Prevalence of oral and maxillofacial lesions in children and adolescents at a regional Brazilian oral pathology service: a retrospective study and the relevant literature review.

PURPOSE: This study assessed the prevalence of maxillofacial lesions in children, i.e., 0-9 years, and adolescents, i.e., 10-19 years, in a Brazilian Oral Pathology Service and compared results with available literature. METHODS: Clinical and histopathological records from January 2007 to August 2020 were analysed and a literature review investigating maxillofacial lesions in paediatric populations was also performed. RESULTS: Overall, "reactive salivary gland lesions" and "reactive connective tissue lesions" were the most prevalent group of soft tissue lesions, affecting children and adolescents equally. From these, mucocele and pyogenic granuloma were the most prevalent histological diagnoses, respectively, regardless of age. These findings were consistent with the 32 studies included. Considering intraosseous lesions, "odontogenic cysts" and "periapical inflammatory lesions" were the most prevalent groups, with no relevant differences between age groups, except for the odontogenic keratocyst, which was more prevalent in adolescents. Moreover, several odontogenic tumours, such as ameloblastic fibroma and odontogenic myxoma, were significantly more prevalent in children. CONCLUSION: Most maxillofacial lesions presented a similar prevalence between children and adolescents. Reactive salivary gland lesions and reactive connective tissue lesions were the prevailing diagnostic categories, regardless of age. Some odontogenic tumours and the odontogenic keratocyst showed significantly different frequencies across these age groups.

Effectiveness of marsupialisation and decompression on the reduction of cystic jaw lesions: a systematic review.

In this study, we aimed to systematically review and critically appraise the available literature concerning the effectiveness of marsupialisation and decompression on the reduction of cystic jaw lesions. The 'Preferred Reporting Items for Systematic Reviews and Meta-Analysis' guidelines were followed and the study protocol was registered at the 'International Prospective Register of Systematic Reviews' (CRD42019116099). Six main databases were searched: Embase, LILACS, PubMed, Scopus, The Cochrane Library, and Web of Science. Searches were complemented with three grey literature sources: Google Scholar, ProQuest, and Open Grey. Any reduction measures, compared with preoperative status or other procedures, were considered. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Thirty-one studies were included, of which five were judged with low, 24 with moderate, and two with high risk of bias. Considering surgical approach, 20 studies assessed the decompression and 11 the marsupialisation technique. Most studies considered these techniques as preliminary treatments, followed by enucleation. From 1088 lesions found, most were odontogenic keratocysts (33.8%), followed by unicystic ameloblastomas (21.0%), dentigerous cysts (20.6%), and radicular cysts (8.4%). Large lesions and younger individuals frequently presented more favourable responses to treatment and anatomical location was not associated with lesion reduction overall. The intervention duration generally ranged between one to two years. In conclusion, marsupialisation and decompression were mostly considered as preliminary treatments, followed by enucleation. Lesion reduction was generally considered insufficient for these techniques to be used as definitive therapies, although benefits concerning the diminished invasiveness of the secondary surgery were often proposed.

Molecular detection and identification of spotted fever group rickettsiae in ticks collected from horses in Cuba.

Spotted fever group (SFG) rickettsiae are obligatory intracellular bacteria that cause disease in humans and other animals. Ixodid ticks are the principal vectors of SFG rickettsiae. The present study aimed to determine the prevalence and species identity of SFG rickettsiae in ticks and horses from urban and rural areas of western Cuba using PCR assays. Tick samples, collected from 79 horses, consisted of 14 Amblyomma mixtum adults, 111 Dermacentor nitens adults and 19 pools of D. nitens nymphs (2-5 individuals/pool). The PCR results revealed the presence of Rickettsia spp. in 64% of the A. mixtum adults, 16% of the D. nitens adults, and 11% of the pooled samples of D. nitens nymphs. In contrast, Rickettsia spp. was not detected in any of the 200 horse blood samples included in this study. DNA sequence data of the rickettsial 17 kDa antigen gene showed that Rickettsia amblyommatis was present in A. mixtum; and Rickettsia felis in D. nitens. This is the first report of R. felis in D. nitens in Cuba. The present study extends our knowledge of the potential vector spectrum and distribution of SFG rickettsiae pathogens in western Cuba.

Extensive preclinical evaluation of an infliximab biosimilar candidate.

