ABSTRACT Introduction: Ticks are ectoparasites, which are vectors of infectious diseases for humans and animals. Vaccination could be an ecological alternative to chemicals to control these ectoparasites. A peptide of the ribosomal protein P0 conjugated to hemocyanin from the mollusk Megathura crenulata (KLH) has shown an effectiveness of more than 90 % against Rhipicephalus sanguineus and R. microplus tick species. However, KLH is an expensive protein that is not an economically viable alternative for developing this peptide as a commercial vaccine. Methods: The synthetic P0 peptide was chemically conjugated to the Bm86 protein obtained by fermentation of a recombinant Pichia pastoris yeast. This conjugate was characterized by SDS-PAGE analysis and mass spectrometry and was used in immunization and challenge experiments against different tick species. Results: SDS-PAGE analysis of this conjugate showed that it is very heterogeneous and that there are from 1 to 18 molecules of pP0 per molecule of Bm86. LC-MS/MS analysis and the combination of 4 different software showed that 49 of the 54 lysine residues and the N-terminal end of the Bm86 protein were partially conjugated to pP0. This conjugate pP0-Bm86 generated an immune response against the peptide when used as an antigen in immunization experiments of different animals. This immune response affected the viability and reproductive potential of different tick species. Conclusion, these results demonstrate that the P0 peptide is a broad spectrum antigen and permit its development as an anti-tick vaccine.

RESUMEN Introducción: Las garrapatas son ectoparásitos vectores de enfermedades infecciosas para humanos y animales. La vacunación pudiera ser una alternativa ecológica respecto a los químicos para controlar estos ectoparásitos. Un péptido de la proteína ribosomal P0 conjugado a hemocianina del molusco Megathura crenulata (KLH) ha mostrado una efectividad de más del 90 % contra garrapatas de la especie Rhipicephalus sanguineus y microplus. Sin embargo, KLH es una proteína costosa que no es una alternativa económicamente viable para el desarrollo del péptido como una vacuna comercial. Métodos: El péptido de P0 sintético se conjugó químicamente a la proteína Bm86 obtenida en fermentación de un clon de levadura Pichia pastoris recombinante. Este conjugado se caracterizó mediante un análisis de SDS-PAGE y espectrometría de masas y se utilizó en experimentos de inmunización y reto contra diferentes especies de garrapatas. Resultados: El análisis de SDS-PAGE de este conjugado demostró que es muy heterogéneo y que hay de 1 a 18 moléculas de pP0 por molécula de Bm86. El análisis de LC-MS/MS y la combinación de 4 softwares diferentes mostró que 49 de los 54 residuos de lisina y el extremo N-terminal de la proteína Bm86 se encontraron parcialmente conjugados al pP0. Este conjugado pP0-Bm86 en experimentos de inmunización de diferentes animales generó una respuesta inmune contra el péptido que afectó la viabilidad y el potencial reproductivo de diferentes especies de garrapatas. En conclusión, estos resultados demuestran que el péptido de P0 es un antígeno de amplio espectro y permite su desarrollo como vacuna anti-garrapatas.

SUMMARY Introduction: to evaluate physical performance of elder people is an important working tool for determining sarcopenia, frailty and that way assessing the functional capacity at this age. Objective: to evaluate physical performance in elder people from policlinic "Heroes del Moncada". Materials and methods: a cross-sectional, descriptive research was carried out in 422 elder people from the Teaching Policlinic "Heroes del Moncada" in the period from May 2011 to May 2014. Physical performance was determined applying the test staying 5 times up from a chair and measuring the speed of a 4.5- meters-long walk. Results: 90.3 % of the people completed the test staying 5 times up from a chair in 13.8 sec. The average speed of the walk was 0.74 m/sec. Conclusions: most of elder people were female, aged 70-79 years, independent according to the Basic and Instrumented Activities of the Daily Life and showing good physical performance.

RESUMEN Introducción: la evaluación del rendimiento físico en los adultos mayores es una importante herramienta de trabajo para determinación de la sarcopenia, la fragilidad y evaluar así la capacidad funcional en esta etapa. Objetivo: evaluar el rendimiento físico en adultos mayores del Policlínico “Héroes del Moncada”, del municipio Plaza de la Revolución, La Habana. Materiales y método: se realizó una investigación descriptiva, de corte transversal en 422 adultos mayores del Policlínico “Héroes del Moncada” en el período comprendido de mayo 2011 a mayo 2014. Se determinó el rendimiento físico a través de la aplicación del test levantarse cinco veces de una silla y la velocidad de la marcha a 4,5 metros de distancia. Resultados: el 90,3% de los adultos mayores completaron el test Levantarse de una silla 5 veces, con tiempo de 13.8 seg, el valor medio de la velocidad de la marcha fue de 0.74m/seg. Conclusiones: la mayoría de las personas mayores fueron del sexo femenino, de 70 a 79 años, independientes para las actividades básica e instrumentadas de la vida diaria y con buen rendimiento físico.

