentrations have been well haracterized in healthy children and adults, but not during infant development. The objectives of this study were to: a) measure plasma GSH concentrations in non-infected infants born from HIV-infected mothers, to b) assess the developmental ariations with age and gender, and c) evaluate for possible associations with growth, anemia, and other maternal and infant variables. One hundred and seventy (170) plasma samples from 44 HIV-uninfected infants (birth to 18 mos.) born to HIV-infected mothers from the Women and Infant Transmission Study (Puerto Rico site) were analyzed. The total plasma GSH geometric mean concentration for all samples analyzed was 1.94 (1.06) mumoles/L. A developmental effect of age was seen with lower concentrations in younger infants (0-2 months) than in older infants 4-18 months. There was no significant effect of gender, anemia, zidovudine exposure, maternal age, maternal CD4 cell percent, or infant growth, although a trend towards increasing GSH concentration was seen with increasing weight for height z-score. These findings have multiple clinical ramifications including prediction of capacity to detoxify oxidants at different ages, and partial explanation for the increased viral loads seen in HIV-infected infants