Is it possible to predict neurosensory alterations in impacted lower third molar removal based on preoperative imaging procedures? A prospective cohort study.

BACKGROUND: Surgical extraction of the lower third molar (LTM) may trigger neurosensory injury of the inferior alveolar nerve, making extraction a real challenge. This study set out to assess whether is it possible to predict neurosensory alterations from preoperative imaging. MATERIAL AND METHODS: A total of 99 patients underwent 124 impacted lower third molar (ILTM) surgeries. Prior to surgery, panoramic and CBCT images were evaluated in an attempt to predict a neurosensory disturbance. Preoperative data (ILTM position, panoramic radiograph signs, inferior alveolar nerve (IAN) location and its contact with the ILTM roots) and intra/postoperative findings (extraction difficulty and sensitivity alterations) were recorded. Descriptive and bivariate data analysis was performed. Statistical comparison applied the chi-square test, Fisher test, and one-way ANOVA test. Statistical significance was established with a confidence interval (CI) of 95%. RESULTS: In 4.03% of cases, patients experienced neurosensory alterations. Of 124 ILTM positions in panoramic radiographs, 76 cases were considered to exhibit a potential neurosensory risk as they presented two or more types of superimposed relationships between ILTM and mandibular canal. Of these, alterations were reported in only three cases (3.95%). Of the 48 remaining ILTM images presenting only one sign, neurosensory alterations were observed in two cases (4.17%). No permanent alterations were recorded in any of the five cases observed. CONCLUSIONS: Within the limitations of the present study, prediction of neurosensory alterations prior to ILTM extraction by means of preoperative imaging did not show a significant statistical correlation with post-surgical incidence. Nevertheless, interruption of the canal´s white line (ICWL) or a diversion of the canal (DC) may predict an increased risk of IAN injury.

Cyanoacrylate versus suture as flap closure methods in mandibular third molar surgery: a split-mouth randomized controlled clinical study.

BACKGROUND: Sutures have been the standard flap closure method of choice following mandibular third molar surgery but can lead to some complications. Tissue adhesives, including cyanoacrylate, have emerged as alternative flap closure method in this surgery to overcome such drawbacks. However, limited clinical trials can be found. Therefore, the aim of this clinical study was to compare two methods of flap closure in mandibular third molar surgery, cyanoacrylate and 4/0 silk sutures, by assessing post-operative outcome measures (pain, swelling, trismus, and healing) and patient-reported outcome measures (PROMs). MATERIAL AND METHODS: A randomized split-mouth clinical trial was designed, in which mandibular third molar (M3M) extractions were performed, where the control side flap was closed with 4/0 silk sutures and the test side flap with cyanoacrylate. Swelling, pain, trismus, healing, and PROMs were recorded post-operatively. These variables were analyzed by means of the nonparametric Mann-Whitney U test, using SPSS statistical software version 28.0.0 (IBM® SPSS®, Chicago, IL, USA). For all results, a 95% confidence interval was recorded (significance level p < 0.05, two-tailed). RESULTS: A total of 17 patients were recruited and 34 mandibular third molar extractions were performed. No statistically significant differences were found in terms of swelling, pain, trismus, healing, and PROMs between both groups (p<0.05). CONCLUSIONS: No statistically significant differences were found between flap closure with 4/0 silk sutures and cyanoacrylate, in terms of surgical post-operative outcomes and PROMs. However, further studies with larger sample sizes are required to be able to affirm it with greater certainty.

Medication related to pigmentation of oral mucosa.

BACKGROUND: The diagnosis of oral melanotic lesions is, more often than not, challenging in the clinical practice due to the fact that there are several reasons which may cause an increase in pigmentation on localized or generalized areas. Among these, medication stands out. MATERIAL AND METHODS: In this work, we have carried out a review in the reference pharma database: Micromedex® followed by a review of the scientific published literature to analyse coincidences and possible discrepancies. RESULTS: Our findings show that there are several prescription drugs that can cause pigmented lesions in the oral mucosa. This must be known by clinicians in order to properly diagnose pigmented lesions. We have identified a set of 21 medicaments which cause these lesions, some of which are used frequently in the clinic, such as Metronidazole, Amitriptyline, conjugated oestrogens and Chlorhexidine gluconate. We also found discrepancies with the data published in specialized literature, some of which wasn't reflected in the Summary of Product Characteristics. CONCLUSIONS: Our work highlights the importance of the proper communication of adverse drug reactions (ADR) by health professionals in order to provide thorough and accurate information and diagnosis.