Infliximab is therapeutic monoclonal antibody (mAb) against TNF-α employed in the treatment of immunoinflammatory diseases. The development of biosimilar mAbs is a global strategy to increase drug accessibility and reduce therapy-associated costs. Herein we compared key physicochemical characteristics and biological activities produced by infliximab and infliximab-Probiomed in order to identify functionally relevant differences between the mAbs. Binding of infliximab-Probiomed to TNF-α was specific and had kinetics comparable to that of the reference product. Both mAbs had highly similar neutralizing efficacy in HUVEC cell cultures stimulated with TNF-α. In vitro induction of CDC and ADCC were also similar between the evaluated products. In vivo comparability was assessed using a transgenic mouse model of arthritis that expresses human TNF-α in a 13-week multiple-administration study. Infliximab and infliximab-Probiomed showed comparable efficacy, safety, and pharmacokinetic profiles. Our results indicate that infliximab-Probiomed has highly similar activities to infliximab in preclinical models, warranting a clinical evaluation of its biosimilarity.

Design of a strong cation exchange methodology for the evaluation of charge heterogeneity in glatiramer acetate.

Complex pharmaceuticals are in demand of competent analytical methods able to analyze charge heterogeneity as a critical quality attribute (CQA), in compliance with current regulatory expectations. A notorious example is glatiramer acetate (GA), a complex polypeptide mixture useful for the treatment of relapsing-remitting multiple sclerosis. This pharmaceutical challenges the current state of analytical technology in terms of the capacity to study their constituent species. Thus, a strong cation exchange methodology was designed under the lifecycle approach to support the establishment of GA identity, trough the evaluation of its chromatographic profile, which acts as a charge heterogeneity fingerprint. In this regard, a maximum relative margin of error of 5% for relative retention time and symmetry factor were proposed for the analytical target profile. The methodology met the proposed requirements after precision and specificity tests results, the former comprised of sensitivity and selectivity. Subsequently, method validation was conducted and showed that the method is able to differentiate between intact GA and heterogeneity profiles coming from stressed, fractioned or process-modified samples. In summary, these results provide evidence that the method is adequate to assess charge heterogeneity as a CQA of this complex pharmaceutical.

Subcutaneous connective tissue reactions to iRoot SP, mineral trioxide aggregate (MTA) Fillapex, DiaRoot BioAggregate and MTA.

AIM: To evaluate connective tissue reactions to iRoot SP (Innovative Bioceramics, Vancouver, BC, Canada), mineral trioxide aggregate (MTA) Fillapex (FLPX) (Angelus Soluções Odontológicas, Londrina, Brazil), DiaRoot Bioaggregate (DiaDent Group International, Burnaby, BC, Canada) and white MTA (Angelus, Londrina, Brazil) in Wistar rats. METHODOLOGY: A total of 128 dentine tubes filled with the materials and 32 empty tubes (control) were implanted into 32 rats. After 7, 15, 30 and 90 days (n = 8 per period), the animals were euthanized, and the tissues were processed for histological evaluation using haematoxylin-eosin (H&E) and Von Kossa (VK) staining. Observations were made for cellular inflammatory components and the presence of multinucleated giant cells (MNGC), macrophages and tissue necrosis. Data were analysed by Fisher's exact and Kruskal­Wallis tests (P < 0.05). RESULTS: In all experimental periods, MTA FLPX and iRoot SP scored higher than the other groups for the variable macrophages (P < 0.05). After 30- and 90-day experimental periods, MTA FLPX scored higher than the other groups for the variable MNGC (P < 0.05). After 90 days, the only group that exhibited samples with severe inflammatory response was MTA FLPX. VK positivity was observed in areas of necrosis in all groups, except in the control group. CONCLUSIONS: The materials were considered biologically acceptable except MTA FLPX, which remained toxic to subcutaneous tissue even after 90 days.

Influence of anatase and rutile phase in TiO2 upon the photocatalytic degradation of methylene blue under solar irradiation in presence of activated carbon.

The influence of activated carbon (AC) on the photocatalytic activity of different crystalline TiO2 phases was verified in the photocatalytic degradation of methylene blue under UV and solar irradiation. The results showed a volcano trend with a maximum photoactivity for the crystalline phase ratio of anatase:rutile equal to 80:20 both under UV or solar irradiation. By contrast, in presence of AC the photocatalytic activity of the binary materials of TiO2/AC followed an exponential trend, increasing as a function of the increase in anatase proportion in the TiO2 framework. The increase in the photoactivity of the binary material TiO2/AC relative to neat TiO2 was up to 22 and about 17 times higher under UV and visible irradiation, respectively. The present results suggest that AC interacts more efficiently with anatase phase than with rutile phase.

