Abstract We conducted a review of the literature on the precise retrograde placement of the supera stent in the superficial femoral artery (PRESTO) and a case report. We use the following English search terms: PRESTO technique, retrograde access, angioplasty, critical ischemia, superficial femoral artery, in the Pubmed and ScienceDirect databases published between January 2017 and December 2019. Were found 5 case reports of patients with critical ischemia treated by PRESTO technique, including patients with lesions of superficial femoral artery, popliteal, iliac, tibioperoneal trunk and posterior tibial artery. They were performed with retrograde access through popliteal artery, femoral artery, posterior tibial artery. They reported a patency rate above 83% at one year, none of them showed a fracture of the Supera stent, none of them presented complications. Retrograde access stenting in the proximal segment of the superficial femoral artery is a safe, reproducible option with adequate short and long-term results.

Resumen Se realiza una revisión de las publicaciones médicas acerca de la colocación retrógrada precisa del stent Supera® en la arteria femoral superficial (PRESTO) y se notifica un caso. Los términos de búsqueda en inglés fueron PRESTO technique, retrograde access, angioplasty, critical ischemia y superficial femoral artery en las bases de datos Pubmed y Science Direct publicados entre enero de 2017 y diciembre de 2019. Se encontraron cinco informes de casos de pacientes con isquemia crítica tratados mediante técnica PRESTO que incluyeron a pacientes con lesiones en las arterias femoral superficial, poplítea, ilíaca, tronco tibioperoneo y tibial posterior. Se efectuó el acceso retrógrado a través de las arterias poplítea, femoral superficial o tibial posterior. Se registró un índice de permeabilidad al año > 83%, pero no se observaron fractura del stent Supera® ni complicaciones. La colocación de stents mediante acceso retrógrado en el segmento proximal de la arteria femoral superficial puede ser una opción segura, reproducible y con resultados promisorios a corto y largo plazos.

ABSTRACT This paper presents, in the context of the universal health strategy, some general considerations and economic actions on financing, efficiency and other economic challenges of public health in Cuba. Official bibliographic sources of the Cuban state were revised up to 2015. The analyses of time series were adjusted to constant prices of 1997 and the official exchange rate of 1 Cuban peso = 1 US dollar. The Cuban National Health System has a solid infrastructure, consisting of a wide network of health facilities that guarantee full coverage, access and equity in the services provided to the population through qualified human resources. An economic analysis was carried out under the conceptual framework of the universal health strategy, with an emphasis in financing, efficiency and challenges of the Cuban public health system to maintain the right to health of its citizens, equity, coverage and access to the services provided, including the elimination of economic, sociocultural and gender barriers, as well as solidarity with the Cuban population and the world. It was concluded that in Cuba, universal health is considered one of its most valuable achievements, although it is needed a most efficient analysis of reliable and available sources, research and application of results to practice on the strengths and weaknesses of the system regarding health economics, updating and a better use of resources and technologies, as well as deepening the lessons learned and facing remaining challenges.

RESUMEN Este trabajo expone, en el contexto de la estrategia de salud universal, algunas consideraciones generales y acciones económicas sobre el financiamiento, la eficiencia y otros desafíos económicos de la salud pública en Cuba. Se revisaron fuentes bibliográficas oficiales del estado cubano hasta 2015. Los análisis de series temporales se ajustaron a precios constantes de 1997 y tasa oficial de cambio: 1 peso cubano = 1 dólar estadounidense. El Sistema Nacional de Salud cubano cuenta con una infraestructura sólida, constituida por una amplia red de instalaciones sanitarias que garantizan la cobertura total, el acceso y la equidad en los servicios de la población con recursos humanos calificados. Se realizó un análisis económico bajo el marco conceptual de la estrategia de salud universal con énfasis en el financiamiento, la eficiencia y los desafíos de la salud pública cubana para mantener el derecho a la salud de sus ciudadanos, la equidad, cobertura y acceso en los servicios que se prestan, incluso la eliminación de las barreras económicas, socioculturales y de género, así como la solidaridad con la población cubana y del mundo. Se concluyó que en Cuba se considera la salud universal como una de sus más valiosas realizaciones, aunque se requiere del análisis más eficiente de fuentes fiables y disponibles, la investigación y aplicación de resultados a la práctica sobre las fortalezas y debilidades del sistema en materia de economía de la salud, actualización y uso de los recursos y tecnologías, así como profundizar en las lecciones aprendidas y enfrentar un conjunto de desafíos.

