ABSTRACT Transcranial Doppler ultrasound is a non-invasive method that allows adequate monitoring of the different parameters that help define behaviors for intensivist physicians ; however, its use is not widespread among the medical communities that care for children with neurocritical conditions. It is the purpose of the authors to update the topic under study and present their experience with pediatric populations. The indications for this method come from research in adult patients . Multicenter studies in different clinical contexts are needed to establish this technique as a reliable diagnostic method in pediatric patients. We conclude that using transcranial Doppler as an auxiliary test in the estimation of intracranial pressure and cerebral perfusion pressure, provides the implementation of therapeutic resources in front of the patient as accurate as possible and offers the possibility of monitoring and evaluating bedside treatments in a minimally invasive way.

RESUMEN La ecografía Doppler transcraneal es un método no invasivo que permite una adecuada monitorización de los diferentes parámetros que ayudan a definir conductas para los médicos intensivistas, sin embargo, su utilización no está generalizada entre las comunidades médicas que atienden niños con afecciones neurocríticas. Es propósito de los autores, actualizar el tema en estudio y presentar su experiencia en población pediátrica. Las indicaciones de este método provienen de investigaciones en pacientes adultos, se necesitan estudios multicéntricos en diferentes contextos clínicos para poder establecer esta técnica como un método de diagnóstico confiable en pacientes pediátricos. Concluimos que utilizar el Doppler transcraneal como prueba auxiliar en la estimación de la presión intracraneal y presión de perfusión cerebral, proporciona adoptar recursos terapéuticos frente al paciente lo más acertados posibles y brinda la posibilidad de hacer un seguimiento y evaluación de los tratamientos a pie de cama de forma mínimamente invasiva.

ABSTRACT Introduction: In Cuba, the nasal application of recombinant human IFN-alpha- 2b (nasalferon) began in personnel at risk in order to prevent SARS-CoV-2 infection. Objective: To characterize the safety in those subjects exposed to the use of Nasalferon at the Surgical Medical Research Center and to explore the effect of the prophylactic use of the drug against acute respiratory symptoms mainly caused by SARS-CoV-2. Material and Methods: Monocentric, prospective, open, and early surveillance epidemiological study conducted in healthcare workers who were administered Nasalferon. Surveillance was performed using the Prescription-Related Adverse Event Monitoring Surveillance method. The main variable was the presence of adverse events. Secondarily, the effect of the drug in preventing virus infection was explored. For the analysis of the main variable, the proportion of subjects who experienced each of the adverse events was estimated. In addition, the frequency distribution of the type of event, intensity, severity, and causality or imputability were estimated. Results: A total of 86 subjects were included; 50 of them experienced 15 types of adverse events. No severe or serious events were reported. Headache, leukopenia, decay, and arterial hypertension were classified as moderate ones. During the whole duration of the treatment and until a month after it, none of the subjects included in the study presented COVID-19 or other viral acute respiratory symptoms. Conclusions: Nasalferon proved to be a safe and tolerable drug and the included subjects did not present acute respiratory symptoms related or unrelated to COVID-19.

RESUMEN Introducción: En Cuba se empezó la aplicación nasal de IFN alfa 2b recombinante humano (Nasalferon) en personal de riesgo para prevenir la infección por el SARS-CoV-2. Objetivo: caracterizar la seguridad de los expuestos al uso del Nasalferon en el Centro de Investigaciones Médico Quirúrgicas y explorar el efecto del uso profiláctico del fármaco contra cuadros respiratorios agudos causados preferentemente por el SARS-CoV-2. Material y Métodos: Estudio epidemiológico monocéntrico, prospectivo, abierto, de vigilancia temprana en trabajadores sanitarios, a los que se le administró nasalferon. Se realizó la vigilancia mediante el método de Vigilancia del Monitoreo de Eventos Adversos Ligados a la Prescripción. La variable principal fue la presencia de eventos adversos. Secundariamente se exploró el efecto del fármaco en la prevención de infección por el virus. Para el análisis de la variable principal se estimó la proporción de sujetos con cada uno de los eventos adversos que se presentaron. Se estimaron, además, la distribución de frecuencia del tipo de evento, intensidad, gravedad y la causalidad o imputabilidad. Resultados: Se incluyeron 86 sujetos, de ellos, 50 experimentaron 15 tipos de eventos adversos. No se reportaron eventos severos ni graves. Los catalogados como moderados fueron: cefalea, leucopenia, decaimiento e hipertensión arterial. Durante el tiempo que duró el tratamiento y hasta un mes después de este, ninguno de los sujetos incluidos presentó COVID-19 ni otros cuadros respiratorios agudos virales. Conclusiones: El Nasalferon resultó ser un fármaco seguro y tolerable y los sujetos incluidos no presentaron cuadros respiratorios agudos relacionados o no con la COVID-19.