Errores técnicos de medida en el diagnóstico de la desnutrición infantil: datos procedentes de intervenciones de Acción Contrael Hambre entre 2001 y 2010 / Technical errors of measurement in the diagnosis of child malnutrition: data from ACF interventions between 2001 and 2010

Se analiza la calidad de las medidas antropométricas efectuadas por 199 antropometristas que actuaron en 17 encuestas nutricionales de Acción Contra el Hambre efectuadas en Afganistán, Bangladesh, Bolivia, Mali, República de Myanmar y Filipinas. Para las tres dimensiones analizadas: peso, talla y perímetro del brazo (MUAC) el error técnico de medida (ETM) absoluto es aceptable, aunque supera el reseñado en la estandarización del Multicenter Growth Reference Study de la Organización Mundial de la Salud (OMS). El nivel de competencia de los equipos de antropometristas que midieron en las 17 intervenciones difiere significativamente. El error técnico de medida relativo (ETM%) supera el margen de tolerancia para el peso en una de las encuestas y en cinco para el MUAC. Por lo que respecta al ETM% inter-observador, se encuentra en un rango adecuado para la talla y el peso, pero excede el nivel de tolerancia recomendado en 11 de las 17 campañas de intervención. Se recomienda hacer énfasis en la formación del personal técnico encargado de tomar las medidas antropométricas y tener especial cuidado en la medida del MUAC (AU)

We analyze the quality of the anthropometric measurements made by 199 anthropometrists who acted in 17 nutritional surveys conducted by ACF in Afgha - nistan, Bangladesh, Bolivia, Mali, Republic of Myanmar and the Philippines. For the three dimensions analyzed: weight, height and arm circumference (MUAC) the technical error of measurement (TEM) is acceptable, although it is over high than standardization values, outlined in the Multicenter Growth Reference Study of the World Helath Organization (WHO). The level of competence anthropometrists teams that measured in the 17 interventions differ significantly. The relative technical error of measurement (TEM%) exceeds the tolerance for the weight in one survey and five for MUAC. With respect to the TEM% inter-observer is in a suitable range for height and weight, but exceeds the recommended tolerance level in 11 of the 17 intervention campaigns. It is recommended to emphasize the training of technical staff in charge of taking anthropometric measurements and take special care in measuring the MUAC (AU)

Stability of plasma electrolytic oxidation coating on titanium in artificial saliva.

Bioactive PEO coating on titanium with high Ca/P ratio was fabricated and characterized with respect to its morphology, composition and microstructure. Long-term electrochemical stability of the coating and Ti(4+) ion release was evaluated in artificial saliva. Influence of the lactic acid and fluoride ions on corrosion protection mechanism of the coated titanium was assessed using AC and DC electrochemical tests. The PEO-treated titanium maintained high passivity in the broad range of potentials up to 2.5 V (Ag/AgCl) for up to 8 weeks of immersion in unmodified saliva and exhibited Ti(4+) ion release <0.002 µg cm(-2) days(-1). The high corrosion resistance of the coating is determined by diffusion of reacting species through the coating and resistance of the inner dense part of the coating adjacent to the substrate. Acidification of saliva in the absence of fluoride ions does not affect the surface passivity, but the presence of 0.1 % of fluoride ions at pH ≤4.0 causes loss of adhesion of the coating due to inwards migration of fluoride ions and their adsorption at the substrate/coating interface in the presence of polarisation.

Phthalates and bisphenols migration in Mexican food cans and plastic food containers.

The presence of endocrine disruptors bisphenol-A, bisphenol-A-dimethacrylate, bisphenol-A-diglycidyl-ether, phthalic-acid, dibutyl-phthalate, diethyl-phthalate and dioctyl-phthalate was determined in vegetable cans, baby bottles and microwaveable containers from the Mexican market. Gas-Chromatography-Mass-Spectrometry was used for the identification and High-Performance-Liquid-Chromatography with UV/Visible light and fluorescence detectors was used for the quantification. Endocrine disruptors were found in all samples. PA and DOP were the substances most commonly found, and maximum concentrations were 9.549 and 0.664 µg/kg, respectively from a jalapeno peppers can. Bisphenol A, phthalic-acid, bisphenol-A-dimethacrylate, bisphenol-A-diglycidyl-ether, dioctyl-phtalate and dibutyl-phthalate were found in baby bottles and microwaveable containers.

