Tongue Flap for Management of Large Palatal Fistulas.

ABSTRACT: One of the worst complications after a primary palatoplasty is the lesion of the neurovascular bundle, results into a type of flap necrosis, having as a final consequence a residual palatine fistula.In our institution the authors usually use tongue flap to repair large fistulas.The authors retrospectively reviewed all patients with large palatal fistulas that were repaired with tongue flap at Fundacion Gantz between January 2002 and December 2020.Fundacion Gantz has 1.067 patients with palatal surgeries, with an incidence of 5,8% for palatal fistulas and 3,2% (n = 2) were considered large.Surgery was done on 24 patients with large residual palatal fistula, all of them with tongue flaps as outpatient surgery. Fifteen were girls and 9 were boys, between 13 and 40 years.The average size of the fistula was 2,5 cm and 100% are localized in the anterior palate.The incidence of complications with tongue flap was 12, 5%: 2 dehiscences and 1 persistent residual fistula. The authors had no complications in phonation due to the lingual donor area.The authors consider that this outpatient surgery, is a reprodutible and safe technique, with a low rate of complications, which allows us to recommend it for the treatment of large palatal fistulas.

Inferring predominant pathways in cellular models of breast cancer using limited sample proteomic profiling.

BACKGROUND: Molecularly targeted drugs inhibit aberrant signaling within oncogenic pathways. Identifying the predominant pathways at work within a tumor is a key step towards tailoring therapies to the patient. Clinical samples pose significant challenges for proteomic profiling, an attractive approach for identifying predominant pathways. The objective of this study was to determine if information obtained from a limited sample (i.e., a single gel replicate) can provide insight into the predominant pathways in two well-characterized breast cancer models. METHODS: A comparative proteomic analysis of total cell lysates was obtained from two cellular models of breast cancer, BT474 (HER2+/ER+) and SKBR3 (HER2+/ER-), using two-dimensional electrophoresis and MALDI-TOF mass spectrometry. Protein interaction networks and canonical pathways were extracted from the Ingenuity Pathway Knowledgebase (IPK) based on association with the observed pattern of differentially expressed proteins. RESULTS: Of the 304 spots that were picked, 167 protein spots were identified. A threshold of 1.5-fold was used to select 62 proteins used in the analysis. IPK analysis suggested that metabolic pathways were highly associated with protein expression in SKBR3 cells while cell motility pathways were highly associated with BT474 cells. Inferred protein networks were confirmed by observing an up-regulation of IGF-1R and profilin in BT474 and up-regulation of Ras and enolase in SKBR3 using western blot. CONCLUSION: When interpreted in the context of prior information, our results suggest that the overall patterns of differential protein expression obtained from limited samples can still aid in clinical decision making by providing an estimate of the predominant pathways that underpin cellular phenotype.

A novel SCN5A mutation, F1344S, identified in a patient with Brugada syndrome and fever-induced ventricular fibrillation.

OBJECTIVE: Brugada syndrome (BS) is an inherited electrical cardiac disorder characterized by right bundle branch block pattern and ST segment elevation in leads V1 to V3 on surface electrocardiogram that can potentially lead to malignant ventricular tachycardia and sudden cardiac death. About 20% of patients have mutations in the only so far identified gene, SCN5A, which encodes the alpha-subunit of the human cardiac voltage-dependent sodium channel (hNa(v)1.5). Fever has been shown to unmask or trigger the BS phenotype, but the associated molecular and the biophysical mechanisms are still poorly understood. We report on the identification and biophysical characterization of a novel heterozygous missense mutation in SCN5A, F1344S, in a 42-year-old male patient showing the BS phenotype leading to ventricular fibrillation during fever. METHODS: The mutation was reproduced in vitro using site-directed mutagenesis and characterized using the patch clamp technique in the whole-cell configuration. RESULTS: The biophysical characterization of the channels carrying the F1344S mutation revealed a 10 mV mid-point shift of the G/V curve toward more positive voltages during activation. Raising the temperature to 40.5 degrees C further shifted the mid-point activation by 18 mV and significantly changed the slope factor in Na(v)1.5/F1344S mutant channels from -6.49 to -10.27 mV. CONCLUSIONS: Our findings indicate for the first time that the shift in activation and change in the slope factor at a higher temperature mimicking fever could reduce sodium currents' amplitude and trigger the manifestation of the BS phenotype.

