Treatment of Stage 2 Medication-Induced Osteonecrosis of the Jaw: A Case Series.

Medication-induced jaw osteonecrosis (MRONJ) is a rare and serious disease with a negative impact on patients' quality of life, whose exact cause remains unclear and which may have a multifactorial origin. Although there are different therapeutic protocols, there is still no consensus. This case series evaluated three patients diagnosed with staged 2 MRONJ treated at the University of Murcia dental clinic according to the protocols described by the Spanish Society of Oral and Maxillofacial Surgery and the American Association of Oral and Maxillofacial Surgeons. Within 12 months of the application of therapeutic protocols, the lesions were completely healed in all cases. Radiography showed slow but progressive healing with normal bone structure. Conservative treatment with antibiotics, chlorhexidine rinses and minimally invasive surgical intervention with necrotic bone resection is effective in treating stage 2 of MRONJ. In cases of refractory osteonecrosis, the application of platelet and leukocyte-rich fibrin (PRF-L) in the surgical approach improves the outcome in soft tissue healing and bone regeneration but further research is needed to confirm its effectiveness.

Vector competence of Aedes aegypti from Havana, Cuba, for dengue virus type 1, chikungunya, and Zika viruses.

BACKGROUND: Like many countries from the Americas, Cuba is threatened by Aedes aegypti-associated arboviruses such as dengue (DENV), Zika (ZIKV), and chikungunya (CHIKV) viruses. Curiously, when CHIKV was actively circulating in the region in 2013-2014, no autochthonous transmission of this virus was detected in Havana, Cuba, despite the importation of chikungunya cases into this city. To investigate if the transmission ability of local mosquito populations could explain this epidemiological scenario, we evaluated for the first time the vector competence of two Ae. aegypti populations (Pasteur and Párraga) collected from Havana for dengue virus type 1 (DENV-1), CHIKV, and ZIKV. METHODOLOGY/PRINCIPAL FINDINGS: Mosquito populations were fed separately using blood containing ZIKV, DENV-1, or CHIKV. Infection, dissemination, and transmission rates, were estimated at 3 (exclusively for CHIKV), 7, and 14 days post exposure (dpe) for each Ae. aegypti population-virus combination. Both mosquito populations were susceptible to DENV-1 and ZIKV, with viral infection and dissemination rates ranging from 24-97% and 6-67% respectively. In addition, CHIKV disseminated in both populations and was subsequently transmitted. Transmission rates were low (<30%) regardless of the mosquito population/virus combination and no ZIKV was detected in saliva of females from the Pasteur population at any dpe. CONCLUSIONS/SIGNIFICANCE: Our study demonstrated the ability of Ae. aegypti from Cuba to transmit DENV, ZIKV, and CHIKV. These results, along with the widespread distribution and high abundance of this species in the urban settings throughout the island, highlight the importance of Ae. aegypti control and arbovirus surveillance to prevent future outbreaks.

Aproximación al consumo de materiales de contenido sexual explícito en adolescentes y jóvenes / Approach to the consumption of materials with explicit sexual contents by adolescents and youths

Introducción: la sexualidad humana es considerada un fenómeno pluridimensional que comprende aspectos biológicos, psicosociales, conductuales, clínicos, morales y culturales, expresándose en todas las dimensiones existenciales. Objetivo: determinar las motivaciones acerca del consumo y reproducción de materiales de contenido sexual explícito. Métodos: estudio descriptivo, transversal, en el Instituto Politécnico 5 de Septiembre en Cienfuegos, del 1ro de septiembre de 2014 al 31 de mayo de 2015. El universo fueron 109 estudiantes de 2do año de carreras técnicas de oficio, la muestra, 29 seleccionados de forma no probabilística. Fueron revisados el diagnóstico y caracterización psicopedagógica grupal e individual para obtener datos que fueron tabulados mediante el coeficiente de concordancia de Kendall. Resultados: existe poco conocimiento sobre sexualidad en los adolescentes estudiados, así como poca percepción de riesgo por las familias y las instituciones con respecto al consumo y reproducción de materiales de contenido sexual explícito por los adolescentes y jóvenes. Conclusiones: los adolescentes encuentran motivaciones intrínsecas para el consumo de materiales de contenido sexual explícito, a partir de necesidades centradas en la satisfacción sexual, intereses pobres que orientan a la búsqueda de información, con sentidos personales, ideales concretos, hábitos y prácticas habituales de genitalidad y actitudes marcadas por los estereotipo de género. Las motivaciones extrínsecas son evidenciadas en los mecanismos de presión social, de imitación o contagio y de aprendizaje social, reforzado por la insuficiente educación de la sexualidad y el fácil acceso a las nuevas tecnologías de información y comunicación, que condicionan actitudes y conductas que propician el consumo de materiales pornográficos, o incluso su reproducción(AU)

