Efectividad de la inhibición suboccipital combinada con corriente interferencial en pacientes con cefalea tensional crónica: un ensayo clínico controlado aleatorizado / Effectiveness of suboccipital muscle inhibition combined with interferential current in patients with chronic tension-type headache: a randomised controlled clinical trial

Introducción: Se ha demostrado que la terapia manual reduce los síntomas autoreportados en pacientes con cefalea tensional crónica (CTC). Sin embargo, la aplicación simultánea de la técnica de inhibición muscular suboccipital y corriente interferencial no se ha investigado previamente. Este estudio evalúa la efectividad de la inhibición muscular suboccipital y la corriente interferencial en comparación con los cuidados habituales sobre el dolor, la discapacidad y el impacto de la cefalea en pacientes con CTC.MétodosLos pacientes se asignaron al azar al grupo de cuidados habituales (n = 13) o experimental (n = 12) que consistió en 20 minutos de inhibición muscular suboccipital y corriente interferencial dos veces por semana durante cuatro semanas. El resultado primario fue el dolor, y los resultados secundarios incluyeron la discapacidad producida por el dolor de cabeza y el impacto del dolor de cabeza que se valoraron por un evaluador cegado al inicio y después de cuatro semanas.ResultadosLos análisis mostraron diferencias entre los grupos a favor del grupo experimental a las cuatro semanas para la discapacidad producida por el dolor de cabeza (Neck Disability Index: g-Hedges = 1,01; p = 0,001; Headache Disability Inventory: g-Hedges = 0,48; p = 0,022) e impacto del dolor de cabeza (HIT-6: g-Hedges = 0,15; p = 0,037) pero no para el dolor autoreportado (Numerical Rating Scale: g-Hedges = 1,13; p = 0,18).ConclusionesLa aplicación simultánea de inhibición muscular suboccipital y corriente interferencial en pacientes con CTC no reduce significativamente el dolor autoreportado a las cuatro semanas. Sin embargo, mejora la discapacidad y el impacto del dolor de cabeza en la vida diaria. Estas mejoras superaron el mínimo cambio clínicamente importante de las mediciones, destacando su relevancia clínica. (AU)

Introduction: Manual therapy has been shown to reduce self-reported symptoms in patients with chronic tension-type headache (CTTH). However, simultaneous application of suboccipital muscle inhibition and interferential current has not previously been investigated. This study evaluates the effectiveness of combined treatment with suboccipital muscle inhibition and interferential current compared to standard treatment for pain, disability, and headache impact in patients with CTTH.MethodsPatients were randomly allocated to receive either standard treatment (n = 13) or the experimental treatment (n = 12), consisting of 20 minutes of suboccipital muscle inhibition plus interferential current twice weekly for 4 weeks. The primary outcome was improvement in pain, and secondary outcomes included improvement in headache-related disability and reduction in headache impact, which were assessed at baseline and at 4 weeks by a blinded rater.ResultsStatistical analysis showed improvements in the experimental treatment group at 4 weeks for headache-related disability (Neck Disability Index: Hedges’ g = 1.01, P = .001; and Headache Disability Inventory: Hedges’ g = 0.48, P = .022) and headache impact (6-item Headache Impact Test: Hedges’ g = 0.15, P = .037) but not for self-reported pain (numerical rating scale: Hedges’ g = 1.13, P = .18).ConclusionsCombined treatment with suboccipital muscle inhibition and interferential current in patients with CTTH did not significantly improve self-reported pain but did reduce disability and the impact of headache on daily life at 4 weeks. These improvements exceed the minimum clinically important difference, demonstrating the clinical relevance of our findings. (AU)

Effectiveness of suboccipital muscle inhibition combined with interferential current in patients with chronic tension-type headache: a randomised controlled clinical trial.

