Spiral, uterine artery doppler and placental ultrasound in relation to preeclampsia.

Preeclampsia (PE) is a multiorgan disorder that complicates around 2-8% of pregnancies and is a major cause of perinatal and maternal morbidity and mortality. PE is a clinical syndrome characterized by hypertension secondary to systemic inflammation, endothelial dysfunction, and syncytiotrophoblast stress leading to hypertension and multiorgan dysfunction. The uterine arteries are the main blood vessels that supply blood to the uterus. They give off branches and plays an important role in maintaining blood supply during pregnancy. The arcuate artery originates from the uterine artery and runs medially through the myometrium. The arcuate arteries divide almost directly into anterior and posterior branches, from which the radial artery leads directly to the uterine cavity during their course. Near the endometrium-myometrium junction, the radial artery generates spiral arteries within the basal layer and functional endometrium. The walls of radial and spiral arteries are rich in smooth muscle, which is lost when trophoblast cells invade and become large-caliber vessels. This physiological transformation of uteroplacental spiral arteries is critical for successful placental implantation and normal placental function. In normal pregnancy, the luminal diameter of the spiral arteries is greatly increased, and the vascular smooth muscle is replaced by trophoblast cells. This process and changes in the spiral arteries are called spiral artery remodeling. In PE, this genetically and immunologically governed process is deficient and therefore there is decreased vascular capacitance and increased resistance in the uteroplacental circulation. Furthermore, this defect in uteroplacental spiral artery remodeling is not only associated with early onset PE, but also with fetal growth restriction, placental abruption, and spontaneous premature rupture of membranes. Doppler ultrasound allows non-invasive assessment of placentation, while the flow impedance decreases as the pregnancy progresses in normal pregnancies, in those destined to develop preeclampsia the impedance is increased.

Is a sFlt-1/PlGF cutoff of 38 suitable to predict adverse outcomes in pregnancies with abnormal uterine artery Doppler velocimetry in the second trimester?

OBJECTIVE: To determine the optimal cutoff value for the soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio to predict maternal and fetal adverse events in pregnancies with uterine artery Doppler scans results above the 95th percentile in the late second trimester. STUDY DESIGN: Retrospective, observational cohort study on 116 asyntomatic patients with abnormal uterine artery Doppler scans at gestational week 25. The sFlt-1/PlGF ratio was determined within the weeks 25 to 29 of gestation and ROC curve analysis performed. The diagnostic validity of different cutoff values to predict severe maternal and fetal complications, i.e. preeclampsia, fetal growth restriction, placental abruption, and fetal death, was analyzed. MAIN OUTCOME MEASURES: An ideal cutoff for sFlt-1/PlGF ratios in pregnancies with abnormal uterine artery Doppler in the second trimester. RESULTS: Applying a cutoff point of 38, the area under the ROC curve was 0.89, generally considered low risk in fetal and maternal complication prediction. The sensitivity was 32.1%, the specificity 98.4%, the positive predictive value (PPV) 94.4%, and the negative predictive value (NPV) 63.3%. A cutoff value of 10, leading to the highest Youden index, performed best at detecting overall complications, increasing sensitivity to 69.8% and the NPV to 76.8%. at the cost of a reduced specificity and PPV. CONCLUSIONS: In pregnancies with abnormal uterine artery Doppler in the second trimester, an sFlt-1/PlGF cutoff value greater than equal to 38 improves its predictive power for adverse events.

Prenatal Diagnosis of Diastematomyelia: a Case Report and Literature Review.

Diastematomyelia is a type of closed spinal dysraphism in which there is splitting of the spinal cord. It is a rare entity that accounts for less than 3% of closed spinal dysraphisms and affects females 1.3 to 6 times more frequently than males. Lesions are usually found in the lower thoracic and upper lumbar regions. It is characterised by two hemicords separated by a bony or cartilaginous spur. In most cases, it is an isolated malformation with a favourable prognosis. However, it may be associated with other abnormalities and sonography is the imaging test par excellence for early prenatal diagnosis. We report a case of diastematomyelia diagnosed by prenatal sonography at 24 weeks' gestation. Amniotic fluid alpha-fetoprotein (AF-AFP) was normal, while amniotic fluid acetylcholinesterase (AF-AChE) was positive. After birth, the diagnosis was confirmed with magnetic resonance imaging (MRI). The anomaly was associated with a spinal lipoma, tethered cord and dermal sinus. A review of all the cases described in the literature to date is carried out.

