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Background: mortality in patients with acute kidney injury is high and sometimes low- and medium-income health systems lack tools capable of predicting the prognosis of these patients. Objective: to estimate the prognostic value of short-term mortality of the neutrophil/lymphocyte ratio in patients with acute kidney injury in an intensive unit care. Methods: a retrospective cohort analytical study was conducted in 124 patients with acute kidney injury from January 1, 2022 to December 31, 2022. A k-means cluster analysis was performed, requesting the creation of three clusters according to values of the neutrophil/lymphocyte ratio. Survival curves were constructed using the Kaplan-Meier method and the survival means were compared using the Log-Rank test. The optimal cut-off point of the neutrophil/lymphocyte ratio was established for the prediction of mortality and the discriminatory capacity was evaluated through the area under the curve of the C statistic. Results: mortality was higher in the third tercil (76.74 %). The deceased patients had a significantly higher median index than the survivors (6.73 vs. 4.55; p

Asociación entre enfermedad renal crónica y embarazo

Association between chronic kidney disease and pregnancy

Introducción: La COVID-19 se presenta como una infección del tracto respiratorio inferior. Entre sus diversas manifestaciones extrapulmonares se encuentra el daño cardiovascular, y estas son las que se asocian a la morbimortalidad. Se realizó una búsqueda de información científica utilizando recursos de las bases de datos PubMed, PubMed Central, SciELO, Ebsco, ClinicalKey y Scopus. Las estrategias de búsqueda formuladas fueron: SARS-CoV-2, COVID-19, complicaciones cardiovasculares; así como sus traducciones al inglés. Objetivo: Describir las complicaciones cardiovasculares en pacientes con la COVID-19. Desarrollo: Existe una amplia diversidad de criterios en la literatura científica acerca del daño cardiovascular en el contexto de la infección por la COVID-19. Las complicaciones cardiovasculares reportadas son: la lesión miocárdica aguda, miocarditis aguda, arritmias cardiacas, síndrome coronario agudo, insuficiencia cardiaca aguda, daño valvular cardiaco, enfermedad tromboembólica venosa y shock. Conclusiones: Se describen las complicaciones cardiovasculares en pacientes con la COVID-19. La infección por SARS-CoV-2 ocasiona daño directo o indirecto en el miocardio, las válvulas cardiacas y el resto del sistema cardiovascular.

Introduction: The COVID-19 typically presents as a lower respiratory tract infection. Among its various extrapulmonary manifestations is cardiovascular damage, and these are the ones that are most associated with morbidity and mortality. A search for scientific information was carried; resources were obtained from databases PubMed, PubMed Central, SciELO, Ebsco, ClinicalKey, and Scopus. The search strategies formulated were: SARS-CoV-2, COVID-19, Cardiovascular complications; as well as its translations into the English language. Objective: To describe the cardiovascular complications in patients with the COVID-19. Development: There is a wide diversity of criteria in the scientific literature regarding cardiovascular damage in the context of COVID-19 infection. Frequently reported cardiovascular complications are acute myocardial injury, acute myocarditis, cardiac arrhythmias, acute coronary syndrome, acute heart failure, heart valve damage, venous thromboembolic disease, and shock. Conclusions: Cardiovascular complications in COVID-19 carriers were described. SARS-CoV-2 infection causes direct or indirect damage to the myocardium, heart valves and the rest of the cardiovascular system.

Background: acute kidney injury is frequent in patients admitted to intensive care units. Despite being a potentially reversible phenomenon, high mortality rates are reported.Objective: to characterize clinical and epidemiological variables in patients with acute kidney injury admitted to the intensive care unit of the “Dr. Ernesto Guevara de la Serna” of the province of Las Tunas, from January to June 2020.Methods: an analytical, retrospective, case-control study was carried out with 60 patients older than 18 years with acute kidney injury, at the aforementioned institution and during the period herein declared. Two groups of 30 patients each were formed, according to vital status at ten days. The following variables were studied: age and sex, personal medical history, development of sepsis during admission, creatinine levels, glomerular filtration rate and urea.Results: the mean age was 52,57 ± 15,03 years and 68,33 % were male. There were differences between both groups in terms of previous chronic kidney disease and sepsis, as well as in creatinine, glomerular filtration rate and urea, always worse in the deceased. The prerrenal cause predominated (71,67 %). The highest incidence of deaths occurred at the third and eighth days of follow-up.Conclusions: patients with acute kidney injury were characterized in an intensive care unit. Previous chronic kidney disease, sepsis, and creatinine levels were variables with different incidence in the groups studied.