INTRODUCTION: Manual therapy has been shown to reduce self-reported symptoms in patients with chronic tension-type headache (CTTH). However, simultaneous application of suboccipital muscle inhibition and interferential current has not previously been investigated. This study evaluates the effectiveness of combined treatment with suboccipital muscle inhibition and interferential current compared to standard treatment for pain, disability, and headache impact in patients with CTTH. METHODS: Patients were randomly allocated to receive either standard treatment (n = 13) or the experimental treatment (n = 12), consisting of 20 minutes of suboccipital muscle inhibition plus interferential current twice weekly for 4 weeks. The primary outcome was improvement in pain, and secondary outcomes included improvement in headache-related disability and reduction in headache impact, which were assessed at baseline and at 4 weeks by a blinded rater. RESULTS: Statistical analysis showed improvements in the experimental treatment group at 4 weeks for headache-related disability (Neck Disability Index: Hedges' g = 1.01, P = .001; and Headache Disability Inventory: Hedges' g = 0.48, P = .022) and headache impact (6-item Headache Impact Test: Hedges' g = 0.15, P = .037) but not for self-reported pain (numerical rating scale: Hedges' g = 1.13, P = .18). CONCLUSIONS: Combined treatment with suboccipital muscle inhibition and interferential current in patients with CTTH did not significantly improve self-reported pain but did reduce disability and the impact of headache on daily life at 4 weeks. These improvements exceed the minimum clinically important difference, demonstrating the clinical relevance of our findings.

Actividad científica de la Sociedad Cubana de Estomatología en 2019

RESUMEN:Tema a presentar: Principales actividades científicas de la Sociedad Cubana de Estomatología en 2019. Objetivo: Exponer las actividades desarrolladas para la actualización científica y el perfeccionamiento de la práctica profesional.Comentarios principales: Se describen los temas abordados, los disertantes y los aportes de cada actividad. También se alude a los resultados de las elecciones de la Sociedad Cubana de Ciencias Estomatológicas.Consideraciones globales: Las actividades realizadas patentizaron la convicción de continuar desarrollando científicamente la profesión, con el fin de brindar atención de excelencia y lograrla salud bucal de todos y para el bien de todos.[AU]

Effectiveness of suboccipital muscle inhibition combined with interferential current in patients with chronic tension-type headache: a randomised controlled clinical trial. / Efectividad de la inhibición suboccipital combinada con corriente interferencial en pacientes con cefalea tensional crónica: un ensayo clínico controlado aleatorizado.

INTRODUCTION: Manual therapy has been shown to reduce self-reported symptoms in patients with chronic tension-type headache (CTTH). However, simultaneous application of suboccipital muscle inhibition and interferential current has not previously been investigated. This study evaluates the effectiveness of combined treatment with suboccipital muscle inhibition and interferential current compared to standard treatment for pain, disability, and headache impact in patients with CTTH. METHODS: Patients were randomly allocated to receive either standard treatment (n = 13) or the experimental treatment (n = 12), consisting of 20 minutes of suboccipital muscle inhibition plus interferential current twice weekly for 4 weeks. The primary outcome was improvement in pain, and secondary outcomes included improvement in headache-related disability and reduction in headache impact, which were assessed at baseline and at 4 weeks by a blinded rater. RESULTS: Statistical analysis showed improvements in the experimental treatment group at 4 weeks for headache-related disability (Neck Disability Index: Hedges' g = 1.01, P = .001; and Headache Disability Inventory: Hedges' g = 0.48, P = .022) and headache impact (6-item Headache Impact Test: Hedges' g = 0.15, P = .037) but not for self-reported pain (numerical rating scale: Hedges' g = 1.13, P = .18). CONCLUSIONS: Combined treatment with suboccipital muscle inhibition and interferential current in patients with CTTH did not significantly improve self-reported pain but did reduce disability and the impact of headache on daily life at 4 weeks. These improvements exceed the minimum clinically important difference, demonstrating the clinical relevance of our findings.

Low detection of Vibrio cholerae carriage in healthcare workers returning to 12 Latin American countries from Haiti.