Intervención educativa sobre COVID-19 en adultos mayores del Consultorio Médico de la Familia No. 4. Cumanayagua, 2020 / Educational intervention on COVID-19 in older adults of the Family Doctor´s Office No. 4. Cumanayagua, 2020

RESUMEN Fundamento la pandemia de COVID-19 causa la muerte de muchas personas, fundamentalmente adultos mayores. Conocer sobre ella es una forma de prevenirla. Objetivo describir los resultados de una intervención educativa sobre COVID-19, en adultos mayores. Métodos intervención educativa realizada en un universo constituido por 230 adultos mayores, del que se seleccionó una muestra de 178 ancianos dispensarizados pertenecientes al consultorio No. 4 del Consejo Popular Brisas, en Cumanayagua. Se realizó un diagnóstico para identificar el nivel de conocimientos sobre la COVID-19, en el que se indagó sobre aspectos acerca de la enfermedad, tales como: síntomas, medidas de prevención, vías de transmisión. También se les preguntó sobre el cumplimiento de las medidas de prevención. Sobre esa base se desarrolló una intervención educativa. Resultados el 50 % presenta factores de riesgo; el conocimiento sobre sintomatología aumentó de 10, 1 % antes de la intervención a 100 % después; sobre vías de transmisión de 35, 9 % a 83,7 % y el de las medidas preventivas de 53, 9 % a 91,7 %. Aprendieron a utilizar el nasobuco de manera correcta. La satisfacción de los adultos mayores con las acciones educativas fue alta. Conclusiones después de la aplicación de las acciones educativas existió un aumento en el conocimiento sobre la enfermedad, lo que puede ser favorable para su prevención en este grupo de ancianos.

ABSTRACT Background: the COVID 19 pandemic causes the death of many people, mainly older adults. Knowing about it is one way to prevent it. Objective: to describe the results of an educational intervention on COVId 19, in older adults Methods: educational intervention carried out in a universe of 230 older adults, from which a sample of 178 dispensed elderly people belonging to the Family Doctor´s Office No. 4 in Cumanayagua was selected. A diagnosis was made to identify the level of knowledge about COVID-19, in which aspects about the disease were investigated, such as: symptoms, prevention measures, transmission routes. They were also asked about compliance with prevention measures. On that basis, an educational intervention was developed. Results: The 50 % present risk factors; knowledge about symptoms increased from 10.1% before the intervention to 100% after; on transmission routes from 35.9 % to 83.7 % and that of preventive measures from 53.9 % to 91.7 %. They learned to use the mask correctly. The satisfaction of the elderly with the educational actions was high. Conclusions: after the application of educational actions, there was an increase in knowledge about the disease, which may be favorable for its prevention in this group of elderly.

A novel nonsense mutation in the SCN5A gene leads to Brugada syndrome and a silent gene mutation carrier state.

BACKGROUND: Brugada syndrome (BS) is an electrical cardiac disorder with a right bundle branch block and ST segment elevation in leads V1 to V3 on surface electrocardiograms (ECGs), and is a syndrome that may lead to sudden cardiac death. PURPOSE: The aim of the present study was to screen for mutations in the SCN5A gene in a family with BS, and to characterize the consequences of the mutation on channel function. RESULTS: A heterozygous nonsense SCN5A mutation (W822X) was identified in the index patient. The mutation was confirmed in the patient's asymptomatic 16-year-old brother and 48-year-old father. The mutation was absent in the index patient's sister and mother. The ECG of the index patient showed a BS type 2 ECG phenotype, which converted into a type 1 ECG phenotype in the presence of flecainide. The ECG of the patient's brother was not typical for BS, but ajmaline treatment unmasked a type 1 ECG phenotype. The ECG of the asymptomatic father was normal at baseline and in the presence of ajmaline. No Na+ currents could be measured in tsA201 cells transfected with W822X mutant channels. Heterozygote expression showed a nearly 50% reduction in Na+ current amplitude with no significant alterations of biophysical properties, indicating a loss of functional Na+ channels, obviously without any dominant-negative activity on wild type channels. CONCLUSIONS: The haploinsufficiency of the Nav1.5 protein is the plausible explanation for the clinical BS phenotype in this family. Because the heterozygous W822X mutation theoretically leads to channel expression at one-half of the normal level, the authors suggest that a modifier gene may influence or rescue the phenotype in the asymptomatic family members.