ABSTRACT INTRODUCTION By the end of 2017, there were more than 28,000 individuals living with HIV in Cuba, over 80% receiving antiretroviral therapy, which dramatically reduces viral replication, improves immune status and decreases risk of transmission. These results could be jeopardized by emergence of HIV-1 drug resistance. In 2009, a test for HIV-1 genotypic resistance was introduced in routine clinical practice in Cuba. OBJECTIVE Investigate antiretroviral resistance and its relation to subtype distribution in HIV-1 treatment-naïve and previously treated patients in Cuba. METHODS Resistance and HIV-1 subtype distribution were determined in 342 antiretroviral treatment-naïve patients and 584 previously treated for HIV-1 whose blood specimens were sent to the Pedro Kourí Tropical Medicine Institute during 2009–2014. Transmitted drug resistance was determined using the Calibrated Population Resistance Tool v.6. Drug resistance analysis was conducted using the algorithm Rega v9.1.0. RESULTS Prevalence of transmitted drug resistance was 11.4%, and 41% of mutated viruses exhibited dual-class resistance to nucleoside reverse transcriptase inhibitor and non-nucleoside reverse transcriptase inhibitor. Overall, 84.9% of patients had ≥1 resistance mutation, 80% had ≥1 nucleoside reverse transcriptase inhibitor mutation, 71.4% had ≥1 non-nucleoside reverse transcriptase inhibitor mutation and 31.7% had ≥1 protease inhibitor mutation. K65R and K101E mutations were significantly more frequent in subtype C, L210W in CRF19_cpx, and M47V/I in CRF BGs (20, 23, 24). Full class resistance to nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors and multidrug resistance were detected in 21.2%, 32.4%, 8% and 4.1% of patients, respectively. Average percentage resistance to nucleoside reverse transcriptase inhibitor, protease inhibitor, full class resistance to nucleoside reverse transcriptase inhibitor, protease inhibitor and multidrug resistance increased in patients failing two or more regimens. Nevertheless, after 2011, a declining trend was observed in the frequency of multidrug resistance and full class resistance to nucleoside reverse transcriptase inhibitors and protease inhibitors. CONCLUSIONS Detected levels of transmitted drug resistance highlight the need for a national surveillance study in treatment-naïve patients. Resistance prevalence is high in previously treated patients but appears to be decreasing over time. The frequency of resistance mutations in recombinant forms of HIV in Cuba needs further study.

ABSTRACT The investigation is directed to the improvement of the process of university extension in the University Siblings Saíz Mounts of Goose of Pinegrove of the River and particularly in the reading promotion from a formative perspective. The logic of the investigation trafficked, by means of diverse investigation methods, for the initial diagnosis of the formation process for the reading promotion in the university extension and the elaboration of the theoretical mark. As theoretical contribution, a pedagogic conception of this process was based, sustained in the cultural promotion as method characteristic of the university extension, what allowed to identify three stages, as well as the principles that regulate its operation. Starting from the presented pedagogic conception, a strategy was designed for its implementation through three specific strategic actions. The scientific result of the work possesses a high generalization potential to the centers of superior education of the country.

RESUMEN La investigación está dirigida al perfeccionamiento del proceso de extensión universitaria y particularmente a la promoción de la lectura desde una perspectiva formativa. La lógica de la investigación transitó, mediante diversos métodos de investigación, por el diagnóstico inicial del proceso de formación para la promoción de la lectura en la extensión universitaria y la elaboración del marco teórico. Como aporte teórico, se fundamentó una concepción pedagógica de dicho proceso, sustentada en la promoción cultural como método propio de la extensión universitaria, lo que permitió identificar tres etapas por las que transcurre, así como los principios que regulan su funcionamiento. A partir de la concepción pedagógica presentada, se diseñó una estrategia para su implementación a través de tres acciones estratégicas. El resultado científico del trabajo posee un elevado potencial de generalización a los centros de educación superior del país.