Introduction: Human sexuality is considered a pluridimensional phenomenon enclosing biological, psychosocial, behavioral, clinical, moral, and cultural aspects, expressed through all existentional dimensions. Objective: Determine the motivations for the consumption and reproduction of materials with explicit sexual contents. Methods: Descriptive, cross-sectional study at 5 de Septiembre Polytechnic Institute of Cienfuegos, from September 1 2014 to May 31 2015. The target group was made up by 109 students of second year from technical trade majors. The sample was 29 chosen by a nonprobabilistic way. We reviewed both the group and individual diagnosis and psychopedagogical characterization to obtain data that were tabulated using Kendall's coefficient of concordance. Results: There is scarce knowledge about sexuality in the adolescents studied, as well as a low perception regarding the consumption and reproduction of materials with explicit sexual contents by the adolescents and youths. Conclusions: The adolescent find intrinsic motivations for the consumption of materials with explicit sexual contents, starting in need centered around sexual satisfaction, poor interests that orientate towards the search for information, with personal senses, concrete ideals, habitual practices of genitality and attitudes marked by the gender stereotypes. The intrinsic motivations evidence the social pressure mechanisms, others of imitations or contagion and of social learning, reinforced by the scarce sexuality education and the easy access to the new information and communication technologies, which condition attitudes and behaviors the foster the consumption of pornographic materials, and event their reproduction(AU)

Microalbuminuria como marcador de riesgo cardiovascular en pacientes hipertensos / Microalbuminuria as a marker of cardiovascular risk in hypertensive patients

Fundamento: la ateroesclerosis es la causa fundamental en el desarrollo de las enfermedades cardiovasculares. Un gran número de víctimas, por lo general saludables, desarrollan un evento cardiovascular mortal o no, y es esta la primera manifestación clínica detectable de la ateroesclerosis. La microalbuminuria es reconocida por estar vinculada con daño renal en pacientes con diabetes tipo 1 y 2, es un potente predictor de enfermedades cardiovasculares y se ha convertido en un marcador de ateroesclerosis en una etapa precoz. Objetivo: determinar la utilidad de la microalbuminuria como marcador de riesgo cardiovascular. Métodos: se realizó un estudio observacional longitudinal, desde el 31 de mayo de 2014 hasta 30 de abril de 2015, para determinar la utilidad de la microalbuminuria como marcador de riesgo cardiovascular en pacientes hipertensos sin daño vascular renal, en el consultorio numero 2 perteneciente a la policlínica Tula Aguilera de la provincia de Camagüey. El universo de estudio estuvo constituido por 66 pacientes hipertensos sin daño vascular renal que cumplieron los criterios de inclusión y exclusión definido, sobre los cuales se realizó el estudio. Para el análisis y procesamiento de los resultados se emplearon medidas de resumen de estadística descriptiva tales como números absolutos y porcentajes, para describir las variables estudiadas. Resultados: la presencia de microalbuminuria predominó en el sexo femenino y en mayores de 60 años, entre los factores de riesgo, el sedentarismo, seguido por la edad mayor de 65 años, fueron los más significativos, de los parámetros bioquímicos analizados la hipercolesterolemia se presentó en mayor número, la microalbuminuria fue positiva con mayor por ciento en los pacientes con enfermedades cardiovasculares asociadas. Conclusiones: se considera que la microalbuminuria no solo es un marcador de daño renal sino que es un indicador de riesgo cardiovascular.

Background: atherosclerosis is the main cause in the development of heart diseases. A big number of victims, generally healthy, present a deadly cardiovascular event and this is the first clinical manifestation that is detected in atherosclerosis. Microalbuminuria is known as being related to kidney damage in patients with type 1 and type 2 diabetes. It is a potential predictor of heart diseases and has become a marker of atherosclerosis in an early stage. Objective: to determine the utility of microalbuminuria as a marker of cardiovascular risk. Methods: an observational longitudinal study was conducted, from May 31st 2014, to April 30th 2015 to determine the utility of microalbuminuria in hypertensive patients without kidney vascular damage in health care center 2 of the clinic Tula Aguilera in Camagüey. The universe of study was composed of 66 hypertensive patients without kidney vascular damage, who met the inclusion and exclusion criteria, upon which the study is based. For the analysis and processing of the results descriptive statistics measures were used such as absolute numbers and percentage to describe the studied variables. Results: the presence of microalbuminuria prevailed in female sex and people over 60 years old. Among the risk factors, sedentarism followed by age over 65 were the most significant. From the analyzed biochemical parameters hipercolesterolemia was higher in number, microalbuminuria was positive with a larger percent in patients with associated heart diseases. Conclusions: it is considered that microalbuminuria is not only a marker of kidney damage but also an indicator of cardiovascular risk.

