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BACKGROUND: The justification for this consensus is the absence of local protocols on Medication-Related Osteonecrosis of the Jaws (MONJ), for prevention, evaluation, and treatment, involving physicians and dentists, leading to suspension of antiresorptive treatments, despite their benefit in the prevention of fragility fractures (40-70%). These fractures cause disability and mortality (80% and 20-30%, respectively), as opposed to the low risk associated with MONJ in osteoporotic (0.01-0.03%) and oncological patients (1.3-1.8%). PURPOSE: To provide management recommendations through algorithms that guide health professionals to prevent, diagnose, and treat MONJ in different clinical scenarios. METHOD: A technical multidisciplinary team composed of specialists with extensive experience in osteoporosis or osteonecrosis of the jaw from Fundación Santa Fé (Bogotá, Colombia) and the Asociación Colombiana de Osteoporosis y Metabolismo Mineral was selected. Three rounds were carried out: definition of questions, answers using Delphi methodology, and the discussion of questions in order to have an agreement. The whole group participated in two phases, and the developer group in the total number of rounds. A literature review was conducted to obtain academic support to design questions with clinical relevance. RESULTS AND CONCLUSIONS: The consensus group generated definitions and recommendations useful for doctors and dentists, following clinical algorithms involving four scenarios: osteoporosis patient who requires dental procedures and has not received antiresorptives, osteoporosis patient who are under treatment with antiresorptives, cancer patients, and MONJ-instituted patients. The therapeutic approach in osteoporosis and cancer patients, in invasive dental procedures, must be relied on the risk-benefit treatment.

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La cirrosis es un estado avanzado de fibrosis, consecuencia de la progresión de la enfermedad hepática crónica, que se caracteriza por destrucción de la arquitectura hepática y predispone al desarrollo de carcinoma hepatocelular. La cirrosis produce cambios metabólicos complejos que conducen al desarrollo de alteraciones en el metabolismo óseo, conocidas como osteodistrofia hepática. En general, el deterioro de la masa y de la calidad ósea obedecen a factores múltiples, como son: las deficiencias nutricionales, el hipogonadismo, el uso de medicamentos, la deficiencia de vitamina D, la inflamación crónica y la gravedad de la enfermedad. La incidencia de osteoporosis es dos veces más alta en los pacientes con enfermedad hepática crónica, comparada con la de la población general. La tasa de fracturas vertebrales y no vertebrales se encuentra incrementada en la enfermedad hepática crónica, especialmente en mujeres posmenopáusicas. La disponibilidad de la densitometría ósea por absorciometría de rayos X de energía dual ha llevado a un aumento en el diagnóstico de osteoporosis y baja masa ósea en pacientes con enfermedad hepática. Por otra parte, la morfometría vertebral tiene un gran rendimiento para el diagnóstico de fracturas vertebrales asintomáticas. Se hace una actualización de la literatura científica de la enfermedad ósea en casos de hepatopatía crónica y de las recomendaciones para el manejo de pacientes con cirrosis, enfocado en la salud ósea.

Cirrhosis is an advanced stage of fibrosis; it is a consequence of the progression of chronic liver disease, characterized by destruction of architecture and predisposes to the development of hepatocellular carcinoma. Cirrhosis cause complex metabolic changes that led to the development of alterations in bone metabolism known as hepatic osteodystrophy (HO). In general deterioration of bone mass and quality are due to multiple factors such as nutritional deficiencies, hypogonadism, use of medications, vitamin D deficiency, chronic inflammation and severity of the disease. The incidence of osteoporosis is twice as high in patients with chronic liver disease compared with the general population. The rates of vertebral and nonvertebral fractures are increased in chronic liver disease, especially in postmenopausal women. The availability of DXA bone densitometry (BMD-DXA) has led to an increase in the diagnosis of osteoporosis and low bone mass (LBM)in patients with liver disease. Moreover, vertebral morphometry (VMP) has a high diagnostic yield of asymptomatic vertebral fractures. This an update of the literature on bone disease in patient with chronic liver disease and recommendations for the management of patients with cirrhosis, focusing on bone health.

