Antibiotic-induced gut dysbiosis leads to activation of microglia and impairment of cholinergic gamma oscillations in the hippocampus.

Antibiotics are widely applied for the treatment of bacterial infections, but their long-term use may lead to gut flora dysbiosis and detrimental effects on brain physiology, behavior as well as cognitive performance. Still, a striking lack of knowledge exists concerning electrophysiological correlates of antibiotic-induced changes in gut microbiota and behavior. Here, we investigated changes in the synaptic transmission and plasticity together with behaviorally-relevant network activities from the hippocampus of antibiotic-treated mice. Prolonged antibiotic treatment led to a reduction of myeloid cell pools in bone marrow, circulation and those surveilling the brain. Circulating Ly6Chi inflammatory monocytes adopted a proinflammatory phenotype with increased expression of CD40 and MHC II. In the central nervous system, microglia displayed a subtle activated phenotype with elevated CD40 and MHC II expression, increased IL-6 and TNF production as well as with an increased number of Iba1 + cells in the hippocampal CA3 and CA1 subregions. Concomitantly, we detected a substantial reduction in the synaptic transmission in the hippocampal CA1 after antibiotic treatment. In line, carbachol-induced cholinergic gamma oscillation were reduced upon antibiotic treatment while the incidence of hippocampal sharp waves was elevated. These alterations were associated with the global changes in the expression of neurotrophin nerve growth factor and inducible nitric oxide synthase, both of which have been shown to influence cholinergic system in the hippocampus. Overall, our study demonstrates that antibiotic-induced dysbiosis of the gut microbiome and subsequent alteration of the immune cell function are associated with reduced synaptic transmission and gamma oscillations in the hippocampus, a brain region that is critically involved in mediation of innate and cognitive behavior.

The Presynaptic Scaffold Protein Bassoon in Forebrain Excitatory Neurons Mediates Hippocampal Circuit Maturation: Potential Involvement of TrkB Signalling.

A presynaptic active zone organizer protein Bassoon orchestrates numerous important functions at the presynaptic active zone. We previously showed that the absence of Bassoon exclusively in forebrain glutamatergic presynapses (BsnEmx1cKO) in mice leads to developmental disturbances in dentate gyrus (DG) affecting synaptic excitability, morphology, neurogenesis and related behaviour during adulthood. Here, we demonstrate that hyperexcitability of the medial perforant path-to-DG (MPP-DG) pathway in BsnEmx1cKO mice emerges during adolescence and is sustained during adulthood. We further provide evidence for a potential involvement of tropomyosin-related kinase B (TrkB), the high-affinity receptor for brain-derived neurotrophic factor (BDNF), mediated signalling. We detect elevated TrkB protein levels in the dorsal DG of adult mice (~3-5 months-old) but not in adolescent (~4-5 weeks-old) mice. Electrophysiological analysis reveals increased field-excitatory-postsynaptic-potentials (fEPSPs) in the DG of the adult, but not in adolescent BsnEmx1cKO mice. In line with an increased TrkB expression during adulthood in BsnEmx1cKO, blockade of TrkB normalizes the increased synaptic excitability in the DG during adulthood, while no such effect was observed in adolescence. Accordingly, neurogenesis, which has previously been found to be increased in adult BsnEmx1cKO mice, was unaffected at adolescent age. Our results suggest that Bassoon plays a crucial role in the TrkB-dependent postnatal maturation of the hippocampus.

Omega-3 and omega-6 fatty acids in primary Sjögren's syndrome: clinical meaning and association with inflammation.

