RESUMEN La vacunación es una forma de contribuir a la protección de la población al reducir el riesgo de efectos graves de la enfermedad COVID-19. Para marzo de 2021, en tiempo récord, la industria biotecnológica cubana contaba con cinco candidatos vacunales. Se realizó una intervención sanitaria con un esquema heterólogo: dos dosis de SOBERANA®02 más una dosis de SOBERANA®Plus, en trabajadores durante el período de marzo a junio de 2021, en el Instituto Finlay de Vacunas, en La Habana, Cuba. Se evaluaron los efectos directos e indirectos de la vacunación con SOBERANA®02 y SOBERANA®Plus en una cohorte de riesgo de infección, enfermedad y diseminación de la COVID-19. La cohorte se estableció en marzo de 2021 en trabajadores con alta exposición al coronavirus de tipo 2 causante del síndrome respiratorio agudo severo, en el área de consulta médica de Instituto Finlay de Vacunas, establecida como sitio clínico. Entre el 22 de marzo de 2021 y el 11 de junio de 2021, se inscribieron un total de 1.776 participantes; de ellos, 1.719 cumplieron los criterios de inclusión con un porcentaje de 96,79 % para la primera dosis, 1.675 recibieron la segunda dosis y 1.653 se vacunaron SOBERANA®Plus como tercera dosis para un 97,87. Mil cuatrocientos cincuenta y siete tenían entre 19 y 59 años, con predominio del sexo femenino. De los participantes, 175 tuvieron acontecimientos adversos y se observaron, predominantemente, una hora después de la administración de cada dosis. La reacción local más referida fue el dolor en el lugar de la inyección. Se registraron pocos acontecimientos adversos no solicitados. No se notificó ningún evento adverso grave o severo asociado a la vacuna. La distribución de casos de COVID-19 fue de 30, 16 y 6 posterior a cada dosis recibida. No se notificaron muertes asociadas a COVID-19. Las vacunas SOBERANA®02 y SOBERANA®Plus tuvieron un buen perfil de seguridad y fueron capaces de reducir la enfermedad grave por COVID-19 y la muerte, ayudando a revertir la situación epidemiológica causada por el coronavirus de tipo 2 causante del síndrome respiratorio agudo severo en Cuba.

ABSTRACT Vaccination is a way to help protect people by reducing the risk of serious effects from COVID-19 illness. By March of 2021, in record time, Cuba’s biotech industry had five vaccine candidates. A sanitary intervention with a heterologous scheme, two doses of SOBERANA®02 and one dose of SOBERANA®Plus, was carried out in workers during the period of March to June 2021 at Finlay Vaccine Institute, in Havana, Cuba. We evaluated the direct and indirect effects of vaccination with SOBERANA®02 and SOBERANA®Plus, in a cohort at risk of infection, disease and spread of the epidemic COVID-19. The cohort was established in March 2021, among workers with high exposure to SARS-CoV-2, at the area of medical consultation at Finlay Vaccine Institute, established as clinical site. Between March 22, 2021 and June 11, 2021, were enrolled a total of 1,776 participants and, of them, 1,719 met the inclusion criteria with a percentage of 96.79% for first dose, of which 1,675 received the second dose and 1,653 received SOBERANA®Plus as third dose for 97.87%. The majority of participants were aged 19-59 years (1,457), being female, the predominant sex. Among the participants, 175 had adverse events, predominantly observed one hour after the administration of each dose. The most common local reaction was injection site pain. Few unsolicited adverse events were recorded. No vaccine-associated severe or serious adverse events were reported. The distribution of COVID-19 case was 30 post first dose, 16 post second dose and 6 post last dose. No deaths associated with COVID-19 were reported. SOBERANA®02 and SOBERANA®Plus vaccines had a good safety profile and were capable of a reduction of severe COVID-19 illness and death helping to reverse the epidemiological situation caused by the SARS-COV-2 in Cuba.

