RESUMEN Se presenta revisión narrativa sobre nefritis intersticial crónica de comunidades agrícolas (CINAC, siglas del inglés Chronic Interstitial Nephritis in Agricultural Communities). Se discute la etiología, manifestaciones clínicas, manejo diagnóstico y terapéutico de esta afección.

ABSTRACT A narrative review on Chronic Interstitial Nephritis in Agricultural Communities (CINAC) is presented. The etiology, clinical manifestations, diagnostic and therapeutic management of this condition are discussed.

RESUMO Estomatite aftosa, uma entidade clínica cuja principal manifestação é o aparecimento de aftas. A busca por medicamentos eficazes para tratá-lo é um "desafio para a comunidade médica". Um ensaio clínico terapêutico randomizado de fase IIb foi realizado, os pacientes portadores da doença foram utilizados no delineamento experimental e desejaram cooperar com o estudo. O objetivo proposto foi avaliar a eficácia e segurança de Propomiel em relação ao tratamento convencional da Febre Aftosa. A amostra foi composta por 102 pacientes, dois grupos de 51 pacientes cada um foram formados; no grupo A (experimental) propomiel foi aplicado e no grupo B (controle) 0,2% de clorexidina aquosa. As variáveis foram consideradas: faixa etária, sexo, dor, cicatrização, tempo, efeito terapêutico, eventos adversos e gravidade dos eventos adversos. Determinou-se a possível existência de diferenças significativas entre as duas terapêuticas por meio do teste de homogeneidade, teste X2 ou teste exato de Fisher com 95% de confiabilidade (p <0,05). Os resultados mostraram a maioria dos pacientes de 19 a 34 anos de idade e sexo feminino, assim como na ausência e intensidade dolorosa; após as 3 primeiras aplicações, 100% dos pacientes melhoraram (grupo experimental) e 86,27 (grupo controle). Após 5 dias, 98,04% das lesões haviam cicatrizado (grupo A) e 90,20% (grupo B). Não houve eventos adversos. Conclui-se que o tratamento com propomel na estomatite aftosa demonstrou eficácia terapêutica e segurança sem diferenças significativas em relação a clorexidina aquosa a 0,2%.

ABSTRACT Aphthous stomatitis, a clinical entity whose main manifestation is the appearance of canker sores. The search for effective medications to treat it is a "challenge for the medical community." A randomized phase IIb therapeutic clinical trial was carried out. Patients carrying the disease were used in the experimental design and wished to cooperate with the trial. The proposed objective was to evaluate the efficacy and safety of Propomiel in relation to the conventional treatment of Foot-and-Mouth Disease. The sample comprised 102 patients, two groups of 51 patients each were formed; in group A (experimental) propomiel was applied and in group B (control) 0.2% aqueous chlorhexidine. The variables that were taken into account: age group, sex, pain, healing, time, therapeutic effect, adverse events and severity of adverse events. It was determined possible existence of significant differences between both therapeutics by means of the homogeneity test, X2 test or Fisher exact probability test with a 95% reliability (p <0.05). The results showed the majority of patients 19-34 years of age and female sex, as well as in absence and painful intensity; after the first 3 applications, 100% of the patients had improved (experimental group) and 86.27 (control group). After 5 days, 98.04% of the lesions had healed (group A) and 90.20% (group B). There were no adverse events. It is concluded that propomel treatment in aphthous stomatitis demonstrated therapeutic efficacy and safety without significant differences with respect to 0.2% aqueous chlorhexidine.