OBJECTIVES: Lipid mediators derived from polyunsaturated fatty acids (FA), have been related to inflammation and immune response regulation. Herein we evaluated the intake and serum levels of ω-3 and ω-6 FA among patients with primary Sjögren's syndrome (pSS), and correlated with ocular/oral sicca symptoms, disease activity and a panel of chemokines/cytokines. METHODS: We included 108 patients and 100 controls. Dietary information was obtained from a food questionnaire of one-day reminder and processed using a nutritional software. Among the SS group, we measured serum ω-3 (α-linolenic acid [α-LN], eicosapentaenoic acid [EPA], docosahexaenoic acid [DHA]) and ω-6 (linoleic acid [LA], arachidonic acid [AA]) by gas chromatography flame ionization. We scored the ESSDAI, ESPRI, Schirmer-I test and NSWSF. In a subsample, we assessed the OSDI, ophthalmologic staining scores and measured CXCL8, CXCL10, CCL2, IL-22 and IL-21 in saliva, and CXCL8, CXCL10, CCL2 and CXCL9 in tears by Luminometry. RESULTS: ω-3 and ω-6 intake was lower in SS patients than controls, and did not correlate with serum levels. We found a negative correlation between α-LN and the OSDI and ESSDAI, as well as DHA and ESSDAI. In tears, AA positively correlated with CXCL9, whereas in saliva, α-LN, DHA and the ω3 sum negatively correlated with CCL2. We observed a negative correlation between the ω6 sum and IL-21. CONCLUSIONS: pSS patients had deficient omega intake. Lower ocular symptoms, ESSDAI scores and salivary CCL2 correlated with higher ω-3 levels, possible suggesting a role in chronic inflammation. Further studies are warranted to deepen in the knowledge of this association.

A General Methodology for the Translation of Behavioral Terms into Vernacular Languages.

As the field of behavior analysis expands internationally, the need for comprehensive and systematic glossaries of behavioral terms in the vernacular languages of professionals and clients becomes crucial. We created a Spanish-language glossary of behavior-analytic terms by developing and employing a systematic set of decision-making rules for the inclusion of terms. We then submitted the preliminary translation to a multi-national advisory committee to evaluate the transnational acceptability of the glossary. This method led to a translated corpus of over 1200 behavioral terms. The end products of this work included the following: (a) a Spanish-language glossary of behavior analytic terms that are publicly available over the Internet through the Behavior Analyst Certification Board and (b) a set of translation guidelines summarized here that may be useful for the development of glossaries of behavioral terms into other vernacular languages.

An earlier uterine environment favors the in vivo development of fresh pig morulae and blastocysts transferred by a nonsurgical deep-uterine method.

This study aimed to evaluate the effect of recipient-donor estrous cycle synchrony on recipient reproductive performance after nonsurgical deep-uterine (NsDU) embryo transfer (ET). The transfers (N=132) were conducted in recipients sows that started estrus 24 h before (-24 h; N=9) or 0 h (synchronous; N=31), 24 h (+24 h; N=74) or 48 h (+48 h; N=18) after the donors. A total of 30 day 5 morulae or day 6 blastocysts (day 0=onset of estrus) were transferred per recipient. The highest farrowing rates (FRs) were achieved when estrus appeared in recipients 24 h later than that in the donors (81.1%), regardless of the embryonic stage used for the transfers. The FR notably decreased (P<0.05) when recipients were -24 h asynchronous (0%), synchronous (61.3%) or +48 h asynchronous (50%) relative to the donors. No differences in litter size (LS) and piglet birth weights were observed among the synchronous and +24 h or +48 h asynchronous groups. While a +24 h asynchronous recipient was suitable for transfers performed with either morulae (FR, 74.3%; LS, 9.2 ± 0.6 piglets) or blastocysts (FR, 84.6%; LS, 9.8 ± 0.6 piglets), a + 48 h asynchronous recipient was adequate for blastocysts (FR, 87.5%; LS, 10.4 ± 0.7 piglets) but not for morulae (FR, 30.0%; LS, 7.3 ± 2.3 piglets). In conclusion, this study confirms the effectiveness of the NsDU-ET technology and shows that porcine embryos tolerate better a less advanced uterine environment if they are nonsurgically transferred deep into the uterine horn.

The NDR family of kinases: essential regulators of aging.