Funciones de enfermería en los procederes de aféresis / Nursing functions in cell therapy procedures

Introducción: Con el paso de los años, la profesión de enfermería ha ganado terreno en diferentes áreas de la medicina y su acción ha llegado a esferas que se creía exclusivas de otros profesionales del sector de la salud, como la Medicina Transfusional y Terapia celular. Objetivo: Describir las funciones de enfermería en los procederes de aféresis. Análisis y síntesis de la información: El trabajo de enfermería se basa en la aplicación de la metodología para la implementación de los cuidados que realiza. El intercambio directo con la persona permite identificar sus necesidades, facilita planear, controlar, ejecutar y evaluar las actividades que se realizan en la práctica diaria. Dentro del área de la Medicina Transfusional el accionar de enfermería es fundamental, ya que puede intervenir en diferentes fases del proceso de la donación de sangre, realiza la centrifugación del componente a obtener, transfunde o implanta componentes sanguíneos y atiende las reacciones adversas del individuo. Conclusiones: La acción de enfermería en la actividad de aféresis para diferentes procedimientos es primordial para preservar la salud del donante y el paciente, así como en la creación o modificación de protocolos de trabajo con mayor eficiencia, eficacia y efectividad en base a los conocimientos y la experiencia en este campo lo que genera una espiral de desarrollo continuo que obliga a la constante actualización en el tema.

Introduction: With the step of the years, the infirmary profession has won land in different areas of the medicine and its action has arrived to spheres that it was believed they were exclusive of other professionals of the sector of the health, as the Medicine Transfusional and cellular Therapy. Objective: to describe the nursing functions in the aphaeresis procedures. Analysis and synthesis of the information: The infirmary work is based on the application of the methodology for the implementation of the cares that he/she carries out. The direct exchange with the patient allows to identify its necessities, as well as it facilitates to drift, to control, to execute and to evaluate the activities that are carried out in the daily practice. Inside the area of the transfusion medicine working of infirmary is fundamental, since it can intervene in different phases of the process of the donation of blood, he/she carries out the centrifugation of the component to obtain, it transfuses or it implants sanguine components and he/she assists the patient's adverse reactions. Conclusions: The nurse action in the aphaeresis activity for different procedures is primordial to preserve the donor's health and the patient, as well as in the creation or modification of work protocols with bigger efficiency, effectiveness and effectiveness based on the knowledge and the experience in this field what generates a hairspring of continuous development that he/she forces to the constant bring up to date in the topic.

Onychomycosis Caused by Kloeckera apiculata: A Case Report in a Patient with Multiple Sclerosis.

We report the first case of onychomycosis caused by Kloeckera apiculata in a woman with multiple sclerosis. Video-dermoscopic examination showed a spiked pattern and distal irregular aspect. Colonies on Sabouraud agar were white, creamy, and smooth. A microscopic examination showed blastoconidia. MALDI-TOF confirmed Kloeckera apiculata as the causal agent.

Neural connections of the pretectum in zebrafish (Danio rerio).

The pretectum is a complex region of the caudal diencephalon which in adult zebrafish comprises both retinorecipient (parvocellular superficial, central, intercalated, paracommissural, and periventricular) and non-retinorecipient (magnocellular superficial, posterior, and accessory) pretectal nuclei distributed from periventricular to superficial regions. We conducted a comprehensive study of the connections of pretectal nuclei by using neuronal tracing with fluorescent carbocyanine dyes. This study reveals specialization of efferent connections of the various pretectal nuclei, with nuclei projecting to the optic tectum (paracommissural, central, and periventricular pretectal nuclei), the torus longitudinalis and the cerebellar corpus (paracommissural, central, and intercalated pretectal nuclei), the lateral hypothalamus (magnocellular superficial, posterior, and central pretectal nuclei), and the tegmental regions (accessory and superficial pretectal nuclei). With regard to major central afferents to the pretectum, we observed projections from the telencephalon to the paracommissural and central pretectal nuclei, from the optic tectum to the paracommissural, central, accessory and parvocellular superficial pretectal nuclei, from the cerebellum to the paracommissural and periventricular pretectal nuclei and from the nucleus isthmi to the parvocellular superficial and accessory pretectal nuclei. The parvocellular superficial pretectal nucleus sends conspicuous projections to the contralateral magnocellular superficial pretectal nucleus. The composite figure of results reveals large differences in connections of neighbor pretectal nuclei, indicating high degree of nuclear specialization. Our results will have important bearings in functional studies that analyze the relationship between specific circuits and behaviors in zebrafish. Comparison with results available in other species also reveals differences in the organization and connections of the pretectum in vertebrates.