RESUMEN La Estomatitis Aftosa, entidad clínica cuya manifestación principal es la aparición de aftas bucales. La búsqueda de medicamentos eficaces para tratarla es un “reto para la comunidad médica”. Se realizó un ensayo clínico terapéutico en fase IIb, aleatorizado, se empleó en el diseño experimental pacientes portadores de la enfermedad, que desearon cooperar con el ensayo; el objetivo propuesto fue evaluar la eficacia y seguridad del Propomiel con relación al tratamiento convencional de la Estomatitis Aftosa. La muestra abarcó 102 pacientes, se conformaron dos grupos de 51 pacientes cada uno; en grupo A (experimental) se aplicó propomiel y en grupo B (control) clorhexidina acuosa al 0.2 %. Las variables que se tuvieron en cuenta: grupo de edades, sexo, dolor, cicatrización, tiempo, efecto terapéutico, eventos adversos y severidad de los eventos adversos. Se determinó posible existencia de diferencias significativas entre ambas terapéuticas mediante la prueba de homogeneidad, prueba de X2 o Prueba de probabilidades exactas de Fisher con una confiabilidad del 95 % (p<0,05). Los resultados mostraron mayoría de pacientes de 19-34 años y sexo femenino, así como en ausencia e intensidad dolorosa; tras las 3 primeras aplicaciones el 100 % de los pacientes habían mejorado (grupo experimental) y el 86,27 (grupo control). A los 5 días el 98,04 % de las lesiones habían curado (grupo A) y el 90,20 % (grupo B). No hubo eventos adversos. Se concluye que el tratamiento con propomiel en la estomatitis aftosa demostró eficacia terapéutica y seguridad sin diferencias significativas con respecto a la clorhexidina acuosa al 0.2 %.

Annular Granuloma is benign chronic inflammatory dermatoses of unknown etiology, usually self-limited. In many cases tuberculoid leprosy resembles an Annular Granuloma and this should always be a differential diagnosis to be considered. The relationship between Annular Granuloma and Leprosy is not yet clear, although it may be related to immunological mechanisms triggered in the course of both diseases. For these reasons it is presented a case of a patient with cutaneous manifestations of annular generalized granuloma, whose onset was concomitant with the ninth month of treatment for Hansen’s disease (tuberculoid clinical form). The main cutaneous manifestations presented were erythematous, papular and annular lesions, predominantly small in size, forming large plaques, located in the neck, upper region of the back and limbs. Histological alterations of the disease were detected, which corroborated the diagnosis. The case is presented because, in the consulted literature, this disease is not frequently described in association with Hansen’s disease.

El granuloma anular es una dermatosis inflamatoria crónica, benigna, de etiología desconocida, generalmente autolimitada. En muchas ocasiones la lepra tuberculoide asemeja un granuloma anular y este siempre debe ser un diagnóstico diferencial a tener en cuenta. La relación entre el granuloma anular y la lepra aún no está muy clara, aunque pudiera estar relacionado con mecanismos inmunológicos desencadenados en el curso de ambas enfermedades. Por tales razones se presenta el caso de una paciente con manifestaciones cutáneas de ungranuloma anulargeneralizado, cuyo comienzo fue concomitante con el noveno mes de tratamiento para la enfermedad de Hansen (forma clínica tuberculoide). Las principales manifestaciones cutáneas que presentaba eran lesiones eritematosas, papulosas y anulares, de tamaños predominantemente pequeño, formando grandes placas, localizadas en cuello, región superior de la espalda y miembros. Se detectaron las alteraciones histológicas propias de la enfermedad, lo que corroboró el diagnóstico planteado. Se presenta el caso porque,en la literatura consultada, esta enfermedad no está descrita frecuentemente en asociación con la enfermedad de Hansen.

Background: patients with human immunodeficiency virus frequently develop skin conditions that affect their quality of life and modify their prognosis. Objective: to describe the most common skin conditions in patients with human immunodeficiency virus. Methods: a case-series study of patients with human immunodeficiency virus was conducted in the province of Cienfuegos. It included all patients diagnosed until February 2008 attending the internal medicine consultation for their follow-up. Forty-seven deceased patients, 12 patients not living in the province and 2 inmates were excluded from the study. Variables analyzed were: age, sex, skin color, self-reported skin conditions and diagnosed skin diseases. Results: Thirty-eight percent of patients were aged 25 to 34 years. Fifty-seven were white-skinned and 75% were male. Approximately half of the patients had AIDS and were under antiretroviral therapy. The skin infection of viral origin most commonly found was herpes simplex (30.0%); of fungal origin, onychomycosis (44 %); and of bacterial origin, folliculitis (43 %). Among papulosquamous disorders, seborrheic dermatitis (74 %) predominated and among other skin disorders, lipodystrophy (23.6 %). Xerosis and pruritus shared equal percentage (16.3 %). Conclusions: viral and fungal skin infections predominated. An important number of these skin conditions were diagnosed during the study, particularly in AIDS patients.

