Vasculitis aórtica en un paciente con lupus eritematoso sistémico / Aortic vasculitis in a patient with systemic lupus erythematosus

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Osteopoiquilia con afectación de la columna vertebral, una presentación atípica / Osteopoikilosis with involvement of the spine, an atypical presentation

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Viscoelasticity and texture of spreadable cheeses with different fat contents at refrigeration and room temperatures.

The effect of the 2 common consumption temperatures, refrigeration temperature (10°C) and room temperature (22°C), on the viscoelasticity, mechanical properties, and perceived texture of commercial cream cheeses was studied. Two samples with different fat contents, regular and low fat, from each of 4 selected commercial brands were analyzed. The selection criteria were based on identification of brands with different percentages of fat content reduction between the regular- and low-fat samples (35, 50, 84, and 98.5%). The fat content of regular-fat samples ranged from 19.8 to 26.0% (wt/wt), and that of low-fat samples ranged from 0.3 to 13.0% (wt/wt). Viscoelasticity was measured in a controlled-stress rheometer using parallel-plate geometry, and the mechanical characteristics of samples were measured using the spreadability test. Differences in the intensity of thickness, creaminess, and roughness between the regular- and low-fat samples of each commercial brand were evaluated at each of the selected temperatures by using the paired comparisons test. At 10°C, all samples showed higher viscoelastic modulus values, firmness, and stickiness, and lower spreadability than when they were measured at 22°C. Differences in viscoelasticity and mechanical properties between each pair of samples of the same brand were greater at 10°C than at 22°C because of the influence not only of fat content but also of fat state. Ingestion temperature did not modify the sensory differences detected between each pair of samples in terms of creaminess and roughness, but it did modify the differences detected in thickness. The joint consideration of sample composition, fat state, and product behavior during oral processing could explain the differences detected in thickness perceived because of measurement temperatures.

Tratamiento de la endometriosis con 5 mg o 25 mg diarios de mifepristona durante 6 meses. Ensayo clínico aleatorizado, doble ciego / Treatment with 5mg or 25mg of mifepristone daily for six months. A randomized double-blind study

Objetivos. Evaluar la eficacia y seguridad de 5 y 25 mg de mifepristona en el tratamiento de la endometriosis. Diseño. Ensayo clínico aleatorizado, doble ciego. Lugar. Hospital Eusebio Hernández, La Habana, Cuba. Sujetos. Veintiséis mujeres con diagnóstico laparoscópico de endometriosis. Tratamientos. Grupo I: una tableta oral diaria de 25mg de mifepristona, o grupo II: una tableta oral diaria de 5mg de mifepristona, durante 6 meses. Se realizó laparoscopia y biopsia endometrial pre y postratamiento. Variable para evaluar eficacia. Reducción de la intensidad de la dismenorrea medida por una escala visual análoga. Resultados. En ambos grupos las disminuciones de la intensidad de la dismenorrea y la dispareunia fueron muy significativas comparadas con los valores iniciales. Todas las mujeres estaban en amenorrea a los 45 días de tratamiento. Conclusiones. La mifepristona, en dosis de 25 o 5mg, podría ser una alternativa para el tratamiento de la endometriosis (AU)

Objectives. To evaluate the safety and efficacy of 5 mg and 25 mg doses of mifepristone for the treatment of endometriosis. Design. Randomized double-blind study. Setting. Eusebio Hernández Hospital, Havana, Cuba. Subjects. Twenty-six women laparoscopically diagnosed with endometriosis were included. Treatment. Group I received one tablet of 25mg mifepristone daily and group II received one tablet of 5mg mifepristone daily for 6 months. Laparoscopy and endometrial biopsy were performed before and after treatment. Variable to evaluate efficacy. Reduction in the intensity of dysmenorrhea measured by a visual analogue scale. Results. In both groups reductions in the intensity of dysmenorrhea and dyspareunia were highly significant compared with initial values (P<.001). All the women were amenorrheic after 45 days of treatment. Conclusions. At doses of 5mg or 25mg, mifepristone could be an alternative for the treatment of endometriosis (AU)

