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Dengue has broadened its global distribution substantially in the past two decades, and many endemic areas are experiencing increases in incidence. The Dominican Republic recently experienced its two largest outbreaks to date with 16,836 reported cases in 2015 and 20,123 reported cases in 2019. With continued increases in dengue transmission, developing tools to better prepare healthcare systems and mosquito control agencies is of critical importance. Before such tools can be developed, however, we must first better understand potential drivers of dengue transmission. To that end, we focus in this paper on determining relationships between climate variables and dengue transmission with an emphasis on eight provinces and the capital city of the Dominican Republic in the period 2015-2019. We present summary statistics for dengue cases, temperature, precipitation, and relative humidity in this period, and we conduct an analysis of correlated lags between climate variables and dengue cases as well as correlated lags among dengue cases in each of the nine locations. We find that the southwestern province of Barahona had the largest dengue incidence in both 2015 and 2019. Among all climate variables considered, lags between relative humidity variables and dengue cases were the most frequently correlated. We found that most locations had significant correlations with cases in other locations at lags of zero weeks. These results can be used to improve predictive models of dengue transmission in the country.

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RESUMEN En la pandemia por la COVID-19, las personas mayores son el grupo que concentra la mayor mortalidad, sobre todo quienes precisan de cuidados de largo plazo por haber perdido su habilidad funcional. Esta población vive en sus domicilios, con la familia o en un centro residencial. Se ha descrito que las personas mayores pueden desarrollar una forma de enfermedad oligosintomática o con una sintomatología clínica particular; por esta razón, las estrategias de tamizaje basadas en síntomas no son las más recomendables. Es necesario detectar de manera precoz a los enfermos en este grupo; por ello, analizamos y proponemos las mejores alternativas disponibles para conseguir este objetivo.

ABSTRACT During the COVID-19 pandemic, older people have been the group with the highest mortality rate, especially those who require long-term care for having lost their functional ability. These people are living at home with their family or in a nursing home. It has been described that older people may develop an oligosymptomatic SARS-CoV-2 infection or particular symptoms of the disease. Therefore, symptom-based screening is not the most recommended strategy in this scenario. Since it is necessary to detect early cases in the elderly population, this research work analyzes and proposes the best available alternatives for attaining such goal.

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Non-domiciliated intrusive triatomine vectors are responsible for a low but significant transmission of Trypanosoma cruzi to humans. Their control is a challenge as insecticide spraying is of limited usefulness, and alternative strategies need to be developed for a sustainable control. We performed a non-randomized controlled trial of an Ecohealth intervention based on window insect screens and community participation to reduce house infestation by Triatoma dimidiata in two rural villages in Yucatan, Mexico. Efficacy of the intervention was measured over a three years follow-up period and entomological indicators showed that the proportion of triatomines found inside houses was significantly reduced in houses with insect screens, which effectively kept more bugs on the outside of houses. Using a previously developed model linking entomological data to the prevalence of infection in human, we predicted that the intervention would lead to a 32% reduction in yearly incidence and in the prevalence of T. cruzi infection. The cost for the coverage of all the windows of a house was of comparable magnitude to what families currently spend on various domestic insecticide, and most screens were still in good conditions after three years. In conclusion, the Ecohealth approach proposed here is effective for the long-term and sustainable control of intrusive T. dimidiata vectors in the Yucatan peninsula, Mexico. This strategy may also be easily adapted to other intrusive triatomine species as well as other regions/countries with comparable eco-epidemiological settings, and would be an excellent component of a larger integrated program for the control of a variety of other vector-borne diseases, bringing additional benefits to the communities. Our results should encourage a further scaling-up of our implementation strategy in additional villages in the region.

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BACKGROUND: Non-domiciliated (intrusive) triatomine vectors remain a challenge for the sustainability of Chagas disease vector control as these triatomines are able to transiently (re-)infest houses. One of the best-characterized examples is Triatoma dimidiata from the Yucatan peninsula, Mexico, where adult insects seasonally infest houses between March and July. METHODS: We focused our study on three rural villages in the state of Yucatan, Mexico, in which we performed a situation analysis as a first step before the implementation of an ecohealth (ecosystem approach to health) vector control intervention. RESULTS: The identification of the key determinants affecting the transient invasion of human dwellings by T. dimidiata was performed by exploring associations between bug presence and qualitative and quantitative variables describing the ecological, biological and social context of the communities. We then used a participatory action research approach for implementation and evaluation of a control strategy based on window insect screens to reduce house infestation by T. dimidiata. CONCLUSIONS: This ecohealth approach may represent a valuable alternative to vertically-organized insecticide spraying. Further evaluation may confirm that it is sustainable and provides effective control (in the sense of limiting infestation of human dwellings and vector/human contacts) of intrusive triatomines in the region.