Revolución, salud y humanidad / Revolution, health and humanity

En noviembre de 2018, el presidente electo de Brasil Jair Bolsonaro se cuestionaba la preparación del personal médico cubano que, en ese momento, prestaba su ayuda solidaria al pueblo brasileño. La colaboración cubana contribuyó a llevar la atención médica a miles de personas que se encontraban en la miseria sin recibir un servicio de salud, como el brindado por los profesionales cubanos. Estos hechos demostraron que una vez más se ha pretendido manchar el nombre de nuestro país. Como apoyo a las declaraciones realizadas por el Ministerio de Salud Pública de Cuba (Minsap) ante estos acontecimientos, consideramos oportuno reflexionar sobre la impronta dejada por el concepto de "Revolución", que nos legara Fidel y su influencia en las actuaciones, actitudes y principios del personal de la salud de nuestro país. Enfatizaremos nuestras reflexiones desde la concepción de que "Revolución es luchar por nuestros sueños de justicia para Cuba y para el mundo, que es la base de nuestro patriotismo, nuestro socialismo y nuestro internacionalismo".1,2 Esta carta, más que homenajear a quienes convierten en realidad los ideales altruistas del socialismo, desea hacer un llamado al compromiso con la patria y con las raíces de las que se nutre nuestra sociedad, que hacen posible que hoy pueda erigirse como estandarte de la salud pública. Cuba no escatima esfuerzos para ejercer su solidaridad en cualquier lugar del mundo y, en las más diversas situaciones, siempre con el sentido del momento histórico en que vivimos. Revolución, en su dimensión más amplia, es el cambio o transformación radical y profunda del pasado inmediato. Se puede producir en varios ámbitos al mismo tiempo: económico, cultural, religioso, político, social militar, entre otros. También se habla de revolución en el contexto de las ideologías (revolución ideológica) o el del arte (revolución artística). En ocasiones se hace abuso del vocablo cuando se prolonga a otros contextos como la moda, el deporte o la última novedad de la música popular. En otras ocasiones esas extensiones del concepto están justificadas, como en la denominada revolución científica.3 Cuando se habla de la Revolución Cubana, se refiere al movimiento social que triunfó el primero de enero de 1959. La victoria del Ejército Rebelde y los grupos clandestinos que operaban en las ciudades, contra la dictadura de Fulgencio Batista, produjo cambios radicales en todas las esferas de la vida social y económica del país. El gobierno revolucionario, apenas instalado en el poder, comenzó la educación en valores a nivel de la población, con énfasis en los profesionales que formaba bajo sus principios éticos. Esta formación en valores, es un proceso humanizador individual, social, vertical y horizontal a lo largo de la vida de las personas, en las que se determina su personalidad desde que nace hasta la ancianidad. Las posturas y actuaciones de los cubanos durante estos años demuestran la solidez de esta ética revolucionaria, que no permite que se defina la Revolución Cubana como lo hacíamos en su origen. Hoy, por supuesto, la definición debe ser más compleja. Cada etapa tiene sus objetivos, los actuales no son los mismos que se propusieron en 1959, cuando la Revolución triunfante se enfrentó a la compleja situación del país: hambre, miseria, analfabetismo, incultura, prostitución y las arcas del gobierno vacías, robadas y llevadas a los Estados Unidos.4 El primero de mayo del año 2000, el Comandante en Jefe Fidel Castro Ruz dio a conocer el concepto de Revolución, que desde ese instante se convirtió en brújula de la labor patriótica de todo el pueblo. Este alcanza a resumir la esencia de la historia pasada, presente y sobre todo futura de la nación cubana. Fidel se refirió a lo que consideró la síntesis de su percepción acerca de lo que es Revolución al definir: (5 Revolución es sentido del momento histórico; es cambiar todo lo que debe ser cambiado; es igualdad y libertad plenas; es ser tratado y tratar a los demás como seres humanos; es emanciparnos por nosotros mismos y con nuestros propios esfuerzos; es desafiar poderosas fuerzas dominantes dentro y fuera del ámbito social y nacional; es defender valores en los que se cree al precio de cualquier sacrificio; es modestia, desinterés, altruismo, solidaridad y heroísmo; es luchar con audacia, inteligencia y realismo; es no mentir jamás ni violar principios éticos; es convicción profunda de que no existe fuerza en el mundo capaz de aplastar la fuerza de la verdad y las ideas. Revolución es unidad, es independencia, es luchar por nuestros sueños de justicia para Cuba y para el mundo, que es la base de nuestro patriotismo, nuestro socialismo y nuestro internacionalismo...(AU)

Alcoholismo y factores de riesgo: estudio descriptivo de corte transversal en área rural de Cumanayagua, Cuba / Alcoholism and risk factors: a cross-sectional study in Cumanayagua, Cuba