Abstract INTRODUCTIONSARS-CoV-2 infection can produce endothelial injury and microvascular damage, one cause of the multiorgan failure associated with COVID-19. Cerebrovascular endothelial damage increases the risk of stroke in COVID-19 patients, which makes prompt diagnosis important. Endothelial dysfunction can be evaluated by using transcranial Doppler ultrasound to study cerebral hemodynamic reserve, but there are few of these studies in patients with COVID-19, and the technique is not included in COVID-19 action and follow-up guidelines nationally or internationally. OBJECTIVEEstimate baseline cerebral hemodynamic patterns, cerebral hemodynamic reserve, and breath-holding index in recovered COVID-19 patients. METHODWe conducted an exploratory study in 51 people; 27 men and 24 women 20–78 years of age, divided into two groups. One group comprised 25 recovered COVID-19 patients, following clinical and epidemiological discharge, who suffered differing degrees of disease severity, and who had no neurological symptoms or disease at the time they were incorporated into the study. The second group comprised 26 people who had not been diagnosed with COVID-19 and who tested negative by RT-PCR at the time of study enrollment. Recovered patients were further divided into two groups: those who had been asymptomatic or had mild disease, and those who had severe or critical disease. We performed transcranial Doppler ultrasounds to obtain baseline and post-apnea tests of cerebral hemodynamic patterns to evaluate cerebral hemodynamic reserve and breath-holding indices. We characterized the recovered patient group and the control group through simple descriptive statistics (means and standard deviations). RESULTSThere were no measurable differences in baseline cerebral hemodynamics between the groups. However, cerebral hemodynamic reserve and breath-holding index were lower in those who had COVID-19 than among control participants (19.9% vs. 36.8% and 0.7 vs. 1.2 respectively). These variables were similar for patients who had asymptomatic or mild disease (19.9% vs.19.8%) and for those who had severe or critical disease (0.7 vs. 0.7). CONCLUSIONSPatients recovered from SARS-CoV-2 infection showed decreased cerebral hemodynamic reserve and breath-holding index regardless of the disease’s clinical severity or presence of neurological symptoms. These abnormalities may be associated with endothelial damage caused by COVID-19. It would be useful to include transcranial Doppler ultrasound in evaluation and follow-up protocols for patients with COVID-19.

ABSTRACT Objectives: to describe the behavior of the myopic defect up to one year of life, in patients who developed retinopathy of prematurity, and to determine the main risk factors for it. Method: a descriptive, longitudinal, prospective study was carried out in 37 patients who, having been treated for retinopathy of prematurity or not, maintained a stable follow-up in consultation after the acute phase of the disease. They were evaluated at 6 and 12 months of life taking into account the variables gestational age at birth, birth weight, type of retinopathy of prematurity, presence of myopia. Results: Median gestational age and birth weight were 30.2 weeks and 1287g. At 6 months, 5 eyes of 27 patients (considering only the right eyes) presented myopia, which represents 18.5%. At 12 months this value increased to 44.4%. Gestational age and birth weight were not related to the development of myopia (p = 0.072) and p = 0.397) at 12 months. In patients with severe retinopathy of prematurity, myopic defect was more frequent (p = 0.003). Conclusions: prematurity and birth weight were not variables that influenced the appearance of myopia. On the contrary, severe retinopathy of prematurity was associated with greater myopia, especially at 12 months.