Aging is defined as a progressive decline of cognitive and physiological functions over lifetime. Since the definition of the nine hallmarks of aging in 2013 by López-Otin, numerous studies have attempted to identify the main regulators and contributors in the aging process. One interesting group of proteins whose participation has been implicated in several aging hallmarks are the nuclear DBF2-related (NDR) family of serine-threonine AGC kinases. They are one of the core components of the Hippo signaling pathway and include NDR1, NDR2, LATS1 and LATS2 in mammals, along with its highly conserved metazoan orthologs; Trc in Drosophila melanogaster, SAX-1 in Caenorhabditis elegans, CBK1, DBF20 in Saccharomyces cerevisiae and orb6 in Saccharomyces pombe. These kinases have been independently linked to the regulation of widely diverse cellular processes disrupted during aging such as the cell cycle progression, transcription, intercellular communication, nutrient homeostasis, autophagy, apoptosis, and stem cell differentiation. However, a comprehensive overview of the state-of-the-art knowledge regarding the post-translational modifications of and by NDR kinases in aging has not been conducted. In this review, we summarize the current understanding of the NDR family of kinases, focusing on their relevance to various aging hallmarks, and emphasize the growing body of evidence that suggests NDR kinases are essential regulators of aging across species.

An automatic weighting system for wild animals based in an artificial neural network: how to weigh wild animals without causing stress.

This paper proposes a novel and autonomous weighing system for wild animals. It allows evaluating changes in the body weight of animals in their natural environment without causing stress. The proposed system comprises a smart scale designed to estimate individual body weights and their temporal evolution in a bird colony. The system is based on computational intelligence, and offers valuable large amount of data to evaluate the relationship between long-term changes in the behavior of individuals and global change. The real deployment of this system has been for monitoring a breeding colony of lesser kestrels (Falco naumanni) in southern Spain. The results show that it is possible to monitor individual weight changes during the breeding season and to compare the weight evolution in males and females.

Increasing NPYergic transmission in the hippocampus rescues aging-related deficits of long-term potentiation in the mouse dentate gyrus.

Loss of neuropeptide Y (NPY)-expressing interneurons in the hippocampus and decaying cholinergic neuromodulation are thought to contribute to impaired cognitive function during aging. However, the interaction of these two neuromodulatory systems in maintaining hippocampal synaptic plasticity during healthy aging has not been explored so far. Here we report profound sex differences in the Neuropeptide-Y (NPY) levels in the dorsal dentate gyrus (DG) with higher NPY concentrations in the male mice compared to their female counterparts and a reduction of NPY levels during aging specifically in males. This change in aged males is accompanied by a deficit in theta burst-induced long-term potentiation (LTP) in the medial perforant path-to-dorsal DG (MPP-DG) synapse, which can be rescued by enhancing cholinergic activation with the acetylcholine esterase blocker, physostigmine. Importantly, NPYergic transmission is required for this rescue of LTP. Moreover, exogenous NPY application alone is sufficient to recover LTP induction in aged male mice, even in the absence of the cholinergic stimulator. Together, our results suggest that in male mice NPYergic neurotransmission is a critical factor for maintaining dorsal DG LTP during aging.

Spontaneous Subcapsular Renal Hematoma as Cause of Hypovolemic Shock in a Chronic Hemodialysis Patient.

Subcapsular renal hematomas may appear spontaneously in patients in chronic hemodialysis, though other causes as neoplasms, vasculitis, and infections should be excluded. Patients may present with abdominal pain and hemorrhagic shock; hence, early diagnosis is vital. Nephrectomy or renal artery embolization are suitable treatment options.

Monitoring of SARS-CoV-2 seroprevalence among primary healthcare patients in the Barcelona Metropolitan Area: the SeroCAP sentinel network protocol.