Is cotrimoxazole prophylaxis against Pneumocystis jirovecii pneumonia needed in patients with systemic autoimmune rheumatic diseases requiring immunosuppressive therapies?

The incidence of Pneumocystis jirovecii pneumonia (PJP) has increased over recent years in patients with systemic autoimmune rheumatic diseases (SARD). PJP prognosis is poor in those receiving immunosuppressive therapy and glucocorticoids in particular. Despite the effectiveness of cotrimoxazole against PJP, the risk of adverse effects remains significant, and no consensus has emerged regarding the need for PJP prophylaxis in SARD patients undergoing immunosuppressor therapies.Objective: To evaluate the efficacy and safety of cotrimoxazole prophylaxis against PJP in SARD adult patients receiving immunosuppressive therapies. Methods: We performed a systematic review, consulting MEDLINE, EMBASE, and Cochrane Library databases up to April 2020. Outcomes covered prevention of PJP, other infections, morbidity, mortality, and safety. The information obtained was summarized with a narrative review and results were tabulated. Of the 318 identified references, 8 were included. Two were randomized controlled trials and six observational studies. The quality of studies was moderate or low. Despite disparities in the cotrimoxazole prophylaxis regimens described, results were consistent in terms of efficacy, particularly with glucocorticoid doses > 20 mg/day. However, cotrimoxazole 400 mg/80 mg/day, prescribed three times/ week, or 200 mg/40 mg/day or in dose escalation, exhibited similar positive performances. Conversely, cotrimoxazole 400 mg/80 mg/day showed higher incidences of withdrawals and adverse effects. Cotrimoxazole prophylaxis against PJP exhibited efficacy in SARD, mainly in patients taking glucocorticoids ≥ 20 mg/day. All cotrimoxazole regimens exposed seemed equally efficacious, although, higher quality trials are needed. Adverse effects were observed 2 months after initiation, particularly with the 400 mg/80 mg/day regimen. Conversely, escalation dosing or 200 mg/40 mg/day regimens appeared better tolerated.

Tumour cell lysate-loaded dendritic cell vaccine induces biochemical and memory immune response in castration-resistant prostate cancer patients.

BACKGROUND: Recently, we produced a tumour antigen-presenting cells (TAPCells) vaccine using a melanoma cell lysate, called TRIMEL, as an antigen source and an activation factor. Tumour antigen-presenting cells induced immunological responses and increased melanoma patient survival. Herein, we investigated the effect of TAPCells loaded with prostate cancer cell lysates (PCCL) as an antigen source, and TRIMEL as a dendritic cell (DC) activation factor; which were co-injected with the Concholepas concholepas haemocyanin (CCH) as an adjuvant on castration-resistant prostate cancer (CRPC) patients. METHODS: The lysate mix capacity, for inducing T-cell activation, was analysed by flow cytometry and Elispot. Delayed-type hypersensitivity (DTH) reaction against PCCL, frequency of CD8(+) memory T cells (Tm) in blood and prostate-specific antigen (PSA) levels in serum were measured in treated patients. RESULTS: The lysate mix induced functional mature DCs that were capable of activating PCCL-specific T cells. No relevant adverse reactions were observed. Six out of 14 patients showed a significant decrease in levels of PSA. DTH(+) patients showed a prolonged PSA doubling-time after treatment. Expansion of functional central and effector CD8(+) Tm were detected. CONCLUSION: Treatment of CRPC patients with lysate-loaded TAPCells and CCH as an adjuvant is safe: generating biochemical and memory immune responses. However, the limited number of cases requires confirmation in a phase II clinical trial.

Clinical presentation of acral lentiginous melanoma: a descriptive study.

