ABSTRACT Introduction: Ki67 is a regulatory protein of cellular cycle which is associated to the proliferation of tumoral cells. Its expression has always had an important role at the tumor classification and it is one of the prognostic and predictive factors in breast carcinoma. Objective: To determine the relationship between the expression of Ki67 and other classic prognostic factors used in breast cancer. Methods: A cross-sectional, analytic and descriptive study was carried out at the Teaching Clinic-Surgical Hospital Celestino Hernández, Villa Clara, from January 2017 to June 2019. It was included 286 women with diagnosis of infiltrating breast carcinoma, whose biopsies were studied by immunohistochemistry. The Ki-67 cell marker expression was categorized as low (Ki-67<20 %) and high (Ki-67>20 %). It was analyzed the relationship between level of expression of Ki67 and other classical prognostic and predictive factors. Results: The no special histological type (ductal carcinoma) was the type more often reported. High expression level of Ki67 was associated with the high histological grade (grade 3) and the overexpression of Her2. Low expression of Ki-67 (<20 %) was associated with the expression of estrogen and progesterone receptors. There was not significant association between the tumor size and the expression of Ki67. Conclusions: The levels of expression of Ki67 showed significant association with several predictive and prognostic factors of breast carcinoma.

RESUMEN Introducción: El Ki67 es una proteína reguladora del ciclo celular asociada a la proliferación de las células tumorales. Su expresión siempre ha tenido un papel en la clasificación tumoral, constituye uno de los factores pronósticos y predictivos en el carcinoma mamario. Objetivo: Determinar la relación entre la expresión del marcador de Ki67 y otros factores pronósticos clásicos del cáncer de mama. Métodos: Se realizó un estudio descriptivo analítico, de corte transversal, realizado en el Hospital Clínico-Quirúrgico Docente Celestino Hernández, Villa Clara, entre enero 2017 y mayo de 2019. Se incluyeron 286 mujeres con diagnóstico de carcinoma de mama infiltrante, a cuyas biopsias se les realizó estudio inmunohistoquímico. La expresión del marcador celular Ki67 fue categorizado como baja (Ki67<20 %) y alta (Ki67>20 %). Se analizó la relación entre el nivel de expresión de Ki67 con otros factores pronósticos y predictivos del carcinoma mamario. Resultados: El tipo histológico no especial (carcinoma ductal) fue el que se reportó con mayor frecuencia. Los niveles de expresión altos del marcador celular Ki67 (Ki67≥20 %) se asociaron con el grado histológico alto (grado 3) y la sobreexpresión de Her2. La expresión baja del Ki-67 (<20 %) se asoció con la expresión de los receptores de estrógeno y progesterona. No se demostró asociación significativa entre la talla tumoral y la expresión de Ki67. Conclusiones: Los niveles de expresión del Ki67 mostraron una asociación significativa con varios factores predictivos y pronósticos clásicos del cáncer de mama.

ABSTRACT Introduction: HER2 overexpression in mammary carcinoma is associated to a higher biological activity of the tumor and to an unfavorable prognosis. Objective: to determine the incidence of pure overexpression of HER2/neu oncogene in mammary carcinomas in “Celestino Hernández” Hospital from Villa Clara Province and its relationship with other variables of prognostic value. Methods: descriptive, retrospective study was carried out at the “Celestino Hernández” Hospital between January 2017 and June 2019. It was included 293 women with diagnosis of infiltrating breast carcinoma, the biopsies were subjected to immunohistochemical study to determine the incidence of HER2 oncogene overexpression and its relationship with other variables of prognostic value. Results: 22 cases (7.5%) with exclusive overexpression of the HER2/neu oncogene were found in the series. Of the patients with carcinomas with HER2 overexpression, 17 (77.3%) were older than 50 years, 20 (90.9%) had tumor size greater than 2 centimeters and 21 (95.45%) were associated with the non-special histological type (ductal carcinoma) of mammary carcinoma. The relationship between HER2/neu oncogene overexpression and moderately and poorly differentiated histological forms of mammary carcinoma stands out. The proliferation index determined by Ki67 was greater than 30% in 17 patients (77.27%). Conclusion: postmenopausal age, non-special histological type, high histological grade, high Ki67 indices and tumor size greater than two centimeters are frequently associated with HER2 overexpression in mammary carcinomas.