INTRODUCTION: SARS-CoV-2 seroprevalence studies are currently being recommended and implemented in many countries. Forming part of the COVID-19 monitoring and evaluation plan of the Catalan Government Health Department, our network aims to initiate a primary healthcare sentinel monitoring system as a surrogate of SARS-CoV-2 exposure in the Barcelona Metropolitan Area. METHODS AND ANALYSIS: The seroCAP is a serial cross-sectional study, which will be performed in the Barcelona Metropolitan Area to estimate antibodies against SARS-CoV-2. From February 2021 to March 2022, the detection of serum IgG antibodies against SARS-CoV-2 trimeric spike protein will be performed on a monthly basis in blood samples collected for diverse clinical purposes in three reference hospitals from the three Barcelona healthcare areas (BCN areas). The samples (n=2588/month) will be from patients attended by 30 primary healthcare teams at 30 basic healthcare areas (BHA). A lab software algorithm will systematically select the samples by age and sex. Seroprevalence will be estimated and monitored by age, sex, BCN area and BHA. Descriptive and cluster analysis of the characteristics and distribution of SARS-CoV-2 infections will be performed. Sociodemographic, socioeconomic and morbidity-associated factors will be determined using logistic regression. We will explore the association between seroprevalence, SARS-CoV-2 confirmed cases and the implemented measures using interrupted time series analysis. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University Institute Foundation for Primary Health Care Research Jordi Gol i Gurina ethics committee. An informed consent is not required regarding the approval of the secondary use of biological samples within the framework of the COVID-19 pandemic. A report will be generated quarterly. The final analysis, conclusions and recommendations will be shared with the stakeholders and communicated to the general public. Manuscripts resulting from the network will be submitted for publication in peer-reviewed journals.

Persistent serological activity in primary Sjögren's syndrome.

To assess the presence of persistent serological activity and its association with clinical outcomes in primary Sjögren's syndrome. Clinical charts of 275 patients were reviewed retrospectively. Persistent serological activity was defined as an increase IgG ≥ 1.6 mg/dL or globulins > 3.7 g/dL or diminished C3 < 52 mg/dL or C4 < 12 mg/dL at least during two consecutive visits during a year (index period). The ClinESSDAI at the index period and the cumulative ClinESSDAI and the SSDDI at the last medical appointment were scored. A total of 159 patients with complete serological data were included mostly women and median disease duration of 10.2 years. Persistent serological activity was identified in 85 patients (53.1%). Only 13 patients changed their status to serological inactivity though the follow-up. Comparison of patients with (n = 85) versus without persistent serological activity (n = 74) showed that the first group had a higher frequency of impaired non-stimulated salivary flow, anti-La/SSB antibody, and RF, as well as higher ClinESSDAI scores. The most affected domains were the constitutional, glandular, cutaneous, renal, and hematological domains. On logistic regression analysis, the RF (OR 6.4, 95% CI 1.8-22, p = 0.003), the renal (OR 12.8, 95% CI 1.7-92, p = 0.01), and the hematological involvement (OR 4.7, 95% CI 1.6-13.4, p = 0.004) remained associated. Half of the patients studied had persistent serological activity, being this status constant through the follow-up. Persistent serological activity was associated with positive RF and higher ESSDAI scores due to hematological and renal activity. Scoring serological activity is an important issue in SS patients.

Comparison of MDRD and the old CKD-EPI equations with the new CKD-EPI equations in kidney transplant patients when glomerular filtration rate is measured with 51Cr-EDTA. / Comparación de las ecuaciones MDRD y de las antiguas ecuaciones CKD-EPI frente a las nuevas ecuaciones CKD-EPI en pacientes con trasplante renal cuando se emplea 51Cr-EDTA para medir el filtrado glomerular.