BACKGROUND AND OBJECTIVE: Acral lentiginous melanomas -the melanomas most commonly found on the distal portions of the limbs- have usually reached more advanced stages than other types of melanoma when diagnosed. Our aim was to describe the clinical presentation of these tumors. MATERIALS AND METHODS: Retrospective, descriptive, observational study of cases recorded in the database of the Instituto Valenciano de Oncología. In telephone interviews the patients answered a questionnaire on the presenting features of the lesion, on the presence of signs and symptoms included in the Glasgow 7-point checklist and the ABCDEs of melanoma, and on diagnostic delay attributable to patient or physician. RESULTS: In the interviews with the 23 patients who responded to the questionnaire, we detected a diagnostic delay of more than 1 year attributable to the patient (delay in seeking care) in 30.4% of the cases. Diagnostic delay of more than 1 year attributable to the physician (failure to suspect the diagnosis) was identified in 20%. The most frequent reasons for consulting a physician about a lesion were changes in size, changes in color, bleeding, or failure to heal. In 20% of the cases the evaluating physician did not order histology for over a year. CONCLUSIONS: Diagnostic delay is a significant problem in acral lentiginous melanoma and may be attributable either to patients or to physicians' failure to recognize warning signs. Melanoma prevention campaigns should place more emphasis on the possibility of melanomas appearing on the palms and, particularly, on the soles.

Rituximab therapy produced rapid and sustained clinical improvement in a patient with systemic onset juvenile idiopathic arthritis refractory to TNF alpha antagonists.

We describe a patient with systemic onset juvenile idiopathic arthritis refractory to disease-modifying antirheumatic drugs, intravenous gamma globulin, and TNF inhibitors (etanercept and infliximab), in whom treatment with rituximab resulted in remission of systemic symptoms (rash and fever), a fall in erythrocyte sedimentation rate, C-reactive protein, and ferritin serum levels, with recovery in disability index and improvement of arthritis. A total of 4 cycles of rituximab were given over 18 months because of relapses. Since her last course, she remains stable and asymptomatic. To our knowledge, this is the first case reported on a long-lasting beneficial effect of rituximab in a patient with soJIA.

Viruela del mono: una nueva amenaza para los dentistas. Vías de contagio / Monkeypox: a new threat to dentists. Contagion routes

El propósito de esta revisión es resumir la virología del virus de la viruela del mono, su transmisión, epidemiología, manifestaciones clínicas, manifestaciones orales, tratamiento y las posibles implicaciones para los dentistas. Se analizan los riesgos de transmisión a trabajadores de la salud. Un paciente asintomático o con síntomas tempranos no específicos puede acudir a la clínica dental para tratamiento odontológico. Los pacientes contagiados asintomáticos o con contacto con el virus, si el tratamiento no es urgente, deben respetar 21 días de cuarentena tras la exposición. Las gotículas respiratorias y los aerosoles a los que estamos expuest os los odontólogos al atender a los pacientes son una de las principales vías de transmisión.Sin embargo, la profesión odontológica está preparada para este nuevo reto ya que aún estamos aplicando todas las medidas de prevención aprendidas con la pandemia de COVID-19 (mascarillas FFP2, gafas, guantes, ventilación, etc) (AU)

The purpose of this review is to summarize the virology of the monkeypox virus, transmission, epidemiology, clinical features, oral manifestations, treatment, and possible implications for dentists. The risks of transmission to health workers are analyzed. A patient with no symptoms or early non-specific symptoms may come to the dental clinic for treatment. These patients or those who have been in contact with the virus, if the treatment is not urgent, must wait 21 days after exposure, which is the quarantine time. Respiratory droplets and aerosols to which dentists are exposed when caring for patients are one of the main routes of transmission. The dental profession is prepared for this new challenge as we are still applying all the prevention measures learned from the COVID-19 pandemic (FFP2 masks, goggles, gloves, ventilation, etc.) (AU)

Different effects of raloxifene and estrogen on interleukin-1beta and interleukin-1 receptor antagonist production using in vitro and ex vivo studies.