ABSTRACT The infection with Human Papilloma viruses (HPV) is the most common sexually transmitted disease worldwide. The HPV 16 and 18 types are responsible for around 70% of cervical cancer cases globally. In Cuba, this is the second cancer in incidence and mortality on women between 15 to 44 years old. The viral capsid is formed by 72 capsomeres, composed by L1 and L2 proteins, being L1 the major protein. The available preventive vaccines are based on virus-like particles (VLPs) assembled from L1 protein produced in eukaryotic hosts and they have high prices, which has hindered their deployment in middle- and low-income countries. The bacterium Escherichia coli has been used as an alternative cheaper host for second-generation HPV vaccine production. The aims of this study were to prepare a working cell bank (WCB) of E. coli BL21 (DE3) harboring the HPV18-His-tag-L1-pET28a plasmid, which encodes the HPV18-L1 protein fused to a six-histidine-Tag; as well as to evaluate L1 protein´s production and solubility under isopropyl-β-D-1-thiogalactopyranoside (IPTG) induction and on auto-inducing conditions, as the first step to tackle L1 purification. The highest L1 levels were detected on terrific broth (TB)-grown cultures induced for 4h or 16h with low-IPTG-concentrations (30 and 60 µmolL-1) or with a lactose/glucose mixture for 16 hours. In both conditions, the protein was mainly detected in the insoluble fraction, so its purification will be carried out under denaturing conditions. The available WCB will allow maintaining the constant quality and homogeneity of the initial inoculum during L1 production to develop a robust purification process.

RESUMEN La infección con el virus del Papiloma Humano (VPH) es la enfermedad de transmisión sexual más común en el mundo. El VPH16 y el 18 son responsables de cerca del 70% de los casos de cáncer de cuello uterino a nivel global. En Cuba, este es el segundo tipo de cáncer, tanto en incidencia como en mortalidad, en mujeres en edades comprendidas entre los 15 y 44 años. La cápside del virus está formada por 72 capsómeros, compuestos por las proteínas L1 y L2, siendo L1 la proteína mayoritaria. Las vacunas preventivas disponibles se basan en partículas semejantes a virus ensambladas a partir de L1 producida en hospederos eucariotas y presentan elevados precios, lo que ha limitado su uso en los países de ingresos medios y bajos. La bacteria Escherichia coli se ha empleado como un hospedero alternativo y más barato para la producción de vacunas de segunda generación contra el VPH. Los objetivos de este estudio fueron preparar un banco de células de trabajo de E. coli BL21 (DE3) con el plasmidio HPV18-His-Tag-L1-pET28a, que codifica para la proteína L1 de VPH18 fusionada a una cola de seis Histidinas (His); así como evaluar la producción y solubilidad de dicha proteína en condiciones de inducción con isopropil-β-D-1-tiogalactopiranósido (IPTG) y de autoinducción, como primer paso para abordar la purificación de la proteína L1. Los mayores niveles de la proteína se detectaron en los cultivos en medio terrific broth (TB) inducidos con bajas concentraciones de IPTG, 30 y 60 µmol/L, y en los que se usó una mezcla de lactosa/glucosa por 16h. En ambos casos, la proteína se encontró mayoritariamente en la fracción insoluble, de modo que su purificación deberá realizarse en condiciones desnaturalizantes. El banco de células de trabajo preparado permitirá mantener constante la calidad y homogeneidad del inóculo inicial durante la producción de L1, lo que posibilitará desarrollar un proceso de purificación robusto.