I.S.Mu.L.T. first-time patellar dislocation guidelines.

Primary traumatic patellar dislocation is common, particularly in young active individuals. A consensus on its management is still lacking. The present work provides easily accessible guidelines to be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, to improve the quality of care and rationalize the use of resources. LEVEL OF EVIDENCE: Ia.

Conservative treatment for Insertional Achilles Tendinopathy: platelet-rich plasma and focused shock waves. A retrospective study.

BACKGROUND: Insertional Achilles tendinopathy (IAT) represents a serious challenge for both physiatrists and surgeons. Here we analyse the results obtained by two conservative treatments [platelet-rich plasma (PRP) injections and focused extracorporeal shock-wave therapy (ESWT)] in physically active patients with IAT. METHODS: During two consecutive periods, 45 consecutive patients with IAT were treated with 3 sessions of ESWT (2400 impulses at 0.17-0.25 mJ/mm2 per session) (24 cases between September 2011 and July 2013) or with 2 autologous PRP injections over two weeks (21 cases between September 2013 and July 2015). All patients were evaluated at 0, 2-, 4-, 6-month follow-up after therapy. The outcome measures were VISA-A, VAS, Patient Satisfaction. RESULTS: Intra-group analysis showed a significant improvement of VISA-A and VAS scores in both groups at all time-points. No differences between groups were observed for VAS and VISA-A scores at all time-points, excepted for VISA-A at 4-months in favour of ESWT group (P=0.049). Patient satisfaction increased progressively (>70% at 6 months) and with no differences between two groups. CONCLUSION: Both ESWT and PRP therapy are effective and safe. Our study confirms the success of these conservative treatments in Achilles tendinopathy, even in the insertional one. LEVEL OF EVIDENCE: IIIa.

Ultrasonographic assessment of the anterolateral ligament of the knee in healthy subjects.

OBJECTIVE: The aim of our study was to determine inter-observer agreement in the ultrasonographic identification of the anterolateral ligament (ALL) and in the evaluation of its length and thickness in healthy subjects. METHODS: 80 healthy volunteers (160 knees) (42 males and 38 females) were enrolled in the study. All subjects underwent ultrasound (US) examination of both knees, performed by two physicians with over ten years of musculoskeletal US experience. In order to keep the ALL under optimal tension, the knee was flexed at approximately 30-35°, slightly internally rotated and length and thickness of the ligament were measured. RESULTS: ALL was identified in 93.8% (150 out of 160) and in 92.5% (148 out of 160) of the knees by Evaluator 1 and Evaluator 2, respectively. Interobserver agreement was substantial to almost perfect for the visualization of the ALL ( =0.90) and for measurements of its length (ICC = 0.83), and strong for measurements of its thickness (ICC = 0.75). CONCLUSION: In our study on healthy subjects, ALL has been visualized with a high rate of reproducibility. Further studies are needed to see if US may be a reliable and reproducible diagnostic tool in patients with traumatic or degenerative knee disorders. LEVEL OF EVIDENCE: II, evidence obtained from cohort study.

Flebotomías en el Instituto de Hematología e Inmunología: análisis de 5 años / Phlebotomy at the Institute of Hematology and Immunology: five-year analysis

La flebotomía terapéutica o sangría se define como la remoción de sangre total. Es una práctica muy antigua, que data de varios siglos atrás y su uso se extendió a diferentes culturas, tanto para la práctica médica como para rituales religiosos. Con los años las indicaciones de este proceder fueron disminuyendo y en la actualidad se emplea en un grupo restringido de enfermedades con el objetivo de remover glóbulos rojos, reducir la cantidad de hierro circulante y disminuir la viscosidad sanguínea.1En el Instituto de Hematología e Inmunología (IHI) está protocolizado que la extracción de sangre total con fines terapéuticos, se acompaña de la reposición de la cantidad extraída con solución salina fisiológica para mantener al paciente isovolumétrico y evitar algunos de los efectos adversos que se habían observado en ancianos o cuando el paciente tenía que realizarse repetidamente el proceder, por lo que se ha considerado esta práctica como una modalidad de eritrocitaféresis, ya que existe extracción de sangre con reposición de soluciones. Con el objetivo de conocer el comportamiento de este procedimiento en el centro se realizó un estudio descriptivo y retrospectivo que incluyó a todos los pacientes a los que se les realizó flebotomías, en el período comprendido entre enero del 2010 y diciembre del 2014...

