<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1029-3019</journal-id>
<journal-title><![CDATA[MEDISAN]]></journal-title>
<abbrev-journal-title><![CDATA[MEDISAN]]></abbrev-journal-title>
<issn>1029-3019</issn>
<publisher>
<publisher-name><![CDATA[Centro Provincial de Información de Ciencias Médicas]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1029-30192018000700540</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Aspectos clínico-epidemiológicos en pacientes con dengue y signos de alarma]]></article-title>
<article-title xml:lang="en"><![CDATA[Clinical-epidemiological features of patient with dengue and alarm signs]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[George Carrión]]></surname>
<given-names><![CDATA[Wilberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bell Castillo]]></surname>
<given-names><![CDATA[Josefa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[García Céspedes]]></surname>
<given-names><![CDATA[María Eugenia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[George Bell]]></surname>
<given-names><![CDATA[María de Jesús]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Ciencias Médicas Hospital General Docente &#8220;Dr. Juan Bruno Zayas Alfonso&#8221; ]]></institution>
<addr-line><![CDATA[Santiago de Cuba ]]></addr-line>
<country>Cuba</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de Ciencias Médicas Facultad de Medicina No. 2 ]]></institution>
<addr-line><![CDATA[Santiago de Cuba ]]></addr-line>
<country>Cuba</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2018</year>
</pub-date>
<volume>22</volume>
<numero>7</numero>
<fpage>540</fpage>
<lpage>551</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_arttext&amp;pid=S1029-30192018000700540&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_abstract&amp;pid=S1029-30192018000700540&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_pdf&amp;pid=S1029-30192018000700540&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN Se realizó un estudio observacional, descriptivo y retrospectivo de 207 pacientes con el serotipo 3 del virus del dengue y signos de alarma, ingresados en la Sala de Cuidados Progresivos del Hospital General Docente &#8220;Dr. Juan Bruno Zayas Alfonso&#8221; de Santiago de Cuba, desde septiembre hasta noviembre del 2015, con vistas a determinar los aspectos clínicos y epidemiológicos en ellos. En la serie un elevado porcentaje correspondió al sexo femenino en edades jóvenes y, a diferencia de lo observado en otros brotes epidémicos, los signos de alarma aparecieron tempranamente, entre el 2do y 3er día de evolución de la enfermedad, con predominio de la hipotensión grave. No existió relación directa entre la trombocitopenia y las manifestaciones hemorrágicas, y el daño hepático primó como manifestación inusual. Se demostró que la vigilancia estricta y la actuación oportuna en la sala contribuyeron a disminuir la gravedad de los pacientes y la mortalidad, a pesar de la elevada virulencia de esta cepa.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT An observational, descriptive and retrospective study of 207 patients with the serotype 3 of the dengue virus and alarm signs, admitted in the Progressive Cares room of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, was carried out from September to November, 2015, with the aim of determining the clinical and epidemiological features in them. A high percentage of the series was of female sex in early youth, contrary to what was observed in other epidemic outbreaks, the alarm signs emerged early, between the 2nd and 3rd days of the disease clinical course, with prevalence of the severe hypotension. Direct relationship didn't exist between thrombocytopenia and the hemorrhagic manifestations, and the hepatic damage prevailed as unusual manifestation. It was demonstrated that the strict surveillance and the opportune performance in the room contributed to decrease its severity in the patients and in mortality, in spite of the high virulence of this stump.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[virus del dengue]]></kwd>
<kwd lng="es"><![CDATA[Aedes aegypti]]></kwd>
<kwd lng="es"><![CDATA[arbovirosis]]></kwd>
<kwd lng="es"><![CDATA[signos de alarma]]></kwd>
<kwd lng="en"><![CDATA[dengue virus]]></kwd>
<kwd lng="en"><![CDATA[Aedes aegypti]]></kwd>
<kwd lng="en"><![CDATA[arbovirosis]]></kwd>
<kwd lng="en"><![CDATA[alarm signs]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Diéguez Fernández]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Sosa Cabrera]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Pérez Arruti]]></surname>
<given-names><![CDATA[AE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[La impostergable participación comunitaria en la lucha contra el dengue]]></article-title>
<source><![CDATA[Rev Cubana Med Trop]]></source>
<year>2013</year>
<volume>65</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>272-6</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Schmidt-Chanasit]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Emmerich]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Tappe]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Günther]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Schmidt]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Wolff]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Autochthonous dengue virus infection in Japan imported into Germany, September 2013]]></article-title>
<source><![CDATA[Euro Surveill]]></source>
<year>2014</year>
<volume>19</volume>
<numero>3</numero>
<issue>3</issue>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Yacoub]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Wertheim]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Simmons]]></surname>
<given-names><![CDATA[CP]]></given-names>
</name>
<name>
<surname><![CDATA[Screaton]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Wills]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cardiovascular manifestations of the emerging dengue pandemic]]></article-title>
<source><![CDATA[Nat Reviews Cardiol]]></source>
<year>2014</year>
<volume>11</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>335-45</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Regueira Betancourt]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
<name>
<surname><![CDATA[Díaz Pérez]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
<name>
<surname><![CDATA[Peña Enamorado]]></surname>
<given-names><![CDATA[PB]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Variables clínicas en pacientes con sospecha de dengue, ingresados en un hospital de campaña]]></article-title>
<source><![CDATA[Rev Electrónica Dr. Zoilo E. Marinello Vidaurreta]]></source>
<year>2014</year>
<volume>41</volume>
<numero>3</numero>
<issue>3</issue>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ocazionez-Jiménez]]></surname>
<given-names><![CDATA[RE]]></given-names>
</name>
<name>
<surname><![CDATA[Ortiz-Báez]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
<name>
<surname><![CDATA[Gómez-Rangel]]></surname>
<given-names><![CDATA[SY]]></given-names>
</name>
<name>
<surname><![CDATA[Miranda-Esquivel]]></surname>
<given-names><![CDATA[DR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Virus del dengue de serotipo 1 (DENV-1) de Colombia: su contribución a la presentación del dengue en el departamento de Santander]]></article-title>
