ABSTRACT Introduction: In Cuba, a country with a low incidence of tuberculosis (TB), there is no information about of the dynamics of transmission of the disease for two decades. Objective: Determine the genetic patterns and sublineages of Mycobacterium tuberculosis complex (MTBC) isolates circulating in 2009 and their relationship with the epidemiological data of the patients. Methods: A retrospective descriptive study was carried out in Cuba with 178 MTBC isolates. Spoligotyping and mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) typing with 24loci were performed. For statistical analysis, non-parametric methods, analysis of variance and homogeneity test, were used. Results: Spoligotyping produced 39 spoligotypes. The S, Beijing, LAM and Haarlem sublineages prevailed. The clustering rate was 75.84% and the Hunter-Gaston discriminatory index (HGDI): 0.8734. MIRU-VNTR typing with 24-loci defined 154 genetic patterns: six grouped 30 isolates and 148 showed unique patterns. The clustering rate was 14.60% and the HGDI: 0.9926. There was a predominance of sublineages by region: S, Beijing and LAM in the West, Center and East, respectively. Conclusions: The dynamics of TB transmission in Cuba in 2009 is reported, inferring that this occurs in a limited manner and belonging to risk groups does not favor transmission. It serves to evaluate a megaproject of the Global Fund to reduce the transmission of TB in this country. The population genetic structure of MTBC resembles that of an Ibero-American country, with the exception of the high frequency of the Beijing and S sublineages.

RESUMEN Introducción: En Cuba, país con baja incidencia de tuberculosis (TB), no existe información sobre la dinámica de transmisión de la enfermedad desde hace dos décadas. Objetivo: Determinar los patrones genéticos y sublinajes de los aislados del complejo Mycobacterium tuberculosis (MTBC) circulantes en el año 2009 y su relación con los datos clínico-epidemiológicos de los pacientes. Métodos: Se realizó un estudio descriptivo retrospectivo en Cuba con 178 aislamientos de MTBC. Se realizó el espoligotipaje y el tipaje con unidades repetitivas intercaladas de micobacterias con repetición en tándem de número variable (MIRU-VNTR) con 24loci. Para el análisis estadístico, se utilizaron métodos no paramétricos, análisis de varianza y prueba de homogeneidad. Resultados: El espoligotipaje produjo 39 espoligotipos, prevaleciendo los sublinajes S, Beijing, LAM y Haarlem. El rango de agrupamiento fue del 75,84 % y el índice discriminatorio de Hunter-Gaston (HGDI): 0,8734. El tipaje por MIRU-VNTR con 24loci definió 154 patrones genéticos: seis agruparon 30 aislados y 148 mostraron patrones únicos. El rango de agrupamiento fue del 14,60 % y el HGDI: 0,9926. Hubo predominio de los sublinajes por región: S, Beijing y LAM en Occidente, Centro y Este, respectivamente. Conclusiones: Se reporta la dinámica de transmisión de la TB en Cuba en el año 2009, infiriéndose que esta ocurre de manera limitada y la pertenencia a grupos de riesgo no favorece la transmisión. Sirve para evaluar un megaproyecto del Fondo Mundial para reducir la transmisión de la TB en este país. La estructura genética poblacional de MTBC se asemeja a la de un país iberoamericano, con la excepción de la alta frecuencia de los sublinajes Beijing y S.

Abstract INTRODUCTION During the pandemic caused by the SARS-CoV-2 virus, some patients who develop severe forms of COVID-19 present thrombotic microangiopathy in the course of the disease’s clinical progression. METHODS Data came from direct patient observation and clinical records. We performed a kidney biopsy and used optical microscopy and immunofluorescence techniques. RESULTS We present the case of a 78-year-old male patient, mestizo, overweight with a history of high blood pressure, ischemic cardiopathy and chronic obstructive pulmonary disease who was first admitted to the hospital due to respiratory symptoms and diarrhea related to COVID-19, from which he recovered. He was subsequently readmitted with symptoms of acute renal dysfunction accompanied by mild anemia and thrombocytopenia; at the same time, he resulted negative for COVID-19 via a real-time polymerase chain reaction test. A kidney biopsy revealed thrombi in glomerular capillaries, acute tubular necrosis, thickening of extraglomerular blood vessel walls, and C3 deposits in the glomerular tufts. CONCLUSIONS We describe a case of thrombotic microangiopathy with kidney biopsy in a patient recovering from COVID-19. Acute renal dysfunction is a form of thrombotic microangiopathy that has been observed in patients recovering from COVID-19.