Introducción: La COVID-19 no presenta distinción de edades, razas y sexo, los niños y jóvenes representan un sector de la población que no escapa a esta realidad. Identificar precozmente la enfermedad favorece a un mejor pronóstico. Se realizó una revisión bibliográfica, utilizando las bases de datos (PubMed, SciELO, Ebsco y Clinical Key). Los descriptores utilizados fueron: SARS-CoV-2, COVID-19, COVID-19 en niños. La búsqueda aportó 77 artículos, de los cuales se descartaron 47 por no cumplir con de los criterios de inclusión. Se tomaron para citar el trabajo 30, el 100 % del año 2020, son citados. Objetivo: Describir aspectos generales de la COVID-19 en pacientes pediátricos. Desarrollo: Para caracterizar la enfermedad existen abundantes artículos científicos a nivel mundial, los pacientes en edades pediátricas son igualmente afectados que el resto de la población. La pertinencia de identificar la enfermedad precozmente, justifica la dispersión existente en la literatura. Conclusiones : A pesar de los avances científicos realizados en múltiples investigaciones, existen todavía elementos de la enfermedad que deben estudiarse a fondo. Aunque generalmente los pacientes pediátricos presentan una mejor evolución probablemente influida por la ausencia de comorbilidades existentes en la población adulta, la COVID-19 tiene similar comportamiento.

Introduction: globally there is an increase in the rates of heart disease, kidney disease and the concomitant presence of both; with a notorious presence of the cardio-renal syndrome. Aim: To describe the types of cardio-renal syndrome, according to their physiopathology. Methods: a bibliographic review was conducted, using the PubMed, SciELO, Ebsco and Clinical Key databases. The period in which the information was searched was June 10-15, 2020. The search strategies included: chronic renal disease, cardiovascular diseases, cardiac and renal syndrome, physiopathological mechanisms; and their translation into Spanish. Development: Cardio-renal syndrome is a highly active biomedical research field. The great utility of the identification of cardiovascular or renal damage justifies the wide dispersion in the literature on this topic. New strategies are been defined in populations at risk for early diagnosis, reducing morbidity and mortality. Conclusions: the 5 types of the cardio-renal syndrome were described. The physiopathology of each one indicates that the renal and cardiovascular systems imbricate common physiopathological mechanisms responsible for the posterior damage of the non-affected organ.

Introduction: COVID-19 does not present a distinction of ages, races and sex, children and youth represent a sector of the population that does not escape this reality. Early identification of the disease favors a better prognosis. Objective: To describe general aspects of COVID-19 in pediatric patients. Methods: A bibliographic review was performed, using the databases (PubMed, Scielo, Ebsco and Clinical Key). The search descriptors used were: SARS-CoV-2, COVID-19, and COVID-19 in children. The search yielded 77 articles, of which 47 were discarded for not meeting the inclusion criteria. 30, 100 % of the year 2020, were taken to cite the work. The analysis-synthesis, induction-deduction and historical-logical methods were used. Development: to characterize the disease, there are abundant scientific articles worldwide, pediatric patients are equally affected than the rest of the population. The relevance of identifying the disease early, justifies the dispersion existing in the literature. Conclusions: Despite the scientific advances made in multiple investigations, there are still elements of the disease that must be studied in depth. Although pediatric patients generally present a better evolution, probably influenced by the absence of existing comorbidities in the adult population, COVID-19 has similar behavior.

