Consideraciones sobre el concepto «salud«: Una propuesta cubana / Considerations on the "health" concept: a Cuban proposal

RESUMEN Introducción: La salud, como meta a lograr, se ha conceptualizado en cuanto a los diferentes países, momentos y contextos socio-históricos, condiciones económicas y criterios de organizaciones y autores. Objetivo: Establecer un consenso ajustado a la actualidad, con punto de partida en los conceptos de salud más difundidos y aceptados. Métodos: Se realizó un análisis de diferentes artículos, revistas y libros publicados relacionados con el tema, además de una revisión de bibliografía impresa y una búsqueda en Internet a través de Google e Infomed. El proceso de revisión se extendió entre octubre de 2019 y enero de 2020. Se analizó cada concepto enunciado y se tuvieron en cuenta las experiencias de los autores en diferentes momentos de su vida personal y profesional, dentro y fuera del país. Conclusiones: En esta investigación se demostraron las carencias de cada concepto enunciado. Luego de su valoración, se propuso un concepto de salud propio para los estándares de Cuba (sin limitar su aplicación fuera de las fronteras del país) relacionado con la realidad actual y el Sistema Integral de Salud.

ABSTRACT Introduction: health, as a goal to be achieved, has been conceptualized in terms of different countries, socio-historical contexts and moments, economic conditions and criteria of organizations and authors. Objective: to establish a consensus in line with the current state of the art, based on the most widespread and accepted health concepts. Methods: an analysis of different published articles, journals and books related to the topic was carried out, in addition to a review of printed literature and an Internet search using Google and Infomed. The review process lasted from October 2019 to January 2020. Each concept was analyzed and authors' experiences in different moments of their personal and professional lives, inside and outside the country, were taken into account. Conclusions: shortcomings of each enunciated concept were demonstrated in this research. After its evaluation, a health concept was proposed for Cuban standards related to the current reality and the Integrated Health System (without limiting its application outside the country's borders).

Algunas consideraciones sobre promoción de salud / Some considerations about health promotion

RESUMEN Introducción: la promoción de salud constituye una herramienta fundamental en la práctica médica ya que va más allá de la mera información al paciente sobre su dolencia y tratamiento. Objetivos: analizar la bibliografía seleccionada sobre la promoción y prevención de salud. Métodos: se tomaron como base criterios personales y un grupo de conceptos y definiciones sobre promoción y prevención de salud con la finalidad de provocar el debate y la polémica entre los profesionales. Se realizó la revisión de disímiles bibliografías cubanas y extranjeras, relacionadas con este tema y con temas afines. Se analizaron diferentes criterios sobre lo que realmente significa promover salud en sus tres dimensiones: biológica, psicológica y social. Esto constituye una herramienta para el personal sanitario sin distinción de perfiles ni niveles de atención en dependencia de su trabajo. Conclusiones: se concluyó que la promoción y el tratamiento forman parte indisoluble de la práctica médica actual.

ABSTRACT Introduction: health promotion constitutes a fundamental tool in medical practice since it goes beyond mere information to patients about their disease and treatment. Objective: to analyze the selected bibliography on health promotion and prevention. Methods: various personal criteria and a group of concepts and definitions on health promotion and prevention were taken as a basis in order to provoke debate and controversy among professionals. A review of dissimilar Cuban and foreign bibliographies related to this topic and related topics was carried out; different criteria were analyzed on what it really means to promote health in its three biological, psychological and social dimensions. This constitutes a tool for health personnel without distinction of profiles or levels of care depending on their work. Conclusions: we concluded that promotion and treatment are an inseparable part of current medical practice.