Fundamento: las afecciones dermatológicas se presentan con frecuencia en pacientes con virus de inmunodeficiencia humana, afectan su calidad de vida e inciden en el pronóstico de estos. Objetivo: describir las afecciones dermatológicas más frecuentes en los pacientes con virus de inmunodeficiencia humana. Métodos: estudio de serie de casos en individuos con virus de inmunodeficiencia humana en la provincia de Cienfuegos, que incluyó a todos los pacientes diagnosticados hasta febrero de 2008 que acudieron a consulta planificada de medicina interna para su seguimiento evolutivo. Se excluyeron 47 pacientes fallecidos, 12 pacientes no residentes en la provincia y 2 reclusos. Se analizaron: edad, sexo, color de la piel, dermatosis referidas, dermatosis diagnosticadas. Resultados: el 38 % de los pacientes tenía entre 25 y 34 años. El 57 % era de piel blanca y 75 % del sexo masculino. Aproximadamente la mitad tenía sida y estaba bajo tratamiento antirretroviral. La dermatosis de origen viral más frecuentemente encontrada fue el herpes simple (30,0 %); de etiología micótica, la onicomicosis (44 %); de etiología bacteriana, la foliculitis (43 %); entre las pápulo escamosas, la dermatitis seborreica (74 %) y dentro de otros desórdenes dermatológicos, la lipodistrofia (23,6 %); mientras que la xerosis de la piel y el prurito compartieron igual porcentaje (16,3 %).Conclusiones: predominaron las dermatosis de etiología viral y micótica. Una parte importante de esas dermatosis fueron diagnosticadas durante la investigación, con mayor frecuencia en pacientes con sida.

The study of vegetation from the Geography perspective focuses on the analysis of the spatial distribution and on the factors affecting it. One of these factors is the climate, which determines the characteristics of the vegetation and, on a larger scale, of the communities. The aim of this paper is to analyze the climate-vegetation relationship by studying adaptations of the jarillal community regarding the semiarid climate in the Lihué Calel National Park, Argentina. Therefore, this contribution is concerned with the knowledge of the characteristics of the environment in order to understand how vegetation responds to certain phenomena, so management of protected areas will be more suitable. Lihué Calel National Park is a national protected area located in the south-center of La Pampa province, Argentina. According to Cabrera (1976) the area belongs to the floristic province of "monte" and the climate is warm and dry. In the interest to achieve the goals of this paper, Thornthwaite and Mather's water balance was done. The data was collected from a weather station that belongs to the national park, for the period 1995-2010. Emberger's pluviothermic coefficient, Lang's rainfall index, De Martonne' s aridity index and Currey's continentality index were analyzed. In addition, ten stands or plots of vegetation were placed to determine the floristic composition and the vegetation physiognomy. Then, plants species were identified as individuals and their adaptive responses were also analyzed. In conclusion, the survey verified that semi-arid climate conditions determine the morphology and the appearance of jarillal . Climate analysis shows that for the period 1995-2010 the average annual temperature is 16.2° C and reveals that thermal summers and winters are well differentiated. Large water deficit is defined, because water balance indicates that the evapotranspiration exceeds precipitation during every month of the year. According to Thornthwaite's criteria, the area is a semiarid climate type. With the analysis of other bioclimatic indices, more information is obtained: Lang's index value is 25.7 (arid), Emberger's index is 41.8 (semiarid), De Martonne's index is 15.9 (that refers to a semi-arid climate) and, at last, Currey's index certified the existence of a continental climate because the result was 1.16. Vegetation was surveyed and the result was quite interesting: 1 508 individuals that belong to 33 species. The percentage is: shrubs 57.6%, grasses 36.4% and Trees 6.1%. Most of them were evergreen and only some deciduous. The distribution of vegetation in Lihué Calel responds to the semi-arid conditions. Some adaptations were observed like the development of the deep root system with an horizontal pattern in order to absorb the water from the soil, the loss of leafs in the unfavorable season, the replacement of leaves by thorns, small resinous leaves, leaf tilting and extensive roots, among others. The dominant plant of the jarillal is Larrea divaricata and it is considered as a xerofite plant. The process indicates that when stomata are open, transpiration rates increase; when they are closed, transpiration rates decrease. The Cactaceae family is represented by two species: Opuntia puelchana and Cereus aethiop . They are considered succulent plants that keep humidity inside. During rainy periods they absorb large amounts of water that they then use during the dry periods. These types of studies are relevant to understand how plants adapt to different environmental events, whether they are natural and/or anthropogenic. As a reference, in 2003, major fires occurred inside the National Park and they affected 7 000 hectares. The resinous leaves of the jarilla helped to propagate the fire all around the place. The next phase of the investigation process will be related to the physiological and morphological properties, through chemical analysis, so the adaptation of vegetation can be tested. With these new studies, the final purpose will be reached: good practice for plant conservation.