RESUMO Este artigo apresenta, no contexto da estratégia da saúde universal, algumas considerações gerais e ações econômicas sobre financiamento, eficiência e outros desafios econômicos da saúde pública em Cuba. As fontes bibliográficas oficiais do estado cubano foram revisadas até 2015. As análises das séries temporais foram ajustadas aos preços constantes de 1997 e à taxa oficial de câmbio 1 peso cubano = 1 dólar norte- americano. O Sistema Nacional de Saúde cubano possui uma sólida infra-estrutura, constituída por uma ampla rede de instalações de saúde que garantem cobertura total, acesso e equidade nos serviços da população com recursos humanos qualificados. Uma análise econômica foi realizada no marco conceitual da estratégia de saúde universal que enfatizou o financiamento, eficiência e desafios da saúde pública cubana para manter o direito à saúde de seus cidadãos, equidade, cobertura e acesso no serviços prestados, eliminação de barreiras econômicas, socioculturais e de gênero; bem como a solidariedade com a população cubana e o mundo. Concluiu-se que, em Cuba, a saúde universal é considerada uma das suas conquistas mais valiosas, embora requer a análise mais eficiente de fontes confiáveis e disponíveis, pesquisa e aplicação de resultados para a prática dos pontos fortes e fracos do sistema em termos de economia da saúde, atualização e uso de recursos e tecnologias, além de aprofundar as lições aprendidas e enfrentando um conjunto de desafios.

ABSTRACT INTRODUCTION Quality of life measurement is an important aspect of comprehensive clinical assessment. It does not have a set definition, but changes according to sociocultural context. Head and neck cancer patients experience substantially decreased health-related quality of life. The Cuban public health system needs to develop its own instrument to measure these patients’ quality of life. OBJECTIVES Construct and validate an instrument to measure quality of life in Cuban patients with nasopharyngeal, laryngeal, oral or mesopharyngeal cancer. METHOD The sample comprised adult patients treated for nasopharyngeal, laryngeal, oral or mesopharyngeal cancer in Cuba’s National Oncology and Radiobiology Institute in 2013 and 2014. To construct and validate the instrument, we selected a sample of 520 patients. Initial interviews were held until no substantially new information emerged; 40 patients were selected to participate in focus groups to identify important problems leading to decreased health-related quality of life. Face validity of the preliminary questionnaire was assessed with 40 patients. Internal consistency and validity were assessed with 400 patients. Score stability was assessed with another 40 patients using a test-retest design. There were 24 experts who participated in the process, 15 in the construction phase and 9 in the content validity evaluation of the preliminary version. Assessment of reliability and validity was based on internationally recognized approaches, including Cronbach alpha and empirical verification of convergent, discriminant, clinical and predictive validity. Response burden was also assessed (completion time and item nonresponse). RESULTS A 65-item questionnaire, CV-I0R-CyC-01, was developed and validated, with three domains (physical functioning, psychosocial functioning and family relationships, disease symptoms and treatment side effects) and two ungrouped questions on perceived general health and perceived health-related quality of life. The instrument displayed satisfactory reliability (homogeneity and stability) and validity (face, content, convergent, discriminant, clinical and predictive). Test–retest correlation was strong. Large differences and a downward trend in health-related quality of life across clinical stages and moderate or high standardized response mean values reflect good clinical and predictive validity. Response burden was acceptable (completion time 6.2 minutes, item nonresponse rate 1.3%–3.8%). CONCLUSIONS CV-I0R-CyC-01’s psychometric properties justify its use in clinical trial protocols with patients with nasopharyngeal, laryngeal, oral or mesopharyngeal cancer.

INTRODUCTION:Although modern technology has extended the survival of breast cancer patients, treatment's adverse effects impact their health-related quality of life. Currently, no instrument exists capable of identifying the range of problems affecting breast cancer patients receiving radiotherapy in Cuba's socioeconomic and cultural context. OBJECTIVES: Construct and validate an instrument to measure the effects of breast cancer and radiotherapy on health-related quality of life in Cuban patients. METHODS: The study was conducted at the Oncology and Radiobiology Institute, Havana, Cuba, from January 2010 through December 2011. Inclusion criteria were: adult female, histological diagnosis of breast cancer, treated with ambulatory radiotherapy, and written informed consent; patients unable to communicate orally or in writing, or who had neurologic or psychiatric conditions were excluded. Development phase: focus groups guided by a list of questions were carried out with 50 women. The patients reported 61 problems affecting their health-related quality-of-life. A nominal group (six oncologists and two nurses) identified the same problems. A syntactic analysis of the information was performed to create items for study and measurement scales. Content validity was determined by a nominal group of seven experts using professional judgment. Another 20 patients were selected to evaluate face validity. Validation phase: the instrument was applied to 230 patients at three different points: before radiotherapy, at the end of radiotherapy and four weeks after radiotherapy was concluded. Reliability, construct validity, discriminant validity, predictive validity, interpretability and response burden were evaluated. RESULTS: The final instrument developed had 33 items distributed in 4 domains: physical functioning, psychological functioning, social and family relationships, and physical and emotional adverse effects of disease and treatment. There were two discrete items: perceived general health and perceived health-related quality of life. Content validity and face validity were assessed as acceptable, by experts and patients respectively. Homogeneity, construct validity, and discriminant validity were satisfactory. The best results were obtained with test-retest reliability, predictive validity, and interpretability; the low rate of unanswered questions indicated that the instrument did not produce excessive patient response burden. CONCLUSION: The new instrument fulfilled the requirements for measuring impact of breast cancer and of radiotherapy on health-related quality of life in these Cuban patients, validating its usefulness for inclusion in clinical trial protocols.