RESUMEN Objetivos: describir el comportamiento del defecto miópico hasta el año de vida, en pacientes que desarrollaron retinopatía de la prematuridad, y determinar los principales factores de riesgo del mismo. Método: se realizó un estudio descriptivo, longitudinal, prospectivo en 37 pacientes que, habiendo sido tratados o no por retinopatía de la prematuridad, mantuvieron un seguimiento estable en consulta posterior a la fase aguda de la enfermedad. Fueron evaluadas a los seis y 12 meses de vida teniendo en cuenta las variables edad gestacional al nacer, peso al nacer, tipo de retinopatía de la prematuridad, presencia de miopía. Resultados: la mediana de edad gestacional y peso al nacer fueron 30,2 semanas y 1 287 g. A los seis meses cinco ojos de 27 pacientes (considerando solo los ojos derechos) presentaron miopía, lo cual representa el 18,5 %. A los 12 meses este valor se incrementó a 44,4 %. La edad gestacional y el peso al nacer no mostraron relación con el desarrollo de miopía (p = 0,072 y p = 0,397) a los 12 meses. En pacientes con retinopatía de la prematuridad grave el defecto miópico resultó más frecuente (p = 0,003). Conclusiones: la prematuridad y el peso al nacer no constituyeron variables que influyeran en la aparición de miopía. Por el contrario, la retinopatía de la prematuridad grave sí se asoció con una mayor miopía, sobre todo a los 12 meses.

Pleural effusion is a common condition in critically ill patients (both clinical and surgical). Its diagnosis and classification are important for followup of patients with cardiorespiratory difficulty. Lung ultrasound is used for this purpose, but no reports have been published on its use in Cuba with critically ill patients in intensive care units. We performed lung ultrasound on 144 such patients with cardiorespiratory illnesses, average age 54 years, predominantly men (66%; 95/144), with average APACHE II score 13.6, and 22.1% mortality risk. Patients were divided into two groups: clinical (bronchopneumonia and cardiac insufficiency) and surgical (postoperative liver and kidney transplant or vascular and cardiovascular surgery) to diagnose and classify pleural effusion according to locus (right, left and bilateral) and structural pattern (I, II A, II B, III and IV). Pleural effusions were diagnosed in 81.2% (117/144) of patients (clinical 44.4%, 52/117; surgical 55.6%, 65/117). Bilateral location was the most common (68.4%, 80/117), followed by right (23.9%, 28/117) and then left (7.7%, 9/117). Structural pattern I (anechoic appearance) was observed in 61.5% of cases (72/117); 21.4% (25/117) were II A, 12.8% (15/117) II B, 3.4% (4/117) III, and 0.9% (1/117) were IV. We found no association between pleural effusion localization and ultrasound structural pattern in clinical patients (Fisher exact test 4.2 p = 0.9). In surgical patients, however, complex ultrasound patterns (II A, II B and III) were significantly more common in bilateral forms (Fisher exact test 14.1; p = 0.009). Further studies of this type in Cuba will help provide useful data for prompt treatment and followup of these patients.