Evaluación cualitativa de metabolitos secundarios en extractos de variedades e híbridos de Morus alba L. (morera) / Qualitative evaluation of secondary metabolites in extracts of Morus alba L. (mulberry) varieties and hybrids

INTRODUCCIÓN: el género Morus constituye una fuente importante de sustancias bioactivas de diversa naturaleza química. Además, el uso de Morus alba L., planta conocida como morera, se ha diversificado gracias a que posee excelentes cualidades nutricionales. En Cuba, sobresale como fuente de forraje por su capacidad de producción de biomasa, composición química, alta degradabilidad, adaptabilidad a diversas condiciones de clima y suelo, perennidad ante el corte y disponibilidad. OBJETIVOS: realizar el tamizaje fitoquímico de 10 variedades e híbridos de M. alba y evaluar la toxicidad de los extractos acuosos en ratas de laboratorio. MÉTODOS: se recolectaron las hojas frescas. Se lavaron, desinfectaron, secaron, y pulverizaron y se extrajeron con n-hexano, etanol y agua. Los extractos se filtraron y se les realizaron las pruebas fitoquímicas de identificación. En ratas se realizó una evaluación de toxicidad de los extractos acuosos para la determinación preliminar de su inocuidad. RESULTADOS: el estudio fitoquímico mostró considerables cantidades de triterpenos y esteroides, así como fenoles y taninos en los extractos evaluados, mientras que no fueron detectados quinonas ni alcaloides. En el ensayo de toxicidad no se manifestaron síntomas clínicos importantes como mortalidad, convulsiones, alteraciones en el ritmo cardiaco o respiratorio. CONCLUSIONES: el análisis fitoquímico de las variedades e híbridos de M. alba, mostraron abundantes cantidades de metabolitos secundarios descritos como agentes antioxidantes. El estudio de toxicidad realizado mostró una inocuidad del extracto acuoso en ratas, por lo que estos extractos sugieren la presencia de propiedades farmacológicas para el tratamiento de numerosas enfermedades asociadas al estrés oxidativo.

INTRODUCTION: the Morus genus constitutes an important source of bioactive substances of diverse chemical nature. In addition, the use of Morus alba L., plant known as mulberry, has been rapidly diversified because it has excellent nutritional qualities. In Cuba, it stands out as forage source due to its biomass production capacity, chemical composition, high degradability, adaptability to different climate and soil conditions, perennial character when pruned and availability. OBJECTIVES: to perform the phytochemical sieving of 10 M. alba varieties and hybrids and evaluate the toxicity of the aqueous extracts in laboratory rats. METHODS: the fresh leaves were collected. They were washed, disinfected, dried, and pulverized and extracted with n-hexane, ethanol and water. The extracts were filtered and the phytochemical identification tests were ran on them. A toxicity evaluation of the aqueous extracts was conducted in rats for the preliminary determination of their innocuousness. RESULTS: the phytochemical study showed considerable quantities of triterpenes and steroids, as well as phenols and tannins in the evaluated extracts, while neither quinones nor alkaloids were detected. In the toxicity trial no important clinical symptoms, such as mortality, convulsions, or alterations of the heart or respiratory rate, appeared. CONCLUSIONS: the phytochemical analysis of the M. alba varieties and hybrids showed abundant quantities of secondary metabolites described as antioxidant agents. The toxicity study conducted showed innocuousness of the aqueous extract in rats, for which these extracts suggest the presence of pharmacological properties for the treatment of many diseases associated to the oxidative stress.

[Reactive C protein as a marker of inflammation in patients with arterial hypertension]. / Proteína C reactiva como marcador de inflamación en hipertensión arterial aguda.

The acute arterial hypertension is an entity of unquestionable pronostic value, due to others factors like dislipidemia, and it plays a main role in the origin of the atherosclerotic process; the cytoquines freed during this process increased C-reactive protein levels in blood. We studied a group of hypertense adult in order to determine lipid and C-reactive protein levels in serum as a marker of inflammation. The results shown high levels of lipid in serum in 100 % of the patients, the highest levels of C-reactive protein corresponded with the highest levels of total cholesterol and LDL oxidized, it was suggested as a atherosclerotic disease risk.