Risk factors for intestinal ischaemia among patients registered in a UK primary care database: a nested case-control study.

BACKGROUND: Intestinal ischaemia, including ischaemic colitis and acute mesenteric ischaemia, causes significant morbidity and mortality. Few population-based studies have estimated incidence and potential risk factors for this disease. AIMS: To estimate the incidence of intestinal ischaemia and identify the associated risk factors in cohorts: (i) patients with irritable bowel syndrome and/or chronic constipation (IBS/CC/both), (ii) individuals free of these conditions. METHODS: Population-based case-control analysis nested in a cohort of patients with first ever recorded diagnosis of IBS/CC/both and a cohort free of these conditions from general population using the General Practice Research Database. RESULTS: Of 78 cases of intestinal ischaemia, 71 were from general population, seven from the IBS/CC/both cohort. Incidence rate of intestinal ischaemia in IBS/CC/both patients vs. general population was 4.49:1.09 per 100,000 person-years; age- and gender-adjusted incidence rate ratio (95% CI) was 2.7 (1.2-5.9). Inflammatory bowel disease and heart failure showed an association with ischaemic colitis [OR (95% CI): 4.2 (0.5-38.4) and 5.6 (2.2-14.1)], but none with acute mesenteric ischaemia. Diabetes and prior cardiovascular surgery were associated with higher risk of acute mesenteric ischaemia, but showed no association with ischaemic colitis. CONCLUSIONS: Results suggest that different risk factors are associated with acute mesenteric ischaemia and ischaemic colitis. However, due to small number of patients, associations should be carefully interpreted.

Paracoccidioidomicosis: Manifestaciones orales e implicaciones sistémicas / Paracoccidioidomicose: Oral manifestations and sistemic implications

La paracoccidioidomicosis es una infección causada por un hongo P. brasiliensis. Se trata de una micosis profunda y sistémica, es considerada una enfermedad endémica en Brasil y en otros países de América Latina. El hongo es adquirido por inhalación, dando lugar a un cuadro clínico pulmonar que puede posteriormente afectar a la piel, mucosa oral, nasal y gastrointestinal; también el bazo y el hígado pueden verse afectados. Es frecuente encontrar linfadenopatías, y verse afectada la glándula suprarrenal y todas las vísceras, causando la muerte del paciente. Las úlceras orales suelen ser lesiones muy dolorosas, por ello el paciente acude a consulta para ser evaluado clínicamente por su odontólogo o estomatólogo. El diagnóstico precoz es la mejor manera de salvar al paciente de las complicaciones de la enfermedad. El número creciente de inmigrantes latinos puede hacer que esta importante enfermedad empiece a ser más prevalente en los países de la Comunidad Europea, por ello conocer en profundidad las características clínicas de esta infección por parte de los odontólogos europeos, es fundamental para llegar a diagnosticarla de forma temprana (AU)

Paracoccidioidomycosis is an infection caused by the p. brasiliensis fungus. This is a deep, systemic fungal infection considered endemic in Brazil and some Latin American countries. The fungus is acquired by inhalation, resulting in a pulmonary disease which may also affect the skin, oral, nasal and gastrointestinal mucosa, as well as the spleen and liver. Patients commonly present lymphadenopathy. The resulting adrenal gland and visceralin volvement can be fatal. Oral lesions are often very painful leading the patient to the dentist or stomatologist for a clinical evaluation. Early diagnosis is the best way to avoid serious complications of the disease. The growing number of Latin immigrants may increase the prevalence of this important disease in the European Community, therefore, the knowledge of the clinical characteristics of this infection by European dentists isessential to early diagnosis (AU)

Interferon-alpha 2b quantification in inclusion bodies using reversed phase-ultra performance liquid chromatography (RP-UPLC).