BACKGROUND: When estimating the glomerular filtration rate (GFR) in kidney transplant patients, significant differences have been found between MDRD and the 2009 CKD-EPI equations, and reference techniques. OBJECTIVE: To analyse and compare the performance of MDRD and the 2009 and 2012 CKD-EPI equations against 51Cr-EDTA plasma clearance in measuring GFR in 270 kidney transplant patients after one year. RESULTS: The mean measured GFR was 43.0±11.4 (18.2-79.4)ml/min/1.73m2, with creatinine levels of 1.42±0.46 (0.60-4.33)mg/dl and cystatin C levels of 1.45±0.53 (0.42-3.48)mg/l. This correlated moderately with creatinine (r=-0.61, P<.001) and cystatin C (r=-0.52, P<.001). Using linear regression techniques, it was found that creatinine, cystatin C, gender and age only explained 52% of GFR total variance. All equations overestimated GFR, with a mean bias of +11.1ml/min/1.73m2 for MDRD, +16.4ml/min/1.73m2 for 2009-CKD-EPI, +15ml/min/1.73m2 for CKD-EPI with cystatin C, and +14.1ml/min/1.73m2 for 2012-CKD-EPI with creatinine and cystatin C. eGFR by MDRD and the 2009 CKD-EPI equation correlated better with 51Cr-EDTA than CKD-EPI with creatinine and/or cystatin C. The overestimations were negatively correlated with creatinine and cystatin C levels, most significantly for CKD-EPI with creatinine and/or cystatin C when GFR was greater than 60ml/min/1.73m2. CONCLUSIONS: The 2012 CKD-EPI equations with creatinine and/or cystatin C significantly overestimate GFR in stage 1 and 2 chronic kidney disease. The MDRD equations is therefore recommended in these cases. The reference method used to measure GFR seems to heavily influence the bias of the equations.

Epidemia de COVID-19 en La Habana, Cuba / COVID-19 Epidemic in Havana

Introducción: A finales de diciembre del 2019 comenzaron a ser reportados en la región asiática de Wuhan pacientes con una infección respiratoria aguda, de origen desconocido. Cuba no está exenta de esta situación. Los primeros casos de COVID-19 se diagnosticaron en el país el 11 de marzo del 2020. A partir de entonces se reportaron casos de la enfermedad en gran parte del país, La Habana fue una de las provincias más afectadas. Objetivo: Analizar la distribución geoespacial de la COVID-19 en La Habana. Método: Se realizó un estudio descriptivo en la provincia La Habana en el período marzo-julio del 2020. Resultados: Con la aparición de los primeros casos se observó un comportamiento homogéneo en todos los municipios de la capital, con mayor concentración en la zona central, siguió un patrón de distribución radial, respondiendo a dos variables que juegan un papel fundamental en el contexto actual: la densidad poblacional y el uso del suelo. Conclusiones: La vulnerabilidad al contagio en un territorio está dada por un grupo de variables y su interrelación, que hacen favorable a un territorio para la propagación y el contagio(AU)

Introduction: At the end of December 2019, patients with an acute respiratory infection, of unknown origin, began to be reported in the Asian region of Wuhan. Cuba was not exempt from this situation. The first cases of COVID-19 were diagnosed in the country on March 11, 2020. Since then, cases of the disease were reported in much of the country, with Havana being one of the hardest hit provinces. Objective: To analyze the geospatial distribution of COVID-19 in Havana. Method: A descriptive study was conducted in the province of Havana in the period March-July 2020. Results: With the appearance of the first cases, a homogeneous behavior was observed in all the municipalities of the capital, with a greater concentration in the central area, and it followed a radial distribution pattern, responding to two variables that play a fundamental role in the current context: population density and land use. Conclusions: The vulnerability to contagion in a territory is given by a group of variables and their interrelation, which make a territory favorable for the spread and contagion(AU)

Coexistance of Amyloidosis and Primary Sjögren's Syndrome: An Overview.