RESUMEN Introducción: la sobrexpresión de HER2 en el carcinoma mamario se asocia a una mayor actividad biológica del tumor y a un pronóstico desfavorable. Objetivo: determinar la incidencia de sobreexpresión pura del oncogén HER2/neu en carcinomas mamarios en el Hospital “Celestino Hernández” de la Provincia de Villa Clara y su relación con otras variables de valor pronóstico. Métodos: estudio descriptivo, retrospectivo realizado en el Hospital “Celestino Hernández” entre enero de 2017 y junio de 2019. Se incluyeron 293 mujeres con diagnóstico de carcinoma de mama infiltrante, a las biopsias se les realizó estudio inmunohistoquímico para determinar la incidencia de la sobreexpresión del oncogén HER2 y su relación con otras variables de valor pronóstico. Resultados: en la serie se encontraron 22 casos (7,5%) con sobreexpresión exclusiva del oncogén HER2/neu. De las pacientes con carcinomas con sobreexpresión de HER2 17 (77,3%) fueron mayores de 50 años, 20 (90,9%) tuvieron talla tumoral mayor de 2dos centímetros y 21 (95,45%) estuvieron asociadas al tipo histológico no especial (carcinoma ductal) del carcinoma mamario. Destaca la relación entre la sobreexpresión del oncogén HER2/neu con formas histológicas moderada y pobremente diferenciadas del carcinoma mamario. El índice de proliferación determinado por Ki67 fue mayor del 30% en 17 pacientes (77,27%). Conclusión: la edad posmenopáusica, el tipo histológico no especial, el grado histológico alto, los altos índices de Ki67 y la talla tumoral mayor de dos centímetros se asocian con frecuencia a la sobreexpresión de HER2 en carcinomas mamarios.

ABSTRACT Introduction: Children cardiovascular diseases constitute a heterogeneous group of congenital and acquired conditions that represent an important cause of pediatric morbidity and mortality. Objective: Describe clinically and epidemiologically pediatric patients who died of cardiovascular diseases between 2005 and 2017. Methods: A retrospective cross-sectional descriptive study was conducted in the 117 pediatric patients who died with a diagnosis of cardiovascular diseases in the Villa Clara province, between 2005 and 2017, with a predominance of documentary analysis as a research method. Results: A mortality rate of 1.6 per 1000 live births was obtained, with a tendency to decrease over time, with a predominance of those who died with white skin (70.09%), and without differences in sex. Congenital heart disease (75.21%) was more frequent, such as aortic coarctation and transposition of large vessels. Among the acquired heart diseases, myocarditis was the most frequent (79.30%). 48.70% of patients were diagnosed in the first week of life and 63.25% of patients received medical treatment. The most frequent causes of death were congenital heart disease itself and multi-organ dysfunction due to sepsis in the congenital group and in those acquired cardiogenic shock. Conclusions: Congenital heart disease predominated, mainly aortic coarctation. Most patients received only medical treatment and the main direct causes of death were congenital heart disease itself and multi-organ dysfunction.

RESUMEN Introducción: Las enfermedades cardiovasculares de la infancia constituyen un grupo heterogéneo de afecciones congénitas y adquiridas que representan una causa importante de morbilidad y mortalidad pediátricas. Objetivo: Describir clínica y epidemiológicamente a los pacientes pediátricos fallecidos por enfermedades cardiovasculares entre los años 2005 y 2017. Métodos: Estudio descriptivo transversal retrospectivo en los 117 pacientes pediátricos fallecidos con diagnóstico de enfermedades cardiovasculares en la provincia de Villa Clara, entre los años 2005 y 2017, con predominio del análisis documental como método de investigación. Resultados: Se obtuvo una tasa de mortalidad de 1,6 por cada 1000 nacidos vivos con tendencia a disminuir en el tiempo, con predominio de los fallecidos con piel blanca (70,09 %), y sin diferencias en cuanto al sexo. Fueron más frecuentes las cardiopatías congénitas (75,21 %) como coartación aórtica y transposición de grandes vasos. Entre las cardiopatías adquiridas fue la miocarditis la más frecuente (79,30 %). Se diagnosticaron en la primera semana de vida 48,70 % de los pacientes y recibieron tratamiento médico 63,25 % de los pacientes. Las causas de muerte más frecuentes fueron la propia cardiopatía congénita de base y la disfunción multiorgánica por sepsis en el grupo de las congénitas y en las adquiridas el shock cardiogénico. Conclusiones: Predominaron las cardiopatías congénitas fundamentalmente la coartación aórtica. La mayoría de los pacientes recibieron solo tratamiento médico y las principales causas directas de muerte fueron la propia cardiopatía congénita y la disfunción multiorgánica.