El estudio de la vegetación desde la Geografía se centra en el análisis de su distribución espacial y los factores que inciden en la misma. Uno de ellos es el clima que determina las características de las formaciones vegetales y, en una escala más grande, a las comunidades. El objetivo de este trabajo es analizar la relación clima-vegetación mediante el estudio de las adaptaciones de la comunidad del jarillal con respecto al clima semiárido en el Parque Nacional Lihué Calel, Argentina. Para ello se realiza el balance hídrico de Thornthwaite y Mather utilizando datos de la estación meteorológica del parque pertenecientes al periodo 1995-2010. Se aplican índices bioclimáticos y se realizan estands para conocer la composición florística y fisonomía de la vegetación. Se analizan las respuestas adaptativas identificadas en los individuos vegetales relevados y se comprueba que el clima semiárido condiciona la morfología y fisonomía del parque. Se demuestra la presencia de vegetación xerófila con predominio de arbustos y de cobertura abierta. Entre las adaptaciones observadas se distinguen la pérdida de hojas en la estación desfavorable, el reemplazo de hojas por espinas, hojas pequeñas y resinosas, inclinación de la hoja y raíces extensas.

Background: over 60 million people worldwide have been affected by the human immunodeficiency virus. Globally, it is the fourth leading cause of death; therefore it is considered a global emergency. Objective: to characterize patients with the human immunodeficiency virus.Methods: a retrospective, descriptive study was conducted involving 21 patients diagnosed with human immunodeficiency virus/AIDS in the Area I in Cienfuegos from 1988 to 2011. The variables analyzed included: age, sex, year of diagnosis, People’s Council they belong to, sexual orientation, educational level, occupation, presence of opportunistic diseases and antiretroviral treatment. Results: groups aged 25 to 34 and 35 to 44 years (33, 33 %) predominated; 90, 48 % of the patients were males with a ratio of 9,5:1; 38,10 % was diagnosed from 2009 to 2011, 71, 4 % of the cases belonged to the Historic Center; 57, 14 % were men who had sex with men; those who completed high school and university studies accounted for 66,66 % of the cases. Workers prevailed (57, 14 %); only 14, 29 % suffered from opportunistic diseases and 52, 4 % was undergoing antiretroviral treatment.Conclusions: infection increased in the last five years, particularly in most sexually active age groups; it was more common in men who have sex with men. More than half of the patients receive antiretroviral treatment.