BACKGROUND: The association of primary Sjogren´s Syndrome (SS) and amyloidosis has been recognized but scarcely assessed. OBJECTIVE: Herein we analyzed the literature regarding this association in order to describe a SS phenotype prone to both conditions. METHODS: PubMed and CINAHL databases were searched from inception until April 2016 for the keywords: Amyloidosis, amyloid, Sjögren's syndrome and their combinations. RESULTS: Most of the cases corresponded to localized amyloidosis mainly at skin and lung, whereas only three cases were systemic. Other places of localized amyloidosis were the kidney, tracheobronchial, tongue, breast, salivary gland and vocal cord. Most of the localized forms corresponded to AL type, whereas AA amyloidosis was uncommon. The diagnosis of amyloidosis followed the SS onset (1-25 years) and in the majority of patients the presence of B cell hyperactivity traduced by hypergammaglobulinemia, positive rheumatoid factor and/or anti-Ro/SSA and anti-La/SSB antibodies were observed. In seven patients, an associated lymphoma was also documented. CONCLUSION: The spectrum of lymphoid proliferation associated with SS extends beyond the classical B cell lymphoma. Localized or systemic amyloidosis might coexist with primary SS. Localized amyloidosis should be suspected in patients with consistently high serologic activity and suggestive lesions.

A novel panel of short mononucleotide repeats linked to informative polymorphisms enabling effective high volume low cost discrimination between mismatch repair deficient and proficient tumours.

Somatic mutations in mononucleotide repeats are commonly used to assess the mismatch repair status of tumours. Current tests focus on repeats with a length above 15bp, which tend to be somatically more unstable than shorter ones. These longer repeats also have a substantially higher PCR error rate, and tests that use capillary electrophoresis for fragment size analysis often require expert interpretation. In this communication, we present a panel of 17 short repeats (length 7-12bp) for sequence-based microsatellite instability (MSI) testing. Using a simple scoring procedure that incorporates the allelic distribution of the mutant repeats, and analysis of two cohort of tumours totalling 209 samples, we show that this panel is able to discriminate between MMR proficient and deficient tumours, even when constitutional DNA is not available. In the training cohort, the method achieved 100% concordance with fragment analysis, while in the testing cohort, 4 discordant samples were observed (corresponding to 97% concordance). Of these, 2 showed discrepancies between fragment analysis and immunohistochemistry and one was reclassified after re-testing using fragment analysis. These results indicate that our approach offers the option of a reliable, scalable routine test for MSI.

Estratificación espacial de la tuberculosis en menores de 15 años de edad en las provincias occidentales de Cuba, 2011-2015 / Spatial stratification of tuberculosis in the western provinces of Cuba, 2011-2015 in children under 15 years

Introducción: La tuberculosis infantil posee baja incidencia en Cuba, no obstante, se considera un indicador de transmisión reciente de la enfermedad. Objetivo: Estratificar espacialmente la tuberculosis en menores de 15 años de edad en la región occidental de Cuba en el periodo 2011-2015, según las metas progresivas hacia la eliminación de la enfermedad. Métodos: Se realizó un estudio ecológico de series temporales. La estatificación espacial de la tuberculosis se realizó a partir de técnicas geoespaciales que asignan a cada territorio valores ponderados graduados con respecto a los rangos establecidos de las medias geométricas de las tasas de notificación en el periodo. Los estratos se corresponden con las metas progresivas hacia la eliminación de la tuberculosis. Resultados: Se encontraron en la categoría de ultracontrol muy avanzado las provincias La Habana [municipios Plaza de la Revolución (2,4), Centro Habana (3,7), San Miguel del Padrón (2,1), Diez de Octubre (1,6) y Marianao (1,0)], Mayabeque [Melena del Sur (3,5) y San José de las Lajas (1,4)] y Matanzas [Unión de Reyes (1,1)]. Conclusiones: La presencia de diferentes estratos geoespaciales de la tuberculosis en menores de 15 años de edad en la región occidental de Cuba constata la necesidad de diseñar estrategias que se adecuen a la realidad de los diferentes territorios. El abordaje geoespacial fortalece la estratificación epidemiológica de acuerdo a las metas progresivas hacia la eliminación de la tuberculosis(AU)