ABSTRACT Introduction: The breast carcinoma which is negative to the expression of hormonal receptors (negative RH) includes the molecular subtypes Her2/neu and triple negative, that are both associated to higher biological activity and a worse forecast. Objective: To determine the real incidence of the subtypes triple negative and Her2/neu in breast carcinoma and its correlation with prognostic value clinic-pathological variables. Methods: A descriptive, cross-sectional study was done in the Hospital Celestino Hernández, Villa Clara, from January 2017 to June 2019. It was included 293 women with diagnosis of infiltrating breast carcinoma, whose biopsies were studied by immunohistochemistry, determining the incidence of the molecular subtypes triple negative and overexpression of Her-2 and its correlation with others prognostic value variables. Results: In the series it was determined the incidence of the molecular subtypes triple negative and Her2/neu. In both molecular subtypes more two third of patients were older than 50 years old, had tumor size larger than 2 cm at the moment of diagnosis and had ductal histology. The correlation of the both molecular subtypes with moderately and poorly histological types of breast carcinoma stands out. In the same way the proliferation index determined by Ki67 was high in more two third of the studied patients. Conclusions: The post-menopausal age, the ductal histologic type, high histologic grade, high index of Ki67 and tumor size larger than 2 cm are often associated to molecular subtypes of breast carcinomas which are negative to the expression of hormonal receptors.

RESUMEN Introducción: El carcinoma mamario negativo a la expresión de receptores hormonales (RH negativo) incluye los subtipos moleculares Her-2/neu y triple negativo, asociados ambos a una mayor actividad biológica del tumor y un pronóstico desfavorable. Objetivo: Determinar la incidenciade los carcinomas triples negativos y Her-2/neu en carcinomas mamarios y su relación con variables clínico-patológicas de valor pronóstico. Métodos: Se realizó unestudio descriptivo, de corte transversal, en el Hospital Celestino Hernández, Villa Clara, entre enero de 2017 a junio de 2019. Se incluyeron 293 mujeres con diagnóstico de carcinoma de mama infiltrante, a cuyas biopsias se les realizó estudio inmunohistoquímico determinando la incidencia de los subtipos moleculares triple negativo y Her2/neu y su relación con otras variables de valor pronóstico. Resultados: En la serie se determinó la incidencia de los subtipos moleculares triples negativo y Her2/neu. En ambos subtipos moleculares, más de las dos terceras partes de las pacientes fueron mayores de 50 años, presentaron tallas tumorales mayor de 2 cm en el momento del diagnóstico y tuvieron histología ductal. Destaca además la relación de ambos subtipos moleculares con formas histológicas moderada y pobremente diferenciadas del carcinoma mamario. De igual forma, en ambos subtipos, el índice de proliferación determinado por Ki67 fue alto en más de las dos terceras partes de las pacientes estudiadas. Conclusiones: La edad posmenopáusica, el tipo histológico ductal, el grado histológico alto, el alto índice de Ki67 y la talla tumoral mayor de 2 cm se asocian con frecuencia a subtipos moleculares del carcinoma mamario negativos a receptores hormonales.

ABSTRACT INTRODUCTION Hypertension is one of the most studied risk factors for cardiovascular disease in adults; in children and adolescents, its global prevalence changes with age, from 1%-3% in children to 3.2% in adolescents. In adults, in addition to hypertension, several biochemical markers of cardiovascular risk have been identified. Confirming an association between these and hypertension in childhood and adolescence would allow for more timely diagnosis and monitoring of cardiovascular disease, since the presence of both the markers and hypertension would imply increased risk. OBJECTIVE Confirm an association between biochemical risk markers of cardiovascular disease and hypertension in children aged 8 to 11 years. METHODS A cross-sectional study of 373 children aged 8-11 years was conducted in 3 primary schools in the city of Santa Clara in central Cuba. The variables examined were age, sex, height, blood pressure, cholesterol, triglycerides, lipoproteins and apolipoproteins. The children were classified as normotensive, prehypertensive or hypertensive, based on blood pressure readings and percentiles for age, sex and height. Descriptive statistics were calculated for quantitative variables. A bivariate analysis, tests of independence for qualitative variables and a means comparison for quantitative variables (ANOVA and its nonparametric alternative, the Kruskal Wallis test) were performed. Fisher’s F-test and its associated probability value were employed. RESULTS Some 32.2% of the children were prehypertensive and 5.1% hypertensive. Cholesterol and triglyceride values were significantly higher in hypertensive than in normotensive children (p = 0.028 and p = 0.047, respectively). HDL numbers were higher in normotensive children (p = 0.001), and LDL numbers and the LDL/ HDL ratio were higher in the hypertensive children, with differences between groups (p = 0.001 for both variables). There were differences between the three blood pressure categories for lipoprotein(a) and ApoA (p <0.001 and p = 0.001), for ApoB and for the ApoB/ApoA ratio (p <0.001 for both variables), with lower ApoA values and higher ApoB and ApoB/ApoA values in the hypertensive children. CONCLUSIONS The biochemical risk markers most strongly associated with hypertension in children are ApoB values, LDL, lipoprotein(a), and LDL/HDL and ApoB/ApoA ratios.