Introducción: el alcohol es la droga más consumida en el mundo. En América Latina se estima que existen 40 millones de alcohólicos, los que suman a su enfermedad carencias en la atención del sistema de salud. En Cuba se implementó el Programa de Control de Alcoholismo que se ejecuta en la atención primaria. Objetivo: determinar los factores de riesgo que con mayor frecuencia se asocian al alcoholismo. Métodos: se realizó un estudio epidemiológico descriptivo de corte transversal en el Consejo Popular de Cuatro Vientos de Cumanayagua, Cuba. Se utilizó el Cuestionario de Indicadores Diagnóstico y el CAGE, el test de percepción del funcionamiento familiar y el cuestionario validado para el estudio. El universo estuvo constituido 77 pacientes mayores de 15 años, de sexo masculino que estaban registrados como alcohólicos en el Consejo Popular de Cuatro Vientos. Resultados: mayor porcentaje de individuos alcohólicos (58,25 por ciento) se concentraron entre los 35 y más años, el 77,6 por ciento no acepta su enfermedad, el 53,7 por ciento refirieron tener al padre como bebedor en el hogar y el 58,3 por ciento de las familias donde se acoge un alcohólico resultó ser disfuncional; en tanto los problemas laborales estuvieron presentes en el 46,3 por ciento de los casos y el 47,8 por ciento no refiere haber presentado ningún problema judicial. Conclusión: se constata que la gran mayoría de los encuestados llegan a desarrollar la enfermedad después de los 35 años de edad. Más de la tercera parte de ellos no tienen crítica de su estado morboso y similar porcentaje conviven en familias disfuncionales. Un elevado número de pacientes alcohólicos enfrentan problemas personales, sociales y/o judiciales.

Introduction. Alcohol is the most consumed drug in the world. It is estimated that there are 40 million alcoholics in Latin America, who in addition to their condition, must also face impoverished health care systems. Cuba implemented an Alcoholism Control Program in primary care. Purpose. To identify the risk factors that are associated most frequently with alcoholism. Methods. A cross-sectional descriptive study was conducted in the Popular Council of Cuatro Vientos in Cumanayagua, Cuba. The Diagnostic Indicators Questionnaire and CAGE, the family perception test and a questionnaire that was validated for the study, were applied. The universe studied were 77 male patients older than 15, and who were registered alcoholics in the Popular Council of Cuatro Vientos. Results. Most alcoholics (58.25 percent) were 35 or older, 77.6 percent did not acknowledge their condition, 53.7 percent reported having a father with a drinking problem at home, and 58.6 percent of the families with an alcoholic member were disfunctional. Work-place problems were present in 46.3 percent of the cases and 47.8 percent referred not having any problems with law enforcement authorities. Conclusion. We found that most of the responders develop the condition after age 35. More than a third are not aware of the critical state of their morbidity and a similar percentage lives in disfunctional families. A large number of alcoholic patients have personal, social and/or judicial problems.

Molecular characterization of the levansucrase gene from the endophytic sugarcane bacterium Acetobacter diazotrophicus SRT4.

The Acetobacter diazotrophicus SRT4 gene encoding levansucrase (EC 2.4.1.10) (IsdA) was isolated from a genomic library. The nucleotide sequence of a 2.3 kb DNA fragment sufficient for complementation of a levansucrase-deficient mutant (obtained by EMS treatment) was determined. The IsdA gene (1751 bp) coded for a polypeptide of molecular mass 64.9 kDa with an isoelectric point of 5.2. The N-terminal amino acid sequence of the extracellular levansucrase indicated the presence of a precursor protein with a putative signal sequence of 51 residues which is possibly cleaved in two successive steps. Expression of the IsdA gene from the lac promoter in Escherichia coli resulted in the production of a protein with levansucrase activity. The deduced amino acid sequence of the IsdA gene was 48% and 46% identical with the levansucrases from the Gram-negative bacteria Zymomonas mobilis and Erwinia amylovora, respectively, but only 28-31% identical with levansucrases from Gram-positive bacteria. Multiple alignments of published levansucrase sequences from Gram-negative and Gram-positive bacteria revealed eight conserved motifs. A comparison of the catalytic properties and the sequence of the A. diazotrophicus levansucrase with those of the Bacillus subtilis levansucrase suggested that one of these motifs may be involved in the specificity of the synthetized product. Disruption of the IsdA gene in the genome of A. diazotrophicus resulted in a mutant lacking both levansucrase activity and the ability to utilize sucrose as a carbon source, suggesting that levansucrase is the key enzyme in sucrose metabolism of A. diazotrophicus.