Manejo activo de la tercera fase del parto más 400 mg de misoprostol sublingual y 200 mg de misoprostol rectal frente a manejo activo solo en la prevención de la hemorragia posparto. Ensayo clínico aleatorizado / Active management of the third phase of labour plus 400 mg of sublingual misoprostol and 200 mg of rectal misoprostol versus active management only in the prevention of post-partum haemorrhage. A randomised clinical trial

Objetivos: Evaluar la eficacia y la seguridad de 400 mg de misoprostol por vía sublingual y 200 mg rectal más manejo activo de la tercera fase del parto frente a manejo activo para prevenir la hemorragia posparto. Sujetos y métodos: Se sometió a 1.400 mujeres a recibir el misoprostol más manejo activo (grupo I) o manejo activo (grupo II). Las variables medidas fueron la incidencia de hemorragia posparto, el volumen de sangre perdido y el uso de uterotónicos adicionales. Resultados: En el grupo I hubo 28/702 (4,0%) hemorragias y en el grupo II 50/698 (7,2%), p = 0,005; riesgo relativo (RR) = 0,538; intervalo de confianza (IC) del 95% para RR (0,335-0,866). En mujeres con hemorragia posparto, el volumen de sangre perdida fue 981 ± 309 cc y 888 ± 326 cc, p = 0,225 en los grupos I y II, respectivamente. Necesitaron uterotónicos adicionales 33 (4,7%) frente a 54 (7,7% mujeres, p = 0,025 en los grupos I y II, respectivamente). Conclusiones: Se podría recomendar la administración de misoprostol por vía sublingual/rectal junto al manejo activo para prevenir la hemorragia posparto (AU)

Objectives: To evaluate the efficacy and safety of 400 mg sublingual misoprostol and 200 mg rectal misoprostol plus active management of the third stage of labour versus active management only to prevent postpartum haemorrhage. Subjects and methods: A total of 1400 women were randomly assigned to receive misoprostol plus active management (group I) or active management only (group II). The variables studied were incidence of postpartum haemorrhage, blood volume lost and need of additional uterotonics. Results: In group I there were 28/702 (4.0%) haemorrhages and in group II 50/698 (7.2%), P=.005; RR =.538; 95% CI for RR (0.335-0.866). In women having postpartum haemorrhage the lost blood volume was 981 ± 309 cc and 888 ± 326 cc. P=.225 in groups I and II, respectively. Additional uterotonics were needed in 33 women in group I (4.7%) vs. 54(7.7%) women in group II (P=.025). Conclusions: The use of sublingual/rectal misoprostol plus active management appears to be useful for the prevention of postpartum haemorrhage (AU)

Ensayo clínico, aleatorizado y controlado para evaluar la eficacia y la seguridad de la administración de 25 µg de misoprostol vaginal frente a 50 µg de misoprostol sublingual para la inducción del trabajo del parto / Randomized, controlled clinical trial to evaluate the safety and efficacy of 25 µg of vaginal misoprostol versus 50 µg of sublingual misoprostol for labor induction

Objetivos: Comparar la eficacia y la seguridad de 25 µg de misoprostol intravaginal frente a 50 µg de misoprostol sublingual en la inducción del trabajo del parto. Pacientes y métodos: Un total de 450 mujeres fueron asignadas de forma aleatoria a recibir 25 µg de misoprostol vaginal o 50 µg sublingual cada 4 h hasta 4 dosis. La variable principal fue el número de partos vaginales en 24 h. Resultados: Un total de 155 (68,9%) de 225 pacientes del grupo sublingual y 154 (68,4%) de 225 del grupo vaginal habían tenido un parto transpelviano (p = 0,920; riesgo relativo [RR] = 1,021; intervalo de confianza [IC] del 95% para RR, 0,685-1,521). El tiempo de inicio del trabajo de parto (promedio ± desviación estándar [DE]) fue de 2,75 ± 2,20 h en el grupo sublingual y de 3,8 ± 2,77 h en el vaginal (p < 0,001). El promedio (± DE) de dosis fue de 1,9 ± 0,8 en el grupo vaginal y de 1,6 ± 0,8 en el sublingual (p = 0,010). Las indicaciones de las cesáreas fueron similares en ambos grupos, al igual que la frecuencia de taquisistolia. Se usó más oxitocina en el grupo vaginal (22,7%) que en el sublingual (14,7%) (p = 0,020). Conclusiones: No se encontraron diferencias significativas entre los 2 grupos de tratamiento, en lo que respecta a la variable principal: número de partos vaginales en 24 h

