<?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>S1029-30192018000800707</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Signos de alarma en pacientes cubanos con dengue según nueva clasificación revisada de la Organización Mundial de la Salud]]></article-title>
<article-title xml:lang="en"><![CDATA[Warning signs in Cuban patients with dengue fever according to new reviewed classification of the World Health Organization]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Tamayo Escobar]]></surname>
<given-names><![CDATA[Osmany Enrique]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[García Olivera]]></surname>
<given-names><![CDATA[Tania María]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[scobar Yéndez]]></surname>
<given-names><![CDATA[Nilia Victoria]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González Rubio]]></surname>
<given-names><![CDATA[Daniel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Castro Peraza]]></surname>
<given-names><![CDATA[Osvaldo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro de Investigaciones Médico-Quirúrgicas  ]]></institution>
<addr-line><![CDATA[La Habana ]]></addr-line>
<country>Cuba</country>
</aff>
<aff id="Af2">
<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="Af3">
<institution><![CDATA[,Instituto de Medicina Tropical &#8220;Pedro Kourí&#8221;  ]]></institution>
<addr-line><![CDATA[La Habana ]]></addr-line>
<country>Cuba</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>10</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>10</month>
<year>2018</year>
</pub-date>
<volume>22</volume>
<numero>8</numero>
<fpage>707</fpage>
<lpage>719</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_arttext&amp;pid=S1029-30192018000800707&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_abstract&amp;pid=S1029-30192018000800707&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_pdf&amp;pid=S1029-30192018000800707&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 transversal en el Instituto de Medicina Tropical &#8220;Pedro Kourí&#8221; de La Habana, donde estuvieron ingresados 485 pacientes desde enero hasta diciembre de 2012 con diagnóstico de infección por dengue, de los cuales se escogió una muestra de 247. Entre los signos de alarma más comunes sobresalieron la cifra ascendente del hematocrito (54,6 %) y el dolor abdominal intenso o mantenido o de ambos tipos (46,1 %). Las señales de alarma aparecieron por lo general al ceder la fiebre; del total de pacientes que las presentaron en algún momento de su evolución, 81,2 % fueron tratados con hidratación intravenosa precoz y ninguno evolucionó hacia la forma grave de la enfermedad. La terapia hidratante parenteral se inició tardíamente en 18,8 % de los afectados, incluidos todos aquellos en estado grave.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT An observational, descriptive and cross sectional study was carried out in "Pedro Kourí" Tropical Medicine Institute from Havana, where 485 patients were admitted from January to December, 2012 with diagnosis of infection due to dengue fever, from whom a sample of 247 was chosen. Among the most common warning signs there were the increasing values of hematocrit (54.6 %), and the intense or sustained abdominal pain or both types (46.1 %). The warning signs generally appeared when fever ceased, and of the total of patients that presented it, 81.2 % at some moment of their clinical course were treated with early intravenous hydration, and none developed the serious form of the disease. The parenteral hydration therapy began belatedly in 18.8 % of the affected, including all those in severe state.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[dengue]]></kwd>
<kwd lng="es"><![CDATA[dengue sin signos de alarma]]></kwd>
<kwd lng="es"><![CDATA[dengue con signos de alarma]]></kwd>
<kwd lng="es"><![CDATA[hidratación intravenosa]]></kwd>
<kwd lng="es"><![CDATA[enfermedad reemergente]]></kwd>
<kwd lng="en"><![CDATA[dengue fever]]></kwd>
<kwd lng="en"><![CDATA[dengue fever without warning signs]]></kwd>
<kwd lng="en"><![CDATA[dengue fever with warning signs]]></kwd>
<kwd lng="en"><![CDATA[intravenous hydration]]></kwd>
<kwd lng="en"><![CDATA[reemerging disease]]></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[Alexander]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Balmaseda]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Coelho]]></surname>
<given-names><![CDATA[IC]]></given-names>
</name>
<name>
<surname><![CDATA[Dimaano]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Hien]]></surname>
<given-names><![CDATA[TT]]></given-names>
</name>
<name>
<surname><![CDATA[Hung]]></surname>
<given-names><![CDATA[NT]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Multicentre prospective study on dengue classification in four South-east Asian and three Latin American countries]]></article-title>
<source><![CDATA[Trop Med Int Health]]></source>
<year>2011</year>
<volume>16</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>936-48</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="book">
<collab>World Health Organization</collab>
<source><![CDATA[Dengue: guidelines for diagnosis, treatment, prevention and control]]></source>
<year>2009</year>
<publisher-loc><![CDATA[Geneva ]]></publisher-loc>
<publisher-name><![CDATA[WHO]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="book">
<collab>Organización Panamericana de la Salud, Organización Mundial de la Salud</collab>
<source><![CDATA[Guías de atención para enfermos de dengue en la región de las Américas]]></source>
<year>2010</year>
<publisher-loc><![CDATA[La Paz ]]></publisher-loc>
<publisher-name><![CDATA[OPS/OMS]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kalayanarooj]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Dengue classification current WHO vs the newly suggested classification for better clinical application?]]></article-title>
<source><![CDATA[J Med Assoc Thai]]></source>
<year>2011</year>
<volume>94</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>74-84</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pozo]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Monroy]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Díaz]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Barrios]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Ramos]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Ulloa]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evaluación de acogida y factores virales asociado con dengue grave en base a la clasificación de la OMS del 2009]]></article-title>
<source><![CDATA[Rev Parásit Vect]]></source>
<year>2014</year>
<volume>7</volume>
<page-range>590-7</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[Thein]]></surname>
<given-names><![CDATA[TL]]></given-names>
</name>
<name>
<surname><![CDATA[Gan]]></surname>
<given-names><![CDATA[VC]]></given-names>
</name>
<name>