Comparison in Joint-Position Sense and Muscle Coactivation Between Anterior Cruciate Ligament-Deficient and Healthy Individuals.

CONTEXT: Tearing of the anterior cruciate ligament (ACL) may disrupt the ability to recognize the knee position in space during limb-repositioning tasks, which is referred to as joint-position sense (JPS). Impairments in JPS have been shown to be lower during active than passive repositioning tasks, thus suggesting that coactivation patterns of the muscles surrounding the knee might compensate for the disrupted JPS and ensure accurate limb repositioning in ACL-deficient individuals. OBJECTIVE: To investigate muscle coactivation patterns during JPS repositioning tasks in ACL-deficient and healthy individuals. DESIGN: Prospective observational study. SETTING: Functional assessment laboratory. PARTICIPANTS: 8 men age 25 ± 8 y with isolated ACL rupture and 10 men age 30 ± 4 y with no history of knee injury. INTERVENTION: JPS was evaluated by means of an electrogoniometer in a sitting position during either passive or active joint-positioning and -repositioning tasks with a 40° target knee angle. MAIN OUTCOME MEASURES: Root mean square (RMS) of the surface electromyogram from the vastus lateralis and biceps femoris muscles was measured during active joint positioning and repositioning. RESULTS: Healthy participants showed a significant decrease in vastus lateralis RMS (-19%) and an increase in biceps femoris RMS (+26%) during joint repositioning compared with positioning. In contrast, ACL-deficient patients showed no modulation in muscle coactivation between joint positioning and repositioning, although they exhibited significantly lower RMS of the vastus lateralis (injured limb, -28%; uninjured limb, -21%) and higher RMS of the biceps femoris (injured limb, +19%; uninjured limb, +30%) than the healthy participants during joint positioning. CONCLUSIONS: The lack of modulation in muscle coactivation patterns between joint positioning and repositioning in ACL-deficient patients might be attributed to disrupted neural control after the injury-related loss of proprioceptive information. These results should be taken into account in the design of rehabilitation protocols with emphasis on muscle coactivation and JPS.

Procederes de aféresis en el Instituto de Hematología e Inmunología / Apheresis procedures at the Institute of Hematology and Immunology

Introducción: en los últimos decenios el interés por las aféresis se ha incrementado debido a que los avances tecnológicos han puesto a disposición de los profesionales de la salud equipamiento dotado de especificidad, seguridad, efectividad y rapidez para la realización de estos procederes en función de la transfusión y la terapéutica. Objetivo: presentar la experiencia acumulada en el Instituto de Hematología e Inmunología en la realización de los diferentes tipos de aféresis. Métodos: se realizó un estudio descriptivo retrospectivo que incluyó a todos los pacientes a los que se les realizó algún proceder de aféresis, en el período comprendido entre enero de 2008 y diciembre de 2013. Se analizaron las variables: datos generales del paciente, centro de procedencia, modalidad de aféresis empleada, método que se empleó y enfermedades que requirieron el proceder. Resultados: se realizaron 3 332 procederes de aféresis, 1 057 de producción con prevalencia de las tromboféresis que representó el 96,68 por ciento. De las 1 078 aféresis terapéuticas realizadas, el primer lugar correspondió a las plasmaféresis con el 26,5 por ciento, seguida de las exanguinotransfusiones (15,8 por ciento). Se realizaron, además, 1 197 aféresis de células mononucleares y plaquetas para su empleo en la Medicina Regenerativa. Conclusiones: los resultados de este primer trabajo muestran el desarrollo paulatino de las aféresis en la institución, tanto de producción como terapéutica, que por una parte promueven la producción de componentes por aféresis, lo que pone a disposición de médicos y pacientes necesitados de hemocomponentes con mayor calidad y seguridad para el tratamiento sustitutivo; y por otra, aporta información sobre las posibilidades reales de esta alternativa terapéutica para algunas enfermedades(AU)