Objectives: To compare the safety and efficacy of 25 µg of vaginal misoprostol versus 50 µg of sublingual misoprostol for induction of labor. Patients and methods: Four hundred fifty women were randomly assigned to receive 25 µg of vaginal misoprostol or 50 µg of sublingual misoprostol every 4 h for up to four doses. The main outcome assessed was the number of vaginal deliveries in 24 h. Results: A total of 155/225 (68.9%) patients in the sublingual group and 154/225 (68.4%) women in the vaginal group delivered vaginally (p = 0.920; RR = 1.021; 95% CI for RR, 0.685-1.521). The mean time (± standard deviation) for starting labor was 2.75 ± 2.20 h in the sublingual group and 3.8 ± 2.77 h in the vaginal group (p < 0.001). The mean number (± standard deviation) of doses was 1.9 ± 0.8 in the vaginal group and 1.6 ± 0.8 in the sublingual group (p = 0.010). Indications for cesarean section and the frequency of tachysystole were similar in both groups. There was a greater need for oxytocin in the vaginal group (22.7%) than in the sublingual group (14.7%) (p = 0.020). Conclusions: No statistically significant differences were found between the 2 treatment groups in the main variable: the number of vaginal deliveries in 24 h

Infecció neonatal per VRS i possibles seqüeles amb sibilàncies de repetició / No disponible

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Sindactilias complejas y complicadas. Revisión y avances terapéuticos / Complex and complicated syndactyly. Review

Sindactilia compleja es aquélla en la que los dedos están unidos por hueso, además de piel, si bien hay casos en los que sin haber fusión ósea la aparición de interconexiones nerviosas, vasculares o tendinosas hace que se los denomine igualmente de este modo. Además, si los huesos unidos son anómalos, lo cual es frecuente (falanges delta, braquidactilia, etc.), la sindactilia se denomina 'complicada'. Presentamos nuestra técnica y resultados en el tratamiento de 35 pacientes con sindactilia congénita compleja o complicada, así como 58 niños con sindactilia adquirida en el contexto de quemaduras y epidermolisis bullosa (AU)

[Complex and complicated syndactylia. Review and treatment progress]. / Sindactilias complejas y complicadas. Revisión y avances terapéuticos.

Complex syndactyly is generally defined as abnormal digital interconnection by bone, but sometimes simple syndactyly with complicated cutaneous, musculotendinous or neurovascular interconnections should be considered complex as well. Additionally, complex syndactyly involving anomalous bones (delta phalanx, brachiphalangism...) falls in different category called "complicated". 35 patients with complex or complicated congenital syndactyly are studied and 58 children with cutaneous syndactyly due to burns and epidermolysis bullosa are analyzed as well.

[Epidemiology of dengue and hemorrhagic dengue in Santiago, Cuba 1997]. / La epidemiología del dengue y del dengue hemorrágico en Santiago de Cuba, 1997.

A dengue epidemic that Cuba reported in 1997 registered more than 500,000 cases of dengue fever produced by viral serotype 1. In 1981, there was an epidemic of dengue hemorrhagic fever produced by serotype 2 of the virus. This time 344,203 clinical cases were reported, 10,312 of which were severe cases of hemorrhagic fever that led to 158 fatalities (101 of them among children). The reintroduction of dengue, and specifically of dengue viral serotype 2 (Jamaica genotype), was quickly detected in January 1997 through an active surveillance system with laboratory confirmation of cases in the municipality of Santiago de Cuba, in the province of the same name. The main epidemiological features of this outbreak are reported in this paper. A total of 3,012 cases were reported and serologically confirmed. These included 205 cases classified as dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS), 12 of which were case fatalities (all among adults). Secondary infection with dengue virus was one of the most important risk factors for DHF/DSS. Ninety-eight percent of the DHF/DSS cases and 92% of the fatal cases had contracted a secondary infection. It was the first time dengue hemorrhagic fever was documented as a secondary infection 16 to 20 years after initial infection. Belonging to the white racial group was another important risk factor for DHF/DSS, as had been observed during the 1981 epidemic. During the most recent epidemic it was demonstrated that the so called "fever alert" is not useful for early detection of an epidemic. Measures taken by the country's public health officials prevented spread of the epidemic to other municipalities plagued by Aedes aegypti.