Resumen Los cultivos agrícolas se ven afectados por diferentes patógenos que ocasionan daños a la planta, pérdidas en la producción, además se pueden presentar restricciones cuarentenarias por la presencia de algún patógeno. Para el control de fitopatógenos en el mayor de los casos, se emplean productos químicos sintéticos, sin embargo, algunos de estos productos se han asociado a riegos a la salud humana o al ambiente. Por lo que es necesario la búsqueda de alternativas más sustentables de control de estos patógenos. Esta investigación se realizó bajo los siguientes objetivos: extraer polifenoles de hojas de gobernadora, hojasén y guanábana, utilizando: diferentes relaciones masa/volumen (m/v), diferentes concentraciones de etanol, simultáneamente ultrasonido-microondas y determinar el efecto de estos polifenoles contra Alternaria alternata y Fusarium solani. Se obtuvieron polifenoles de hojas de gobernadora, hojasén y guanábana mediante combinación de ultrasonido-microondas, y usando diferentes relaciones masa-volumen y porcentajes de etanol. Además, se observó que el grupo de polifenoles obtenido con la relación masa/volumen (m/v) 1:8 y etanol al 70% (CD) a partir de hojas de Gobernadora y el grupo de polifenoles obtenido con la relación m/v 1:16 y etanol al 70% (CA) a partir de hojas de hojasén fueron las más efectivos contra Fusarium solani inhibiendo 90.4 y 60.67%, respectivamente. En Alternaria alternata no se encontraron diferencias en el efecto de la inhibición por los diferentes grupos de polifenóles evaluados, y se mostraron valores de inhibición entre 50-60% en comparación con el testigo negativo (sin polifenoles). En el perfil de grupo de polifenoles CD obtenido de gobernadora se encontraron diversos compuestos polifenolicos reportados por tener actividad antimicrobiana entre los que destacan: epirosmanol, rosmadiol apigenina, catequina, procianidina C1. Los compuestos polifenolicos aislados de gobernadora, hojasen y guanábana utilizando métodos (ultrasonido-microondas) y disolventes (agua y etanol) amigables con el ambiente presentan actividad antifúngica contra F. solani y A, alternata.

Abstract Crops are affected by different pathogens that cause damage to the plant and production losses. Quarantine restrictions may also occur due to the presence of a pathogen. In most cases, synthetic chemical products are used to control phytopathogens. However, some of these products have been associated with risks to human health or the environment. Therefore, it is necessary to search for more sustainable alternatives to control these pathogens. This research was carried out under the following objectives: 1. To extract polyphenols from Creosote bush, Tarbush and Soursop leaves using: different mass/volume ratios (m/v), different concentrations of ethanol, simultaneous ultrasound-microwave and 2. To determine the effect of these polyphenols against Fusarium solani and Alternaria alternata. Polyphenols were obtained from Creosote bush, Tarbush and Soursop leaves by combining ultrasound-microwave, and using different mass-volume ratios and ethanol percentages. The group of polyphenols (CD) obtained with a mass/volume (m/v) ratio of 1:8 and 70% ethanol from Creosote bush leaves and the group of polyphenols (CA) obtained with a m/v ratio 1:16 and 70% ethanol from Tarbush leaves were the most effective against Fusarium solani, inhibiting 90.4 and 60.67%, respectively. For Alternaria alternata, no differences were found in the mycelial inhibition by the different groups of evaluated polyphenols, with inhibition values between 50-60% in comparison to the negative control (without polyphenols). In the profile of CD polyphenols group obtained from Creosote bush, different polyphenolic compounds reported to have antimicrobial activity were found, among which the following stand out: epirosmanol, rosmadiol, apigenin, catechin, and procyanidin C1. Polyphenolic compounds isolated from Creosote bush, Tarbush, and Soursop leaves using environmentally friendly methods (ultrasound-microwave) and solvents (water and ethanol) showed antifungal activity against F. solani and A. alternata.