SUMMARY This investigation was undertaken to characterize the prevalence of intestinal Vibrio cholerae in healthcare workers (HCWs) returning from Haiti due to the ongoing cholera epidemic. Eight hundred and fifty asymptomatic HCWs of the Cuban Medical Brigade, who planned to leave Haiti, were studied by laboratory screening of stool culture for V. cholerae. A very low percentage (0.23%) of toxigenic V. cholerae serogroup O1, serotype Ogawa was found. To the best of our knowledge, this study represents the largest reported screening study for V. cholerae infection in asymptomatic HCWs returning from a cholera-affected country. Cholera transmission to health personnel highlights a possible risk of transmitting cholera during mobilization of the population for emergency response. Aid workers are encouraged to take precautions to reduce their risk for acquiring cholera and special care should be taken by consuming safe water and food and practising regular hand washing.

Síndrome de desgaste profesional en los médicos de atención primaria de Ávila / Burnout syndrome in general practitioners of Avila

Objetivo. Analizar el nivel de desgaste profesional o burnout que presentaban los médicos de atención primaria de Ávila y la influencia de factores sociales, laborales y de salud en la aparición del mismo. Material y métodos. Se realizó un estudio epidemiológico transversal y descriptivo dirigido a todo el personal médico de atención primaria de Ávila durante el primer semestre de 2011, mediante 2 cuestionarios: el Maslach Burnout Inventory y otro de variables sociodemográficas, laborales y de salud. Resultados. Se obtuvo una tasa de respuesta del 51,8%. La edad media fue de 48,55 ± 8,16. El 52% eran varones, casados el 77%, con plaza en propiedad el 45%, trabajando en centros rurales el 78% y realizando guardias más consulta el 82%. La prevalencia en nuestro estudio resultó ser baja, 16% en su grado grave. Constatamos una alta prevalencia de la enfermedad, 68%, en su grado grave o moderado/grave. Estar casado (p = 0,012), no hacer guardias (p < 0,0001), trabajar en zona rural (p = 0,008) y ser médico de área (p = 0,03) predispone a padecer burnout en grado grave o moderado/grave. Conclusiones. Encontramos un nivel moderado de burnout. Al contrario de lo que pensaban muchos facultativos, la prevalencia de la enfermedad en su forma grave fue baja, pero sí fue elevada al considerar en conjunto los grados grave y moderado/grave. Por tanto, se deberían extender medidas para reducir el estrés laboral de los médicos con el fin de una mejor práctica laboral y eficiencia profesional (AU)

Objective. To determine the level of burnout in general practitioners of Avila and the influence of social, occupational and health factors. Material and methods. A descriptive cross-sectional epidemiological study was conducted and aimed at all Primary Care medical staff of Avila during the first half of 2011, using two questionnaires: the Maslach Burnout Inventory and other sociodemographic, health and occupational variables. Results. A response rate of 51.8% was obtained. The mean age was 48.55 ± 8.16, and 52% were male, 77% married, 45% with tenure, 78% worked in rural centres, and, 82% performed out of hours home visits plus clinics. The prevalence of severe burn out was low (16%) in our study was low. A high prevalence (68%) of moderate/severe level of the condition was found. Being married (P = .012), do not guards (P < .0001), working in rural areas (P = .008), and to be an area doctor (p=.03), predisposes to suffer burnout in severe or moderate/severe burnout. Conclusions. A moderate level of burnout was found. Contrary to what many doctors thought, the prevalence of the condition in its severe form was low, but was high when taking the severe and moderate/severe forms together. Therefore, measures should be extended to reduce occupational stress of doctors, in order to improve working practices and professional efficiency (AU)

[Burnout syndrome in general practitioners of Avila]. / Síndrome de desgaste profesional en los médicos de atención primaria de Ávila.

OBJECTIVE: To determine the level of burnout in general practitioners of Avila and the influence of social, occupational and health factors. MATERIAL AND METHODS: A descriptive cross-sectional epidemiological study was conducted and aimed at all Primary Care medical staff of Avila during the first half of 2011, using two questionnaires: the Maslach Burnout Inventory and other sociodemographic, health and occupational variables. RESULTS: A response rate of 51.8% was obtained. The mean age was 48.55±8.16, and 52% were male, 77% married, 45% with tenure, 78% worked in rural centres, and, 82% performed out of hours home visits plus clinics. The prevalence of severe burn out was low (16%) in our study was low. A high prevalence (68%) of moderate/severe level of the condition was found. Being married (P=.012), do not guards (P<.0001), working in rural areas (P=.008), and to be an area doctor (p=.03), predisposes to suffer burnout in severe or moderate/severe burnout. CONCLUSIONS: A moderate level of burnout was found. Contrary to what many doctors thought, the prevalence of the condition in its severe form was low, but was high when taking the severe and moderate/severe forms together. Therefore, measures should be extended to reduce occupational stress of doctors, in order to improve working practices and professional efficiency.