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Se aislaron e identificaron los hongos presentes en granos de arroz manchados, de la variedad INCA LP-5, cosechados durante las épocas lluviosas de los años 2003 y 2005, en áreas de la Estación Experimental del Arroz “Los Palacios”, Pinar del Río, perteneciente al Instituto Nacional de Ciencias Agrícolas (INCA). Se determinó la incidencia y se realizaron las pruebas de patogenicidad mediante los postulados de Koch. Se identificaron 35 especies, correspondientes a 19 géneros de hongos asociados a granos manchados de la variedad INCA LP-5, y entre ellas se señalaron, como nuevos registros asociados al manchado del grano de arroz para Cuba a: Bipolaris maydis, Fusarium merismoides, F. solani, F. subglutinans, Penicillium itallicum, Phoma medicaginis var. pinodella y Syncephalastrum racemosum. Los hongos de mayor incidencia fueron Bipolaris oryzae, Sarocladium oryzae y especies de los géneros Alternaria, Fusarium, Curvularia y Phoma. Se confirmó que los hongos F. subglutinans, B. oryzae, A. padwickii, Alternaria sp., F. verticillioides, C. lunata, C. lunata var. aeria, C. pallescens, C. senegalensis, Curvularia sp., Phoma sp. y S. oryzae, son agentes causales del manchado del grano de arroz.

Isolation and identification of the fungi present in spotted rice grains of the INC LP-5 variety, harvested during the rainy seasons of the years 2003 and 2005, was done at sites of the Experimental Rice Station “Los Palacios”, Pinar del Río, belonging to the Instituto Nacional de Ciencias Agrícolas (INCA). Incidence was determined, and pathogenicity tests were carried out according to Koch’s postulates. Thirty-five species corresponding to 19 fungi genus associated to spotted grains of the INCA-LP-5 variety were identified, and among them, the following strains were indicated as new registrations associated to spotting of rice grains in Cuba: Bipolaris maydis, Fusarium merismoides, F. solani, F. subglutinans, Penicillium itallicum, Phoma medicaginis var. pinodella and Syncephalastrum racemosum. The fungi with the highest incidence were Bipolaris oryzae, Sarocladium oryzae and species of the genus Alternaria, Fusarium, Curvularia and Phoma. It was confirmed that the fungi F. subglutinans, B. oryzae, A. padwickii, Alternaria sp., F verticilloides, C. lunata, C.lunata var. aeria, C. pallescens, C. senegalensis, Curvularia sp., and S. oryzae, are causative agents of the spotting of rice grains.

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Los paragangliomas funcionales son tumores raros, originados en el tejido cromafín extraadrenal productor de catecolaminas, y su presentación durante el embarazo es aún más inusual; existen pocos casos de esta condición reportados en la literatura. No obstante, la sospecha de paraganglioma debe ser tenida en cuenta como diagnóstico diferencial en pacientes con hipertensión durante el embarazo; en especial, cuando esta se presenta de manera paroxística antes de la semana 20 de gestación, asociada a fogajes faciales, sin proteinuria ni edemas. La confirmación se realiza mediante pruebas bioquímicas e imagenológicas, y el tratamiento es principalmente quirúrgico; se da especial atención al control pre, trans y postoperatorio de las cifras tensionales y del estado hemodinámico de la paciente, dada la naturaleza del tumor. Este artículo presenta el caso de una mujer adulta con diagnóstico de paraganglioma funcional retroperitoneal, cuya primera manifestación clínica fue eclampsia. Seguidamente se hace una breve revisión de la literatura relacionada.

Functional paragangliomas are rare tumors which originate in the extra-adrenal chromaffin tissue which produces catecolaminas; and, their appearance during pregnancy is even rarer; very few cases have been reported upon in the literature. Nevertheless, the suspicion of paraganglioma should be considered as a differential diagnosis in pregnant patients with hypertension, especially when occuring paroxistically before the 20th month of gestation, and when associated with facial flushing unaccompanied by proteinuria or edemas. Confirmation is made with biochemical or imaging tests, and treatment is primarily surgical. Special attention is paid to patient´s blood pressure stats and hemodynamic state at pre-, trans- and postoperative stages, due to the nature of the tumor. This article presents the case of an adult female diagnosed with functional extradrenal paraganglioma whose first clinical manifestation was eclampsia. A brief review of the related literature is also included.