ABSTRACT Introduction: The congenital valvulopatías is a group of entities in which the main alteration anatomofuncional is in the heart valves. Objective: To characterize the pediatric patients with diagnostic of born congenital valvulopatías. Methods: He/she was carried out a retrospective descriptive investigation starting from the registrations of congenital valvulopatías of the service of Cardiology of the Hospital Pediatric University student "José Luis Miranda" in the period of 2005 at the 2016. The population was conformed by the 147 alive born children with diagnostic of congenital valvulopatías, a sampling was not used intentional probabilístico by approaches, being conformed the sample by 143. The collection of the information was carried out through the documental revision of the clinical histories. Results: The rate of incidence of the congenital valvulopatías was of 1,5 x 1000 born alive, the lung estenosis prevailed containing to 70,6 % of those diagnosed he/she was prevalence of the masculine sex in 50,3 %, it was determined that 45,5 % of the cases was diagnosed before the 29 days where a prenatal diagnosis is included. Conclusions: The development of the prenatal diagnosis of the congenital cardiopatías has facilitated the decrease of the incidence of the most complex malformations. The knowledge of the congenital illnesses of the heart contributes to operate in a sure way and with complete anatomical resolution to many of these children in the prenatal period or when they are small nurslings, to avoid the global deterioration of these when the cardiopatía is not resolved.

RESUMEN Introducción: Las valvulopatías congénitas son un grupo de entidades en las cuales la principal alteración anatomofuncional está en las válvulas cardiacas. Objetivo: Caracterizar los pacientes pediátricos nacidos vivos con diagnósticos de valvulopatías congénitas. Métodos: Se realizó una investigación descriptiva retrospectiva a partir de los registros de valvulopatías congénitas del Servicio de Cardiología del Hospital Pediátrico Universitario “José Luis Miranda” en Santa Clara, Cuba, en el periodo de 2005 a 2016. La población estuvo conformada por los 147 niños nacidos vivos con diagnóstico de valvulopatías congénitas. Se empleó un muestreo no probabilístico intencional por criterios y la muestra quedó conformada por 143. La recogida de la información se realizó a través de la revisión documental de las historias clínicas. Resultados: La tasa de incidencia de la valvulopatías congénitas fue de 1,5 x 1 000 nacidos vivos, predominó la estenosis pulmonar que agrupó el 70,6 % de los diagnosticados. Se encontró predominio del sexo masculino con 50,3 %, se determinó que 45,5 % de los casos se diagnosticaron antes de los 29 días de nacido, período que incluye un diagnóstico prenatal. Conclusiones: El desarrollo del diagnóstico prenatal de las cardiopatías congénitas ha posibilitado la disminución de la incidencia de las malformaciones más complejas. El conocimiento de las enfermedades congénitas del corazón contribuye a operar de forma segura y con resolución anatómica completa a muchos de estos niños en el período prenatal o cuando son lactantes pequeños, para evitar el deterioro global de estos cuando la cardiopatía no está resuelta.