Introduction: in recent decades, interest in apheresis has increased due to advances in technology that have made them available to health professionals with access to specific equipment, safety, effectiveness and speed to perform these procedures in terms of transfusion and therapeutics. Objective: to present the experience gained at the Institute of Hematology and Immunology in performing different types of apheresis. Methods: adescriptive retrospective study was performed which included all patients who underwent an apheresis procedure between January 2008 and December 2013. Variables were: patient´s general data, the establishment of provenance, method where analyzed apheresis was performed, method used, and diseases requiring the proceeding. Results: 3 332 apheresis proceedings were done : 1 057 for production with thrombopheresis prevalence which ranked 96,68 percent. Of the 1 078 therapeutic apheresis performed, the first place went to plasmapheresis with 26,5 percent, followed by exchange transfusions (15,8 percent); 1 197 apheresis of mononuclear cells and platelets to be used in regenerative medicine were also conducted. Conclusions: the results of this preliminary study show the gradual development in the use of apheresis procedures in our institution, with both production and therapy aims, which not only allows the diffusion of production of components by apheresis which provides physicians and patients in need of blood products with higher quality and security replacement therapy, but also provides knowledge about the actual possibilities for alternative therapy in some diseases(AU)

Procederes de aféresis en el Instituto de Hematología e Inmunología / Apheresis procedures at the Institute of Hematology and Immunology

Introducción: en los últimos decenios el interés por las aféresis se ha incrementado debido a que los avances tecnológicos han puesto a disposición de los profesionales de la salud equipamiento dotado de especificidad, seguridad, efectividad y rapidez para la realización de estos procederes en función de la transfusión y la terapéutica.Objetivo: presentar la experiencia acumulada en el Instituto de Hematología e Inmunología en la realización de los diferentes tipos de aféresis.Métodos: se realizó un estudio descriptivo retrospectivo que incluyó a todos los pacientes a los que se les realizó algún proceder de aféresis, en el período comprendido entre enero de 2008 y diciembre de 2013. Se analizaron las variables: datos generales del paciente, centro de procedencia, modalidad de aféresis empleada, método que se empleó y enfermedades que requirieron el proceder.Resultados: se realizaron 3 332 procederes de aféresis, 1 057 de producción con prevalencia de las tromboféresis que representó el 96,68 por ciento. De las 1 078 aféresis terapéuticas realizadas, el primer lugar correspondió a las plasmaféresis con el 26,5 por ciento, seguida de las exanguinotransfusiones (15,8 por ciento). Se realizaron, además, 1 197 aféresis de células mononucleares y plaquetas para su empleo en la Medicina Regenerativa.Conclusiones: los resultados de este primer trabajo muestran el desarrollo paulatino de las aféresis en la institución, tanto de producción como terapéutica, que por una parte promueven la producción de componentes por aféresis, lo que pone a disposición de médicos y pacientes necesitados de hemocomponentes con mayor calidad y seguridad para el tratamiento sustitutivo; y por otra, aporta información sobre las posibilidades reales de esta alternativa terapéutica para algunas enfermedades(AU)

Introduction: in recent decades, interest in apheresis has increased due to advances in technology that have made them available to health professionals with access to specific equipment, safety, effectiveness and speed to perform these procedures in terms of transfusion and therapeutics.Objective: to present the experience gained at the Institute of Hematology and Immunology in performing different types of apheresis.Methods: adescriptive retrospective study was performed which included all patients who underwent an apheresis procedure between January 2008 and December 2013. Variables were: patient´s general data, the establishment of provenance, method where analyzed apheresis was performed, method used, and diseases requiring the proceeding.Results: 3 332 apheresis proceedings were done : 1 057 for production with thrombopheresis prevalence which ranked 96,68 percen Of the 1 078 therapeutic apheresis performed, the first place went to plasmapheresis with 26,5 percen, followed by exchange transfusions (15,8 percen); 1 197 apheresis of mononuclear cells and platelets to be used in regenerative medicine were also conducted.Conclusions: the results of this preliminary study show the gradual development in the use of apheresis procedures in our institution, with both production and therapy aims, which not only allows the diffusion of production of components by apheresis which provides physicians and patients in need of blood products with higher quality and security replacement therapy, but also provides knowledge about the actual possibilities for alternative therapy in some diseases(AU)