INTRODUCTION: Knowledge of prognostic factors in end-stage renal disease patients has improved dialysis management and methods for reducing morbidity and mortality, underlining the importance of identification, prevention and control of these factors. OBJECTIVE: Identify factors affecting prognosis (survival or death) in hemodialysis patients at the Medical-Surgical Research Center in Havana over a ten-year period. METHODS: Descriptive, prospective study of 81 end-stage renal disease patients who received hemodialysis at the Medical-Surgical Research Center from 1995 to 2004. Prognostic factors were identified at initiation of and during dialysis treatment, using chi square, t test, McNemar test, Kaplan Meier analysis, log-rank test and Cox regression model, with significance threshold set at p <0.05. RESULTS: Hypertension and diabetes were the leading causes of end-stage renal disease. Six patients were referred late. Mean survival was 4.4 years; with survival of 86.6%, 54.7% and 26.6% at one, three and five years respectively. Factors predictive of decreased survival that were most frequent at initiation of hemodialysis were hypertension and chronic anemia (both present in 95.9% of cases); malnutrition, hypoalbuminemia, cardiovascular disease and chronic liver disease increased during treatment while hypertension decreased. In multivariate analysis, prognostic factors that significantly predicted decreased survival were hypertension, inadequate vascular access and diabetes. Patients aged <60 years and those with malnutrition, hypoalbuminemia, anemia, cardiovascular disease or liver disease had lower survival figures at the end of the study period. Leading causes of death were infections (45.2%) and cardiovascular disease (41.9%); the latter was present in 93.5% of deaths, independent of underlying cause of death. CONCLUSIONS: Survival of hemodialysis patients diminished at five years. Some negative predictive factors are present at initiation of hemodialysis, such as diabetes, hypertension and chronic anemia; others increased later, including malnutrition, hypoalbuminemia, cardiovascular disease and liver disease.

Introduction: lower respiratory infections rank first among related infections in health care intensive care units. Objectives: to describe the incidence and consequences of stay and mortality of ventilator-associated tracheobronchitis (TAVM) in ICU. Methods: a multicenter, descriptive, prospective and cross-sectional study was conducted in 6 adult ICU. 454 patients were studied. The study variables were collected in two databases. Results: TAVM incidence rate: 1.76 %, relative to the total number of patients with risk factor: 6.06 %. Incidence density: 7.61 % by 1000 d with risk factor. Average stay, TAVM: 13.13 d, patients without IRCS: 5.49 d (p = 0.006). Mortality, TAVM: 25 %, VAP: 55.2 %, patients without IRCS: 14.9 % (p = 0.000). Conclusions: TAVM is not uncommon in ICU. Its diagnosis involves increased stay and its mortality in ventilated patients. The implementation of surveillance and prevention measures is requiered.

Introducción: las infecciones respiratorias bajas ocupan el primer lugar entre las infecciones relacionadas con el cuidado sanitario en unidades de cuidados intensivos. Objetivos: describir la incidencia y las consecuencias, sobre estadía y mortalidad, de la traqueobronquitis asociada a ventilación mecánica (TAVM) en UCI. Métodos: estudio multricéntrico, descriptivo, prospectivo y transversal, en 6 UCI de adultos. Se estudiaron 454 pacientes. Las variables de estudio fueron recogidas en 2 bases de datos. Resultados: tasa de incidencia de TAVM: 1,76 %. Con respecto al número total de pacientes con factor de riesgo: 6,06 %. Densidad de incidencia: 7,61 ‰ por 1 000 d con factor de riesgo. Estadía media, TAVM: 13,13 d, pacientes sin IRCS: 5,49 d (p=0,006). Mortalidad, TAVM: 25 %, NAVM: 55,2 %, pacientes sin IRCS: 14,9 % (p=0,000). Conclusiones: la TAVM no es infrecuente en UCI. Su diagnóstico implica aumento de estadía y mortalidad en pacientes ventilados. Se justifica la implementación de medidas de vigilancia y prevención.