The increase in lumbar spine BMD in response to Raloxifene (RLX), a selective estrogen receptor modulator, is smaller in magnitude compared to the response to treatment with estradiol (E2). The reasons for this observation are unclear. Estrogen has a potent effect on the production of proinflammatory cytokines which support osteoclastogenic and bone resorption. Therefore the different response to RLX may relate, at least in part, to a difference in the ability of RLX to modulate the production of proinflammatory cytokines which are abundant in the red marrow of the vertebrae. The aim of this study was to determine the effect of RLX and E2 both in vitro and ex vivo on the production of the pro-resorptive cytokine interleukin-1beta (IL-1beta) and its antagonist, interleukin-1 receptor antagonist (IL-1ra). We obtained samples of peripheral blood from (a) 10 untreated postmenopausal women with osteopenia (ages 53 to 72 years, mean 61 years), (b) 15 postmenopausal women (ages 52 to 72 years, mean 63 years) at baseline and after 6 months of RLX therapy (60 mg/day) and (c) 10 postmenopausal women (ages 60 to 75 years, mean 64 years) at baseline and 6 months after a single E2 implant (25 mg). Cultures of whole blood from the untreated women were incubated with RLX or 17beta-E2 at 1 pM, 100 pM, 10 nM and 1 microM concentrations. LPS-stimulated whole blood cultures from the raloxifene- and estradiol-treated women were prepared at baseline and at 6 months. IL-1beta and IL-1ra were measured by ELISA in the conditioned media. In vitro there was a significant dose-dependent decrease in IL-1beta and IL-1ra in response to 17beta-E2 (both P<0.0001) which was not apparent in response to RLX (both P>0.05). In ex vivo cultures from women receiving 6 months treatment with E2 implants, there was a significant decrease in IL-1beta (-36+/-8%, P=0.01) but no significant change in IL-1ra (+29+/-20%, P=0.3). There was no significant change in either IL-1beta or IL-1ra after 6 months RLX therapy (+20+/-14% and +12+/-10%, both P>0.05). We conclude that treatment with RLX, unlike estradiol does not modulate the production of the proinflammatory cytokines IL-1beta and IL-1ra using in vitro or ex vivo whole blood culture methods. This may account, at least in part for the reduced efficacy of RLX therapy compared to estrogen which has been observed in vivo on bone mineral density, bone turnover and reduction in fracture risk.

Valoración de las diferentesopciones de tratamientoen el manejo clínico delSíndrome de Boca Ardiente(SBA) / ASSESSMENT OF THE DIFFERENT TREATMENT OPTIONS IN THE CLINICAL MANAGEMENT OF BURNING MOUTH SYNDROME (BMS)

Introducción: El Síndrome de Boca Ardiente (SBA), cuya definición y fisiopatología continúan siendo un tema de debate actual, tampoco cuenta con unas pautas universalmente aceptadas para su tratamiento. Por ello, el objetivo del presente trabajo es presentar una valoración de los distintos tratamientos para el manejo clínico de los pacientes con SBA en base a la evidencia científica disponible, para que se valore su aplicación en cada caso concreto. Material y métodos: Se realizó una búsqueda en las bases de datos de PubMed (MEDLINE) y The Cochrane Library (Wiley) sobre los distintos tratamientos del SBA. Con los datos obtenidos respecto a la efectividad de cada modalidad terapéutica y los efectos adversos que produce, se han elaborado tres diferentes líneas de tratamiento. Resultados: En la primera línea de tratamiento encontramos los chicles, la LLLT (terapia con láser de baja potencia, en inglés), el protector lingual, la psicoterapia, clonazepam tópico, ALA (ácido alfa-lipoico, en inglés) y la Catauma. Conclusión: Hacen falta más investigaciones que brinden una orientación suficiente a los clínicos sobre las modalidades terapéuticas efectivas y que permitan establecer una correcta estrategia en el manejo del SBA (AU)

Introduction: The definition and pathophysiology of Burning Mouth Syndrome (BMS) remain a subject of ongoing debate, and there are no universally accepted guidelines for its treatment. Therefore, the objective of this paper is to present an assessment of the different treatments for the clinical management of patients with BMS on the basis of the available scientific evidence, so that their application in each specific case can be assessed. Material and methods: A search was carried out in the PubMed (MEDLINE) and The Cochrane Library (Wiley) databases on the different treatments for BMS. With the data obtained regarding the effectiveness of each therapeutic modality and the adverse effects it produces, three different lines of treatment have been developed. Results: The first line of treatment includes chewing gum, LLLT (low level laser therapy), tongue guard, psychotherapy, topical clonazepam, ALA (alpha lipoic acid) and Catauma. Conclusion: Further research is required to provide sufficient guidance to clinicians on effective therapeutic modalities and to establish a correct strategy in the management of BMS (AU)