Background: the consequent diseases on atherosclerosis and the risk factors associated with it can be minimized, mostly if they are early detected and changed.Objective: to identify the presence of early atherosclerotic signals in children and adolescents belonging to Doctor’s Office No. 48 of the health district of “7 de Noviembre” University Polyclinic of the municipality of Majibacoa, province of Las Tunas, from November 30, 2019 to February 21, 2020.Methods: an observational, descriptive and cross-sectional study was carried out with a universe of 831 patients belonging to the aforementioned health district and during the period of time herein declared. The sample was made up of the 94 patients of 19 years of age. The following variables were assessed: age, sex, and various atherogenic signals. Frequency distribution analysis and descriptive statistics were used.Results: the 11 to 15 age group predominated, with a mean of 11,13 ± 4,693 years. The male sex was more affected, 60,64 %. Sedentary lifestyle was the risk factor mostly identified (61,70 %), followed by smoking (47,87 %) and low intake of vegetables (40,43 %). In the female sex there was a prevalence of the presence of two atherogenic signals (in 40,54 % of the cases) and in the male sex there was only one atherogenic signal (38,30 %).Conclusions: the presence of atherogenic signals was identified in a group of patients susceptible to develop diseases consequent on atherosclerosis.

Background: acute renal injury is a clinical syndrome resulting from multiple etiologies, which becomes evident in the sudden loss of renal functions. The constant search for biomarkers for its diagnosis is aimed at its early detection and prevention.Objective: to describe biomarkers of acute renal injury, according to the most updated bibliography.Methods: a bibliographic review was carried out using as information resources the ones available through the Infomed network (PubMed, SciELO, Ebsco and Clinical Key), as well as the Google Academic search engine. 81 % of the consulted bibliography belonged to the last 5 years and 64 % to the last 3 years. The methods used in the study were analysis-synthesis, induction-deduction and historical-logical.Results: in order to overcome the limitations of traditional markers and achieve an accurate diagnosis, and therefore a less unfavorable prognosis, new biomarkers have been identified such as: the kidney injury molecule 1, neutrophil gelatinase-associated lipocalin, interleukin 18, combination of tissue metalloproteinase inhibitor 2 and insulin-like growth factor binding protein 7, urinary N-acetyl-β-glucosamidase, Na-H exchanger isoform-3, liver-type fatty acid binding protein 1, netrin 1, fibroblast growth factor 23 and glutathione S-transferase.Conclusions: acute renal injury is a common condition today. In the scientific literature there are abundant articles on the use of sensitive and specific serum and/or urinary biomarkers, very useful for establishing the early diagnosis of it.

Introducción: la nefritis lúpica es la afectación orgánica de mayor frecuencia de aparición en el lupus eritematoso sistémico. Objetivo: caracterizar los pacientes con nefritis lúpica atendidos en el Hospital General Docente “Dr. Ernesto Guevara de la Serna” de Las Tunas. Métodos: se realizó un estudio observacional, descriptivo de corte transversal, en un grupo conformado por 15 pacientes que recibieron atención médica en el Hospital General Docente “Dr. Ernesto Guevara de la Serna” en la provincia de Las Tunas en el período comprendido de marzo de 2016 a julio de 2017. La muestra estuvo conformada por 15 pacientes. Resultados: el 100 % de la muestra estudiada correspondió al sexo femenino; el 46,6 % de los pacientes fue diagnosticado con lupus eritematoso sistémico entre los 21 y 30 años de edad y el 40 % del total debutó con nefritis lúpica en el momento del diagnóstico; la mayoría de los pacientes presentó como manifestación clínica la proteinuria subnefrótica; el 40 % de los pacientes mostró el tipo III de nefritis lúpica o glomerulonefritis proliferativa focal; el 100 % de los pacientes presentó proteinuria, el 66,6 % de los pacientes recibió tratamiento combinado con ciclofosfamida y prednisona. Conclusiones: el sexo femenino es el único afectado en el presente estudio. La mayor cantidad de pacientes debutó con nefritis lúpica en el momento del diagnóstico del lupus eritematoso sistémico. Todos los pacientes incluidos en el estudio presentaron proteinuria en algún momento del período estudiado. El tratamiento combinado fue el más utilizado.