Introduction: Non-medical staff members in hospitals are highly credible at population level, and are a source of opinion even though they do not have sufficient medical training. Objectives: To analyse the attitudes of non-medical professionals of Spanish and Latin American hospitals towards organ donation and identify the factors that influence these attitudes. Material and method: Through the "Proyecto Colaborativo Internacional Donante" (International Collaborative Donor Project), a stratified random sample was selected from non-medical services of eleven hospitals: 3 Spanish (n=277), 5 Mexican (n=632), 2 Cuban (n=42) and 1 Costa Rican (n=101). Results: Of the 1052 professionals surveyed, 72% (n=754) were in favour of donating an organ after death. By country, 98% of Cubans, 80% of Mexicans, 66% of Costa Ricans and 52% of Spanish were in favour (P<.001). The most influential variables were: 1) country, with results being more positive in Mexico (odds ratio [OR]=2.197), 2) believing in the possibility that they will require a transplant (OR=2.202), 3) having discussed the issue with their family (OR=3.23), 4) the positive attitude of their partner towards donation (OR=3.322), 5) not being concerned about possible mutilation of their body after donation (OR=3.378), 6) preferring options other than burial (OR=2.525), 7) accepting an autopsy (OR=2.958). Conclusions: The attitude of non-medical staff members of hospitals towards the donation of their own organs varies greatly depending on the country of the respondent. Psychosocial factors that influence these attitudes are similar to those described at the population level.

Introducción: El personal no sanitario de centros hospitalarios tiene una importante credibilidad a nivel poblacional, siendo un grupo generador de opinión sin formación sanitaria adecuada. Objetivo: Analizar la actitud hacia la donación de los órganos de los profesionales no sanitarios de hospitales españoles y latinoamericanos, y determinar los factores que condicionan dicha actitud. Material y métodos: Del Proyecto Colaborativo Internacional Donante se selecciona una muestra aleatoria y estratificada entre los servicios no sanitarios de once hospitales: 3 españoles (n = 277), 5 mexicanos (n = 632), 2 cubanos (n = 42) y 1 costarricense (n = 101). Resultados: De los 1052 profesionales encuestados, el 72 % (n = 754) está a favor de la donación de órganos tras fallecer. Por país, el 98 % de los cubanos están a favor, el 80 % de los mexicanos, el 66 % de los costarricenses y el 52 % de los españoles (p < 0,001). Las variables con más peso son: 1) país, siendo más favorable en México (odds ratio [OR] = 2,197); 2) creer en la posibilidad de necesitar un trasplante (OR = 2,202); 3) haber comentado el tema con la familia (OR = 3,23); 4) actitud favorable de la pareja hacia la donación (OR = 3,322); 5) no estar preocupado por la posible mutilación del cuerpo tras la donación (OR = 3,378); 6) preferir otras opciones distintas de la inhumación (OR = 2,525); 7) aceptar la realización de una autopsia (OR = 2,958). Conclusiones: La actitud hacia la donación de órganos propios entre el personal no sanitario de centros hospitalarios presenta variaciones importantes según el país del encuestado. Los factores psicosociales que condicionan dicha actitud son similares a los descritos a nivel poblacional.

INTRODUCTION: Continuous venovenous hemodiafiltration, generally used in patients with acute renal failure, enables elimination of humoral mediators of systemic inflammatory response and sepsis from blood. This effect should improve treatment results in patients with multiple organ dysfunction, but evidence of improved survival is insufficient. OBJECTIVES: Describe the effect of continuous venovenous hemodiaflitration on patients with multiple organ dysfunction syndrome in terms of systemic and brain hemodynamics, oxygenation, metabolism and status on ICU separation. METHODS: An observational case series was done of 18 patients (11 men and 7 women) aged 24-78 years with multiple organ dysfunction syndrome treated with continuous venovenous hemodiafiltration in the Medical-Surgical Research Center's ICU in Havana. General, systemic and brain hemodynamic, oxygenation and metabolic variables were assessed immediately before and 12 hours after starting the procedure; vital status on separation from intensive care was recorded. For analysis, patients were grouped by whether cause of multiple organ dysfunction syndrome was septic or nonseptic. Variable means before and after treatment were compared using the Wilcoxon matched pairs test. Standardized mortality ratios were calculated for both groups, with survival efficacy defined by a ratio of <0.9. RESULTS: After 12 hours continuous venovenous hemodiafitration, the septic group showed clinical improvement, with statistically significant improvement in all variables except mean arterial pressure and brain hemodynamics. Survival to discharge from ICU was 64%, with a standardized mortality ratio of 0.66. In the nonseptic group, survival was 0% and ratio was 2.13; temperature was the only variable found to improve significantly. CONCLUSIONS: Continuous venovenous hemodiafltration improved clinical parameters and survival in patients with multiple organ dysfunction of septic origin. Further studies are needed with larger numbers of patients to corroborate these results.