Protonation of kanamycin A: detailing of thermodynamics and protonation sites assignment.

Protonation of an aminoglycoside antibiotic kanamycin A sulfate was studied by potentiometric titrations at variable ionic strength, sulfate concentration and temperature. From these results the association constants of differently protonated forms of kanamycin A with sulfate and enthalpy changes for protonation of each amino group were determined. The protonation of all amino groups of kanamycin A is exothermic, but the protonation enthalpy does not correlate with basicity as in a case of simple polyamines. The sites of stepwise protonation of kanamycin A have been assigned by analysis of (1)H-(13)C-HSQC spectra at variable pH in D(2)O. Plots of chemical shifts for each H and C atom of kanamycin A vs. pH were fitted to the theoretical equation relating them to pK(a) values of ionogenic groups and it was observed that changes in chemical shifts of all atoms in ring C were controlled by ionization of a single amino group with pK(a) 7.98, in ring B by ionization of two amino groups with pK(a) 6.61 and 8.54, but in ring A all atoms felt ionization of one group with pK(a) 9.19 and some atoms felt ionization of a second group with pK(a) 6.51, which therefore should belong to amino group at C3 in ring B positioned closer to the ring A while higher pK(a) 8.54 can be assigned to the group at C1. This resolves the previously existed uncertainty in assignment of protonation sites in rings B and C.

Linfoma no Hodgkin extraganglionar. Reporte de un caso / Extraganglionar non-Hodgkin´s lymphoma. A case report

El linfoma no Hodgkin extraganglionar es un trastorno linfoproliferativo crónico de causa aún dudosa. Se reporta un caso de una paciente con una masa tumoral a nivel del anillo de Waldeyer, se realizó el diagnóstico por biopsia de la lesión de un linfoma no Hodgkin de alto grado de malignidad extraganglionar. Se inició tratamiento con esquema ChopBleo y se obtuvo repuesta favorable, presentó recaída hematológica dos años más tarde, por lo que se inició tratamiento con radioterapia de cabeza y cuello con resultados alentadores. Actualmente se mantiene asintomática.

The extraganglionar non Hodgkin's lymphoma is a chronic lynphoproliferative disorder of still doubtful cause. A case of a patient with a tumoral mass at the level of the Waldeyer ring is reported, the diagnosis by biopsy of the lesion was carried out of a non -Hodgkin's lymphoma of highly degree of extraganglionar malignancy. The treatment with ChopBleo schema was initiated and favorable response was obtained, the patient presented hematological relapse two years later, for which treatment with radiation therapy of head and neck was initiated with encouraging results. At present is maintained asymptomatic.

Síndrome de Evans: Reporte de un caso / Evans´ syndrome: Acase report

El Síndrome de Evans es un trastorno inmunológico atípico y poco frecuente causado por anticuerpos contra antígeno de membrana, de hematíes y plaquetas cursando con manifestaciones hemorrágicas en piel y mucosas generalmente de evolución no siempre favorable. Se reporta un caso con púrpura trombocitopénica autoinmune y anemia hemolítica autoinmune. El diagnóstico se realizó determinando la presencia de anticuerpos contra las células sanguíneas antes mencionadas. El tratamiento inmunosupresor inicialmente, quirúrgico, y citotóxico no fue efectivo.

ABSTRACT The Evans´ syndrome is an atypical immunological disorder and little frequent caused by antibodies against antigen of membrane, erythrocytes and platelets progressing with hemorrhagic manifestations in the skin and mucous membranes generally of not always favourable evolution. A case of autoimmune thrombocytopenic purpura and autoimmune haemolytic anemia is reported. The diagnosis was carried out determining the presence of antibodies against the blood cells before mentioned. The immunosuppressant treatment initially, surgical, and cytotoxic was not effective.

Aplicación de l fórmula de cockcroft y gault en la comunidad / Application of Cockcroft and Gault formula in the community