Elevación de seno conBetafosfato Tricálcico yposterior colocación deimplantes. A propósito deun caso / Sinus lift with tricalcium beta-phosphate and subsequent implant placement. Case report

La extracción o pérdida dental supone la remodelación del alveolo y una pérdida progresiva del hueso alveolar residual. Esta disminución en altura, debido a la presencia delseno maxilar en el sector posterosuperior, puede comprometer la disponibilidad ósea adecuada para la colocación de implantes. Como solución a esto, surge la técnica de elevación de seno. En esta técnica, se emplean diversos materiales de injerto, entre los que se encuentran el betafosfatotricálcico (b-TCP). Este material presenta propiedades osteoconductivas y osteoinductivas. Además, se reabsorbe más fácil que otros sustitutos óseos y es fácilmente reemplazado por nuevo hueso. Se ha comparado su comportamiento clínico con otros materiales de injerto, sin encontrar diferencias significativas. Además, a 10 años, los implantes colocados en elevaciones de seno realizadas con b-TCP han mostrado altas tasas de supervivencia. Caso clínico. Se presenta el caso clínico de una paciente, mujer de 52 años de edad, sin antecedentes médicos de interés. Acude a consulta por dolor en el 26. Tras la exploración diagnóstica radiológica e intrabucal se aconsejó a la paciente la extracción del 26. Ocho meses después, y realizando un estudio con CBCT se informó a la paciente sobre la posibilidad de rehabilitación con implantes, previa cirugía de elevación sinusal. Se realizó la elevación sinusal con b-TCP como material de injerto. Pasados tres meses, se procedió a la colocación de tres implantes, adquiriendo estos una buena estabilidad primaria Discusión y conclusiones. Se utilizan diversos materiales de injerto en la técnica de elevación sinusal, injertos de hueso autólogo, xenoinjertos e injerto aloplásticos. Se ha comparado el comportamiento clínico del b-TCP con otros materiales de injerto sin mostrar diferencias significativas. Por otro lado, se ha estudiado un periodo de espera menor a 6 (AU)

Tooth extraction or loss involves alveolar remodelling and progressive loss of residual alveolar bone. This reduction in height, due to the presence of the maxillary sinus in the posterosuperior sector, can compromise adequate bone availability for implant placement. The sinus lift technique has emerged as a solution to this problem. In this technique, various grafting materials are used, including beta-phosphatidic acid (b-TCP). This material has osteoconductive and osteoinductive properties. In addition, it is more easily resorbed than other bone substitutes and is easily replaced by new bone. Its clinical behaviour has been compared with other graft materials, without finding significant differences. In addition, at 10 years, implants placed in sinus lifts performed with b-TCP have shown high survival rates. Clinical case: The clinical case of a 52-year-old female patient with no medical history of interest is presented. She went for consultation due to pain in tooth 26. Following the radiological and intraoral diagnostic examination, the patient was advised to have tooth 26 extracted. Eight months later, and after a CBCT study, the patient was informed about the possibility of rehabilitation with implants, following sinus lift surgery. The sinus lift was performed with b-TCP as graft material. After three months, three implants were placed, acquiring a good primary stability. Discussion and conclusions: different graft materials are used in the sinus lift technique, autologous bone grafts, xenografts and alloplastic grafts. The clinical performance of b-TCP has been compared with no significant differences found. Furthermore, a waiting period of less than 6 months has been studied for the placement of implants. These implants showed high primary stability and survival rates of 99-100%. Therefore, b-TCP is a safe material for sinus lifts and allows the placement of implants in a healing time of less than 6 months (AU)

Monitoring alendronate and estradiol therapy with quantitative ultrasound and bone mineral density.