ABSTRACT Introduction: there is a lot of controversy with regard to who should be responsible for sedation during digestive endoscopy, particularly in advanced procedures that require deep sedation such as enteroscopy. The aim of this study was to evaluate the endoscopist-directed sedation viability during single balloon enteroscopy. Material and method: this was a prospective, observational study of a series of consecutive enteroscopies. The clinical staff included an endoscopist, scrub nurse and a nurse in charge of monitoring and sedative administration. The following parameters were monitored: pulse oximetry, blood pressure (every five minutes), electrocardiogram and respiratory rate. There was continuous supplemental oxygen and CO2 insufflation. The patient was in the left lateral decubitus position and a fluoroscopic control was used. Results: forty-four explorations were performed in 39 patients, 24 were male and 15 female. The median age was 74 (18-89) and the ASA score was I in 12 cases, II in 23 cases and III in nine cases. Comorbidities were present in 68% of cases. The drugs used included propofol in 23 cases, propofol and midazolam in ten cases, propofol/midazolam/fentanyl in two cases, propofol and fentanyl in two cases, and midazolam/fentanyl in seven cases. All procedures were complete. The length of the procedure was 52 minutes (20-120). There were diagnostic findings in 65.9% of cases and therapeutic measures in 47.7%. There were no severe complications and the rate of complications derived from sedation was 22.7%. Conclusion: endoscopist-directed sedation is effective and safe for single balloon enteroscopy. Multi-center and wider studies are needed in order to better assess the efficacy, safety and efficiency of sedation controlled by a non-anesthetist during advanced endoscopy in this field.

RESUMEN Introducción: existe controversia sobre quién debe responsabilizarse de la sedación en endoscopia digestiva, sobre todo en los procedimientos avanzados que exigen sedación profunda. La enteroscopia es uno de ellos. El objetivo del trabajo es valorar la viabilidad de la sedación controlada por endoscopista durante la enteroscopia de monobalón. Material y método: estudio prospectivo observacional de una serie de enteroscopias consecutivas. Personal dedicado: endoscopista, enfermera instrumentista y enfermera encargada de monitorización y administración de sedantes. Monitorización: pulsioximetría, tensión arterial cada cinco minutos, registro electrocardiográfico y frecuencia respiratoria. Administración continua de oxígeno. Insuflación con CO2. Posición del paciente: decúbito izquierdo. Control fluoroscópico. Resultados: cuarenta y cuatro exploraciones en 39 pacientes (24 hombres, 15 mujeres). Edad 74 (18-89). Grado ASA: I-12, II-23, III-9. Comorbilidades en el 68% de los casos. Fármacos empleados: propofol, 23 casos; propofol y midazolam, diez casos; propofol, midazolam y fentanilo, dos casos; propofol y fentanilo, dos casos; y midazolam y fentanilo, siete casos. Procedimientos completados: 100%. Tiempo de exploración: 52 minutos (20-120). Hallazgos diagnósticos en el 65,9% de los casos; maniobras terapéuticas en el 47,7%. Complicaciones graves: ninguna. Complicaciones menores derivadas de la sedación: 22,7%. Conclusión: la sedación controlada por endoscopista es eficaz y segura en la realización de enteroscopia con monobalón. Son convenientes estudios multicéntricos y con mayor número de casos para una mejor valoración de la eficacia, seguridad y eficiencia de la sedación por no anestesista en endoscopia avanzada en nuestro medio.

Background: There are limited data concerning endoscopist-directed endoscopic retrograde cholangiopancreatography deep sedation. The aim of this study was to establish the safety and risk factors for difficult sedation in daily practice. Patients and methods: Hospital-based, frequency matched case-control study. All patients were identified from a database of 1,008 patients between 2014 and 2015. The cases were those with difficult sedations. This concept was defined based on the combination of the receipt of high-doses of midazolam or propofol, poor tolerance, use of reversal agents or sedation-related adverse events. The presence of different factors was evaluated to determine whether they predicted difficult sedation. Results: One-hundred and eighty-nine patients (63 cases, 126 controls) were included. Cases were classified in terms of high-dose requirements (n = 35, 55.56%), sedation-related adverse events (n = 14, 22.22%), the use of reversal agents (n = 13, 20.63%) and agitation/discomfort (n = 8, 12.7%). Concerning adverse events, the total rate was 1.39%, including clinically relevant hypoxemia (n = 11), severe hypotension (n = 2) and paradoxical reactions to midazolam (n = 1). The rate of hypoxemia was higher in patients under propofol combined with midazolam than in patients with propofol alone (2.56% vs. 0.8%, p < 0.001). Alcohol consumption (OR: 2.674 [CI 95%: 1.098-6.515], p = 0.030), opioid consumption (OR: 2.713 [CI 95%: 1.096-6.716], p = 0.031) and the consumption of other psychoactive drugs (OR: 2.015 [CI 95%: 1.017-3.991], p = 0.045) were confirmed to be independent risk factors for difficult sedation. Conclusions: Endoscopist-directed deep sedation during endoscopic retrograde cholangiopancreatography is safe. The presence of certain factors should be assessed before the procedure to identify patients who are high-risk for difficult sedation.