BACKGROUND The transmission routes for American cutaneous leishmaniasis (ACL) are in flux, so studies examining its transmission in humans, mammalian hosts, and sand fly vectors are urgently needed. OBJECTIVES The aim of this work was understand the epidemiological cycles of Leishmania spp., which causes ACL in the Andean Region of Venezuela, by identifying the Leishmania and the sand fly species involved in human and dog infections. METHODS Thirty-one biopsies from patients in Mérida and Táchira states with suspected ACL were studied by both parasitological tests (cultures and hamster inoculation) and a molecular test [Internal transcribed spacer 1 (ITS1) nested polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP)]. We also conducted a survey to detect Leishmania infection in dogs (Immunifluorescence antibody test and ITS1 nested PCR-RFLP) and sand flies (ITS1 nested PCR-RFLP) from El Carrizal, a highly endemic focus of ACL in Venezuela. FINDINGS Three different Leishmania species were identified in the clinical samples from humans (Leishmania braziliensis, L. guyanensis, and L. mexicana) and dogs (L. guyanensis and L. mexicana). The predominant sand fly species found were those from the Verrucarum group (infected with L. mexicana) and Lutzomyia migonei (infected with L. guyanensis and L. mexicana). MAIN CONCLUSIONS We show that Lu. migonei may be the putative vector in two ACL epidemiological cycles, involving L. guyanensis and L. mexicana. We also report for the first time the presence of L. guyanensis in domestic animals.

Bladder exstrophy is a severe congenital anomaly of lower urinary tract that affects the bladder, pelvic bones, abdominal wall, external genitalia, perineum and in some cases intestine. Conventional treatments are based on surgical techniques, in order to reconstruct bladder, genitals and close wall defect. We present a case of a 3 year old girl, in which surgical treatment was applied 6 times without results. It was decided to combine the surgical treatment with application of regenerative medicine. It was applied platelet lysate in the bladder wall and the edges of the abdominal wall at the rate of 1 mL weekly for 4 weeks, achieving tissue regeneration. It enabled to face the edges of those structures and perform conventional surgical technique. As a result, we achieved a total closure of bladder, urethra and abdominal wall, without fistulas either between these structures or outside. Therefore the use of platelet lysate promotes growth and tissue regeneration comprising the urinary tract, decreasing number of interventions, time exposition structures of the abdominal cavity, and post surgical complications such as fistulas.

La extrofia vesical es una anomalía congénita grave del tracto urinario inferior que afecta la vejiga, los huesos pelvianos, la pared abdominal, los genitales externos, el perineo y, en algunos casos, el intestino. Los tratamientos convencionales están basados en técnicas quirúrgicas, para lograr reconstruir la vejiga, los genitales y cerrar el defecto de la pared. Se presenta el caso de una niña de 3 años de edad, en la que el tratamiento quirúrgico se había aplicado en 6 ocasiones sin resultados. Se decidió combinar el tratamiento quirúrgico con la aplicación de medicina regenerativa. Se le aplicó lisado de plaquetas en la pared de la vejiga y los bordes de la pared abdominal a razón de 1 mL semanal, durante 4 semanas. Se logró la regeneración de los tejidos que permitió afrontar los bordes de dichas estructuras y realizar la técnica quirúrgica convencional. Como resultado se logró cierre total de vejiga, uretra y pared abdominal, sin fístulas entre estas estructuras ni al exterior. La utilización del lisado de plaquetas favorece el crecimiento y regeneración de los tejidos que componen el tracto urinario. La cirugía puede ser una solución definitiva, después de haber aplicado los factores de crecimiento plaquetarios, que preparan el tejido en cuanto a calidad y cantidad, favoreciendo el afrontamiento de los bordes, la cicatrización y disminuyendo las complicaciones posquirúrgicas.

Introduction: Increased P wave dispersion are identified as a predictor of atrial fibrillation. There are associations between hypertension, P wave dispersion, constitutional and echocardiographic variables. These relationships have been scarcely studied in pediatrics. Objective: The aim of this study was to determine the relationship between P wave dispersion, blood pressure, echocardiographic and constitutional variables, and determine the most influential variables on P wave dispersion increases in pediatrics. Method: In the frame of the PROCDEC II project, children from 8 to 11 years old, without known heart conditions were studied. Arterial blood pressure was measured in all the children; a 12-lead surface electrocardiogram and an echocardiogram were done as well. Results: Left ventricular mass index mean values for normotensive (25.91 ± 5.96 g/m2.7) and hypertensive (30.34 ± 8.48 g/m2.7) showed significant differences P = .000. When we add prehypertensive and hypertensive there are 50.38% with normal left ventricular mass index and P wave dispersion was increased versus 13.36% of normotensive. Multiple regression demonstrated that the mean blood pressure, duration of A wave of mitral inflow, weight and height have a value of r = 0.88 as related to P wave dispersion. Conclusions: P wave dispersion is increased in pre- and hypertensive children compared to normotensive. There are pre- and hypertensive patients with normal left ventricular mass index and increased P wave dispersion. Mean arterial pressure, duration of the A wave of mitral inflow, weight and height are the variables with the highest influence on increased P wave dispersion.