La miocardiopatía periparto como causa de insuficiencia cardiaca en el embarazo y el puerperio / Peripartum cardiomyopathy as a cause of heart failure in pregnancy and the postpartum period

La miocardiopatía periparto es una enfermedad con una elevada morbimortalidad y que, a pesar de sus riesgos potenciales, no es posible prevenirla. Por ello, solo podremos actuar sobre los factores de riesgo asociados a su aparición y sobre las complicaciones una vez diagnosticada. Debido a su baja incidencia, es difícil el conocimiento real de esta enfermedad, ya que se basa en artículos publicados sobre series reducidas de casos. El propósito de esta revisión es realizar una descripción de la fisiopatología, las manifestaciones clínicas, el diagnóstico y el tratamiento de la enfermedad, enfocada principalmente en el manejo obstétrico de la gestante (AU)

Peripartum cardiomyopathy is a serious disease with high morbidity and mortality. Despite its potential risks, prevention is not possible. Therefore, the only feasible strategy is to treat the risk factors and associated complications. Due to the low incidence of peripartum cardiomyopathy, is difficult to achieve real knowledge of this disease, which is based on small case series. This review aims to describe the pathophysiology, clinical manifestations, diagnosis and treatment of peripartum cardiomyopathy, with special emphasis on the obstetric management of pregnant women (AU)

Eficacia del implante de células mononucleares autólogas en el tratamiento de la periodontitis crónica / Effectiveness of autologous mononuclear cells implant in patients with chronic periodontitis

Introducción: los buenos resultados en la regeneración de tejidos mediante la implantación de células mononucleares en distintas especialidades médicas en el mundo y en Cuba, ha motivado a considerar el periodonto como candidato para esta terapia.Objetivo: determinar la eficacia del implante de células mononucleares autólogas en el tratamiento de la periodontitis crónica a 48 meses de evolución. Material y Métodos: se realizó un ensayo clínico fase III, aleatorizado y controlado en pacientes con periodontitis crónica durante los años 2008 a 2014. De ese grupo de pacientes se evaluaron 30 que tenían 48 ó más meses de recibir tratamiento en la consulta de Periodoncia del Hospital Enrique Cabrera en el período comprendido de febrero a mayo de 2015; 15 habían recibido tratamiento con células mononucleares (grupo estudio) y 15 terapia convencional (grupo control). La movilización a la sangre periférica de las células mononucleares se realizó mediante la aplicación del factor estimulador de colonias de granulocitos (FEC-G). Resultados: se aprecia una disminución del promedio de todas las variables clínicas, que es marcada en cada uno de los períodos evolutivos con respecto al estado inicial de los pacientes a los 6, 12, 36 y 48 meses posteriores al tratamiento en el grupo de estudio, mientras que en el control las manifestaciones de la enfermedad fueron reapareciendo paulatinamente a medida que avanzaba el tiempo post-tratamiento. Estos resultados fueron significativos. Conclusiones: la terapia celular regenerativa con células mononucleares autólogas es eficaz para el tratamiento de pacientes con periodontitis y su efecto es prolongado(AU)

Introduction: over the last years, in Cuba and other countries, encouraging results have been obtained in different medical specialties in the field of tissue regeneration by implanting stem cells; it has motivated us to consider periodontal tissue as a target for this therapy. Objective: To determine the efficacy of the implant of mononuclear autologous cells for the treatment of 48 months evolution chronic periodontitis. Material and Methods: 30 patients attending the Periodontology Clinic of the "Enrique Cabrera" hospital for over48 months during years 2008 to 2014 where included in the study, divided into two groups 15 patients each: group A were treated with autologous mononuclear cells and group B, who underwent classic therapy. The peripheral blood autologous mononuclear cells (MNC-SP) were mobilized with granulocyte colony- stimulating factor (G-CSF). Results: group A patients showed a significant average decrease in all clinical variables, more remarkable in every of the evolution periods as compared to the initial stage of every patient at 6, 12, 24 and 48 months after starting the treatment. In Group B patients, signs of the disease gradually reappeared as the post-treatment period proceeded.Conclusions: regenerative cell therapy with MNC-SP is effective and long lasting in patients with periodontitis(AU)