Introduction: the child of a diabetic mother (CDM) can suffer alterations during pregnancy by this maternal disease. When it appears in the second half of gestation, we talk of diabetic foetopathy, which is more frequent in women with uncontrolled metabolic and gestational diabetes mellitus (GDM). Age, parity, obesity, weight gain during pregnancy, degree of glucose intolerance, among others, can influence fetal growth determinants. The research sought to understand the relationship of these factors with birth weight. Objective: to identify modifiable factors, which increase the frequency of newborns with appropriate weight for gestational age in diabetic pregnant women. Methods: results are analyzed in 2 038 live births born from diabetic mothers (350 diabetic pre-gestational and diabetic gestational 1 688), during 14 years. Results: occurrence of excess neonatal weight was 11.83%, its reduction was achieved, but with no increase in weight. No significant differences were observed in the frequency of excess body weight among pre-gestational and gestational diabetic patients. Neonatal overweight is associated with parity, maternal pre- pregnancy overweight, excessive weight gain and degree of metabolic control during pregnancy. Underweight was associated with low maternal weight before pregnancy, gestational hypertensive disease and mother vascular glomerular injury. Conclusion: the excess or low weights in infants in relation with their gestational age were associated with different risk factors.

Introducción: el hijo de madre con diabetes (HMD) puede sufrir alteraciones durante el embarazo por la enfermedad materna. Cuando aparece en la segunda mitad de la gestación hablamos de fetopatía diabética, más frecuente en mujeres con descontrol metabólico y en la diabetes mellitus gestacional (DMG). La edad, paridad, obesidad, ganancia de peso durante el embarazo, grado de intolerancia a la glucosa, entre otros, pueden influir como determinantes del crecimiento fetal. Los autores se propusieron conocer la relación de estos factores con el peso del neonato. Objetivo: identificar factores modificables en las embarazadas con diabetes que permitan aumentar la frecuencia de recién nacidos de adecuado peso según edad gestacional. Métodos: se analizaron los resultados en 2 038 nacidos vivos hijos de madres con diabetes (350 diabéticas pregestacionales y 1 688 diabéticas gestacionales), durante 14 años. Resultados: la frecuencia de exceso de peso corporal neonatal resultó 11,83 %, se alcanzó su reducción, pero sin aumento del bajo peso. No existieron diferencias significativas en frecuencia de exceso de peso corporal entre las diabéticas pregestacionales y las gestacionales. El exceso de peso neonatal se relacionó con: multiparidad, exceso de peso materno pregestacional, ganancia de peso excesiva y grado de control metabólico durante el embarazo. El bajo peso se relacionó con: bajo peso materno pregestacional, enfermedad hipertensiva gravídica y lesión vascular materna a nivel glomerular. Conclusión: los recién nacidos con exceso o bajo peso para la edad gestacional se relacionaron con factores de riesgo diferentes.

Sinaloa is one of the main tomato producer states in Mexico; however, its tomato production has been seriously affected by diseases related to the presence of geminivirus transmitted by whitefly, causing great economic losses for the state. in this study, geminivirus present in tomato plants were identified and characterized by nested polymerase chain reaction (PCR) and later sequencing analysis. A total of 507 plants were analyzed, from which, 197 plants showed symptoms of the presence of geminivirus and 310 plants did not show any symptoms of the presence of geminivirus. After analysis, 134 samples were found positive, 99 (73.8%) corresponding to plants that presented symptoms, and 35 (26.1%) without symptoms. From the 134 positives samples detected by nested PCR, 64.2% belonged to TYLCV, 22.4% to SLCV, 6.7% were variants of other viruses (STLCV AV1, PHYVV, CuLCrV segment A and B) and 3.7% contained geminivirus whose type was not identified. The nested PCR allowed detection of geminivirus transmitted by whitefly in tomato plants with, and without symptoms. Posterior sequencing analysis allowed to determine the different types of virus, as well as, new variants of geminivirus which has not been previously detected in tomato plants.