Interferon-alpha 2b (IFN-alpha 2b) is a recombinant therapeutic cytokine produced as inclusion bodies using a strain of Escherichia coli as expression system. After fermentation and recovery, it is necessary to know the amount of recombinant IFN-alpha 2b, in order to determine the yield and the load for solubilization, and chromatographic protein purification steps. The present work details the validation of a new short run-time and fast sample-preparation method to quantify IFN-alpha 2b in inclusion bodies using Reversed Phase-Ultra Performance Liquid Chromatography (RP-UPLC). The developed method demonstrated an accuracy of 100.28%; the relative standard deviations for method precision, repeatability and inter-day precision tests were found to be 0.57%, 1.54% and 1.83%, respectively. Linearity of the method was assessed in the range of concentrations from 0.05 mg/mL to 0.5 mg/mL, the curve obtained had a determination coefficient (r(2)) of 0.9989. Detection and quantification limits were found to be 0.008 mg/mL and 0.025 mg/mL, respectively. The method also demonstrated robustness for changes in column temperature, and specificity against host proteins and other recombinant protein expressed in the same E. coli strain.

Ciclofosfamida (CIC) en lupus eritematoso sistémico (LES): dosis acumulada y eventos adversos: estudio multicéntrico / Cyclophosphamide (CYC) in systemic lupus erythematosus accumulated dose and adverse events: multicentric study

Objetivo: Describir los eventos adversos (EA) asociados a ciclofosfamiday su relación con la dosis acumulada. Material y método: Se revisaron las historias clínicas de pacientes con LES (Criterios ACR) de 6 centros de Reumatología de la Argentina. Se incluyeron 81 pacientes (72 mujeres y 9 hombres) que habían recibido tratamiento con pulsos mensuales de CIC (0,5-1g/m2). Se estudiaron los EA asociados a CIC, dosis acumulada, dosis de corticosteroides y actividad de la enfermedad al momento del evento. Se excluyeron los pacientes con otro tratamiento inmunosupresor. Resultados: La edad de diagnóstico del LES fue x¯ 26 años (DS 11,3); tiempo de evolución de la enfermedad x¯ 6,2 años (DS 5,9). La edad al inicio de CIC fue x¯ 30 años (DS 12,4). Se encontraron 105 eventos adversos asociados a CIC en 53 pacientes (65,4%). Infección (45%) fue el efecto más frecuente, fatal en 6 pacientes; intolerancia gástrica (náuseas y vómitos) en 21% y las citopenias 14,3%. Tres pacientes (2,8%) presentaron amenorrea y sólo una cistitis hemorrágica. No se detectaron neoplasias. La mediana de dosis acumulada al momento del EA fue 2600 mg. Al comparar los pacientes con y sin EA, no se encontraron diferencias significativas en el SLEDAI ni en la dosis de prednisona recibida. No se encontró asociación entre dosis acumulada de CIC y náuseas, vómitos, convulsiones y citopenias (p NS). Al aplicar el modelo de riesgo proporcional para eventos múltiples, el riesgo de infecciones aumentaba a mayor dosis de CIC. Los pacientes que fallecieron por sepsis recibieron una dosis mediana de CIC de 4000 mg. Conclusiones: 1) La dosis acumulada de CIC se asoció a infecciones: mayor dosis, mayor número de infecciones. 2) Náuseas, vómitos, convulsiones y citopenias fueron eventos independientes de la dosis de CIC.

Ciclofosfamida (CIC) en lupus eritematoso sistémico (LES): dosis acumulada y eventos adversos: estudio multicéntrico / Cyclophosphamide (CYC) in systemic lupus erythematosus accumulated dose and adverse events: multicentric study