Misoprostol 3, 4, or 5 days after methotrexate for early abortion. A randomized trial.

A randomized trial was conducted including 287 pregnant women seeking elective abortion to compare the efficacy of misoprostol given 3, 4, or 5 days after methotrexate for abortion at < or = 63 days' gestation. Subjects received 50 mg/m2 methotrexate intramuscularly and were randomly allocated to self-administer vaginally 800 micrograms of misoprostol 3, 4, or 5 days after the methotrexate. The misoprostol dose was repeated 48 and 96 h later if the abortion did not occur. Outcome measures included successful abortion (complete abortion without requiring a surgical procedure), and side effects. Eighty-six cases (93%; 95% confidence interval [CI] 85%-97%) aborted in Group I; 90 cases (92%; 95% CI 84%-96%) aborted in Group II (relative risk [RR] = 1.09; RR 95% CI 0.38-3.14); and 89 (93%; 95% CI 86%-97%) cases aborted in Group III (RR = 0.97; RR 95% CI 0.33-2.87). No significant statistical differences were obtained for the success rates when misoprostol was given days 3, 4, or 5 after the administration of methotrexate (p = 0.97) nor with any of the characteristics of the subjects. Complete abortion occurred in 265/287 (92%; 95% CI 89%-95%) patients. Twenty-two cases (8%; 95% CI 5%-11%) resulted in failure. Side effects for methotrexate were minimal while for misoprostol they were moderate. This combination could be an alternative to surgical abortion or the use of antiprogestins and prostaglandins for medical abortion.

PIP: A randomized trial was conducted including 287 pregnant women seeking elective abortion to compare the efficacy of misoprostol given 3, 4, or 5 days after methotrexate for abortion at 63 days or less gestation. Subjects received 50 mg/sq. m methotrexate intramuscularly and were randomly allocated to self-administer vaginally 800 mcg of misoprostol 3, 4, or 5 days after methotrexate administration. The misoprostol dose was repeated 48 and 96 hours later if the abortion did not occur. Outcome measures included successful abortion (complete abortion without requiring a surgical procedure) and side effects. 86 cases [93%; 95% confidence interval (CI), 85-97%] aborted in Group I; 90 cases (92%; 95% CI, 84-96%) aborted in Group II [relative risk (RR) = 1.09; RR 95% CI, 0.38-3.14]; and 89 cases (93%; 95% CI, 86-97%) aborted in Group III (RR = 0.97; RR 95% CI, 0.33-2.87). No significant statistical differences were obtained for the success rates when misoprostol was given days 3, 4, or 5 after methotrexate administration (p = 0.97) nor with any of the characteristics of the subjects. Complete abortion occurred in 265/287 patients (92%; 95% CI, 89-95%). 22 cases (8%; 95% CI, 5-11%) resulted in failure. Side effects for methotrexate were minimal, while for misoprostol they were moderate. This combination could be an alternative to surgical abortion or the use of antiprogestins and prostaglandins for medical abortion.

[Pancreatic secretion in rats treated with intra-aortic prostaglandin E1]. / Secreción pancreática en ratas tratadas con prostaglandina E1 intraaórtica.

The effects from one dose of PGE1 on the endocrine pancreatic secretions have been studied in rat. The dose is injected i.a. very near the pancreas in the abdominal aorta at the level of the caeliac artery. Glycemia, insulinemia and glucagonemia are studied after i.v. glucose injection in: a) normal rats; b) rats free from their endogenous rate of PGs by previous treatment with indomethacin i.p. and c) with an excessive rate of PGE1. The treatment with PGE1 produces an inhibitory effect on the insulinic response to glucose, as well as hyperglycemia and hyperglucagonemia. In the cases without the endogenous rat of PGs the insulinic secretion as a response to glucose is greatly improved.