Toxicological, Enzymatic, and Molecular Assessment of the Insecticide Susceptibility Profile of Triatoma infestans (Hemiptera: Reduviidae, Triatominae) Populations From Rural Communities of Santa Cruz, Bolivia

A wide range of insecticide resistance profiles has been reported across Bolivian domestic and sylvatic populations of Triatoma infestans (Klug, 1834) (Hemiptera, Reduviidae), including some with levels proven to be a threat for vector control. In this work, the insecticide profile of domestic T. infestans was studied with standardized toxicological bioassays, in an area that has not undergone consistent vector control. F1 first-instar nymphs hatched in laboratory from bugs captured in three communities from the Santa Cruz Department were evaluated with different insecticides. Moreover, the enzymatic activity of esterases and cytochrome P450 monooxygenases was measured in individual insects to evaluate the possible mechanism of metabolic resistance to pyrethroids. In addition, the DNA sequence of sodium channel gene (kdr) was screened for two point mutations associated with pyrethroid resistance previously reported in T. infestans. All populations showed reduced susceptibility to deltamethrin and α-cypermethrin, albeit the RR50 values varied significantly among them. Increased P450 monooxygenases and permethrate esterases suggest the contribution, as detoxifying mechanisms, to the observed resistance to deltamethrin in all studied populations. No individuals presented either mutation associated to resistance in the kdr gene. The level of susceptibility to α-cypermethrin, the insecticide used by the local vector control program, falls within an acceptable range to continue its use in these populations. However, the observed RR50 values evidence the possibility of selection for resistance to pyrethroids, especially to deltamethrin. Consequently, the use of pyrethroid insecticides should be closely monitored in these communities, which should be kept under entomological surveillance and sustained interventions.

Is imidacloprid an effective alternative for controlling pyrethroid-resistant populations of Triatoma infestans (Hemiptera: Reduviidae) in the Gran Chaco ecoregion?

The prevention of Chagas disease is based primarily on the chemical control of Triatoma infestans (Klug) using pyrethroid insecticides. However, high resistance levels, correlated with control failures, have been detected in Argentina and Bolivia. A previous study at our laboratory found that imidacloprid could serve as an alternative to pyrethroid insecticides. We studied the delayed toxicity of imidacloprid and the influence of the blood feeding condition of the insect on the toxicity of this insecticide; we also studied the effectiveness of various commercial imidacloprid formulations against a pyrethroid-resistant T. infestans population from the Gran Chaco ecoregion. Variations in the toxic effects of imidacloprid were not observed up to 72 h after exposure and were not found to depend on the blood feeding condition of susceptible and resistant individuals. Of the three different studied formulations of imidacloprid on glass and filter paper, only the spot-on formulation was effective. This formulation was applied to pigeons at doses of 1, 5, 20 and 40 mg/bird. The nymphs that fed on pigeons treated with 20 mg or 40 mg of the formulation showed a higher mortality rate than the control group one day and seven days post-treatment (p < 0.01). A spot-on formulation of imidacloprid was effective against pyrethroid-resistant T. infestans populations at the laboratory level.

Analysing deltamethrin susceptibility and pyrethroid esterase activity variations in sylvatic and domestic Triatoma infestans at the embryonic stage

The aim of the present work was to study the deltamethrin susceptibility of eggs from Triatoma infestans populations and the contribution of pyrethroid esterases to deltamethrin degradation. Insects were collected from sylvatic areas, including Veinte de Octubre and Kirus-Mayu (Bolivia) and from domiciliary areas, including El Palmar (Bolivia) and La Pista (Argentina). Deltamethrin susceptibility was determined by dose-response bioassays. Serial dilutions of deltamethrin (0.0005-1 mg/mL) were topically applied to 12-day-old eggs. Samples from El Palmar had the highest lethal dose ratio (LDR) value (44.90) compared to the susceptible reference strain (NFS), whereas the Veinte de Octubre samples had the lowest value (0.50). Pyrethroid esterases were evaluated using 7-coumaryl permethrate (7-CP) on individually homogenised eggs from each population and from NFS. The El Palmar and La Pista samples contained 40.11 and 36.64 pmol/min/mg protein, respectively, and these values were statistically similar to NFS (34.92 pmol/min/mg protein) and different from Kirus-Mayu and Veinte de Octubre (27.49 and 22.69 pmol/min/mg protein, respectively). The toxicological data indicate that the domestic populations were resistant to deltamethrin, but no statistical contribution of 7-CP esterases was observed. The sylvatic populations had similar LDR values to NFS, but lower 7-CP esterase activities. Moreover, this is the first study of the pyrethroid esterases on T. infestans eggs employing a specific substrate (7-CP).