ABSTRACT Introduction: the results of surgical procedures in cardiac surgery depend, to a great extent, on the quality of post-operative care. The complexity of the evolution of these patients requires attention from specialized personnel and a differentiated support structure. Objectives: to characterize patients in the postoperative period of cardiac surgery and to describe the main postoperative complications. Methods: we conducted a cross-sectional descriptive study of cases operated and received in the postoperative period of cardiac surgery at the Hospital Provincial Universitario Cardiocentro “Ernesto Guevara” during 2018. Results: 161 cardiac surgery patients were received in the postoperative period; 70.8% were male and most of them were between 45 and 54 years old (32.3%); valve surgery was performed on 49.1%; 16.1% of the total patients were ventilated for more than 48 hours and many were complicated by nosocomial pneumonia (11.8%) and there was a very low frequency of post-operative strokes. Conclusions: the behavior of most of the variables studied in the postoperative period was adequate and patients with invasive mechanical ventilation for more than 48 hours, as well as nosocomial pneumonia, presented high levels in the postoperative period for this type of surgery.

RESUMEN Introducción: los resultados de los procedimientos quirúrgicos en Cirugía cardíaca dependen, en gran medida, de la calidad de los cuidados postoperatorios. La complejidad de la evolución de estos pacientes requiere atención de personal especializado y una estructura de apoyo diferenciada. Objetivos: caracterizar a los pacientes en el postoperatorio de intervención quirúrgica cardíaca y describir las principales complicaciones postoperatorias. Métodos: se realizó un estudio descriptivo de corte transversal de los casos operados y recibidos en el postoperatorio de Cirugía cardíaca del Hospital Provincial Universitario Cardiocentro “Ernesto Guevara” durante el año 2018. Se incluyeron todos los casos operados de cirugía cardíaca electiva o urgente, de ambos sexos y mayores de 18 años. Resultados: fueron recibidos en el postoperatorio 161 pacientes de intervención quirúrgica cardíaca; el 70,8% eran del sexo masculino y la mayoría de 45 a 54 años (32,3%); las cirugías valvulares fueron realizadas al 49,1%; el 16,1% del total de pacientes se ventiló más de 48 horas y numerosos se complicaron con neumonía nosocomial (11,8%) y hubo una frecuencia muy baja de accidentes cerebrovasculares en el postoperatorio. Conclusiones: el comportamiento de la mayoría de las variables estudiadas en el postoperatorio fue adecuado y los pacientes con ventilación mecánica invasiva por más de 48 horas, así como la neumonía nosocomial, se presentaron de forma elevada en el postoperatorio para este tipo de intervención quirúrgica.

ABSTRACT Introduction: nocturnal enuresis in children is a frequent reason for attending the doctor’s office. Objective: to evaluate the clinical evolution in pediatric patients from 5 to 18 years old with non-organic nocturnal enuresis treated with homeopathic drugs. Methods: a quasi-experimental intervention study was conducted. The sample intentionally comprised 327 patients with nocturnal enuresis from the Homeopathy Clinic at Pepe Portilla Provincial Pediatric Teaching Hospital, from January 2015 to January 2018. Descriptive tools such as frequency tables and percentage calculation were applied to process the data. In addition to the Kolmogorov Smirnov test to compare the trend of the variables between two independent groups. Results: male children between 5 and 11 years old predominated. In both groups, primary enuresis, the characteristic inability to wake up and family history of enuresis prevailed. In the study group, 76.1% had complete response to treatment, only one case had no response, in the control group only 8.3% of patients had complete response. Conclusions: homeopathy is a useful therapeutic modality in the treatment of non-organic nocturnal enuresis in children.

RESUMEN Introducción: la enuresis nocturna en niños es motivo de consulta frecuente. Objetivo: evaluar la evolución clínica en pacientes pediátricos de cinco a 18 años, con enuresis nocturna no orgánica, tratados con medicamentos homeopáticos. Métodos: se realizó un estudio cuasi-experimental de intervención. La muestra se conformó de forma intencional por 327 pacientes con enuresis de la consulta de Homeopatía del Hospital Provincial Pediátrico Docente, “Pepe Portilla”, de enero del 2015 a enero 2018. En el procesamiento se utilizaron herramientas descriptivas como tablas de frecuencias y cálculo porcentual. Además de la prueba Kolmogorov Smirnov para comparar tendencia de variables entre dos grupos independientes. Resultados: predominaron los niños entre cinco a 11 años del sexo masculino. En ambos grupos prevaleció la enuresis primaria, la incapacidad para despertar y los antecedentes familiares de enuresis. En el grupo estudio, 76,1 % tuvo respuesta completa al tratamiento, solo un caso no tuvo respuesta; en el grupo control solo 8,3 % de los pacientes obtuvo respuesta completa. Conclusiones: la Homeopatía es una modalidad terapéutica útil en el tratamiento de la enuresis no orgánica en niños.