Introducción: La dispersión de onda P incrementada se señala como predictor de fibrilación auricular, existiendo asociación entre hipertensión arterial, dispersión de onda P y variables ecocardiográficas y constitucionales. Estas relaciones han sido poco estudiadas en pediatría. Objetivo: Determinar la relación de la dispersión de la onda P con presión arterial, variables ecocardiográficas y constitucionales, y determinar las variables más influyentes en los incrementos de la dispersión de la onda P en pediatría. Método: Se estudiaron en el marco del proyecto PROCDEC II niños de 8 a 11 años. Se midió presión arterial, se realizó electrocardiograma de superficie y ecocardiograma. Resultados: Los valores de media del índice de masa ventricular izquierda para normotensos (25.91 ± 5.96 g/m2.7) e hipertensos (30.34 ± 8.48 g/m2.7) mostraron diferencias significativas (p = 0.000). Un 50.38% de prehipertensos más hipertensos presentan índice de masa ventricular normal y dispersión de la onda P incrementada versus normotensos (13.36%). La presión arterial media, la duración de la onda A, el peso y la talla presentan un valor de r = 0.88 al relacionarlo de forma múltiple con la dispersión de la onda P. Conclusiones: El índice de masa ventricular y la dispersión de la onda P demuestran ser mayores en pacientes prehipertensos e hipertensos que en normotensos. Se encontraron pacientes prehipertensos e hipertensos con índice de masa ventricular normal y dispersión de la onda P incrementada. Las variables que demostraron mayor influencia en los aumentos de la dispersión de la onda P fueron la presión arterial media, la duración de la onda A del flujo mitral, el peso y la talla.

INTRODUCTION Hypertension and obesity in adults have been linked to increased EKG P-wave dispersion; the association has been shown in relation to hypertension, left ventricular hypertrophy and atrial enlargement. Though studies in children have linked P-wave dispersion to left ventricular hypertrophy, scant pediatric literature relates P-wave dispersion to hypertension and obesity. OBJECTIVE Assess the association of P-wave dispersion with blood pressure and nutritional status in a pediatric population. METHODS This cross-sectional study is part of the PROCDEC II project for pediatric hypertension diagnosis and control in Santa Clara, Cuba. Twelve-lead EKG and four blood pressure readings were conducted on a sample of 656 children aged 8-11 years. Blood pressure <90th percentile for age, sex and height was considered normal; 90th-95th percentile, prehypertension; and >95th percentile, hypertension. The main study variables were P-wave dispersion and systolic, diastolic and mean arterial pressure (MAP). Secondary variables were sex, height, weight, and body mass index. Comparisons of means, analysis of variance and linear correlations were done. RESULTS Mean P-wave dispersion differed significantly (p ≤0.05) among normotensive (30.10 ms), prehypertensive (32.99 ms) and hypertensive children (39.14 ms), as did mean MAP (p <0.05). P-wave dispersion and MAP were significantly correlated in prehypertensive and hypertensive children. Most overweight and obese children with high P-wave dispersion were prehypertensive or hypertensive. CONCLUSIONS Associations observed between P-wave dispersion and MAP in normotensive, prehypertensive and hypertensive children suggest potential for early detection of EKG patterns showing vulnerability. Given the relationship between increased P-wave dispersion and hypertension already described in adults, use of P-wave dispersion could be a simple, economical and noninvasive method of predicting risk of hypertensive cardiomyopathy in prehypertensive and hypertensive children; this in turn could guide timely, effective treatment and secondary prevention. Similar studies on a larger sample are needed to corroborate these results.