El buen funcionamiento del sistema renal es uno de los procesos biológicos más importantes para la conservación del medio interno e indispensable para un buen estado de salud. Con el objetivo de evaluar la función renal a través del índice de filtrado glomerular (IFG) mediante la fórmula de Cockcroft y Gault se realizó un estudio descriptivo observacional en 216 pacientes mayores de 20 años en un consultorio del municipio Güáimaro, que constituyó la muestra de estudio durante junio de 2004 y marzo de 2006. Se utilizaron variables cuantitativas y cualitativas como peso, edad, sexo, antecedentes patológicos personales, determinación de creatinina sérica y se calculó el IFG a cada paciente aplicando la fórmula; estos datos fueron recogidos en una encuesta. Con la información obtenida se creó una base de datos procesados en una microcomputadora Pentium 3 mediante el programa estadístico SPSS - 10. En la muestra estudiada se detectó un 11.5 % de pacientes con IFG patológico. La disminución leve del filtrado glomerular fue la alteración más frecuentemente encontrada. La hipertensión arterial y la diabetes mellitus fueron los antecedentes patológicos que más se presentaron. La utilización de esta fórmula reportó un ahorro de $ 172.80 y se logró pesquisar 25 pacientes con IFG patológico sin manifestaciones clínicas de insuficiencia renal crónica.

The good operation of renal system is one of the most important biological processes for the conservation of the internal enviroment and indispensable for a good state of health. With the objective to assess the renal function through the glomerular filtration rate (GFR) by means of the Cockcroft and Gault formula an observacional descriptive study was carried out to 216 patients older than 20 years in a doctor's office from Guáimaro municipality, that constituted the sample of the study from June 2004 to March 2006. Qualitative and quantitative variables were utilized like weight, age, sex, personal pathological antecedents, determination of serumal creatinine and the GFR was calculated to each patient applying the formula; these data were collected in a survey. With the information obtained in a Pentium 3 microcomputer a database was created by means of the SPSS - 10 statistical program. In the sample studied was detected a 11.5% of patients with pathological GFR. The mild decrease of the glomerular filtered was the most frequent alteration found. Arterial hypertension and diabetes mellitus were the pathological antecedents most presented. The utilization of this formula reported savings of $ 172.80 and was achieved to inquest 25 patients with pathological GFR without clinical manifestations of chronic renal insufficiency.

Influencia del oontrol glucémico en las gestantes diabéticas / Influence of glycemic control in the diabetic expectant mothers

Durante la gestación el organismo necesita un mayor aporte de insulina al precisar una mayor utilización de glucosa, por lo que el embarazo es una situación metabólica en la que ocurren cambios hormonales que favorecen el desarrollo de la diabetes. El presente estudio descriptivo se realizó en embarazadas con diabetes gestacional (97) y diabetes pregestacional (11) diagnosticadas en el Hospital Provincial Ginecobstétrico “Ana Betancourt de Mora” durante el año 2004. Se investigó el control de la glucemia mediante la determinación del perfil glucémico y su repercusión en los resultados perinatales. En ambos grupos se determinaron una serie de variables recogidas en una encuesta. Los datos se procesaron por el sistema estadístico SPSS, se halló distribución de frecuencia en valores absolutos y por cientos. En el estudio predominó el buen control, existió mayor frecuencia de regular y mal con el incremento de la edad, excesivo peso materno, mayor tiempo de evolución de la diabetes pregestacional y la presencia de varios factores de riesgo materno. La sepsis y la hipertensión arterial fueron las enfermedades más frecuentes asociadas al embarazo con 36 y 32 pacientes, respectivamente. Por otra parte la edad mayor de 30 años estuvo presente el 58.3 % constituyendo el factor de riesgo de mayor incidencia. Las complicaciones perinatales más frecuentes fueron la sepsis, el síndrome de dificultad respiratoria y la ictericia a pesar del buen control metabólico logrado, predominaron estas morbilidades asociadas a enfermedades o factores de riesgo en la madre.

During gestation the oragnism needs a greater contribute of insulin needing a greater utilization of glucose, pregnancy is a metabolic situation in which hormonal changes occur that favor the development of diabetes. The present descriptive study was conducted in pregnant women with Gestational Diabetes (97) and Pregestational Diabetes (11) diagnosed at "Ana Betancourt de Mora" Ginecobstetric Provincial Hospital during the year 2004. The glycemic control by identifying glycemic profile and its impact on perinatal outcomes, was investigated . In both groups a number of variables collected in a survey were determined. Data were processed by the SPSS statistical system, frequency distribution in absolute values and percents was found. Good control dominated in the study, greater frequency of regular and bad with the increase in age, excessive maternal weight, greater evolution time of pregestational diabetes and the presence of several maternal risk factors. Sepsis and arterial hypertension were the most frequent diseases associated at pregnancy with 36 and 32 patients, respectively. On the other hand the age over than 30 years was present 58.3% constituting the risk factor of greater incidence. The most frequent perinatal complications were sepsis, respiratory distress syndrome and jaundice in spite of the good metabolic control achieved, predominated morbidities associated to these diseases or risk factors in the mother.