Introduction:clinical assays are the cornerstone of present clinical research. They have increased in the last few years in Cuba due to the accelerated development of the drug and biotechnological industry. This type of research work requires that institutions where it is performed have adequate structural conditions in place to guarantee the compliance with good clinical practices. Objectives: to analyze the difficulties found by two groups of experts as to the performance of clinical assays in the national healthcare system. Methods: descriptive-type qualitative research study conducted from February to October 2013. Fifteen experts were interviewed and divided into two groups by their type of function: group 1 with 7 protocol designers and group 2 with 8 clinical researchers. The gathered information was analyzed and classified into meaning units and categories. Results: both groups considered that pressure upon medical assistance, lack of incentives for the researcher, few material resources and poor training of human resources were the most significant difficulties. Additionally, the members of Group I stated that the low number of certified sites and the slow approval of clinical assays by the ethical commissions are barriers to work. Conclusions: the difficulties that both groups of experts found reveal the little support of institutions for the clinical assay performance that is not seen as a need of the health care system to resolve health problems.

Introducción: los ensayos clínicos constituyen la piedra angular de la investigación clínica actual. Su número se ha incrementado en los últimos años en Cuba por el desarrollo acelerado de la industria médico-farmacéutica y biotecnológica. Este tipo de investigación requiere que las instituciones donde se ejecutan cuenten con condiciones estructurales que garanticen el cumplimiento de las buenas prácticas clínicas. Objetivos: analizar las dificultades percibidas por expertos para la ejecución de ensayos clínicos en el Sistema Nacional de Salud. Métodos: se realizó una investigación cualitativa de tipo descriptiva entre los meses de febrero-octubre de 2013. Se entrevistaron 15 expertos divididos en dos grupos según función: grupo 1, con 7 diseñadores de protocolos y grupo 2, con 8 investigadores clínicos. La información se analizó y clasificó en unidades de significado y categorías. Resultados: ambos grupos consideraron que la presión asistencial, la falta de estimulación al investigador, escasos recursos materiales y deficiente capacitación de los recursos humanos, constituyeron dificultades significativas. Adicionalmente, los expertos del grupo I señalaron como barrera la poca cantidad de sitios certificados y la lenta aprobación de los ensayos clínicos por los comités de ética. Conclusiones: las dificultades percibidas por ambos grupos de expertos hablan a favor del insuficiente apoyo institucional que tienen los ensayos clínicos, que además no son vistos como una necesidad del Sistema para dar respuesta a problemas de salud.

Clinical and epidemiological behaviour of bronchial asthma in elderlies is almost an unknown topic in the investigations carried out in the field, because studies conducted in adult population approach a single age group from 15 years old on. Bronchial asthma is considered a health problem given its high prevalence: about 10% of the Cuban population suffers from it. In elderlies it is an underdiagnosed and undertreated disease often confused with chronic lung disease, so it is very important to able to evaluate the specific characteristics it presents in elderlies in order to attack the disease effectively, and promote the life quality of asthmatic elderlies.

El comportamiento clínico y epidemiológico del asma bronquial en los adultos mayores, resulta un tópico casi desconocido en las investigaciones realizadas en el medio, porque los estudios de la población adulta incorporan a los asmáticos a partir del grupo de edad de 15 años y más. El asma bronquial está considerada como un problema de salud dada su alta prevalencia: alrededor del 10 % de la población en Cuba la padece. En el anciano es una enfermedad subdiagnosticada y subtratada y por lo general confundida con la enfermedad pulmonar obstructiva crónica, por lo que reviste gran importancia su conocimiento para poder evaluar las peculiaridades presentes en los ancianos y de esta manera combatir esta afección de manera eficaz, y así favorecer la calidad de vida del asmático de la tercera edad.

The behavior of the transport of streptokinase antibodies from the mother to the newborn infant, as well as the factors influencing on it, were studied here. 125 blood samples were obtained from the antecubital vein of the puerperas and from the umbilical cord of their children. Surveys were done to collect data from the medical histories of the mothers and the newborn infants. An immunoenzimatic, heterogenous and qualitatitve sandwich doble antigen method was used to detect anti-streptokinase antibodies. According to the results, it was concluded that there is an active transport of anti-streptokinase antibodies from the mother to the fetus and that this transport is influenced by the chronological age of the mother, the gestational age, the mother’s nutritional status and the birth weight.

Se estudió cómo se comporta el transporte de anticuerpos anti-estreptoquinasa entre la madre y el recién nacido y cuáles son los factores que influyen en este. Se colectaron 125 muestras sanguíneas de puérperas, por la vena antecubital y de sus respectivos hijos a partir del cordón umbilical. Se confeccionaron encuestas para la recolección de datos a partir de las historias clínicas de las madres y los recién nacidos. Se empleó un método inmunoenzimático, heterogéneo, cualitativo, tipo sandwich de doble antígeno para la detección de anticuerpos anti-estreptoquinasa. A partir de los resultados obtenidos se concluyó que existe un transporte activo de los anticuerpos anti-estreptoquinasa de la madre al feto y que este transporte se ve influenciado por la edad cronológica de la madre, la edad gestacional, el estado nutricional de la madre y el peso del recién nacido.