Comparative study of the level of health education of primary and secondary teachers

A study was carried out on the health education level among primary and secondary school teachers in the municipality of Artemisa, in relation with the prevention of the most frequent oral diseases. So, a sample representing 60% of the universe under study was surveyed. An assessing method was established rating sanitary education levels as good, deficient and poor. Comparisons were made among the different groups--by age, sex, educational level, and negative points which influenced most on the rating in connection with the health education levels. Finally, it is concluded that the health education level is deficient for the largest percent of the group under study.     

Beh?et's syndrome. Report of the first case in Cuba

This paper deal with the case of a patient undergoing Beh?et's disease, with ulcerous lesions in the oral cavity and scrotum. A brief review of this entity, not yet reported in our country, is carried out. Value of immunomodulating therapy (interferon and levamisole) in the elongation of disease relapses is pointed out.     

The systemic vasodilatory action of protamine: is it inhibited or mediated by heparin?

The administration of protamine to neutralize the circulating heparin is common practice in cardiovascular surgery. The use of this drug is some-times associated with hemodynamic alterations of varying degree and intensity (systemic hypotension, pulmonary hypertension and even cardiogenic shock). An intrinsic action of protamine has been suggested to be the cause of these vascular reactions. This action is blocked when protamine forms a complex with heparin, although in other cases it appears that the heparin-protamine complex is the factor responsible for these hemodynamic alterations. The aim of this experimental study was to characterize the vasodilatory action of protamine on the systemic circulation, determining whether or not it is dose-dependent; to analyze the role of endothelium; and to evaluate whether this vasodilatory effect is modified by the presence of heparin. Materials and methods. The abdominal aorta was dissected from eight New Zealand rabbits and then sectioned into vascular rings for study in an organ chamber. Mechanical disruption of endothelium was performed on some rings (n = 14). Once submaximal contraction was reached (ClK 80 mM), protamine sulfate with a final concentration in the organ chamber of 80–400 μg/ml was added to one of the groups (n = 12). In the second group (n = 12), equal con-centrations of protamine were tested in the presence of heparin at a final concentration of 100 U/ml. Results. The mean vasodilatation reached in the group of rings exposed only to protamine was 95.4±1.5% with respect to the submaximal contraction induced with ClK. In the second study group, the rings were exposed to protamine at equally increasing concentrations (80–400 μg/ml) but with the presence of heparin in the organ chamber. The mean vasodilatation in this group was 90±1.5. No statistically significant differences in vasodilatation were found between this group and the protamine without heparin group. On the other hand, in the endothelium-denuded rings (n = 14) exposed to isolated protamine and to protamine-heparin, no vasodilatory response was observed. Conclusion. Our results show that the administration in vitro of protamine induces endothelium-dependent vasodilatation of the systemic circulation. Likewise, this relaxing effect mediated through endothelium is not blocked when protamine forms a complex with heparin in comparable concentrations of both drugs. Based on these preliminary findings, we believe that in highrisk patients the prevention of systemic vasodilatation and cardiovascular collapse produced by protamine should move towards the use of other substances that can neutralize the anticoagulant effect of heparin or towards pre-medication guidelines that prevent these secondary effects in the case of protamine administration.     

Infections in cardiac transplant recipients: clinical and microbiological characteristics and consequences

INTRODUCTION: Infections are one of the main complications that cause morbidity and mortality in cardiac transplant recipients. We sought to establish the incidence of infections, identify the predisposing factors and determine their consequences. PATIENTS: A prospective study of 30 patients who received cardiac transplantations in our hospital from July 2003 to May 2005. RESULTS: Of the 30 transplant recipients, 93.3% were men (average age, 48 years); the average age of the women was 53 years. The incidence of infection was 70%: 21 episodes of infection. The main clinical symptoms were bacteriemia (28%), pneumonia (19%), and surgical wound infections (14%). The etiology of the infection, as established in 12 cases (57%), was bacterial (66%), viral (25%), or fungal (9%). The most common microorganisms were cytomegalovirus and coagulase-negative staphylococcus. None of the donors had a history of infection. There was a higher frequency of serious complications, such as renal failure (12.9%), respiratory insufficiency (9.6%), and multiorgan failure (9.6%) among patients with versus without infections (P < .05). The 1-year survival rate of patients with infections was similar to that of patients with no infections (83% vs 88%, P = NS). CONCLUSIONS: The incidence of infections was 70%. Bacteremia, pneumonia, and surgical wound infections occurred most frequently. Cytomegalovirus and coagulase-negative staphylococcus were the most frequent microorganisms. Patients with infections had the most serious complications, but their survival rate was similar to that of patients free of this complication.     