Viral myocarditis is the result of a myocardial inflammation provoked by different viruses. This cardiac disease is doubtless a cardiovascular urgency in the adult due to its complications. The clinical picture is characterized by arrhythmias and cardiac failure that may to lead to death. The more frequent long-term myocarditis sequela is the dilated myocardiopathy. In present paper etiology, pathophysiology, symptomatology, diagnosis and treatment of viral myocarditis in the adult are reviewed.

La miocarditis viral es resultado de una inflamación del miocardio provocada por diferentes virus. Esta enfermedad cardíaca constituye sin duda una urgencia cardiovascular en el adulto por las complicaciones que ocasiona. El cuadro clínico se caracteriza por arritmias e insuficiencia cardíaca que pueden conducir a la muerte. La secuela más frecuente de la miocarditis viral a largo plazo es la miocardiopatía dilatada. En el presente trabajo se revisa etiología, fisiopatología, sintomatología, diagnóstico y tratamiento de la miocarditis viral en el adulto.

The objective of this multicentre study was to identify the concentrations of cardiac troponin I having a higher probability of cardiovascular and extracardiovascular complications in patients with acute myocardial infarction that were treated with or without fibrinolysis at the intensive care units. These patients were followed for 10 days and divided into two prognostic groups: one without complications (n = 53) and other with clinical complications (n = 28). The plasma extracted from 3 h to 72 h after the onset of symptoms was retrospectively evaluated in an enzyme linked immunoadsorbent assay amplified with streptavidin-biotin for quantifying cardiac troponin I. About 45% of the patients had received recombinant streptokinase for fibrinolysis, from the onset of the symptoms and up to 6 hours. In the fibrinolysis group (n = 32), the concentrations of cardiac troponin I of complicated patients were similar to uncomplicated patients. Cardiac troponin I concentrations in patients without fibrinolysis (n = 49) were higher in complicated than in non-complicated patients (W = 287, p = 0.016). The biological activities of other cardiac biomarkers in complicated patients were as high as in uncomplicated patients treated with or without fibrinolysis. The concentration of cardiac troponin I of 2 ng/mL or higher, was a good predictor of the risk of clinical complications in patients without fibrinolysis (odds ratio: 6.6; 95% confidence interval: 1.5-29.4). In the infarction patients without therapeutic fibrinolysis, cardiac troponin I concentrations could be used to stratify them at the intensive care units and may be evaluated as an indicator of fibrinolysis in other studies.

El objetivo de este estudio multicéntrico fue identificar las concentraciones de troponina I cardiaca con mayor probabilidades de complicaciones cardiovasculares y extracardiovasculares en los pacientes con infarto miocárdico agudo que fueron tratados con o sin fibrinolisis en las unidades de cuidados intensivos. Estos pacientes fueron seguidos clínicamente por 10 días y divididos en dos grupos: no complicado (n = 53) y complicado (n = 28). Los plasmas extraídos de los pacientes desde las 3 horas a las 72 horas de inicio de los síntomas fueron retrospectivamente evaluados en un análisis inmunoenzimático en fase sólida amplificado con estreptavidina-biotina para cuantificar troponina I cardiaca. Alrededor del 45% de los pacientes estudiados recibieron fibrinolisis con estreptoquinasa recombinante desde el inicio de los síntomas a 6 horas de evolución. Con la fibrinolisis (n = 32), los pacientes complicados tuvieron las concentraciones de troponina I cardiaca similares a los no complicados. Cuando no se indicó la fibrinolisis (n = 49), los pacientes complicados presentaron mayores concentraciones de troponina I cardiaca que los no complicados (W = 287, p = 0.016). Las actividades biológicas de otros biomarcadores cardiacos fueron similares entre los pacientes complicados y no complicados en el tratamiento con o sin fibrinolisis. La concentración de troponina I cardiaca mayor o igual a 2 ng/ mL fue un buen predictor de riesgos de complicaciones clínicas en los pacientes sin fibrinolisis (razón de productos cruzados: 6.6; intervalo de confianza de 95%: 1.5-29.4). Los pacientes con infarto miocárdico agudo tratados sin fibrinolisis pudieran ser mejor estratificados por riesgos de complicaciones mediante la determinación de las concentraciones de troponina I cardiaca. Este biomarcador pudiera ser evaluado como indicador de fibrinolisis en estudios posteriores.