ABSTRACT Stevia rebaudiana Bertoni is worldwide known for its medicinal properties. The objective of this work was to obtain genetic profiles of in vitro grown plants or propagated by cuttings to detect genetic polymorphisms. For this, two DNA extraction protocols were first evaluated, both with modifications. The purified samples were used for random amplification of polymorphic DNA with six pairs of primers. A matrix of data was made from the band patterns. The similarity and genetic distance between both groups of plants were calculated. Genomic DNA was obtained only when the modified protocol proposed by Doyle and Doyle was applied. One of the six primers used was effective for the amplification of DNA segments. In this work, we provide a fast, simple and efficient DNA purification protocol for S. rebaudiana leaf samples. This might be applied for the study of genetic variability and the detection of somaclonal variations using other PCR-based techniques.

RESUMEN Stevia rebaudiana Bertoni es una especie reconocida a nivel mundial por sus propiedades medicinales. El objetivo de este trabajo fue obtener perfiles genéticos de plantas cultivadas in vitro y otras propagadas mediante corte de esquejes para detectar polimorfismos genéticos. Para ello, primero se evaluaron dos protocolos de extracción de ADN, ambos con modificaciones. Las muestras purificadas se utilizaron para la amplificación aleatoria de ADN polimórfico con seis pares de cebadores. A partir de los patrones de bandas, se confeccionó una matriz de datos y se calculó la similitud y la distancia genética entre ambos grupos de plantas. Solo fue posible obtener ADN genómico cuando se aplicó el protocolo propuesto por Doyle y Doyle con modificaciones. De los seis cebadores empleados, solo uno fue efectivo para la amplificación de segmentos de ADN de esta especie. El protocolo de purificación propuesto es rápido, simple y eficiente. Se recomienda para la extracción de muestras ADN en la especie. Estas pueden ser empleadas en la implementación de otras técnicas para el estudio de la variabilidad genética y la detección de variaciones somaclonales en S. rebaudiana.

ABSTRACT Introduction: Male hypogonadism may cause a significant reduction in the quality of life. The determination of total testosterone constitutes the initial option for the biochemical diagnosis of hypogonadism. Objective: To determine the reference interval of total testosterone for the male population in reproductive age of Plaza de la Revolución municipality. Methods: It was conducted a cross-sectional and descriptive study in a representative sample (n=143) of the male population from 20 to 40 years old of Plaza de la Revolución municipality. For the recruitment of the sample it was used a direct method. The reference interval was established through a non-parametric method. There were conducted interrogations, physical examination, complementary biochemical (blood glucose, cholesterol, triglycerides, HDL-c, LDL-c), and hormonal tests (total testosterone, PRL, FSH and LH). Results: The average age was 29.7 years. The body mass index ranged between 18.95 and 29.88 kg/m2 (mean value of 24.15). The means of the waist and hip circumferences were 86.62 and 99.77 cm, respectively. The reference interval of total testosterone calculated for the male population of Plaza de la Revolución municipality was of 7.69 to 40.52 nmol/L. The mean for total testosterone was 19.10 nmol/L. Conclusions: The reference interval of total testosterone calculated for the adult male population (20 - 40 years old) of Plaza de la Revolución municipality differs from that reported by the manufacturer of the diagnostic kit and it can be useful in clinical practice.