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BACKGROUND: Chagas disease is a tropical parasitic disease affecting about 10 million people, mostly in the Americas, and transmitted mainly by triatomine bugs. Insect vector control with indoor residual insecticides and the promotion of housing improvement is the main control intervention. The success of such interventions relies on their acceptance and appropriation by communities, which depends on their knowledge and perceptions of both the disease and the vector. In this study, we investigated school-aged children's knowledge and perception on triatomine vectors and Chagas disease to further understand how communities view this vector and the disease in Yucatan, Mexico. METHODOLOGY/PRINCIPAL FINDINGS: We performed an analysis of children's drawings on the theme of triatomines and their house in several rural villages, to explore in an open-ended manner their views, understanding and misconceptions. A total of 261 drawings were collected from children ages 6-12 from four villages. We found that children are very familiar with triatomine vectors, and know very well many aspects of their biology and ecology, and in particular their blood-feeding habits. On the other hand, their drawings suggest that the role of triatomines as vectors of a chronic and severe cardiac disease is less understood, and the main perceived health threat appears limited to the bite itself, as previously observed in adults. CONCLUSIONS/SIGNIFICANCE: These results have important implications for the specific design of future education materials and campaigns, and for the promotion of the inclusion of children in raising Chagas disease awareness in these endemic communities.

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Introducción. El blanqueamiento dental es de los procedimientos más solicitados a los odontólogos. Desde los años 90 han aumentado las técnicas y presentaciones de los productos usados para este procedimiento. Por el aumento en la demanda del blanqueamiento dental, se puede encontrar gran número de estudios en la literatura, por lo cual es difícil sacar conclusiones válidas sobre la efectividad a largo plazo de las técnicas disponibles. Objetivo. El objetivo de esta revisión sistemática es determinar si el blanqueamiento dental es efectivo a largo plazo, cuál sistema de blanqueamiento es el más efectivo, cuánto perdura en el tiempo y cuáles son las variables que intervienen en el éxito. Materiales y métodos. Los artículos utilizados en esta revisión son ensayos clínicos aleatorizados, buscados electrónica y manualmente entre 1980 y el 2013, en diferentes bases de datos. Resultados. De 4.581 artículos encontrados, se seleccionaron 8 artículos para incluir en la revisión, ya que cumplían con los criterios establecidos. Después de seleccionar los artículos definitivos para la revisión, se hizo una evaluación metodológica de estos, por medio de la cual se encontró que el nivel de evidencia fue alto en tres artículos, medio en cuatro y bajo en uno. Conclusión. Teniendo en cuenta la buena ‘evidencia’ que se encontró, se concluye que: la efectividad del blanqueamiento a largo plazo no depende de la técnica del blanqueamiento empleada. El cambio de color registrado durante el blanqueamiento dental fue similar en todos los grupos evaluados. El blanqueamiento en casa, es un tratamiento efectivo. A pesar de que se mantienen los cambios de color logrados con el blanqueamiento, se presenta una recidiva de leve a moderada.

Introduction: Tooth whitening is one of the most requested treatments in dentistry; since the 90’s the techniques and product presentations used for this procedure have increased. Due to the rise in the demand for tooth whitening, a great number of studies can be found in the literature, for this reason it is hard to draw valid conclusions about long term effectiveness of the different techniques for tooth whitening available in the market. Aim: The objective of this systematic review was to determine the long term effectiveness of tooth whitening, which tooth whitening system is the most effective, how long it endures throughout time, and which variables are involved in its success. Methods: The studies used in this systematic review were randomized clinical trials searched electronically and manually in a period between 1980, and 2013, in different data bases. Results: out of 4.581 articles found, 8 were selected to be included, since they met the inclusion criteria. After choosing the articles to be included, a methodological assessment of them was done, 3 presented high evidence, 4, medium and 1 low. Conclusion: Taking into account the good evidence found it could be concluded that: long-term effectiveness of tooth whitening does not depend on the whitening technique used. The change in color registered during tooth whitening, was similar for all groups. At home tooth whitening is an effective treatment. Even though the changes in color obtained are maintained, a relapse in color from mild to moderate is observed.

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Antecedentes: Los pacientes con Neumonía Adquirida en la Comunidad que requieren ingreso hospitalario es muy variable según las series (12 por ciento-66 por ciento), la mayor parte de los estudios retrospectivos realizados sugieren que los factores más importantes que afectan al pronóstico y la evolución de la enfermedad son la edad avanzada, la presencia de enfermedades subyacentes, así como un retraso en el diagnóstico y tratamiento por lo que debido a esto y a los altos costos que representa el manejo de estas infecciones es necesario el uso de criterios que predicen la mortalidad y que permiten identificar pacientes con neumonía de pobre pronóstico en un estadio temprano de la enfermedad. Objetivo: Determinar la eficacia de criterios de severidad del PSI y el CURB-65 en los pacientes con NAC para predecir la mortalidad, en los pacientes que ingresan por emergencia y hospitalizados. Materiales y Métodos: Es un estudio descriptivo, retrospectivo, que se realizó en el Hospital Nacional Dos de Mayo durante el periodo del 01 de enero del 2010 al 31 de diciembre del 2010. La muestra estuvo conformada por todos los pacientes con diagnóstico de NAC que ingresaron por el servicio de emergencia y fueron hospitalizados. Se utilizó la prueba estadística de Chi-cuadrado para determinar la asociación entre severidad del PSI y mortalidad; asimismo, entre severidad del CURB-65 y mortalidad. Para las pruebas de significación estadística se utilizó el nivel alfa=0,05; es decir, toda vez que el valor de P resultó menor que 0,05 se consideró el resultados como estadísticamente significativo. Resultados: Del total de pacientes con NAC, el 50 por ciento fue de sexo masculino, el 38,2 por ciento de estos tuvieron más de dos antecedentes patológicos, el 24 por ciento fueron del grupo de fallecidos, el 36,0 por ciento presentaron una clase IV como criterio de severidad del PSI, el 10.5 por ciento presentaron una puntuación de 4-5 como criterio de severidad del CURB-65. Se...