Abstract The production of chickpea (Cicer arietinum L.) is constantly compromised by a complex of pathogens that cause root wilt and rot (RWR). Some of the strategies used for the management of this disease are the use of resistant varieties, crop rotation, solarization, removal of regrowths and use of seeds free of pathogens or treated with fungicides, although the results have been limited or not very satisfactory, in recent years, biological control and organic products have become more important. In the present work, polyphenols were obtained from ethanolic extracts by the ultrasound-microwave-assisted technique of plant species: thunder (L. lucidum) leaf, sorghum (S. bicolor) grains and moringa (M. oleifera) leaves. The corresponding qualitative analysis was carried out using HPLC masses and the antifungal effect of each group of polyphenol extracts on three phytopathogenic fungi that make up the complex of root wilt and rot was determined by means of the technique of plate dilution and poisoned medium. The percentage of inhibition and the inhibitory concentration (IC50) were determined. The results indicate that polyphenols have high biological effectiveness on the fungus Macrophomina and Fusarium solani, the activity for Fusarium oxysporum f. sp. ciceris depended on the polyphenols of each plant species; polyphenols of L. lucidum with a concentration of 491.99 ppm. Additionally, it was found that all the groups of polyphenols had in their chemical composition some compounds of recognized microbial activity such as: flavones, anthocyanins, catechins and alkylphenols, among others.

Resumen La producción del garbanzo (Cicer arietinum L.) constantemente está comprometida por un complejo de patógenos que ocasionan la marchitez y pudrición de raíz (MPR). Algunas de las estrategias empleadas para el manejo de esta enfermedad son el uso de variedades resistentes, rotación de cultivos, solarización, retiro de socas y uso de semillas libre de patógenos o tratadas con fungicidas, aunque los resultados han sido limitados o poco satisfactorios, en los últimos años, el control biológico y los productos orgánicos ha cobrado mayor importancia. En el presente trabajo se obtuvieron polifenoles de extractos etanólicos mediante la técnica asistida de ultrasonido- microondas de las especies vegetales: hoja de trueno (L. lucidum), granos de sorgo (S. bicolor) y hojas de moringa (M. oleífera). Se les realizó el correspondiente análisis cualitativo mediante HPLC masas y se determinó el efecto antifúngico de cada grupo de polifenoles extracto sobre tres hongos fitopatógenos que conforman el complejo de la marchitez y pudrición de raíz, por medio de la técnica de dilución en placa y medio envenenado. Se determinó el porcentaje de inhibición y la concentración inhibitoria (CI50). Los resultados indican que los polifenoles tienen elevada efectividad biológica sobre el hongo Macrophomina y Fusarium solani, la actividad para Fusarium oxysporum f. sp. ciceris dependió de los polifenoles de cada especie vegetal; polifenoles de L. lucidum con una concentración de 491.99 ppm. Adicionalmente se comprobó que todos los grupos de polifenoles tenían en su composición química algunos compuestos de reconocida actividad microbiana como lo son: flavonas, antocianinas, catequinas y alquifenoles, entre otros.

ABSTRACT Introduction: Chronic kidney disease mainly affecting male farmers and not associated to traditional causes has been present in Central America for twenty years. The condition is characterized by the presence of chronic interstitial nephritis, but its ultrastructural features are not fully known. Factors suggested as responsible for its occurrence include the use of agrochemicals and other nephrotoxic agents, chronic dehydration and medicine consumption. Objective: Describe the ultrastructural characteristics of chronic interstitial nephritis in farming communities. Method: A cross-sectional descriptive study was conducted of renal biopsy samples from eight patients diagnosed with chronic interstitial nephritis in farming communities. Results: Of the eight patients studied, two (25%) were farm workers and five (62.5%) were female. Two of the patients (25%) had stage 2 and six (75%) stage 3 chronic kidney disease. In five patients evidence was found of phagolysosomes with lipid component mixed with electrodense material in distal tubule cells. An equal number of patients had myeloid bodies with laminated areas and central nucleus in proximal tubule and blood vessel cells. Conclusions: Evidence of phagolysosomes and myeloid structures of unknown content and origin was found in renal tubules and vessels of patients from farming communities diagnosed with chronic interstitial nephritis.