RESUMEN Introducción: El hipogonadismo masculino puede provocar una reducción importante de la calidad de vida. La determinación de testosterona total constituye la opción inicial para el diagnóstico bioquímico del hipogonadismo. Objetivo: Determinar el intervalo de referencia de testosterona total para la población masculina en edad reproductiva del municipio Plaza de la Revolución. Métodos: Se realizó un estudio transversal y descriptivo, en una muestra representativa (n= 143) de la población masculina entre 20 y 40 años de edad, del municipio Plaza de la Revolución. Para el reclutamiento de la muestra se utilizó un método directo. El intervalo de referencia se estableció mediante un método no paramétrico. Se realizó interrogatorio, examen físico, complementarios bioquímicos (glucemia, colesterol, triglicéridos, HDL-c, LDL-c), y hormonales (testosterona total, PRL, FSH y LH). Resultados: El promedio de edad fue de 29,7 años. El índice de masa corporal osciló entre 18,95 y 29,88 kg/m2 (valor medio 24,15). Las medias de las circunferencias de cintura y cadera fueron de 86,62 cm y 99,77 cm respectivamente. El intervalo de referencia de testosterona total calculado para la población masculina del municipio Plaza de la Revolución, fue de 7,69 a 40,52 nmol/L. La mediana para la testosterona total fue de 19,10 nmol/L. Conclusiones: El intervalo de referencia de testosterona total calculado para la población masculina adulta (20 - 40 años) del municipio Plaza de la Revolución difiere del reportado por el fabricante del kit diagnóstico y puede resultar de utilidad en la práctica clínica.

ABSTRACT Stevia rebaudiana Bertoni is a species recognized worldwide for its medicinal properties. The objective of this work was to micropropagate Stevia plants from ex vitro explants. Shoots of plants of this specie growing at greenhouse were selected. In the in vitro establishment, the effect of disinfection time and the concentration of sodium hypochlorite on the survival of the explant were evaluated. The established explants were transferred to the multiplication culture medium, where the effect of the growth regulators (6-benzylaminopurine and indoleacetic acid) and the number of subcultures on the multiplication coefficient were determined. Then, the response of the plants in the acclimatization phase was evaluated, in comparison with plants propagated by cutting. Sodium hypochlorite at 1% allowed the disinfection of the explants with a survival of 94.5%, regardless of the time. The growth regulators did not modify the multiplication coefficient with subcultures every 15 days. It is possible to use different combinations of substrate based on zeolite and compost during the acclimatization of micropropagated plants. These developed a greater number of leaves and height than those propagated by cutting.

RESUMEN Stevia rebaudiana Bertoni es una especie reconocida a nivel mundial por sus propiedades medicinales. El objetivo de este trabajo fue micropropagar plantas de Stevia a partir de explantes ex vitro. Se seleccionaron brotes de plantas de esta especie crecidas en casa de cultivo. En el establecimiento in vitro, se evaluó el efecto del tiempo de desinfección y la concentración de hipoclorito de sodio sobre la supervivencia del explante. Los explantes establecidos se transfirieron a medio de cultivo de multiplicación, donde se determinó el efecto de los reguladores de crecimiento (6-bencilaminopurina y ácido indolacético) y el número de subcultivos, sobre el coeficiente de multiplicación. Luego, se evaluó la respuesta de las plantas en la fase de aclimatización, en comparación con plantas propagadas mediante corte de esquejes. El hipoclorito de sodio al 1% permitió la desinfección de los explantes con una supervivencia de 94.5%, independientemente del tiempo. Los reguladores de crecimiento no modificaron el coeficiente de multiplicación con subcultivos cada 15 días. Es posible emplear diferentes combinaciones de sustrato a base de zeolita y compost durante la aclimatización de las plantas micropropagadas. Estas desarrollaron mayor número de hojas y altura, que las propagadas mediante corte de esquejes.