Análisis ecográfico de las modificaciones en la velocidad del flujo sanguíneo en la arteria vertebral producidas por el movimiento de rotación cervical máxima / Ultrasonography analysis of vertebral artery blood flow velocity changes on produced by the maximal cervical rotation

Objetivos Los test premanipulativos para la insuficiencia vertebrobasilar (TPIBV) suelen incorporar la rotación cervical para comprobar la solvencia de las arterias vertebrales (AV), aunque las investigaciones acerca del efecto de la rotación en el flujo de la AV discrepan y arrojan dudas en cuanto a la validez de las pruebas. Como un primer paso en esta línea el objetivo fue comprobar el efecto de la rotación cervical en los parámetros hemodinámicos de la AV en sujetos sanos. Material y método Se contó con 10 mujeres voluntarias sanas de 18 a 23 años (media: 20,3; DT: 1,64 años) a las que se le realizaron ecografías Doppler bilaterales en el segmento de la AV suboccipital (AV3) en la posición de rotación neutra, contralateral y homolateral. Se calcularon la velocidad del pico sistólico (VPS), velocidad del pico diastólico (VPD), velocidad media (VM) e índice de resistencia (IR). Los datos se analizaron con una ANOVA de medidas repetidas y las comparaciones se realizaron con la corrección de Bonferroni (SPSS v15.0; IC del 95%).Resultados No se detectaron diferencias estadísticamente significativas en cuanto a la lateralidad y la rotación cervical ni en VPS (FVPS=0,935; p=0,47) ni en VPD (FVPD=1,067; p=0,39), ni en VM (FVM=1,172; p=0,34), ni en IR (FIR=1,183; p=0,33). Debe destacarse la baja potencia de los análisis (entre el 30 y el 38%) por lo que la ausencia de diferencias debe considerarse con precaución. Conclusiones Los parámetros hemodinámicos de la AV no se modificaron en sujetos sanos con las rotaciones cervicales, cuestión que debe ser investigada en sujetos con insuficiencia vertebrobasilar (AU)

Objectives The pre-manipulative vertebrobasilar insufficiency tests (PVBIT) generally incorporate cervical rotation to verify the solvency of the vertebral arteries (VA). However, research on the effect of rotation on VA blood flow differ and question the validity of the tests. The first aim of this study was to verify the effect of cervical rotation on the hemodynamic parameters of the VAs in healthy subjects. Material and method Ten healthy female volunteers, aged 18 to 23 years (mean: 20.3, SD: 1.64 years), were subjected to bilateral Doppler ultrasonographies over the suboccipital segment of the AV (AV3) with neutral, contralateral and ipsilateral cervical rotation positions. We calculated peak systolic velocity (PSV), peak diastolic velocity (PDV), mean velocity (MV) and resistance index (RI). The data were analyzed with repeated measures ANOVA and comparisons were made with Bonferroni correction (SPSS v15.0, C.I. 95%).Results No statistically significant differences were detected regarding lateralization or rotation in the values of PSV (FPSV=0.935, P=.47), or PDV (FPDV=1.067, P=.39), or MV (FMV=1.172, P=.34), or RI (FRI=1.183, P=.33). The low power of analysis (between 30 and 38%) should be noted and thus the absence of differences should be observed with caution. Conclusions Hemodynamic parameters of the VA did not change with cervical rotations in healthy women so that this question should be studied in patients with vertebrobasilar insufficiency (AU)

Análisis discriminante del patrón textural ecográfico con matrices de concurrencia como nueva herramienta para el estudio del tendón / Discriminant analysis of the ultrasonographic textural pattern with co-occurrence matrices as a new tool for ultrasonographic of tendon