RESUMEN Introducción: Desde hace 20 años se presenta en Centroamérica una enfermedad renal crónica que fundamentalmente afecta a hombres agricultores y no asociada a las causas tradicionales. Se caracteriza por presentar una nefritis intersticial crónica, en tanto las características ultraestructurales no se conocen con exactitud. En su origen se invoca el uso de agroquímicos y otros agentes nefrotóxicos, la deshidratación crónica, el consumo de medicamentos, entre otros factores. Objetivo: Describir las características ultraestructurales de la nefritis intersticial crónica en comunidades agrícolas. Método: Se realizó un estudio descriptivo de corte transversal. Se estudiaron muestras de biopsias renales de ocho pacientes con diagnóstico de nefritis intersticial crónica de las comunidades agrícolas. Resultados: De los ocho pacientes estudiados, dos (25 %) trabajaban en labores agrícolas y cinco eran del sexo femenino (62,5 %). Dos de los pacientes (25 %) presentaban una enfermedad renal crónica estadio 2, y seis (75 %) estadio 3. En cinco pacientes se hallaron fagolisosomas con presencia de componente lipídico entremezclado con material electrodenso en células del túbulo distal. En igual cantidad de pacientes se observaron cuerpos mieloides con zonas laminadas y núcleo central en células de túbulo proximal y de los vasos sanguíneos. Conclusiones: En pacientes de comunidades agrícolas que padecen nefritis intersticial crónica se evidencian fagolisosomas y estructuras mieloides en túbulos y vasos renales, cuyo contenido y origen se desconocen.

ABSTRACT Introduction: There are multiple articles published that address the subject of open science and its importance for society, especially for the research community. This constitutes, inevitably, the present and future of scientific journals as a method of expanding research with high quality and credibility. Open science, as a movement, has several components including the management of citations and references of data, codes and materials, which support the need for authors to have available the underlying content of the articles published and constituting the base for the results obtained in each investigation. Objective: Assessment of the efficacy of improved recovery protocols in cardiac surgery. Methods: The proposed protocol was prepared by the main researcher (Cuban public registry of clinical trials: RPCEC00000304) and is described according to the recommendations of the international checklist for clinical trials (SPIRIT). Conclusions: They would be related to whether it can be demonstrated, after the end of the investigation, if the protocol reason for the intervention is better, equal to, or worse than the control protocol.

RESUMEN Introducción: Múltiples son los artículos publicados que abordan el tema de la ciencia abierta y su importancia para la sociedad, especialmente para la comunidad de investigadores. Esta constituye, ineludiblemente, el presente y futuro de las revistas científicas como método de expandir las investigaciones con alta calidad y credibilidad. La ciencia abierta como movimiento, tiene varios componentes y dentro de ellos, la gestión de citas y referencias de datos, códigos y materiales, que fundamentan la necesidad de que los autores tengan disponibles los contenidos subyacentes a los artículos que se publican y que constituyen la base de los resultados obtenidos en cada investigación. Objetivo: Evaluación de la eficacia de los protocolos de recuperación mejorada en cirugía cardiaca. Métodos: El protocolo que se propone fue elaborado por la investigadora principal (registro público cubano de ensayos clínicos RPCEC00000304) y se describe acorde a las recomendaciones de la lista internacional de chequeo para ensayos clínicos (SPIRIT). Conclusiones: Estarían en relación a si se puede demostrar, después de terminada la investigación, si el protocolo motivo de la Intervención, es mejor, igual o peor que el protocolo de control.

ABSTRACT Introduction: An epidemic of chronic kidney disease (CKD) of devastating consequences has been taking place in El Salvador over the last few decades. In a significant portion of affected subjects, no other common cause of chronic kidney disease is present, such as diabetes and hypertension. This illness is usually called Chronic Kidney Disease from Non-Traditional Causes (CKDnT). Previous studies have shown a high prevalence of exposure to agrochemicals in affected populations, particularly in rural areas. In addition to sustained exposure to agrochemicals, the other leading hypothesis to explain this epidemic is prolonged exposure to high temperatures and dehydration in a context of exhausting agricultural work. Objectives: To assess the possible causal effect of exposure to agrochemicals in the emergence of the CKD epidemic in the adult population of El Salvador. Methods: We conducted a case-control analysis based on the 2015 survey of Chronic Diseases in Adults in El Salvador, a national probabilistic sample that covered 4,817 adults ≥20 years old. Those suffering from CKD were considered cases; the rest were managed as controls. Self-reported agrochemical exposures, other risk factors and health conditions were recorded. For binary exposures, the odds ratio (OR) of CKD and CKDnT was estimated. For variables measuring length of exposure, the average values for cases and for controls were compared. In all cases, the corresponding 95% confidence intervals were calculated. Multivariate logistic regression was used to examine the association between exposure to agrochemicals and CKD while controlling for potential confounding variables. Results: Regardless of how past exposure to agrochemicals was characterized (e.g., contact with paraquat or aerial fumigation) the OR of both CKD and CKDnT was always greater than 1.0 (range, 1.36 to 3.75). Similarly, the average number of years of exposure was consistently higher for cases than for controls for all continuous variables examined (greater than 2 years in most cases). Conclusions: The results of this study are consistent with previous epidemiologic and toxicological evidence and support the hypothesis that exposure to agrochemicals may be causally implicated in the ongoing CKD epidemics in El Salvador.