ABSTRACT Introduction: The periodontal diseases are the joint of the inflammatory diseases that affect the supporting tissues of the tooth. It´s considered health problem that behave as a risk factor that influences upon systemic conditions like diabetes mellitus. Objective: Determine behave of the periodontal diseases in diabetic patients. Materials and methods: An observant, descriptive and transversal studied was carried out in the policlinic Juan Gualberto Gomez from Los Arabos Matanzas provinces from January to May 2016 in a universe of 12 diabetic patients older than 20 years, of both sex, without distinction in the color of the skin and in a full physical and motor conditions. They were analyzed variables than: age, sex, prevalence and severity of the periodontal disease also oral areas with periodontal affection. Results: The more significant age from 61 years old and more. The female sex prevailed with 75 %; the 66 % had periodontal disease. Gingivitis was presented from mild to moderate in a 25 %. The 41,6 % presented moderate levels of periodontitis. Thebuccalareas were affected in a 75 %. The area of the lower incisors was the most significant compared with theupper incisors and upper molars with 50 %. Conclusions: The periodontal disease showed a high prevalence in the population studied. The female with 61 years old and more prevailed in correspondence with the current aging in population mild gingivitis and moderate periodontitis prevailed. Buccal areas of lower incisors and upper molars were affected by periodontal disease.

RESUMEN Introducción: la enfermedad periodontal es el conjunto de enfermedades inflamatorias que afectan los tejidos de soporte del diente. Se considerada un problema de salud, que se comporta como indicador de riesgo que influye en enfermedades sistémicas como la diabetes mellitus. Objetivo: determinar el comportamiento de la enfermedad periodontal en pacientes diabéticos. Materiales y métodos: se realizó estudio observacional, descriptivo, transversal, en policlínico “Juan Gualberto Gómez” Los Arabos, Matanzas, de enero a mayo 2016 en un universo conformado por 12 pacientes diabéticos mayores de 20 años, sin distinción de sexo y color de piel, con plenitud de sus facultades físicomotoras. Se estudiaron variables demográficas, prevalencia y gravedad de la enfermedad periodontal y áreas bucales con afectación periodontal. Resultados: resaltó la edad 61 y más años con 50 %. Predominó sexo femenino con un 75 %, el 66,6 % presentó enfermedad periodontal. La gingivitis de leve a moderada se presentó en 25 %. El 41,6 % presentó formas benévolas de periodontitis. Las superficies vestibulares se afectaron en el 75 %, el área de incisivos inferiores destacó sobre los superiores al igual que los molares superiores ambas con 50 %. Conclusiones: la enfermedad periodontal mostró una alta prevalencia en la población estudiada, resaltaron las féminas en la edad de 61 y más año en correspondencia con el envejecimiento poblacional actual. Predominó la gingivitis de tipo leve y la periodontitis moderada. Las zonas vestibulares de incisivos inferiores y molares superiores se afectaron por enfermedad periodontal.