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El embarazo ectópico bilateral espontáneo es una condición clínica infrecuente que ocurre en 1 de cada 1.580 embarazos ectópicos. En los últimos 25 años se han reportado 72 casos de embarazo ectópico bilateral, 31 de los cuales han sido espontáneos y en ninguno de ellos se ha logrObjetivo: determinar la prevalencia y los genotipos de los papillomavirus humanos (PVH) en mujeres con lesiones escamosas intraepiteliales de bajo grado (LEIBG). Métodos: noventa y seis mujeres de la clínica e colposcopia fueron incluidas. La presencia de los PVH en las biopsias fue determinada por ensayo de reacción en cadena de la polimerasa (RCP) con oligonucleótidos para el gen L1. Las muestras fueron coamplificadas con MY09/MY11/HMB01 e iniciadores para betaglobina GH20/PC04. Para tipificar se utilizó hibridación reversa en línea. Resultados: el ADN de PVH fue detectado en 28/96 (29,1 por ciento) pacientes, de las cuales 21/28 (75 por ciento) tuvieron infección con un sólo tipo y 7/28 (25 por ciento); infección múltiple. En 29/39 (74,3 por ciento) fueron de alto riesgo y 10/39 (25,7 por ciento) de bajo riesgo. Encontramos 13 diferentes tipos 9/13 (69,2 por ciento) de ellos de alto riesgo. PVH 58 fue el tipo más frecuente. Conclusiones: la prevalencia de VPH en mujeres con diagnóstico citológico de LEIBG fue menor que la esperada; este resultado sugiere una clasificación inadecuada de los diagnósticos.

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BACKGROUND: Group A rotavirus (RV) is associated with acute infectious diarrhea (AID) in children and adults. The clinical manifestations of RV infection are classified as slight, moderate and severe and could be the results of differing rotaviral serotypes. Attempts have been made to correlate the severity of the infection with specific RV groups, subgroups (SG) serotypes and electropherotypes, but the results have been inconclusive. OBJECTIVE: To correlate the severity of the RV infection with the strains of RV isolated from the patients. STUDY DESIGN: 142 feces were collected from patients with AID caused by RV. The samples were subjected to polyacrylamide gel electrophoresis (PAGE) to determine the electrophoretic pattern and immunoenzymatic assays with monoclonal antibodies specific for serotype, SG and group. The Program EPIINFO 6.0 was used to analyze the correlation. RESULTS: The 142 RV strains isolated were from group A and long electrophoretic pattern. Respect to the symptoms were classified, 43 (30%) as slight; the RV isolates corresponding to these patients were 35 of serotype G1P1A SG II; 4 G1P1A SG I and II; 1 G1P1A SG Non I Non I; 1 G3 SG II; 1 G3 SG Non I and Non II and 1 G3 SG I and II. 89 (53%) of patients showed moderate clinical symptoms. 58 isolates of RV were G1P1A SG II; 11 G1P1A SG Non I Non II; 9 G1P1A SG I and II; 1 G1P1B SG II; 1 G4P1A SG II; 1G1 and G4 SG I and II; 6 G3 SG Non I Non II; 2 G3 SG II. The severe RV infection occurred in only 10 (7%). 8 were serotype G1P1A SG II and 2 were G1P1A SG I and II. CONCLUSION: This study demonstrated that the severity of AID has no significant statistical relationship to the specific RV strains isolated from the patients.

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OBJECTIVE: To describe the cases of rotavirus infection occurred in Yucatan, Mexico, in the year 2000. MATERIAL AND METHODS: From January to May 2000, were studied 668 patients with acute infectious diarrhea and their fecal samples. A questionnaire was applied and the samples were analyzed by polyacrylamide gel electrophoresis with silver stained. Incidence rates and the frequency of clinical manifestations were calculated. RESULTS: The cases of rotavirus occurred from January to April 2000. Three hundred-thirty seven (50.45%) samples were positives. The higher incidence rate of 0.70% was observed in infants 6 to 8 months of age. Vomit, nausea and hyperthermia were the more frequent clinical manifestations. Abdominal pain and dehydration occurred in 45.9% and 41.8% of the cases respectively. CONCLUSIONS: Presentation of the cases was similar to the reported by the countries with tempered climate. The risk of becoming ill by rotavirus was greater in the children under 1 year of age. Abdominal pain requires be carefully explored. Surveillance of the cases must be carried out throughout the year.

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