ObjetivoEvaluar el poder clasificatorio por grupo de edad y sexo de modelos discriminantes (MD) a partir de la ecotextura del tendón de Aquiles (TA).Material y métodosSe diseñó un estudio de observacional, transversal sobre 103 sujetos (49 mujeres y 54 hombres) con edades comprendidas entre los 18 y los 53 años (media = 29,8; desviación estándar = 0,86). Se tomaron ecografías transversales bilaterales a 20 mm de la inserción del TA con un ecógrafo Sonosite-Titan (L38 a 5-10 Hz). Se obtuvieron 60 variables texturales a partir de las matrices de concurrencia del nivel de gris (GLCM): contraste, homogeneidad, uniformidad, entropía y correlación para tres escalas (1, 5 y 10 píxeles) y dos orientaciones (0° y 90°) con el programa ImageJ 1.43. Se realizó un análisis multidimensional discriminante exploratorio con el método de inclusión forzosa con SPSS 15.0 (IC del 95%).ResultadosEn el MD global la sensibilidad fue del 74% y la especificidad del 91% para el grupo de edad. En el MD de mujeres la sensibilidad fue del 90% y la especificidad del 97%, mientras que en el MD de los hombres fueron del 96 y el 99%, respectivamente. Tras las validaciones cruzadas entre mujeres y hombres, las sensibilidades se redujeron a un 30%, lo que sugiere que el comportamiento ecotextural del TA en hombres y en mujeres es diferente.ConclusiónEl análisis multivariante de la ecotextura del TA con GLCM mostró una buena sensibilidad y especificidad en la clasificación de los sujetos según el grupo de edad, que mejoraron cuando los modelos se segmentaron según el sexo(AU)

AbstractObjectiveThe aim of this study was to evaluate the classification power as the age and sex of discriminant models (DM) generated from the echo-texture of the Achilles tendon (AT).Materials and methodsThe design was an observational, cross-sectional study report on 103 subjects (49 females and 54 males) 18 to 53 years old (mean = 29.8, SD = 0.86). We took bilateral transverse ultrasonographies at 20 mm from the insertion of the AT. Sixty variables were obtained from grey level co-occurrence matrices (GLCM): contrast, homogeneity, uniformity, entropy and correlation for three scales (1, 5 and 10 pixels) and two orientations (0° and 90°) with ImageJ 1.43 software. Multidimensional discriminant models were performed with forced inclusion method (CI95%).ResultsThe global MD for classification by age group showed a sensitivity of 74% and a specificity of 91%. In the DM women's ultrasound pattern sensitivity increased to 90% and specificity 97%, while sensitivity and specificity of ultrasound pattern DM men were 96% and 99% respectively. When cross-validations were performed for models of women and men, the sensitivities of the models were reduced to 30%, suggesting that the AT echotextural behavior is different.ConclusionMultidimensional analysis of Achilles tendon echotexture with GLCM showed good sensitivity and specificity in the classification of subjects by age group that improved when the models were segmented by gender(AU)

Enfoques mucosales en vacunologia de Neisseria

Meningococcal B strains accounts for some 72 percent and 28 percent of meningococcal diseases in infants and toddlers in Europe and the USA, respectively. Nevertheless, meningococcal diseases are rare in Cuba owing to the wide spread program on antimeningococcal vaccination in the country. Finlay Institute is one of the pioneering organizations in Neisseria Vaccinology mainly by its contribution to N. meningitidis serogroup B outer membrane-based bivalent vaccine, VA-MENGOC-BC™. This vaccine was given intramuscularly in more than 60 million doses corresponding 10,7 millions of them to Cuban young adults, children, and infants. However, most dangerous or commensally Neisseria strains enter and establish in the mucosa, where the secretory (S) IgA is the main specific guardian and is mainly induced by mucosal routes. However, few mucosal vaccines exist principally due to the absent of mucosal adjuvants. We develop a Finlay Adjuvant (AF) platform based in outer membrane vesicles (Proteoliposome, PL) and its derivate Cochleate (Co). AFPL1 derived from serogroup B N meningitidis is a potent Th1/CTL driving parenteral adjuvant. AFCo1 is a potent mucosal adjuvant. Therefore, we sought to go deeper in the possible mucosal cross recognition between N. meningitidis serogroups and Neisseria species and explore a concurrent mucosal and parenteral immunization strategy (SinTimVaS) in order to develop suitable mucosal vaccines. Experiments were conducted in Balb/c or C57Bl6 mice with mucosal and systemic immunization using AFCo1 and AFPL1. Human sera and saliva were also analyzed for cross cognition. Mucosal cross recognition at SIgA level in human saliva between N. meningitidis serogroups B, A, C, Y, and W135 were observed. This SIgA cross recognition response was also observed between pathogenic (N meningitidis serogroup B, N gonorrhoeae) and non-pathogenic strains (N flava, N lactamica). The possible influence of meningococcal vaccination ...(AU)