Acute respiratory infections are the first cause of visits to the physician's offices and of morbidity in the developing and developed countries. Children under 5 have some physiological and immunological characteristics that make them more susceptible to present these respiratory processes. In spite of the fact that the lower respiratory infection usually attracts the attention due to their greater complexity, cost of treatment and complications, the upper are more frequent at the outpatient department. Due to their common presentation at the allergology department and to the load of anxiety generated in the relatives of these children with recurrent respiratory infections, it was decided to make a review of some aspects of interest related to them. It was our objective to improve the knowledge of these entities to identify those children with higher risk for presenting recurrence of these respiratory infections. These entities, which are most of viral aetiology and limited course are an important cause of the use and abuse of drugs, such as antibiotics, with harmful effects for the children's health.

Las infecciones respiratorias agudas constituyen la primera causa de consultas médicas y de morbilidad, tanto en los países desarrollados como en los países en vías de desarrollo. Los niños menores de 5 años tienen algunas características fisiológicas e inmunológicas que los hacen más susceptibles para presentar estos procesos respiratorios. A pesar que las infecciones respiratorias agudas bajas concentran habitualmente la atención por su mayor complejidad, costo del tratamiento y complicaciones, son las altas las que se presentan en mayor número en la consulta ambulatoria. Por la frecuente presentación en la consulta de alergología y por la carga de ansiedad que se genera en los familiares de estos niños con infecciones respiratorias recurrentes, nos decidimos a realizar una revisión sobre algunos aspectos de interés relacionados con ellas. Nuestro objetivo es mejorar el conocimiento de estas entidades, para identificar aquellos niños con mayor riesgo de presentar recurrencia de estas infecciones respiratorias. Estas entidades, que en su mayoría son de etiología viral y curso limitado, son causa importante de uso y abuso de medicamentos, entre ellos, los antibióticos, con efectos perjudiciales en la salud de los niños.

En recent years and advances in research field of bronchial asthma, features in its prevention has been changing among specialists treating it. Aim of this paper is to transmit the basic and necessary knowledge to medicine professionals for that in each asthmatic patient treated for the first time, the triggering allergens, aggravating factors, and the surrounded sociocultural ones, affecting him be determined. Authors approach sensitivity to allergens from embryonic stage and the lactation in atopic child, when we must to consider the case of an allergic and in high risk child, the more significant risk factors, with practical experiences in “Calixto García” University Hospital, and recommendations for preventions of allergic diseases in infants and breast-fed child in high risk of allergy.

En los últimos años, y con motivo de los avances que se realizan en el campo de la investigación del asma bronquial, los conceptos en su prevención han ido cambiando entre los especialistas que lo tratan. Este trabajo tiene como objetivo llevar el conocimiento básico necesario a los profesionales de la medicina, para que a cada paciente asmático, atendido por primera vez, se le determinen los alergenos desencadenantes, los factores agravantes y socioculturales que le rodean y que pueden estar afectándolo. Se aborda la sensibilización a alergenos desde la etapa embrionaria y lactancia en el niño atópico, cuándo debemos considerar a un niño con alto riesgo alérgico, los factores de riesgo más importantes, con experiencias prácticas en el Hospital Universitario “Calixto García”, y las recomendaciones para la prevención de las enfermedades alérgicas en lactantes e infantes de alto riesgo alérgico.