Sinaloa es uno de los principales productores de tomate en México, sin embargo, su producción se ha visto afectada por enfermedades relacionadas con la presencia de geminivirus transmitidos por mosca blanca, ocasionando fuertes pérdidas económicas. En el presente trabajo, se identificaron y caracterizaron los geminivirus presentes en plantas de tomate, mediante la técnica de reacción en cadena de la polimerasa (PCR) anidada y posterior análisis de secuenciación. De 507 muestras de plantas analizadas, 197 presentaron síntomas y 310 no los mostraron; se encontraron un total de 134 muestras positivas, que corresponden a 99 (73.8%) que presentaron síntomas y 35 (26.2%) que no los presentaron. De las 134 muestras positivas detectadas por PCR anidada, 64.2% presentó el virus TYLCV, 22.4% SLCV, 6.7% correspondieron a variantes de otros virus (STLCV AV1, PHYVV, CuLCrV segmento A y B) y 3.7% no se identificó el tipo de geminivirus. La PCR anidada permitió detectar los geminivirus transmitidos por mosca presentes en plantas de tomate, tanto con síntomas como sin ellos, y su posterior secuenciación permitió determinar los diferentes tipos de geminivirus presentes, así como nuevas variantes de geminivirus y virus que no habían sido reportados previamente en tomate.

Radiogenic proctitis is a frequent complication of therapeutic radiation at the pelvic region. The aim of this study was to determine the efficacy of the epidermal growth factor (EGF) in treating patients with proctitis as a complication of radiotherapy of gynecological tumors. A phase II, placebo-controlled, randomized, double blind clinical trial was carried out. The treatment groups were: A) a solution of human recombinant epidermal growth factor (10 µg/ ml) in carboxymethyl cellulose or B) placebo (carboxymethylcellulose solution alone); the treatment was administered as a retention enema (20 mL) twice a day after bowel movement for 6 months. We included women of 18-75 years of age with proctitis as a complication of an ionizing radiation treatment of gynecological malignant tumors, confirmed by endoscopy, who gave their consent to participate. Thirty-seven patients were included. The basic demographic variables and were homogeneous among groups, which were comparable. There were more responses in group A (EGF) than in the control (placebo), but the difference was not statistically significant. Considering only those patients who completed the treatment, the difference in response was greater with EGF (86% vs 60%). The symptoms disappeared more rapidly in the group treatedwith EGF (p=0.027 and p=0.016, for bleeding and tenesmus, respectively). The product under study was well tolerated. Although there are signs of improvement in some symptoms, the sample was too small to demonstrate the effectiveness of Hebervis in the treatment of proctitis.

La proctitis radiógena es una complicación frecuente de la terapia radiante en la región pélvica. El objetivo de este estudio fue determinar la eficacia del Factor de Crecimiento Epidérmico (EGF) en el tratamiento de pacientes con proctitis como una complicación de la radioterapia de tumores ginecológicos. Se ejecutó un ensayo clínico fase II, controlado con placebo, aleatorizado y doble ciegas. Los grupos de tratamiento fueron: A) Solución viscosa de carboximelticelulosa con aditivo de EGF (10 µg/mL) y B) Placebo (solución viscosa de carboximelticelulosa); el tratamiento se administró en forma de enemas a retener (20 mL) dos veces al día, después de la evacuación intestinal, durante 6 meses. Se incluyeron mujeres con edades comprendidas entre 18-75 años, con proctitis como una complicación de la radiación ionizante del tratamiento de tumores malignos ginecológicos, confirmados por endoscopia, que dieron su consentimiento de participación. Treinta y siete pacientes fueron incluidas. Las variables demográficas y de base fueron homogéneas entre los grupos, por lo que fueron comparables. Hubo más respuestas en el grupo A (EGF) que en el control (placebo), pero la diferencia no fue estadísticamente significativa. Considerando solamente las pacientes que completaron el tratamiento, la diferencia en la respuesta fue mayor (86% vs 60%). Los síntomas desaparecieron más rápidamente en el grupo tratado con EGF (p=0.027 y p=0.016, para el sangrado y el tenesmo, respectivamente). El producto en estudio fue bien tolerado. Aunque hay indicios de mejoría de algunos síntomas, la muestra fue insuficiente para demostrar la eficacia del Hebervis en la curación de la proctitis.