[Development of a multiple PCR method for the identification of Ureaplasma parvum and Ureaplasma urealyticum]. / Desarrollo de un método de PCR-múltiple para la identificación de Ureaplasma parvum y Ureaplasma urealyticum.

Ureaplasma parvum and Ureaplasma urealyticum, also known as biovar parvum and biovar T960, respectively, could be associated with several disorders in men, women, and mainly, in newborn children with under weight. Several methods have been developed in order to identify the species or biovars of ureaplasmas. We developed a Multiplex-PCR method using the UPS-UPSA and UUS2-UUA2 primers, specific for U. parvum and U. urealyticum, respectively. This Multiplex-PCR method was used to identify cultures of clinical positive samples to Ureaplasma spp. by the "MYCOFAST Evolution-2" Kit. Of 56 positive cultures to Ureaplasma spp. from newborn children, 70% were U. parvum and 30% U. urealyticum; in 76 positive samples in women, 83% corresponded to U. parvum and 17% to U. urealyticum, while in 63 positive samples of men, 76% identified U. parvum and 24% U. urealyticum. The PCR-multiplex method showed specificity for the identification of the biovars or species of ureaplasmas of clinical interest.

Desarrollo de un método de PCR-múltiple para la identificación de Ureaplasma parvum y Ureaplasma urealyticum. / [Development of a multiple PCR method for the identification of Ureaplasma parvum and Ureaplasma urealyticum]

Ureaplasma parvum and Ureaplasma urealyticum, also known as biovar parvum and biovar T960, respectively, could be associated with several disorders in men, women, and mainly, in newborn children with under weight. Several methods have been developed in order to identify the species or biovars of ureaplasmas. We developed a Multiplex-PCR method using the UPS-UPSA and UUS2-UUA2 primers, specific for U. parvum and U. urealyticum, respectively. This Multiplex-PCR method was used to identify cultures of clinical positive samples to Ureaplasma spp. by the [quot ]MYCOFAST Evolution-2[quot ] Kit. Of 56 positive cultures to Ureaplasma spp. from newborn children, 70

were U. parvum and 30

U. urealyticum; in 76 positive samples in women, 83

corresponded to U. parvum and 17

to U. urealyticum, while in 63 positive samples of men, 76

identified U. parvum and 24

U. urealyticum. The PCR-multiplex method showed specificity for the identification of the biovars or species of ureaplasmas of clinical interest.

Desarrollo de un método de PCR-múltiple para la identificación de Ureaplasma parvum y Ureaplasma urealyticum / [Development of a multiple PCR method for the identification of Ureaplasma parvum and Ureaplasma urealyticum]

Ureaplasma parvum and Ureaplasma urealyticum, also known as biovar parvum and biovar T960, respectively, could be associated with several disorders in men, women, and mainly, in newborn children with under weight. Several methods have been developed in order to identify the species or biovars of ureaplasmas. We developed a Multiplex-PCR method using the UPS-UPSA and UUS2-UUA2 primers, specific for U. parvum and U. urealyticum, respectively. This Multiplex-PCR method was used to identify cultures of clinical positive samples to Ureaplasma spp. by the [quot ]MYCOFAST Evolution-2[quot ] Kit. Of 56 positive cultures to Ureaplasma spp. from newborn children, 70

were U. parvum and 30

U. urealyticum; in 76 positive samples in women, 83

corresponded to U. parvum and 17

to U. urealyticum, while in 63 positive samples of men, 76

identified U. parvum and 24

U. urealyticum. The PCR-multiplex method showed specificity for the identification of the biovars or species of ureaplasmas of clinical interest.