Introduction: Children tuberculosis has a low incidence in Cuba, however, it is considered an indicator of recent transmission of the disease. Objective: Spatially stratify tuberculosis in children under 15 years of age in the western region of Cuba in the period 2011-2015, according to the progressive goals towards the elimination of the disease. Methods: An ecological time series study was conducted. The spatial stratification of tuberculosis was carried out from geospatial techniques that assign to each territory weighted values graded with respect to the established ranges of the geometric means of the notification rates in the period. The strata correspond to the progressive goals towards the elimination of tuberculosis. Results: The provinces of Havana [municipalities : Plaza de la Revolución (2.4), Centro Habana (3.7), San Miguel del Padrón (2.1), Diez de Octubre (1.6) and Marianao (1.0)], Mayabeque (municipalities : Melena del Sur (3.5) and San José de las Lajas (1.4)] and Matanzas [municipalities : Unión de Reyes (1.1)] were found in the category of very advanced ultracontrol. Conclusions: The presence of different geospatial strata of tuberculosis in children under 15 years of age in the western region of Cuba confirms the need to design strategies that adapt to the reality of the different territories. The geospatial approach strengthens the epidemiological stratification according to the progressive goals towards the elimination of tuberculosis(AU)

Factores asociados a la distribución espacial de la tuberculosis en La Habana, 2015 / Factors associated with the spatial distribution of tuberculosis in Havana, 2015

Introducción: El año 2015 es el marco de referencia temporal internacional para evaluar las acciones de la estrategia Fin a la tuberculosis. La eliminación de la enfermedad como problema de salud requiere de la identificación de poblaciones y territorios en mayor riesgo, y de los determinantes de su distribución geográfica. Objetivo: Determinar la influencia de factores socioeconómicos, demográficos y geoespaciales en la distribución espacial de la tuberculosis en La Habana en el año 2015. Métodos: Se realizó un estudio ecológico. Se describió la distribución espacial del total de casos de tuberculosis, la confección TB/VIH y los casos TB/reclusos a nivel de municipio; así como de variables socioeconómicas, demográficas y geoespaciales con datos disponibles de todos los municipios de la provincia. Se realizaron mapas temáticos para cada una de las variables. Posteriormente, se realizó un análisis de superposición de capas. Resultados: Se observó una mayor concentración de casos en el centro-sur de la provincia; principalmente en los municipios Centro Habana, Habana Vieja, Diez de Octubre y Boyeros, a excepción de este último, estos municipios son los más densamente poblados, los que tienen mayor ocupación del suelo y condiciones de vida más desfavorables. Conclusiones: La distribución espacial de la tuberculosis en La Habana está estrechamente relacionada al comportamiento de variables socioeconómicas, demográficas y geoespaciales en sus diferentes municipios. Estas variables deben ser tomadas en cuenta en intervenciones de salud dirigidas a la eliminación de la enfermedad en la provincia(AU)

Introduction: The year 2015 constitutes the international time frame of reference to evaluate the actions of the End tuberculosis strategy. The elimination of the disease as a health problem requires the identification of populations and territories at greatest risk, and the determinants of their geographical distribution. Objective: Determine the influence of socio-economic, demographic and geospatial factors on the spatial distribution of tuberculosis in Havana in 2015. Methods: An ecological study was conducted. The spatial distribution of total TB cases, TB/HIV and TB/inmate cases at the municipality level was described; as well as socio-economic, demographic and geospatial variables with data available from all municipalities in the province. Thematic maps were made for each of the variables. Subsequently, a layer overlap analysis was performed. Results: A higher concentration of cases was observed in the center-south of the province; mainly in the municipalities of Centro Habana, Habana Vieja, Diez de Octubre and Boyeros ; with the exception of the latter, these municipalities are the most densely populated, those with the highest land occupation and the most unfavorable living conditions. Conclusions: The spatial distribution of tuberculosis in Havana is closely related to the behavior of socio-economic, demographic and geospatial variables in its different municipalities. These variables should be taken into account in health interventions aimed at eliminating the disease in the province(AU)

[GUTI-VAL apparatus: respiratory deficiency and non-invasive ventilation]. / Dispositivo GUTI-VAL. Insuficiencia respiratoria con ventilación no invasiva.