Objetivo: Describir los eventos adversos (EA) asociados a ciclofosfamiday su relación con la dosis acumulada. Material y método: Se revisaron las historias clínicas de pacientes con LES (Criterios ACR) de 6 centros de Reumatología de la Argentina. Se incluyeron 81 pacientes (72 mujeres y 9 hombres) que habían recibido tratamiento con pulsos mensuales de CIC (0,5-1g/m2). Se estudiaron los EA asociados a CIC, dosis acumulada, dosis de corticosteroides y actividad de la enfermedad al momento del evento. Se excluyeron los pacientes con otro tratamiento inmunosupresor. Resultados: La edad de diagnóstico del LES fue x¯ 26 años (DS 11,3); tiempo de evolución de la enfermedad x¯ 6,2 años (DS 5,9). La edad al inicio de CIC fue x¯ 30 años (DS 12,4). Se encontraron 105 eventos adversos asociados a CIC en 53 pacientes (65,4%). Infección (45%) fue el efecto más frecuente, fatal en 6 pacientes; intolerancia gástrica (náuseas y vómitos) en 21% y las citopenias 14,3%. Tres pacientes (2,8%) presentaron amenorrea y sólo una cistitis hemorrágica. No se detectaron neoplasias. La mediana de dosis acumulada al momento del EA fue 2600 mg. Al comparar los pacientes con y sin EA, no se encontraron diferencias significativas en el SLEDAI ni en la dosis de prednisona recibida. No se encontró asociación entre dosis acumulada de CIC y náuseas, vómitos, convulsiones y citopenias (p NS). Al aplicar el modelo de riesgo proporcional para eventos múltiples, el riesgo de infecciones aumentaba a mayor dosis de CIC. Los pacientes que fallecieron por sepsis recibieron una dosis mediana de CIC de 4000 mg. Conclusiones: 1) La dosis acumulada de CIC se asoció a infecciones: mayor dosis, mayor número de infecciones. 2) Náuseas, vómitos, convulsiones y citopenias fueron eventos independientes de la dosis de CIC.(AU)

Modified penicillin acylase signal peptide allows the periplasmic production of soluble human interferon-gamma but not of soluble human interleukin-2 by the Tat pathway in Escherichia coli.

Production of periplasmic human interferon-gamma (hINF-gamma) and human interleukin-2 (hIL-2) by the Tat translocation pathway in Escherichia coli BL21-SI was evaluated. The expression was obtained using the pEMR vector which contains the Tat-dependent modified penicillin acylase signal peptide (mSPpac) driven by the T7 promoter. The mSPpac-hINF-gamma was processed and the protein was transported to periplasm. Up to 30.1% of hINF-gamma was found in the periplasmic soluble fraction, whereas only 15% of the mSPpac-hIL-2 was processed, but hIL-2 was not found in the periplasmic soluble fraction.

The influence of haemostatic agents on healing of healthy human dental pulp tissue capped with calcium hydroxide.

AIM: To investigate the hypothesis that different haemostatic agents could impair the histological response of human pulps capped with calcium hydroxide. METHODOLOGY: Forty-five third molars scheduled for extraction were selected. Class I cavities with pulp exposures were prepared. Three agents were used to control bleeding: 0.9% saline solution (control, n = 14), 5.25% sodium hypochlorite (n = 16) and 2% chlorhexidine digluconate (n = 15). The pulps were dressed with hard-setting calcium hydroxide cement. After 7, 30 or 90 days, teeth were extracted, formalin-fixed and prepared for histochemical techniques. The biological response was categorized using the following criteria: inflammatory response, soft tissue organization, reactionary dentine and reparative dentine. Data were submitted to statistical analysis, using nonparametric Kruskal-Wallis one-way analysis of variance on ranks. Differences amongst groups were detected using Dunn's method. RESULTS: The statistical analysis disclosed that whilst inflammatory response decreased over time, reactionary dentine deposition and reparative dentine formation increased in the latter periods of evaluation (P < 0.05). The three agents had similar performances for all criteria evaluated. The conventional pulp response to calcium hydroxide was observed over time, and complete pulp healing was observed in 88% of the specimens after 90 days. CONCLUSION: The three haemostatic agents did not impair the healing process following pulp exposure and capping with calcium hydroxide at different time intervals investigated.

[Satellite manifestations of internal diseases]. / Manifestaciones satélites de las enfermedades internas.

AIMS: Define the concept of satellite manifestations (SM) and to determine the number and types of them that appear in the diseases of each one of the subspecialties of the Internal Medicine. METHODS: 290 diseases are reviewed in agreements of Internal Medicine and specialties books and in each one are described the types of SM that they present. RESULTS: The respiratory diseases are the group that more SM presents and the less one the neurological. The most frequent type of SM are dermatological. The diseases that have more variety of types of SM are the endocrinologicals. Analyzing the percentages of every type of SM in relation with the number of diseases of every group, the highest are the dermatological SM in cardiac diseases. CONCLUSIONS: The SM are a very frequent phenomenon in the current medical practice and express the holistic character of the disease. His knowledge is indispensable in the internal medicine and subspecialties, where they can suppose a help in the diagnoses, though a bad knowledge of his reality can mean the opposite.