INTRODUCTION Pneumococcal infections are a major cause of morbidity and mortality and are associated with considerable economic burden on health systems. To prevent pneumococcal infections, 7-valent conjugate vaccines have been available for over a decade; more recently, 10- and 13-valent conjugate vaccines have been formulated, which are more immunogenic than vaccines with capsular polysaccharides only. In Cuba, a new vaccine candidate has been developed, PCV7-TT, a conjugate of tetanus toxoid with antigens of seven of the serotypes of Streptococcus pneumoniae with highest circulation in Cuba and in the world: 1, 5, 6B, 14, 18C, 19F and 23F. OBJECTIVE Assess the safety of the vaccine candidate PCV7-TT in healthy adults and conduct a preliminary assessment of its immunogenicity. METHODS A phase I, double-blind clinical trial was performed at the National Toxicology Center in Havana, Cuba. Healthy male volunteers aged 18–35 years were randomly assigned to two groups: 20 received the vaccine candidate PCV7-TT and 20 the polyvalent antipneumococcal vaccine PNEUMO-23 used as control, each in a single intramuscular dose. To assess safety, the occurrence of adverse events was monitored for 30 days following inoculation. To explore immunogenicity, concentrations of serotype-specific antibodies was quantified before and 30 days after inoculation, as well titers of opsonophagocytic antibodies. (National Clinical Trial Registry RPCEC00000133) RESULTS Local adverse events were pain, redness, induration, increased sensitivity to touch, and warmth in the injection area. Pain was registered in 70% of individuals who received PCV7-TT and in 75% of those vaccinated with PNEUMO-23. Reported systemic adverse events were general malaise, headache and drowsiness. All adverse events appeared in the first 72 hours post inoculation and lasted no longer than 3 days. One event was reported that was classified as severe in intensity and serious in consequences, but it was unrelated to vaccination—acute appendicitis in one individual inoculated with the control vaccine. Before vaccination, all participants but one had antibody concentrations ≥0.20 μg/ml against the vaccine strains; after vaccination 100% of individuals were positive and the concentrations of antibodies increased in previously positive volunteers. Some individuals had opsonophagocytic antibodies against serotypes 1, 14, 19F and 23F before vaccination, with highest concentrations against serotypes 14 and 19F. After vaccination, the percent of individuals with opsonophagocytic titers ≥1:8 for all serotypes in the vaccine was >50% in both groups. CONCLUSIONS A single dose of candidate vaccine PCV7-TT was safe when used in healthy adults. Preliminary results showed that it was able to activate an immune response against the serotypes of Streptococcus pneumoniae used.

INTRODUCTION Climate variability, the primary expression of climate change, is one of the most important environmental problems affecting human health, particularly vector-borne diseases. Despite research efforts worldwide, there are few studies addressing the use of information on climate variability for prevention and early warning of vector-borne infectious diseases. OBJECTIVES Show the utility of climate information for vector surveillance by developing spatial models using an entomological indicator and information on predicted climate variability in Cuba to provide early warning of danger of increased risk of dengue transmission. METHODS An ecological study was carried out using retrospective and prospective analyses of time series combined with spatial statistics. Several entomological and climatic indicators were considered using complex Bultó indices -1 and -2. Moran’s I spatial autocorrelation coefficient specified for a matrix of neighbors with a radius of 20 km, was used to identify the spatial structure. Spatial structure simulation was based on simultaneous autoregressive and conditional autore-gressive models; agreement between predicted and observed values for number of Aedes aegypti foci was determined by the concordance index Di and skill factor Bi. RESULTS Spatial and temporal distributions of populations of Aedes aegypti were obtained. Models for describing, simulating and predicting spatial patterns of Aedes aegypti populations associated with climate variability patterns were put forward. The ranges of climate variability affecting Aedes aegypti populations were identified. Forecast maps were generated for the municipal level. CONCLUSIONS Using the Bultó indices of climate variability, it is possible to construct spatial models for predicting increased Aedes aegypti populations in Cuba. At 20 × 20 km resolution, the models are able to provide warning of potential changes in vector populations in rainy and dry seasons and by month, thus demonstrating the usefulness of climate information for epidemiological surveillance.

INTRODUCTION Death from acute myocardial infarction is due to many factors; influences on risk to the individual include habits, lifestyle and behavior, as well as weather, climate and other environmental components. Changing climate patterns make it especially important to understand how climatic variability may influence acute myocardial infarction mortality. OBJECTIVES Describe the relationship between climate variability and acute myocardial infarction mortality during the period 2001–2012 in Havana. METHODS An ecological time-series study was conducted. The universe comprised 23,744 deaths from acute myocardial infarction (ICD-10: I21–I22) in Havana residents from 2001 to 2012. Climate variability and seasonal anomalies were described using the Bultó-1 bioclimatic index (comprising variables of temperature, humidity, precipitation, and atmospheric pressure), along with series analysis to determine different seasonal-to-interannual climate variation signals. The role played by climate variables in acute myocardial infarction mortality was determined using factor analysis. The Mann-Kendall and Pettitt statistical tests were used for trend analysis with a significance level of 5%. RESULTS The strong association between climate variability conditions described using the Bultó-1 bioclimatic index and acute myocardial infarctions accounts for the marked seasonal pattern in AMI mortality. The highest mortality rate occurred during the dry season, i.e., the winter months in Cuba (November–April), with peak numbers in January, December and March. The lowest mortality coincided with the rainy season, i.e., the summer months (May–October). A downward trend in total number of deaths can be seen starting with the change point in April 2009. CONCLUSIONS Climate variability is inversely associated with an increase in acute myocardial infarction mortality as is shown by the Bultó-1 index. This inverse relationship accounts for acute myocardial infarction mortality’s seasonal pattern.