¿Sabemos cuáles son los efectos adversos de los medicamentos que recetamos? / Are we aware of the side effects of the drugs we prescribe?

Muchos de los medicamentos que utilizamos en nuestras consultas, y a los que presuponemos inocuidad, pueden producir multitud de efectos secundarios que en ocasiones pueden llegar a ser letales. La agranulocitosis es una poco frecuente alteración sanguínea consistente en una neutropenia severa que asocia infecciones graves y una elevada mortalidad. Un gran número de medicamentos se han asociado con la producción de agranulocitosis antibióticos, antiinflamatorios, antidepresivos, etc...Dentro de estos medicamentos el metamizol ha sido uno de los fármacos que clásicamente se ha asociado a este trastorno sanguíneo. Ampliamente utilizado, el metamizol, goza de gran popularidad no sólo entre el ambiente médico sino entre los mismos pacientes que pueden conseguirlo sin receta médica en cualquier farmacia dentro de nuestro país. Aunque la asociación de agranulocitosis y metamizol es poco frecuente debemos tenerla presente por las graves consecuencias que puede traer. Tal fue el caso de la paciente que describimos, la cual tras ha ber recibido metamizol debió ser atendida urgentemente en su domicilio, siendo posteriormente remitida al hospital. La analítica en urgencias mostró una agranulocitosis. Posteriormente ingresaría en la unidad de cuidados intensivos donde, a pesar de las medidas de soporte y la antibioterapia, la paciente falleció a las pocas horas (AU)

Typing and susceptibility to penicillin of Neisseria meningitidis isolated from patients in Cuba (1993-1999).

The susceptibility to penicillin of 111 Neisseria meningitidis strains was assessed by the agar-dilution procedure and serosubtypes were determined by a whole-cell enzyme-linked immunoassay using monoclonal antibodies reagents. Thirty-five isolates showed reduced sensitivity to penicillin (MIC > or = 0.1 mg/l and < or = 1 mg/l) and no resistant strains were detected. The most common phenotype was B:4:P1.15 (77.5%) and a rising trend of non-typeable and non-subtypeable strains was detected. The increase in levels of minimal inhibitory concentrations of meningococci to penicillin gives cause for concern and the increase in non-typeable and non-subtypeable isolation demand the use of molecular biology techniques for their typing.

Neisseria gonorrhoeae resistant to ciprofloxacin: first report in Cuba.

BACKGROUND AND OBJECTIVES: The Cuban Ministry of Public Health plans to implement the syndromic approach to sexually transmitted diseases in persons with urethral or vaginal syndrome in Cuba using 500 mg ciprofloxacin as therapy. Although the emergence of clinical isolates of Neisseria gonorrhoeae with decreased susceptibility to ciprofloxacin have been sporadically detected in Cuba, there has been no report of isolates that exhibited significant resistance to this drug. This is the first report of the isolation of a N gonorrhoeae strain resistant to ciprofloxacin in Cuba. STUDY DESIGN: Case report. CONCLUSIONS: This case emphasizes the need for awareness regarding the potential emergence of a clinically significant resistance of N gonorrhoeae in Cuba. There is a need for continued antimicrobial susceptibility surveillance of Cuban isolates to ciprofloxacin and other fluoroquinolones.

Characterization of Neisseria gonorrhoeae strains isolated from patients with conjunctivitis.

The conjunctivitis produced by Neisseria gonorrhoeae is the less frequently reported clinical form of gonococcal infection. We aim to phenotypically characterize N. gonorrhoeae isolated from conjunctivae sites. A total of six cases of this disease were notified in the Camagüey province, Cuba. All the strains isolated were penicillin-producing, showed the serogroup WI and exhibited the same antimicrobial susceptibility pattern and plasmid profile (2.6-3. 2-24.5). The results contribute to the characterization of N. gonorrhoeae strains circulating in our environment.