Background: to determine the prognostic factors for mortality in patients with terminal chronic kidney disease undergoing hemodialysis treatment contributes to the benefits of more accurate therapeutic attitudes.Objective: to identify the prognostic factors for mortality in patients with terminal chronic kidney disease undergoing hemodialysis treatment at the department of nephrology of the “Dr. Ernesto Guevara de la Serna” General Teaching Hospital of Las Tunas, from January 2016 to February 2019.Methods: an analytical, prospective, cohort study was carried out with 80 patients with terminal chronic kidney disease undergoing hemodialysis treatment at the aforementioned institution and during the period herein declared. The sample was divided into two groups, according to mortality or survival at the end of the study. The Cox proportional hazards and regression model was used to measure covariates that influence on the event. Survival curves were constructed using the Kaplan–Meier estimator. To contrast hypotheses and to compare the survival distributions the Log-rank test was used.Results: the Cox proportional hazards and regression model determined the age over 65 years (p=0,025; HR: 2,523; CI: 1,163-7,600), the presence of central venous catheter (p=0,049; HR: 1,791; CI: 1,036-4,473), albumin less than 35 g/L (p=0,000; HR: 3,468; CI: 1,760-5.879) the presence of arrhythmias (p=0,003; HR: 3,354; CI: 1,576-5,453) and Kt/V levels higher than 1,3 (p=0,000; HR: 4,655; CI: 1,807-8,230) as prognostic factors for mortality.Conclusions: age older than 65 years, the presence of central venous catheter, albumin values lower than 35 g/L, the development of arrhythmias and Kt/V levels higher than 1,3 were identified as prognostic factors for mortality in patients with terminal chronic kidney disease undergoing hemodialysis treatment.

Background: the early diagnosis of hypertensive nephropathy contributes to distinguish the follow-up and treatment of these patients, according to risk scales.Objective: to determine the predictive value of albuminuria for hypertensive nephropathy in hypertensive patients of the health district of the “Manuel Fajardo Rivero” Teaching Polyclinic of Las Tunas, from June 2018 to March 2019.Methods: a retrospective, observational, analytical, case-control study was carried out with 100 hypertensive patients with risk factors for hypertensive nephropathy at the aforementioned institutions and during the period herein declared. The sample was divided into two groups according to the presence (cases) or not (controls) of hypertensive nephropathy, in a ration of 1:3. Multivariate analysis was used to identify the independent predictive factors for hypertensive nephropathy. The discriminatory power of albuminuria as a predictor of hypertensive nephropathy was assessed by means of the area under the ROC curve.Results: glomerular filtration rate was significantly lesser in the patients with hypertensive nephropathy, with more hyperuricemia and more frequent hypercholesterolemia. Albuminuria was identified as a prognostic factor for hypertensive nephropathy (OR: 2,246, 95 % CI: 2,003-2,979), along with age, years of progress of HTN, stage 2 and non-controlled hypertension. The discriminatory power was very good, index C: 0,885 (95 % CI: 0,820-0,951).Conclusions: albuminuria was an important independent predictor of hypertensive nephropathy in the patients with arterial hypertension included in the study.