Resumen Introducción: La relación entre la disfunción diastólica y la dispersión de la onda P (PWD) en el electrocardiograma se ha estudiado durante algún tiempo. En este sentido, la ecocardiografía se está convirtiendo en una herramienta de diagnóstico para mejorar la estratificación de riesgo en la hipertensión leve. Objetivo: Determinar la dependencia de las PWD en el electrocardiograma de las variables ecocardiográficas en una población pediátrica. Métodos: De un total de 565 niños de tres escuelas primarias, fueron estudiados 515 niños. Fueron excluidos del estudio, aquellos niños cuyos padres se negaron a participar, y los niños con enfermedades congénitas conocidas. Se les realizó electrocardiograma de superficie de 12 derivaciones y se realizaron 4 tomas de presión arterial. Fueron medidas las ondas P del electrocardiograma y calculada su dispersión. Se realizó ecocardiografía para medidas estructurales y Doppler pulsado del flujo mitral. Resultados Se demuestra correlación significativa entre la PWD y la tensión arterial media para prehipertensos e hipertensos r= 0.32, p <0.01 y r= 0.33 p <0.01, respectivamente. Existe una correlación significativa entre PWD y área de la aurícula izquierda (r= 0.45 y p <0.01). Conclusiones: Existe dependencia de la dispersión de la onda P del electrocardiograma de la tensión arterial media. Se demostró dependencia de la dispersión de la onda P sobre el área auricular izquierda. Este resultado sugiere la existencia de cambios en las características electrofisiológicas auriculares y cambios hemodinámicos en la población pediátrica estudiada.

Abstract Introduction: The relationship between diastolic dysfunction and P-wave dispersion (PWD) in the electrocardiogram has been studied for some time. In this regard, echocardiography is emerging as a diagnostic tool to improve risk stratification for mild hypertension. Objective: To determine the dependence of PWD on the electrocardiogram and on echocardiographic variables in a pediatric population. Methods: Five hundred and fifteen children from three elementary schools were studiedfrom a total of 565 children. Those whose parents did not want them to take part in the study, as well as those with known congenital diseases, were excluded. Tests including 12-lead surface ECGs and 4 blood pressure (BP) measurements were performed. Maximum and minimum P-values were measured, and the PWD on the electrocardiogram was calculated. Echocardiography for structural measurements and the pulsed Doppler of mitral flow were also performed. Results: A significant correlation in statistical variables was found between PWD and mean BP for pre-hypertensive and hypertensive children, i.e., r= 0.32, p <0.01 and r= 0.33, p <0.01, respectively. There was a significant correlation found between PWD and the left atrial area (r= 0.45 and p <0.01). Conclusions: We highlight the dependency between PWD, the electrocardiogram and mean blood pressure. We also draw attention to the dependence of PWD on the left atrial area. This result provides an explanation for earlier changes in atrial electrophysiological and hemodynamic characteristics in pediatric patients.

Experiences in the nationwide program for the integral care of the patient with diabetic foot ulcer using Heberprot-P. The Cuban product Heberprot-P is indicated for the treatment of complex diabetic foot ulcers (DFU). After its registration in 2006, the product was included into the Cuban List of Medicines and a nationwide program for the integral care of the DFU patient began. To date Heberprot-P is available in more than 85 Cuban health institutions and more than 3 800 diabetic patients with ulcers in their feet have received the benefits of this unique product. An integral program has been established for the attention of the patient with DFU, including the advanced technology of Heberprot-P. This program relies on the closely linked and coordinated interaction between the primary and secondary levels of health, in which prevention and therapy merge each other. The Ministry of Public Health of Cuba has established impact indicators in order to control and assess the performance of the program.

El novedoso producto cubano Heberprot-P está indicado para el tratamiento de las úlceras complicadas del pie diabético (UPD). Una vez aprobado su registro sanitario, pasó a formar parte del Cuadro Básico de Medicamentos de Cuba, y se inició el proceso de extensión nacional. Más de 3800 pacientes diabéticos con úlceras en sus pies en Cuba han recibido las bondades de este medicamento, que se administra en más de 85 instituciones de salud del país. Se ha establecido un Programa de atención integral al paciente con úlcera del pie diabético que incluye el uso del Heberprot-P. Este programa está organizado sobre la base del trabajo coordinado del nivel primario y secundario de salud, en el que se funden el papel preventivo y terapéutico de la atención al paciente diabético. El Ministerio e Salud Pública cubano ha establecido indicadores de impacto para medir y controlar el desarrollo de este programa.