RESUMEN Introducción: Durante las últimas décadas, una epidemia de enfermedad renal crónica (ERC) de consecuencias devastadoras ha tenido lugar en El Salvador. Una parte importante de los sujetos afectados, no padece de una causa frecuente para padecer enfermedad renal crónica, tal como como diabetes e hipertensión. En tal caso, suele distinguirse la dolencia mediante el nombre de Enfermedad Renal Crónica de Causas no Tradicionales (ERCnT). Estudios previos muestran una alta prevalencia de exposición a agroquímicos en las poblaciones afectadas, particularmente en las zonas rurales. Además de la exposición sostenida a agroquímicos, la otra hipótesis principal para explicar esta epidemia es la exposición prolongada a altas temperaturas y deshidratación, en un contexto de trabajo agrícola agotador. Objetivos: Evaluar el posible efecto causal de la exposición a agroquímicos en la irrupción de la epidemia de ERC en la población adulta de El Salvador. Métodos: Se realizó un estudio de casos y controles, a partir de la Encuesta de Enfermedades Crónicas no Transmisibles en Adultos en El Salvador, basada en una muestra probabilística nacional que abarcó 4,817 adultos de 20 o más años de edad, concluida en 2015. Fueron considerados “casos” todos aquellos que padecían ERC; el resto dos restantes participantes se manejaron como controles. Se registraron las exposiciones a agroquímicos, así como a otros factores de riesgo y condiciones de salud según testimonio de los participantes. Para las exposiciones binarias, se estimó la razón de odds (OR) con respecto a padecer ERC y ERCnT. Para las variables que medían la duración de la exposición, se compararon los valores medios para casos y controles. En todos los casos, se calcularon los respectivos intervalos de confianza al 95%. Se utilizó la regresión logística multivariada para examinar la asociación entre la exposición a agroquímicos y la ERC, controlando las posibles variables confusoras. Resultados: Independientemente de cómo fuera caracterizada la exposición pasada a agroquímicos (por ejemplo, contacto con paraquat o fumigación aérea), el OR de ERC y ERCnT siempre fue mayor que 1.0 (rango, 1.36 a 3.75). Del mismo modo, la media de años de exposición fue consistentemente más alta para los casos que para los controles, para todas las variables continuas examinadas (más de 2 años en la mayoría de los casos). Conclusiones: Los resultados de este estudio son consistentes con la evidencia epidemiológica y toxicológica previa y respaldan la hipótesis de que la exposición a agroquímicos puede estar causalmente implicada en la epidemia de ERC que se registra en El Salvador.