Few studies have compared quantitative ultrasound with bone mineral density (BMD) in monitoring response to therapy in osteoporosis. The aim of our study was to compare finger ultrasound variables and BMD for monitoring alendronate and estradiol therapy in postmenopausal women. We recruited 26 women aged 50 to 79 yr (mean: 65 yr) with osteoporosis; 18 patients received 10 mg/d of alendronate and 500 mg/d of calcium carbonate and 8 patients received 500 mg/d of calcium carbonate only. We recruited 21 hysterectomized postmenopausal women who were randomized to treatment or control. The treatment group received a 25-mg estradiol implant, which was replaced every 6 mo. The control group had a sham procedure. In the alendronate group, there were significant changes at 1 yr at the lumbar spine (p<0.05), bone transmission time (p<0.01), and pure speed of sound (p<0.001) and the changes continued into the second year. In the estradiol implant group, there were significant changes at 1 yr at the lumbar spine (p<0.001), the femoral neck (p<0.05), and the pure speed of sound (p<0.01). For alendronate, the signal-to-noise ratio was similar between the lumbar spine and bone transmission time (1.8 and 1.4) and greater than for the pure speed of sound and femoral neck (0.8 and 0.7); for estradiol, the signal-to-noise ratio was similar between the lumbar spine and femoral neck (2.0 and 1.5) and greater than for the pure speed of sound and bone transmission time (1.1 and 0.6). These results indicated that changes in finger ultrasound are similar in clinical utility to dual-energy X-ray absorptiometry measurements at the femoral neck for the monitoring of antiresorptive treatments for osteoporosis.

Adolescent idiopathic scoliosis: epidemiology and treatment outcome in a large cohort of children six years after screening.

A prospective study was carried out in a cohort of 6873 children to determine diagnosis and treatment rates for adolescent idiopathic scoliosis (AIS) and to establish the distribution of parameters related to bracing. The follow-up completion rate was 85%, and prevalence rates were adjusted accordingly. The prevalence of AIS of 6 degrees or more at time of diagnosis was 8.1%. The female to male ratio for curves of 6 degrees or more was 1.07:1 with an increase to 6:1 for curves greater than 21 degrees. The rate of brace treatment was 2.8 per 1000. Deterioration, defined as progression of a scoliosis curve to the point where a brace was prescribed, was found in 3.7% of the scoliosis group. Fifteen children were prescribed braces: eight did not follow the treatment plan adequately (non-compliers), and five among these abandoned the follow-up programme. However, none of the non-compliers deteriorated to the point where spinal fusion was required.

Fructose 2,6-bisphosphate levels and modulation of glycolysis by histamine, cholecystokinin, and forskolin in isolated rabbit gastric glands.

In isolated rabbit gastric glands incubated in the presence of 1 mmol/L glucose, the content of fructose 2,6-bisphosphate (F-2,6-P2) was 5.7 +/- 0.5 pmol/mg dry weight. This value was progressively incremented by increasing glucose concentration in the incubation medium, and was almost doubled at 10 mmol/L glucose. Under these conditions, a close correlation could be established between the levels of F-2,6-P2 and the rate of L-lactate formation (r = .98; P less than .05). Both histamine (0.1 mmol/L) and cholecystokinin octapeptide (CCK-OCT; 0.1 mumol/L) increased L-lactate production, without significant changes in either F-2,6-P2 concentration or the amount of 6-phosphofructo-2-kinase in active form. In contrast, forskolin, which markedly increased the glandular content of cyclic adenosine monophosphate (cAMP), partially blocked glucose consumption and caused a significant reduction in both F-2,6-P2 levels and the proportion of 6-phosphofructo-2-kinase in active form. Furthermore, forskolin partially blocked the rate of glucose uptake by isolated gastric glands. Our results suggest a regulatory role of F-2,6-P2 in the control of the glycolytic flux in response to glucose, but not in its response to histamine or CCK-OCT.

Sulfonylurea effects on acid and pepsinogen secretion in isolated rabbit gastric glands.

The influence of different sulfonylureas on the rate of acid and pepsinogen secretion was studied in isolated rabbit gastric glands. Neither tolbutamide (10-500 microM), chlorpropamide (10-500 microM), glibenclamide (1-50 microM) nor glipizide (1-50 microM) exerted a secretory effect. In contrast, gliquidone caused a marked and dose-dependent stimulation of acid production in gastric glands incubated under basal conditions and potentiated the stimulatory effect of both histamine and carbachol. Gliquidone also increased the rate of pepsinogen release in gastric glands incubated either under basal conditions or in the presence of cholecystokinin-octapeptide or isoproterenol. The secretory effects of gliquidone were associated with a significant increase in the glandular content of cyclic AMP, caused by a competitive inhibition of low-Km cyclic AMP phosphodiesterase. Our results indicate that, among the assayed sulfonylureas, only gliquidone, in the micromolar range, stimulates acid and pepsinogen secretion through a cyclic AMP-dependent mechanism.