<source><![CDATA[Biomédica]]></source>
<year>2013</year>
<volume>33</volume>
<numero>^s1</numero>
<issue>^s1</issue>
<supplement>1</supplement>
<page-range>22-30</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wiwanitkit]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Comentarios en torno a "Factores de riesgo en la epidemia de dengue en Querétaro"]]></article-title>
<source><![CDATA[Rev Med Inst Mex Seguro Soc]]></source>
<year>2014</year>
<volume>52</volume>
<numero>2</numero>
<issue>2</issue>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Diéguez Fernández]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Sosa Cabrera]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Pérez Arruti]]></surname>
<given-names><![CDATA[AE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[La impostergable participación comunitaria en la lucha contra el dengue]]></article-title>
<source><![CDATA[Rev Cubana Med Trop]]></source>
<year>2013</year>
<volume>65</volume>
<numero>2</numero>
<issue>2</issue>
</nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Marín Lizarraga]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Vilcarromero Llaja]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Forshey]]></surname>
<given-names><![CDATA[BM]]></given-names>
</name>
<name>
<surname><![CDATA[Celis-Salinas]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Ramal-Asayag]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Morrison]]></surname>
<given-names><![CDATA[AC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Compromiso gastrointestinal agudo en pacientes con dengue por serotipo 4. Comunicación de un caso y revisión de la literatura]]></article-title>
<source><![CDATA[Rev Chil Infectol]]></source>
<year>2013</year>
<volume>30</volume>
<numero>5</numero>
<issue>5</issue>
</nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cavalcanti de Souza Leal Diniz]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Dias da Silva Henriques]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[da Silva Leandro]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Leal Aguiar]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Barbosa Beserra]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Resistance of Aedes aegypti to temephos and adaptive disadvantages]]></article-title>
<source><![CDATA[Rev Saúde Pública]]></source>
<year>2014</year>
<volume>48</volume>
<numero>5</numero>
<issue>5</issue>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Galán Herrera]]></surname>
<given-names><![CDATA[JF]]></given-names>
</name>
</person-group>
<source><![CDATA[Dengue: ¿dónde nos encontramos en el desarrollo de una vacuna eficaz?]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Amin Blanco]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<source><![CDATA[Identificación de epítopos de proteínas del virus dengue utilizando una biblioteca de péptidos presentados en fagos filamentoso]]></source>
<year>2014</year>
<publisher-loc><![CDATA[La Habana ]]></publisher-loc>
<publisher-name><![CDATA[Instituto Superior de Ciencias Médicas]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Arieta Centeno]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<source><![CDATA[El dengue]]></source>
<year>2013</year>
</nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bacallao Martínez]]></surname>
<given-names><![CDATA[GC]]></given-names>
</name>
<name>
<surname><![CDATA[Quintana Morales]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Dengue. Revisión bibliográfica]]></article-title>
<source><![CDATA[Acta Médica del Centro]]></source>
<year>2013</year>
<volume>7</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Correa Martínez]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Cabrera Morales]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Martínez Licor]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Martínez Núñez]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Consideraciones clínicas y terapéuticas sobre el dengue]]></article-title>
<source><![CDATA[CCM]]></source>
<year>2016</year>
<volume>20</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[León Cabrera]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Fariñas Reinoso]]></surname>
<given-names><![CDATA[AT]]></given-names>
</name>
<name>
<surname><![CDATA[Galindo Reymondo]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Dihigo Faz]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Prior García]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Hernández Bravo]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Estratificación epidemiológica del riesgo de las enfermedades emergentes y reemergentes por áreas de salud. Provincia de Matanzas. 2002-2006]]></article-title>
<source><![CDATA[Rev Med Electrón]]></source>
<year>2011</year>
<volume>34</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>34-46</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Amin]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Reyes]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Calero]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Camacho]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Acosta]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Predicción de epítopos T y B de la proteína NS4b del virus dengue tipo 3]]></article-title>
<source><![CDATA[Vaccimonitor]]></source>
<year>2013</year>
<volume>22</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>14-21</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mamani]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Nuevo serotipo 5 del virus dengue: Necesidad de fortalecer la vigilancia molecular en Perú]]></article-title>
<source><![CDATA[Rev Perú Med Exp Salud Pública]]></source>
<year>2014</year>
<volume>31</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hernández Gómez]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Olivera Cuadra]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Alonso Reyes]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez Niebla]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Cárdenas Carvajal]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez Aguilera]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Preparación del estudiante de Medicina en prevención y control del dengue]]></article-title>
<source><![CDATA[Rev EDUMECENTRO]]></source>
<year>2014</year>
<volume>6</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>174-87</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bell Santos]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Oduardo Pérez]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Caracterización de colaboradores cubanos con dengue en el municipio venezolano de Bolívar]]></article-title>
<source><![CDATA[MEDISAN]]></source>
<year>2015</year>
<volume>19</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Espinosa Brito]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Fiebre hemorrágica dengue. Estudio clínico en pacientes adultos hospitalizados]]></article-title>
<source><![CDATA[Medisur]]></source>
<year>2014</year>
<volume>12</volume>
<numero>4</numero>
<issue>4</issue>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