In El Salvador, chronic kidney disease had reached epidemic proportions towards the end of this century’s first decade. In 2011–2012, the Ministry of Health reported it was the leading cause of hospital deaths in men, the fifth in women, and the third overall in adult hospital fatalities. Farming was the most common occupation among men in dialysis (50.7%). By 2017, chronic kidney disease admissions had overwhelmed hospital capacity. In 2009, El Salvador’s Ministry of Health, Cuba’s Ministry of Public Health and PAHO launched a cooperative effort to comprehensively tackle the epidemic. The joint investigations revealed a total prevalence of chronic kidney disease in the adult population of farming communities higher than that reported internationally (18% vs.11%–14.8%), higher in men than in women (23.9% vs 13.9%) and higher in men who were farmers/farmworkers than in men who were not (31.3% vs. 14.8%). The disease was also detected in children. An association was found between chronic kidney disease and exposure to agrochemicals (OR 1.4–2.5). In 51.9% of all chronic kidney disease cases, traditional causes (diabetes, hypertension, glomerulopathies, obstructive nephropathies and cystic diseases) were ruled out and the existence of a particular form of chronic kidney disease of nontraditional etiology was confirmed (whose initial cases were reported as early as 2002). In the patients studied, functional alterations and histopathologic diagnosis confirmed a chronic tubulointerstitial nephritis; most presented with neurosensory hearing loss, altered tendon reflexes and tibial artery damage. The main results of this cooperation were the epidemiologic, physiopathologic, clinical and histopathologic characterization of chronic kidney disease of nontraditional etiology. This characterization facilitated case definition for the epidemic and led to the hypothesis of systemic toxicity from agrochemicals (e.g., paraquat, glyphosate), which particularly affect the kidneys and to which farmers/farmworkers (who may also become dehydrated in the fields) are most exposed. The research thus also laid the foundations for design of comprehensive intersectoral government actions to reduce cases and put an end to the epidemic. Chronic kidney disease; chronic renal failure; tubulointerstitial nephritis; epidemiology; histopathology; international cooperation; agrochemicals; environmental pollutants, noxae, and pesticides; occupational health; PAHO; El Salvador; Cuba

ABSTRACT INTRODUCTION Chronic kidney disease has reached epidemic levels in several Central American countries since the early years of this century. In El Salvador, it is the second cause of death in men, the fifth in persons over 18 years old and the third cause of hospital deaths in the adult population. Its features, especially those of a subtype unassociated with traditional risk factors such as diabetes and high blood pressure, are only partially understood. OBJECTIVE Estimate the magnitude of chronic kidney disease in the adult population of El Salvador, considering both prevalence of the disease in its diverse forms as well as presence of potential risk factors nationally and in major subpopulations. METHODS A descriptive, cross-sectional analysis was conducted on data obtained from the Survey of Chronic Non-communicable Diseases in Adults in El Salvador, completed in 2015. The original data (interviews and measurements) were collected between October 2014 and March 2015 from 4817 adults employing a two-stage probabilistic cluster sample, with stratification of primary sampling units. Our analysis, using 20 of the 118 primary variables included in the original survey, focused on point estimation of prevalence rates and means, related to both traditional biological risk factors and nontraditional ones, such as insufficient hydration, strenuous working conditions and exposure to toxic agents. A separate analysis was performed to estimate prevalence of chronic kidney disease from nontraditional causes. Corresponding confidence intervals were calculated with proper weighting. RESULTS The general prevalence of chronic kidney disease in El Salvador was 12.8% (men 18.0%; women 8.7%). Of the chronically ill kidney patients, 13.1% were between 20 and 40 years of age. Among biological risk factors, the most frequent was high blood pressure (37.0%). Among nontraditional risk factors, high levels of sugary drink consumption (81.0%), insufficient hydration (65.9%) and high levels of exposure to agrochemicals in the work environment (12.6%) were also observed. Prevalence of chronic kidney disease from nontraditional causes was 3.9% (men 6.1%; women 2.2%). CONCLUSIONS Chronic kidney disease has reached epidemic proportions in El Salvador. The data confirm a health tragedy that, although especially striking older men, also takes a severe toll on young men and women. The results confirm findings of previous research in several Salvadoran agricultural communities. The relatively high level of population exposure to agrochemicals is important and alarming, especially in rural areas, meriting health-impact studies that include and go beyond possible impact on chronic kidney disease.

ABSTRACT Introduction: The basis of the National Health System in Cuba is the Primary Health Care; the family doctor registers the patients to evaluate the risks, to carry out the treatment, and follow-up them in the community. Chronic Kidney Disease affects the 10% of the adult population, that is why the active surveillance is necessary. Objectives: To evaluate and compare all patient registries of Chronic Kidney Disease and Chronic Kidney Disease with Diabetes Mellitus (2014- 2017). Material and Methods: The total of patients registered with Chronic Kidney Disease (glomerular filtration rate <60 mL/min/1.73 m2), and among them the diabetic patients; comparing the prevalence rate per 1 000 inhabitants, (sex, age, province). The data were obtained from the registries of the National Direction for Statistics. Results: Dispensarization increased in 2017 vs 2014: CKD 21,0%, and CKD with diabetes mellitus 47,21%. It increased according to age and it reached its maximum value in the group of 60-64 year-old ages for the CKD (8,99 per 1 000 inhabitants) and among them, more than 65 years old (1,35 per 1 000 inhabitants) for CKD with Diabetes Mellitus. There are differences in rates in the provinces in a frequency of CKD (6,28-1,06), and CKD with Diabetes Mellitus (0,82-0,11). The diagnosis of CKD-DM vs the existent diabetic and dispensarized population between 1,25-0,1% also varies. Conclusions: The dispensarization has increased for CKD and CKD with Diabetes Mellitus. The cuban state guarantees the sustainability of the universal access of the medical care in each community; the advice to patients; the diagnostic tools and the covering of essential medications.