<surname><![CDATA[Lye]]></surname>
<given-names><![CDATA[DC]]></given-names>
</name>
<name>
<surname><![CDATA[Yung]]></surname>
<given-names><![CDATA[CF]]></given-names>
</name>
<name>
<surname><![CDATA[Leo]]></surname>
<given-names><![CDATA[YS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Utilities and limitations of the world health organization 2009 warning signs for adult dengue severity]]></article-title>
<source><![CDATA[PLoS Negl Trop Dis]]></source>
<year>2013</year>
<volume>7</volume>
<page-range>2023-9</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Martínez]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Caracterización clínico-epidemiológica y ecográfica de pacientes con dengue confirmado Santiago de Cuba]]></article-title>
<source><![CDATA[MEDISAN]]></source>
<year>2010</year>
<volume>14</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>665-74</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[González]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Castro]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Kourí]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Pérez]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Martínez]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Vazquez]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Classical dengue hemorrhagic fever resulting from two dengue infections spaced 20 years or more apart Havana, Dengue 3 epidemic, 2001-2002]]></article-title>
<source><![CDATA[Internat J Infect Diseas]]></source>
<year>2005</year>
<volume>9</volume>
<page-range>280-5</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Leo]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Gan]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Ng]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Hao]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Ng]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Pok]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Utility of warning signs in guiding admission and predicting severe disease in adult dengue]]></article-title>
<source><![CDATA[BMC Infect Dis]]></source>
<year>2013</year>
<volume>13</volume>
<page-range>498-506</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="book">
<collab>Organización Panamericana de la Salud</collab>
<collab>Organización Mundial de la Salud</collab>
<source><![CDATA[Los casos de dengue en las Américas se quintuplicaron en diez años, según nuevos datos de la OPS/OMS]]></source>
<year>2014</year>
<publisher-loc><![CDATA[Washington, D.C. ]]></publisher-loc>
<publisher-name><![CDATA[OPS]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="book">
<collab>Organización Panamericana de la Salud</collab>
<collab>Organización Mundial de la Salud</collab>
<source><![CDATA[Descripción de la situación epidemiológica actual del dengue en las Américas]]></source>
<year>2014</year>
<publisher-loc><![CDATA[Washington, D.C. ]]></publisher-loc>
<publisher-name><![CDATA[OPS]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="book">
<collab>World Health Organization</collab>
<source><![CDATA[Dengue, countries or areas at risk, 2013]]></source>
<year>2014</year>
<publisher-loc><![CDATA[Geneva ]]></publisher-loc>
<publisher-name><![CDATA[WHO]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="book">
<collab>Pan American Health Organization</collab>
<collab>World Health Organization</collab>
<source><![CDATA[Number of reported cases of dengue and severe dengue (SD) in the Americas, by country: epidemiological week]]></source>
<year>2015</year>
<publisher-loc><![CDATA[Washington, D.C. ]]></publisher-loc>
<publisher-name><![CDATA[PAHO]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="book">
<collab>Perú. Ministerio de Salud</collab>
<source><![CDATA[Incidencia acumulada de dengue sin señales de alarma, con señales de alarma y dengue grave por regiones en el Perú]]></source>
<year>2011</year>
<publisher-loc><![CDATA[Lima ]]></publisher-loc>
<publisher-name><![CDATA[MINSA]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<collab>Perú. Ministerio de Salud</collab>
<article-title xml:lang=""><![CDATA[Resumen de las enfermedades o eventos bajo vigilancia epidemiológica en el Perú]]></article-title>
<source><![CDATA[Bol Epidemiol (Lima)]]></source>
<year>2014</year>
<volume>23</volume>
<numero>22</numero>
<issue>22</issue>
<page-range>442-6</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[Yacoub]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Wills]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Predicting outcome from dengue]]></article-title>
<source><![CDATA[BMC Med]]></source>
<year>2014</year>
<volume>12</volume>
<page-range>147-9</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[Simmons]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Farrar]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
<name>
<surname><![CDATA[Chau]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Wills]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Dengue current concepts]]></article-title>
<source><![CDATA[N Engl J Med]]></source>
<year>2012</year>
<volume>366</volume>
<numero>15</numero>
<issue>15</issue>
<page-range>1423-32</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Usman]]></surname>
<given-names><![CDATA[HB]]></given-names>
</name>
<name>
<surname><![CDATA[Safitri]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Lum]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Martínez]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Kroeger]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Horstick]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evidence for the use of intravenous rehydration for treating severe dengue with plasma leakage in children and adults a systematic review]]></article-title>
<source><![CDATA[WHO Dengue Bull]]></source>
<year>2012</year>
<volume>36</volume>
<page-range>149-65</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[Kularatne]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
<name>
<surname><![CDATA[Weerakoon]]></surname>
<given-names><![CDATA[KG]]></given-names>
</name>
<name>
<surname><![CDATA[Munasinghe]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Ralapanawa]]></surname>
<given-names><![CDATA[UK]]></given-names>
</name>
<name>
<surname><![CDATA[Pathirage]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Trends of fluid requirement in dengue fever and dengue haemorrhagic fever a single centre experience in Sri Lanka]]></article-title>
<source><![CDATA[BMC Res Notes]]></source>
<year>2015</year>
<volume>8</volume>
<page-range>130-7</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Myburgh]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Mythen]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Resuscitation fluids]]></article-title>
<source><![CDATA[N Engl J Med]]></source>
<year>2013</year>
<volume>369</volume>
<page-range>1243-51</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