Introduction: hypothyroidism is the resulting clinical picture of a reduction in the biological activity of thyroid hormones due to their low production or little use. Its association with Down syndrome has been previously described by other authors; however, few studies on the frequency of association of both entities in Cuba and on the clinical form of hypothyroidism in these patients have been conducted. Objectives: to evaluate the association of Down syndrome and hypothyroidism in patients seen at our service from January to December 2011. Methods: twenty four patients with Down syndrome, aged 3 to 7 years, were attended at the endocrinology service of "William Soler" pediatric hospital. Results: it was found that all these patients exhibited high values of hypophysial thyrotrop hormone, 18 had osseous age retardation (75 %) and 4 showed low size of less than 3 percentiles (16.6 %). Conclusions: hypothyroidism is a frequent disease associated with Down syndrome, so its detection and early treatment in these children is of vital importance to improve their cognitive development and integral growth.

Introducción: el hipotiroidismo es el cuadro clínico resultante de una disminución de la actividad biológica de las hormonas tiroideas ocasionada por un déficit en la producción o utilización de estas. Su asociación con el síndrome de Down ha sido previamente descrita por otros autores, pero hay pocos estudios sobre la frecuencia con que se relacionan ambas entidades en Cuba, y la forma clínica en que se presenta el hipotiroidismo en estos pacientes. Objetivo: evaluar la asociación del síndrome de Down con el hipotiroidismo en pacientes atendidos en nuestro servicio en el período comprendido de enero de 2010 a diciembre del mismo año. Métodos: se estudiaron 24 pacientes con diagnóstico de síndrome de Down, entre 3 y 7 años de edad, en la consulta de Endocrinología del Hospital Pediátrico "William Soler". Resultados: se encontró que en el 100 % de los pacientes estudiados (24) se presentaban cifras elevadas de hormona tirotropa hipofisiaria, retraso de la edad ósea (18 para un 75 %), y baja talla < 3 percentil (4 para un 16,6 %). Conclusiones: el hipotiroidismo es una entidad frecuentemente asociada con el síndrome de Down, por lo que la detección y el tratamiento precoz en estos niños es de vital importancia para mejorar su desarrollo cognitivo y crecimiento integral.

A literature review on the aspects related to hypertensive crisis to try to expose, in a clear and precise way, some elements related to this disease was carried out. Positive and differential diagnoses were taken into account, as well as the treatment in the different clinical situations from which it was concluded that the hypertensive crisis continue being the main complication of hypertension, so the first disquisition of the doctor when facing them, should be to determine quickly if it is an hypertensive emergency or urgency and how to treat them.

Se realizó una revisión bibliográfica sobre los aspectos relacionados con las crisis hipertensivas para tratar de exponer, de forma clara y precisa, algunos elementos referentes a esta enfermedad. Se tomaron en cuenta los diagnósticos positivo y diferencial, así como el tratamiento en las diferentes situaciones clínicas, de cuyo análisis se concluyó que las crisis hipertensivas continúan siendo la principal complicación de la hipertensión arterial, de modo que la primera disquisición del médico al enfrentarlas, debe ser determinar rápidamente si se trata de una urgencia o emergencia hipertensiva y cómo tratarlas.