Fundamento: más de 60 millones de personas en el mundo han sido afectadas por el virus de la inmunodeficiencia humana. Mundialmente es la cuarta causa de mortalidad, por lo que se considera una emergencia global.Objetivo: caracterizar pacientes con el virus de inmunodeficiencia humana.Métodos: estudio descriptivo, retrospectivo que incluyó a los 21 pacientes con diagnóstico de virus de inmunodeficiencia humana/sida detectados en el Área I de Cienfuegos desde 1988 a 2011. Se analizaron las variables: edad, sexo, año de diagnóstico, Consejo Popular al que pertenecen, orientación sexual, escolaridad, ocupación, presencia de enfermedades oportunistas, tratamiento con antirretrovirales. Resultados: predominaron los grupos de 25 - 34 y de 35- 44 años (33, 33 %); el 90,48 % de los pacientes eran del sexo masculino con una razón de 9,5:1; el 38,10 % se diagnosticó del 2009 al 2011, el Centro Histórico aportó el 71, 4 % de los casos; un 57, 14 % eran hombres que tenían sexo con hombres; el nivel medio y superior aportaron el 66, 66 % de los casos. Prevalecieron los trabajadores con 57, 14 %; solo el 14,29 % presentó enfermedades oportunistas y el 52, 4 % tratamiento antirretroviral. Conclusiones: la infección se incrementó en el último quinquenio, en pacientes con edades de mayor actividad sexual; fue mayor en hombres que tienen sexo con hombres. Más de la mitad de los pacientes lleva tratamiento con antirretrovirales.

Background: Although few fungal species are considered to be pathogenic to humans and even when they are commonly less relevant than bacteria or viruses, they are not insignificant as a cause of disease. From a practical point of view, it was found that the mycosis fungoides they cause is one of the first reasons for consultation in our country and the world. Objective: To determine the main clinical and epidemiological features and laboratory findings of pediatric patients affected by ringworm. Methods: A descriptive, case series study was conducted. It included 102 patients with dermatophytosis. The information about these patients was collected from medical records and laboratory results of scraping and cultures of the lesions. Results: We obtained more positives in the test by culture (70.59%), compared to a 66, 7% in the examination by scraping, being Trichophyton rubrum the most common causative agent in the nails and body. The age group from 15 years old on predominated, as well as white skinned and female patients. Most patients were infected through contact with dogs. Conclusions: The percentage of pediatric patients with dermatophytosis is not low. This remains a frequent cause of medical consultation

Fundamento: a pesar de que pocas especies de hongos son patógenos para los humanos y aun cuando su importancia  es menor que las de las bacterias o los virus, no son insignificantes como causa de enfermedades. Desde el punto de vista práctico se ha comprobado que las micosis que estos causan representan uno de los primeros motivos de consulta dermatológica en nuestro país y el mundo. Objetivo: determinar las principales características clínico-epidemiológicas y de laboratorio de pacientes en edad pediátrica afectados por dermatofitosis. Métodos: estudio descriptivo, de serie de casos que incluyó 102 pacientes con diagnóstico de dermatofitosis cuya información fue  recogida de historias clínicas y en el laboratorio al realizarse raspado y cultivo de las lesiones. Resultados: se obtuvo mayor positividad en el examen por cultivo (70,59 %), frente a 66, 7 % en el examen por raspado; el Trichophyton rubrum fue el agente causal más frecuente en las uñas y en el cuerpo,  predominó en el grupo de 15 años y más, en los pacientes de color de piel blanca y en las féminas. La mayoría de los pacientes se infectaron a través del contacto con canes. Conclusiones: no son bajos los por cientos de pacientes pediátricos con dermatofitosis, la cual continúa siendo causa frecuente de consulta médica

The case of a 37 years old, black skinned, male patient who attended Dermatology Consultation in his health area is presented. The patient had skin lesions on the palms of his hands and the soles of his feet. He stated that these injuries had worsened with time. Eventually they became hyperkeratotic lesions affecting the knuckles and the knees. The patient also presented a deformity of his fingernails resembling a parrot’s beak that produced pain and moderate hyperhidrosis. A diagnosis of diffuse orthokeratotic Thost-Unna keratoderma was completed. This keratoderma occurs in one out of every 40 000 people and is hereditary. Because it is such an uncommon presentation with biological implications, psychological impact and work impediments, that requires a specific medical monitoring, it was decided to present this case to be published.