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La menina es una proteína supresora de tumor codificada por el gen MEN1, cuya mutación produce procesos neoplásicos en múltiples tejidos del organismo que pueden manifestarse por generaciones como síndromes familiares. La mutación genera un espectro de enfermedad que va desde el hiperparatiroidismo familiar aislado hasta la neoplasia endocrina múltiple de tipo 1, caracterizada por neoplasias de paratiroides, hipófisis anterior, páncreas endocrino y duodeno, entre otras. Como ejemplo, se presentan dos casos de pacientes con neoplasias endocrinas secundarias a la mutación del gen MEN1. Se revisa la información actual sobre la etiopatogenia y carcinogénesis entendidos apenas recientemente, al igual que otras mutaciones involucradas en los síndromes neoplásicos expuestos y se dan unas recomendaciones finales.

Menin is a tumor suppressor protein, encoded by the MEN1 gene, whose mutation can generate neoplastic disease in multiple tissues of the human body, which for generations can manifest as familial syndromes. The mutation generates a spectrum of diseases ranging from familial isolated hyperparathyroidism to multiple endocrine neoplasia type 1, characterized by neoplasm of parathyroid glands, anterior pituitary, endocrine pancreas and duodenum, among others. We present two cases of patients with endocrine neoplastic disease secondary to menin’s mutation. We review current information regarding its ethiopathogeny and its mechanism of carcinogenesis just recently understood. Additionally we review other mutations involved in the neoplastic syndromes exposed and present some final recommendations.

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6-Phosphogluconate dehydrogenase (6PGDH) is a key enzyme of the oxidative branch involved in the generation of NADPH and ribulose 5-phosphate. In the present work, we describe the cloning, sequencing and characterization of a 6PGDH gene from Leishmania (Leishmania) mexicana. The gene encodes a polypeptide chain of 479 amino acid residues with a predicted molecular mass of 52 kDa and a pI of 5.77. The recombinant protein possesses a dimeric quaternary structure and displays kinetic parameter values intermediate between those reported for Trypanosoma brucei and T. cruzi with apparent K(m) values of 6.93 and 5.2 µM for 6PG and NADP(+), respectively. The three-dimensional structure of the enzymes of Leishmania and T. cruzi were modelled from their amino acid sequence using the crystal structure of the enzyme of T. brucei as template. The amino acid residues located in the 6PGDH C-terminal region, which are known to participate in the salt bridges maintaining the protein dimeric structure, differed significantly among the enzymes of Leishmania, T. cruzi, and T. brucei. Our results strongly suggest that 6PGDH can be selected as a potential target for the development of new therapeutic drugs in order to improve existing chemotherapeutic treatments against these parasites.

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La familia es un conjunto de personas interactuantes, atadas al "clima" que ellas crean y en el cual se desenvuelven. El clima familiar nos aproxima a entender el comportamiento interpersonal de los miembros de una familia y evaluar su calidad funcional. Esta investigación es un estudio de campo, descriptivo, del clima familiar del estado Táchira, basado en la escala de clima familiar realizada y adaptada a Venezuela por Williams y colaboradores. El objetivo es elaborar el clima familiar para el Táchira; compararlo con el clima familiar venezolano; y determinar si existen diferencias entre estados socioeconómicos y la procedencia geográfica de las familias tachirenses. Se utilizó como instrumento la escala de clima familiar y el método de Graffar. Se seleccionó, aleatoriamente, una muestra de 136 familias. Al comparar el clima familiar nacional con los resultados obtenidos en el táchira no hubo grandes diferencias entre ambos, a excepción de la escala de control, que aparece con dos deciles menos para el Táchira; la escala de conflicto supera en un decil al parámetro nacional. Se observa una diferencia a favor del Táchira en la escala moral y religiosa y una diferencia significativa para el parámetro nacional en la escala orientación intelectual y cultural.

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