RESUMEN Introducción: La base del Sistema Nacional de Salud en Cuba es el médico de la familia quienes registran, evalúan los riesgos, tratan y siguen a los pacientes en su comunidad. La enfermedad renal crónica afecta al 10% de la población adulta por lo cual es necesaria su activa vigilancia. Objetivos: evaluar y comparar la dispensarización por ERC y ERC-DM entre 2014 y 2017. Material y Métodos: Pacientes registrados con ERC (tasa de filtración glomerular <60 mL/min/1,73 m2) total y de causa diabética; tasa de prevalencia x 1 000 habitantes, (sexo, edad, provincia). Los datos se obtuvieron de los registros de la Dirección Nacional de Estadísticas. Resultados: Se incrementa la dispensarizacion en 2017 vs 2014: por ERC 21%, y de ellos con ERC ocasionada por diabetes en un 47,21%. Existió un aumento a mayor edad y alcanzó su valor máximo en el grupo de edades de 60-64 años para la ERC (8,99 x 1 000 habitantes) y entre los mayores de 65 años (1,35 x 1 000 habitantes) para la ERC-DM. Existen diferencias en las tasas provinciales, en la frecuencia de ERC (6,28-1,06), y de ERC-DM (0,82-0,11), también varía el diagnostico ERC-DM vs la población diabética existente y dispensarizada entre un 1,25-0,1% Conclusiones: Existe una mejoría en la dispensarización por ERC y por ERC-DM. La garantía por el Estado Cubano del acceso universal, de la atención centrada desde cada comunidad; en el asesoramiento a los pacientes; de las herramientas diagnósticas y la cobertura de medicamentos esenciales garantiza su sostenibilidad.

ABSTRACT. Apple production in the Sierra de Arteaga, Coahuila is mainly based on the Golden Delicious cultivar. Production based on only a few cultivars represents a genetic risk, because if they are susceptible to a pest, disease or climate change much of this production would be lost if one or more of these conditions occurred. Foreseeing this situation, farmers have introduced different commercial apple cultivars, but there is little information about the genetic diversity among them. Therefore, the aim of this study was to estimate the rates of intraspecific genetic diversity of 12 different apple cultivars using inter-simple sequence repeat (ISSR) molecular markers. Employing nine ISSR primers, it was possible to identify 124 DNA bands, of which 63% were polymorphic, with genetic diversity of 0.24. Results suggest that these cultivars are adapted to the region’s climate and can be utilized to increase the overall plantation area, in order not to depend on a single cultivar.

RESUMEN. La producción de manzana en la Sierra de Arteaga, Coahuila se basa principalmente en el cultivar Golden Delicious. La siembra de pocos cultivares representa un riesgo, de plagas, enfermedades o cambios climáticos, que pueden afectar la producción. Por lo que los agricultores han introducido diferentes variedades de manzano, de los que no se tiene información sobre su diversidad genética. El objetivo fue estimar los índices de diversidad genética intraespecíficos con marcadores moleculares intersecuencias simples repetidos (ISSR) de 12 cultivares de manzano de la Sierra de Arteaga. Con ayuda de nueve iniciadores se identificaron 124 bandas, de las cuales el 63% fueron polimórficas, con diversidad genética de 0.24. Los resultados sugieren que éstos cultivares están adaptados a las condiciones climáticas de la región y se pueden utilizar para incrementar el área de plantación, para no depender de un cultivar.