Introducción: La mortalidad temprana en los pacientes con enfermedad renal crónica representa un gran problema de salud, por lo que el diseño de modelos pronósticos novedosos constituye una prioridad. Objetivo: Diseñar una red neuronal artificial para la predicción de mortalidad en pacientes con enfermedad renal crónica en hemodiálisis. Métodos: Se realizó un estudio analítico, de cohorte prospectivo, en pacientes con enfermedad renal crónica en hemodiálisis durante el período del 1 de enero de 2013 al 31 de diciembre de 2017. Se analizaron un total de 36 atributos en 392 pacientes. Se utilizó el perceptrón multicapa para el diseño de una red neuronal artificial compuesta por 12 variables. Finalmente, se evaluó la tabla de clasificación, la capacidad discriminatoria del algoritmo y la importancia normalizada de las variables pronósticas. Resultados: La red neuronal artificial presentó porcentajes globales de clasificación correcto de un 96,3 % en la muestra de entrenamiento y un 96,7 % en la muestra de validación. La capacidad discriminatoria fue muy buena, área COR de 0,989. Las variables pronósticas de mortalidad de mayor importancia normalizada fueron la enfermedad cardiovascular, la albúmina y la sepsis. Conclusiones: La red neuronal artificial contribuye a la estratificación del riesgo de mortalidad de los pacientes con enfermedad renal crónica en hemodiálisis. El modelo presenta buena capacidad discriminatoria e indicadores de eficacia estadística. Las variables pronósticas identificadas son de fácil determinación e interpretación, por lo que se considera como una herramienta predictiva de útil implementación en la toma de decisiones médicas en el ámbito clínico.

Introducción: La predicción de mortalidad en pacientes con enfermedad renal crónica, mediante escalas o índices pronósticos presenta limitaciones reales. Objetivo: Diseñar una escala predictiva de mortalidad en pacientes con enfermedad renal crónica. Métodos: Se realizó un estudio observacional, analítico, longitudinal prospectivo en 169 pacientes con enfermedad renal crónica desde el 1 de enero de 2022 al 31 de diciembre de 2022. La investigación se desarrolló en 2 etapas: Durante los primeros 6 meses del año se analizaron las variables de estudio para el diseño de la escala predictiva. En los próximos 6 meses, los pacientes fueron seguidos para identificar la ocurrencia o no de la variable dependiente mortalidad. Se determinó la capacidad discriminatoria de la escala predictiva y se evaluaron curvas de supervivencia. Resultados: Las variables que conformaron la escala predictiva fueron edad > 65 años, enfermedad cardiovascular, albúmina < 35 g/L, dislipidemia, hemoglobina < 10 g/L y ácido úrico > 390 mmol/L. El poder discriminatorio para predecir mortalidad fue bueno, índice C: 0,856 (IC 95 %: 0,783-0,929; p< 0,001). Los pacientes con valores menores a 4 puntos presentaron media de supervivencia de 149,438 ± 7,296 días. En cambio, los que tenían valores superiores presentaron media de supervivencia de 93,128 ± 8,545 días. Conclusiones: La escala predictiva contribuyó a la estratificación del riesgo de mortalidad de los pacientes. Las variables incluidas son de fácil determinación e interpretación por lo que es un modelo útil en la toma de decisiones médicas en el ámbito clínico actual.

Introducción: Existen experiencias positivas en Cuba relativas a la COVID-19, que incluyen la participación comunitaria en las estrategias de salud, paraenfrentaresta epidemia en la atención primaria. Objetivo: Evaluar la efectividad de una intervención comunitaria para disminuir los casos de la COVID-19. Métodos: Se implementó una intervención comunitaria en la población del Policlínico Docente "Dr. Gustavo Aldereguía Lima", de Las Tunas (53 392 habitantes),en el período del 11 de julio al 24 de octubre de 2021. Las variables estudiadas fueron; casos sospechosos en cuerpo de guardia, casos confirmados, casos sospechosos ingresados en el domicilio, casos confirmados ingresados en el domicilio, estratificación del área de salud, complejidad de las semanas estadísticas, tendencia, fallecidos, letalidad, cobertura de vacunación y efectividad. Se realizó un análisis descriptivo de los datos de las variables . Resultados: Ingresaron en el domicilio 8314 (15,60 %) sospechosos de la COVID-19. Los meses de mayor y menor complejidad, fueron agosto y octubre. En la semana 1 se confirmaron entre 401 y 500 casos, con reducción sostenida de la tasa de incidencia y letalidad, desde la semana estadística 35; a partir de la cual inician los reportes de pacientes inmunizados (26 422 en total) con las vacunas cubanas Abdala y Soberana Plus. Conclusiones: La intervención comunitaria, junto a la inmunización anti-COVID-19, fue efectiva para disminuir los casos de la COVID-19 en la población estudiada.