Background: left atrial size is a recognized factor in-creasing the risk of atrial fibrillation. Left atrial electri-cal properties are modified, with a greater dispersión of the P wave on the electrocardiogram. Aim: to determine the relation between left atrial área and P wave dispersión in children. Methods: 400 healthy children from 8 to 11 years of age had a 12 lead ECG. Máximum and mínimum vol-tages of the P wave and P wave dispersión were measu-red. Blood pressure was recorded in 4 sepárate measu-rements. Echocardiography was used to determine left atrial área. Results: Compared to normotensive children, mean dispersión of the P wave was higher in hypertensives (38.5 vs 32.5 ms, respectively). The most significant difference was observed between normotensives and pre-hypertensive children (regression analysis, p=0.001). Linear regression analysis showed a posi-tive correlation of P wave dispersión and left atrial área Conclusion: P wave dispersión and left atrial área are positively correlated in groups of normal, pre-hypertensive and hypertensive children. The corres-ponding mean valúes of dispersión follow the same tendency

Antecedentes: Entre los factores descritos para desarrollar fibrilación auricular se encuentra el mayor tamaño de la aurícula izquierda; esto lleva a cambios en sus propiedades eléctricas y a mayores valores de dispersión de la onda P del electrocardiograma. Objetivo: Determinar la dispersión de la onda P con relación al área de la aurícula izquierda en niños entre 8 a 11 años. Métodos: Se estudiaron 400 niños aparentemente sanos de ese rango de edad. Se les realizó electrocardiograma de superficie de 12 derivaciones para medir los valores de P máxima, P mínima y se calculó la dispersión de la onda P; se les midió 4 veces la presión arterial. Se realizó además, ecocardiograma para medición del área auricular izquierda. Resultados: Los valores de media de dispersión de la onda P aumentan desde normotensos a hiper-tensos (32.5 a 38.5 ms, respectivamente), existiendo diferencias significativas intergrupos, encontrando la mayor significación al comparar los normotensos con el grupo de prehipertensos (p=0.001). Un estudio de regresión demostró la dependencia de la dispersión de la onda P del electrocardiograma en el grupo de normotensos y prehipertensos con r=0,22 y p<0.05. Una regresión lineal para la muestra de niños hipertensos muestra una correlación positiva para la dependencia de la onda P con el área auricular izquierda. Conclusiones: Existe dependencia de la dispersión de la onda P del electrocardiograma con el área auricular izquierda, así como diferencias significativas entre valores medios de dispersión de la onda P en los subgrupos de niños normotensos, prehipertensos e hipertensos.

Acinetobacter baumanii is a microorganism that is acquiring a great relevance as a nosocomial pathogen. It has developed a great increase of antimicrobial resitance that makes difficult to find an effective drug capable of covering all the severe infections it produces, leading to therapeutical failure in many cases. That is why we carried out a characterization study of Acinetobacter baumanii strains, isolated from patients admitted to determine their sensitivity level to a wide range of antibiotics. The diagnostic tests were performed using API system, with ID 32 GTN and ATB GN 5 galleries. There were identified 72 strains, which showed high levels of resistance against the assayed antibiotics. More than 65% percent of resistance to b-lactamics was obtained. The less active antibiotics within this group were Amoxicillin, Ticarcillin, Piperacillin, Cefotaxime, and Cefuroxime, with 100% de resistance in all the cases. Cyprofloxacine, the only quinolone tested, showed 100% of resistance. Among the aminoglycosides, Amikacin was the most effective antimicrobial agent, and that with the lowest resistance. The carbapenemics, imipenem and meropenem had also high values of resistance (52.8% and 55.2%, respectively).

Acinetobacter baumanii, microorganismo que está adquiriendo mucha relevancia como patógeno nosocomial, ha desarrollado gran aumento de la resistencia antimicrobiana, lo que dificulta hallar un fármaco eficaz que cubra las infecciones graves que produce, dando lugar en muchos casos al fracaso terapéutico. Por esto nos motivamos a identificar cepas de Acinetobacter baumanii aisladas de pacientes hospitalizados y determinar su sensibilidad frente a un amplio grupo de antibióticos. Las pruebas diagnóstico se realizaron empleando el sistema API, con galerías ID 32 GN y ATB GN 5. Se identificaron 72 cepas, las cuales mostraron elevados niveles de resistencia frente a los antibióticos ensayados. Se obtuvo más de 65 % de resistencia frente a los b-lactámicos, los antibióticos menos activos dentro de este grupo fueron: amoxicilina, ticarcilina, piperacilina, cefotaxima y cefuroxima, con 100% de resistencia en todos los casos. La ciplrofloxacina, única quinolona probada, mostró también 100 % de resistencia. Dentro de los aminoglucósidos, la amikacina fue el antimicrobiano más efectivo, incluso el de menor porcentaje de resistencia. Los carbapenémicos, imipenem y meropenem se comportaron también con altos valores de resistencia, 52,8 y 55,2 %, respectivamente.