ABSTRACT: Genetic analysis is important to identify genetic variability in organisms inhabiting a specific region. In this study, a sotol population was characterized through five elevational levels at one location in the Chihuahuan Desert in Mexico, using amplified fragment length polymorphisms (AFLP) markers. Population genetic diversity, polymorphic loci, Nei's unbiased heterozygosity, average and effective number of alleles, and optimum number of samples were determined. A dendrogram was constructed, and Shannon entropy was calculated. Based on the estimated parameters, the middle elevational level had the highest genetic variation. The optimum sample size to determine genetic variability in sotol was from 24 to 26 plants. In the produced dendrogram, no association was observed among plants belonging to the same stratum, which could be explained by the high genetic flow among plants from different strata. These results provide a foundation of knowledge for understanding the genetic diversity in sotol populations growing in the Chihuahuan Desert mountains. The information will allow designing strategies for implementing sotol breeding and conservation programs.

RESUMEN: El análisis genético es importante para identificar variabilidad genética en organismos que habitan una determinada región. En este estudio una población de sotol fue caracterizada a través de cinco niveles altitudinales de una localidad del desierto chihuahuense en México, usando marcadores de polimorfismos de fragmentos amplificados (AFLP). Se determinó la diversidad genética de la población, loci polimórficos, heterosigocidad insesgada de Nei's, promedio y número efectivo de alelos, y número óptimo de muestras. Un dendrograma fue construido y la entropía de Shannon fue calculada. Con base en los parámetros estimados se observó que la altitud media tiene la mayor variación genética. El tamaño de muestra óptimo para determinar la variabilidad genética en sotol fue de 24 a 26 plantas. En el dendrograma obtenido no se observó asociación de datos entre plantas del mismo estrato, lo cual puede ser explicado por el mayor flujo genético entre plantas de diferentes estratos. Estos resultados establecen la base para el conocimiento de diversidad genética en poblaciones de sotol que crecen en las montañas del desierto chihuhuense. La información generada permitirá diseñar estrategias para implementar programas de mejoramiento y conservación.

ABSTRACT INTRODUCTION For two decades, various countries have experienced an epidemic of chronic kidney disease unexplainable by traditional causes. Typically a chronic tubulointerstitial nephritis, it predominantly affects young male agricultural workers and has been reported in several countries in Central America, as well as in Sri Lanka, India and Egypt. Recent studies in El Salvador have also reported the disease in male nonagricultural workers and in women, both those working in agriculture and not. Epidemiological information on whether this condition affects pediatric populations is virtually nonexistent. Globally, estimates of chronic kidney disease prevalence in pediatric populations range from 21 to 108 per million population. OBJECTIVE Determine the prevalence of urinary markers of renal damage and of chronic kidney disease in persons aged <18 years in rural Salvadoran communities. METHODS Pediatric NefroSalva was a descriptive epidemiologic study in three agricultural regions with known high prevalence of chronic kidney disease of uncertain etiology: Bajo Lempa, Guayapa Abajo and Las Brisas. Demographic and health data were collected and physical measurements were taken for 2115 persons aged <18 years, 1058 boys and 1057 girls. Urine samples were tested for markers of renal damage and blood samples analyzed to measure creatinine for estimating glomerular filtration rate (Schwartz formula). Median glomerular filtration rate was compared with reference values for age groups 2-12 and 13-17 years; mean glomerular filtration rate trends were assessed for age groups 2-5, 6-12 and 13-17 years. Positive test results were confirmed after three months. RESULTS Prevalence of urinary markers of renal damage was 4%, 4.3% in girls and 3.8% in boys. Microalbuminura (albumin:creatinine ratio 30-300 mg/g) was detected in both sexes and all age groups in all three regions, with prevalences of 2.6%-3.8% in boys and 3.3%-3.8% in girls. Macroalbuminuria (albumin:creatinine ratio >300 mg/g) was detected only in girls in Las Brisas, 2.3%. Glomerular hyperfiltration (compared to international norms) was found in all age-sex groups in all three regions. Prevalence of chronic kidney disease was 3.9%—4.1% in girls and 3.6% in boys. The prevalence of chronic renal failure was 0.1%. CONCLUSIONS High prevalence of chronic kidney disease in children and adolescents calls attention to the need for primary prevention from very early ages. This finding in children in areas where chronic kidney disease of uncertain etiology is common in adults is consistent with a contribution of environmental toxins to the epidemic observed in these areas.