Toxicological and biochemical analysis of the susceptibility of sylvatic Triatoma infestans from the Andean Valley of Bolivia to organophosphate insecticide

To increase our knowledge of the natural susceptibility of Triatoma infestans to an organophosphate insecticide, we performed toxicological and biochemical studies on three sylvatic populations from Bolivia and two populations from domestic dwellings from Bolivia and Argentina. Fifty-per-cent lethal doses (LD50) were determined based on the topical application of fenitrothion on first instar nymphs and mortality was assessed at 24 h. Both type of populations exhibited LD50ratios significantly higher than 1 with a range of the values (1.42-2.47); the maximum value were found in a sylvatic (-S) population, Veinte de Octubre-S. Samples were biochemically analysed using a glutathione S-transferase activity assay. The highest significant activity was obtained for Veinte de Octubre-S and the lowest activity was obtained for the reference population (102.69 and 54.23 pmol per minute per mg of protein respectively). Two out of the three sylvatic populations (Veinte de Octubre-S and Kirus Mayu-S) exhibited significantly higher glutathione S-transferase activity than that of the reference population. Based on this analysis of the natural susceptibility of this organism to organophosphate insecticides, continental and focal surveys of organophosphate susceptibility should be conducted to evaluate the evolution and distribution of this phenomenon.

Toxicity of non-pyrethroid insecticides against Triatoma infestans (Hemiptera: Reduviidae)

Triatoma infestans (Klug) is the main vector of Chagas disease, which is a public health concern in most Latin American countries. The prevention of Chagas disease is based on the chemical control of the vector using pyrethroid insecticides. In the last decade, different levels of deltamethrin resistance have been detected in certain areas of Argentina and Bolivia. Because of this, alternative non-pyrethroid insecticides from different chemical groups were evaluated against two T. infestans populations, NFS and El Malá, with the objective of finding new insecticides to control resistant insect populations. Toxicity to different insecticides was evaluated in a deltamethrin-susceptible and a deltamethrin-resistant population. Topical application of the insecticides fenitrothion and imidacloprid to first nymphs had lethal effects on both populations, producing 50% lethal dose (LD50) values that ranged from 5.2-28 ng/insect. However, amitraz, flubendiamide, ivermectin, indoxacarb and spinosad showed no insecticidal activity in first instars at the applied doses (LD50 > 200 ng/insect). Fenitrothion and imidacloprid were effective against both deltamethrin-susceptible and deltamethrin-resistant populations of T. infestans. Therefore, they may be considered alternative non-pyrethroid insecticides for the control of Chagas disease.

Evaluation of the toxic and teratogenic potential of the anticonvulsant drug 4-hydroxy, 4-ethyl, 4-phenylbutyramide in mice

The toxicity profiles of the phenyl alcohol amides: 4-hydroxy, 4-ethyl, 4-phenylbutyramide (HEPB) and two lower homologous: 3-hydroxy, 3-ethyl, 3-phenylpropionamide (HEPP) and 2 hydroxy, 2-ethyl, 2-phenylacetamide (HEPA) were studied in mice. TD50 value was determined by oral administration and LD50 by oral and intraperitoneal routes. The results indicate that HEPP is less toxic than the others, both of which had very similar toxicity. Furthermore, the teratogenic potential of HEPB was investigated in mice after oral administration. The compound was administered on days 6 - 15 of gestation at doses of 0, 5, 25, 50 or 100 mg/kg of weight. On day 17 of pregnancy the mice were sacrifed and the pups examined. An increase of body weight in both mothers and fetuses was observed at 25 and 50 mg/kg, as a sign of maternal toxicity. Considering the litter data, embryotoxicity and fetotoxicity were only shown at the highest dose. Howeever, the HEPB treatment did not result in malformations of live fetuses or resorptions when the implantations were considered as the individual entity