Evaluation of the role of RET polymorphisms/haplotypes as modifier loci for MEN 2, and analysis of the correlation with the type of RET mutation in a series of Spanish patients

Multiple endocrine neoplasia type 2 (MEN 2) is an autosomal dominant cancer syndrome, which is divided into three subtypes: MEN 2A, MEN 2B and familial medullary thyroid cancer (FMTC). Approximately 92% of MEN 2 cases are caused by mutations in exons 10, 11, 13-16 of the RET proto-oncogene. There exists inter- and intra-familial phenotypic variability among the MEN 2 families, even when the disease is caused by the same RET mutation, suggesting a role for genetic modifiers, such as polymorphisms/haplotypes. We have sought to determine the frequency and position of RET germline mutations in a cohort of 114 Spanish probands with any sign of MEN 2, and to search for putative modifier loci. Mutational screening of RET revealed 9 different mutations, present in 26 of the 114 probands (22.8%). In addition, distributions of 8 RET polymorphisms and the haplotypes comprising them, were studied in the context of the families positive for RET mutational screening, in order to evaluate them as genetic modifiers. The relationship between RET mutation type and presence of a polymorphism/haplotype was analyzed. The relationship between the presence of pheochromocytoma (PC) and/or hiperparathyroidism (HPT) in carriers of the same RET mutation, and the genotype for the specific variants was also studied. The results derived from those analyses revealed no associations of any variant/haplotype to a specific mutation or to the clinical presentation. Nevertheless, these observations do not permit us to exclude the possible role of other variants in RET or other related genes, in the final presentation of the disease.     

Economic,clinical, and humanistic outcomes (ECHOs) of pharmaceutical care services for minority patients: A literature review

BackgroundThe U.S. population of racial/ethnic minorities continues to increase; however, health disparities and poor health outcomes among many of them continue to be a major public health problem confronting the U.S. health care system.ObjectivesThe objective of this review was to summarize published pharmaceutical care services literature reporting economic, clinical, and/or humanistic outcomes (ECHOs) among racial/ethnic minorities. Studies that reported differences by race/ethnicity and studies where most participants were from multiracial/ethnic minorities were included.MethodsPubMed and International Pharmaceutical Abstracts databases were searched for articles that reported the effects of pharmaceutical care on ECHOs among racial/ethnic minorities published between January 1980 and November 2010. The literature review was focused on racial groups that included black/African-American, Native American, Indian American Asian, Alaska Native, Native Hawaiian, and Pacific Islander patients, and ethnic group that was non-white Hispanic/Latino patients.ResultsThere were 24 articles that studied the impact of pharmaceutical care on ECHOs by race/ethnicity or where most participants were from multiracial/ethnic minorities. Twenty-three studies reported that pharmaceutical care has a positive impact on health outcomes of the studied populations. About half of the studies meeting inclusion criteria evaluated only 1 type of patient outcome, primarily clinical outcomes. Education/consultation and medication/therapy management were the most commonly evaluated types of pharmaceutical care services throughout the studied groups. Comprehensive disease management was evaluated mainly in multiracial/ethnic populations and blacks/African-Americans. Few studies adopted randomized controlled designs, which make it difficult to attribute changes in patient outcomes to the provision of pharmaceutical care. Nine studies that involved cooperation between pharmacists and other medical professionals reflect an increased tendency for interprofessional collaboration in the current health care system.ConclusionThis review shows that there is a positive relationship between pharmaceutical care and ECHOs in patients from racial/ethnic minority groups. However, more studies are needed to document the effects of pharmaceutical care on reducing racial/ethnic health disparities and to determine which interventions are most effective among certain groups with health disparities.