Mechanical non-invasive ventilation provides a useful therapeutic option to treat some types of respiratory deficiencies. This apparatus improves the morbid mortality rate and shortens hospital stays especially since it prevents tracheotomy, but it can produce some inconveniences. The authors evaluate the efficiency of the GUTI-VAL Connection Apparatus in the treatment of patients suffering from a respiratory deficiency used along with a CPAP mask in terms of the degree of comfort and acceptance patients have, the prevention of a tracheotomy and of cutaneous lesions. This study, run over a 13 month period, dealt with patients checked into our Intensive Care Unit, a multidimensional unit in a county hospital, suffering from acute respiratory deficiencies or chronic acute deficiencies to whom treatment with mechanical non-invasive ventilation type CPAP with a GUTI-VAL apparatus was applied. The authors conclude that this apparatus proved to have a low mortality rate, few complications and good patient tolerance.

Detección prospectiva espacio-temporal de conglomerados de COVID-19 en Cuba

RESUMEN Introducción: Durante enfermedades infecciosas emergentes en curso como la COVID-19, la vigilancia espacio-temporal es fundamental para identificar áreas prioritarias para intervenciones específicas, diferenciar intensidad diagnóstica y asignación de recursos. Objetivo: Modelar la evolución del riesgo relativo de presentación de casos de COVID-19 e identificar conglomerados en municipios donde la enfermedad se mantuvo en el periodo posterior al descenso de la curva epidémica en Cuba. Métodos: El periodo mencionado comprendió entre el 26/05/2020 hasta el 4/09/2020. Se realizaron corridas cíclicas del modelo prospectivo espacio-temporal de Poisson, con incrementos progresivos de 14 días, mediante la aplicación SaTScan™ 9.6. Resultados: Se identificaron 15 conglomerados significativos (p ≤ 0,0001) cuya extensión involucró desde uno hasta trece municipios, con distribución en seis provincias (Pinar del Río, Artemisa, La Habana, Mayabeque, Matanzas, Villa Clara y Ciego de Ávila). En los conglomerados todos los municipios mostraron riesgo relativo alto, entre ellos, La Palma en la provincia de Pinar del Río y Ciego de Ávila en la provincia del mismo nombre, con los valores más altos, 119,95 y 121,04, respectivamente. Conclusión: El modelo empleado pudo identificar los conglomerados en territorios con significativa probabilidad de ocurrencia de COVID-19, así como periodos de evolución del riesgo relativo. Además, reconoce los municipios que merecen prioridad para intensificar en ellos intervenciones de contención y control sanitario y evitar la reemergencia de la enfermedad con mayor dispersión espacial.

ABSTRACT Introduction: During the occurrence of ongoing emerging infectious diseases such as COVID-19, spatiotemporal surveillance is crucial to identify priority areas for specific interventions, differentiate diagnostic intensity and assign resources. Objective: To model the evolution of the relative risk of presentation of COVID-19 cases and to identify clusters in municipalities where the disease remains at the stage following the descent of the epidemic curve in Cuba. Methods: The period mentioned was from 26/05/2020 to 4/09/2020. Cyclic runs of Poisson's prospective spatiotemporal model were performed, with progressive 14-day increases, using the software SaTScan™ 9.6. Results: A total 15 significant clusters were identified (p ≤ 0.0001) extending over one to thirteen municipalities and distributed in six provinces (Pinar del Río, Artemisa, Havana, Mayabeque, Matanzas, Villa Clara and Ciego de Ávila). In the clusters, all municipalities showed a high relative risk among them, La Palma in Pinar del Rio province and Ciego de Avila in the province of the same name, with the highest values, 119.95 and 121.04, respectively. Conclusion: The model was able to identify territories with a significant likelihood of COVID-19 occurrence, as well as periods in the evolution of relative risk. It also showed that surveillance and early warning strategies may facilitate prioritization of health control and containment interventions aimed at preventing the reemergence of the disease with greater spatial coverage.