Inverse correlation between estrogen receptor content and peroxidase activity in human mammary tumors.

Identification and characterization of cytoplasmic estrogen receptor gave a biochemical basis for mammary hormone dependence, nevertheless, hormone receptor determination is not enough to allow us a complete prediction of hormone dependence thus search for new biochemical markers is a goal for experimental oncologists. In the present communication we report an inverse correlation between peroxidase activity in the human breast tumor tissue and the percentage of positive estrogen receptor in a group of 50 patients. Thus preliminary interpretation can be done about the actual role of this enzyme in relation to hormone dependence.

[Thrombophlebitis of the cavernous sinus secondary to polysinusitis. Report of a new case]. / Tromboflebitis del seno cavernoso secundaria a polisinusitis. Aportación de un nuevo caso.

Cavernous sinus thrombophlebitis syndrome is uncommon nowadays. Despite the wide range of antimicrobial agents it carries a high mortality. The disease frequently arises from infection of face, mouth, nose and paranasal sinuses, reaching the cavernous sinus by venous spread. Involvement of adjacent anatomic structures accounts for most of the clinical findings. Meningeal involvement, bilateral orbital edema and ocular cranial nerves palsy are very helpful in the differential diagnosis. Streptococcus spp., Staphylococcus spp., Haemophilus influenzae and anaerobic organisms are considered to be the most frequent etiological agents. In the present paper we report a case of cavernous sinus thrombophlebitis following left side polysinusitis. The patient presented with the main clinical features of the syndrome along with Streptococcus equisimilis and Fusobacterium necrophorum bacteremia. Urgent surgery of infected sinuses and appropriate antibiotic therapy led to a favorable outcome. The patient made and excellent progress and was discharged completely recovered two weeks after admission.

Características clínicas de la niñez menor de cinco años con desnutrición aguda complicada hospitalizados en 36 hospitales de la red de servicios de Salud Pública, año 2014 / Clinical features of children under five years with complicated acute malnutrition hospitalized in 36 hospitals of the public health service network- year 2014

La desnutrición aguda es un problema grave de salud. Actualmente afecta a 52 millones de niños menores de cinco años con prevalencia de 8% a nivel mundial. el riesgo de muerte para niños con desnutrición aguda moderada y severa es de 3 y 9 veces más que los niños con un estado nutricional normal.

The impact of subcutaneous oestradiol implants on biochemical markers of bone turnover and bone mineral density in postmenopausal women.

OBJECTIVE: To evaluate the anabolic effect of oestrogen on bone by comparing the response of markers of bone formation (and resorption) and bone mineral density (BMD) to subcutaneous oestradiol implants. DESIGN: One year double-blind placebo controlled randomised study. SETTING: Clinical research unit within a teaching hospital. POPULATION: Twenty-one hysterectomised postmenopausal women were randomised to 25 mg oestradiol implants at baseline and at six months or to have a sham procedure at baseline and six months. METHODS: BMD and quantitative ultrasound (QUS) were assessed at baseline and one year. Bone alkaline phosphatase (bone ALP), procollagen type I N-terminal propeptide (PINP), osteocalcin (OC), free deoxypyridinoline (iFDPD), N-telopeptide of type I collagen (NTX), serum oestradiol and intact parathyroid hormone (PTH) were measured at baseline, 4, 8, 12 and 24 weeks. MAIN OUTCOME MEASURES: Percentage change markers of bone turnover and PTH and change in oestradiol levels over first six months and percentage of changes in DXA and QUS over one year. RESULTS: PINP, bone ALP and OC increased by 28%, 7% and 9%, respectively (P < 0.01) during the first four weeks of treatment and then decreased significantly. Lumbar spine (LS) and total hip (TH) BMD increased by 5.4% and 6.0% (P < 0.001), respectively, and femoral neck (FN) BMD by 3.7% (P < 0.05) during the first year of treatment compared with control subjects. The peak serum oestradiol level was achieved four weeks after implant insertion. Mean PTH levels increased significantly in subjects receiving subcutaneous oestradiol. CONCLUSION: Subcutaneous oestrogen exerted an apparent anabolic effect on bone, which was initially reflected by an increase in bone formation markers and later by a large increase in BMD.