Se presenta el caso de un paciente de color de piel negra, sexo masculino y de 37 años de edad que acudió a consulta del Servicio de Dermatología de su área de salud por presentar lesiones cutáneas en las palmas de las manos y en las plantas de los pies. Refirió que las lesiones se agudizaron con el tiempo. Estas se convirtieron en lesiones hiperqueratósicas que afectaban nudillos y rodillas. Presentaba una deformidad de los uñas de las manos, de aspecto de pico de loro, acompañada de dolor y moderada hiperhidrosis. Se llegó al diagnóstico de queratodermia ortoqueratósica difusa de Unna Thost. Esta queratodermia se presenta en una de cada 40 000 personas y es de origen hereditario. Por lo infrecuente de su presentación, la afectación biológica, repercusión psicológica y limitación laboral que presupone, así como el seguimiento médico que lleva, se decidió presentar este caso.

Background: Condyloma acuminatum is a common condition in our country and the world. It is considered to be a sexually transmitted infection, but it is commonly unreported. Objective: To determine the main clinical and epidemiological characteristics of patients with condilomatosis. Methods: A case series study was conducted in Health Areas number II, V and VII of Cienfuegos. The sample included 72 patients diagnosed with condyloma acuminatum. The following variables were analyzed: age, sex, educational level, residence area, location of lesions, number of sexual partners referred in the past 12 months, personal medical history of sexually transmitted infections and associated infections, sexual preferences and way of disease detection. Results: Genital condilomatosis was the most frequent infection. Females were predominant mostly between 20 and 39 years old (51.4%), while 55.6% (66.7%) of patients had achieved a secondary educational level and presented a personal medical history of sexually transmitted infections and associated infections prior to diagnosis. Concomitant infections were found in 23, 6% of patients: 70.6% of the cases presented bacterial vaginosis. Condyloma acuminatum was predominant in heterosexual patients and in those who reported between 2 and 3 sexual partners in the last 12 months. Most cases were diagnosed spontaneously. Conclusions: The clinical and epidemiological characteristics of patients diagnosed with condilomatosis in the Health Areas number II, V and VII are similar to those reported in other cases studied in the country and the world.

Fundamento: el condiloma acuminado es una afección frecuente en nuestro país y en el mundo, considerada una infección de transmisión sexual, pero que no es notificada habitualmente. Objetivo: determinar las principales características clínico-epidemiológicas de pacientes afectados por condilomatosis. Métodos: estudio de serie de casos, realizado en las Áreas II, V, VII del municipio Cienfuegos, que incluyó 72 pacientes con diagnóstico de condiloma acuminado. Se analizaron las variables: edad, sexo, nivel de escolaridad, área de procedencia, localización de las lesiones, número de parejas sexuales referidas en los últimos 12 meses, antecedentes patológicos personales de infecciones de transmisión sexual e infecciones asociadas, preferencia sexual y modo de detección de la enfermedad. Resultados: la condilomatosis genital fue la más frecuente, predominó en el sexo femenino, edades entre 20 y 39 años (51,4 %) y en el nivel escolar medio superior (66,7 %); el 55,6 % de los pacientes presentaron antecedentes patológicos personales de infecciones de transmisión sexual e infecciones asociadas previas al diagnóstico; el 23, 6 % presentó infección concomitante con el diagnóstico de condilomatosis y de ellos, 70,6 % correspondió a vaginosis bacteriana. La enfermedad predominó en heterosexuales y en los que refirieron entre 2 y 3 parejas sexuales en los últimos 12 meses. La mayoría de los casos fueron diagnosticados de forma espontánea. Conclusiones: las características clínico-epidemiológicas de los pacientes diagnosticados con condilomatosis pertenecientes a las áreas de salud II, V, VII son similares a las reportadas en los casos estudiados en el país y en el mundo.

The case of a female patient of 23 years of age is presented. The patient attended to the dermatology consultation in her health area for skin lesions in the neck area, of 10 years of evolution with new lesions after three years in different parts of her body (armpits, periumbilical, vaginal and rectal regions). These lesions present an aspect similar to orange skin, surrounded by yellow papules. the diagnosis was pseudoxanthoma elasticum after the clinical and histopathological analysis, and the perimetry. We present this case since this is an infrequent disease and for the importance of an early diagnosis of skin lesions in a systemic disease.

Se presenta el caso de una paciente femenina, de 23 años de edad que acudió a consulta de Dermatología de su área de salud por presentar lesiones cutáneas localizadas en el cuello, de 10 años de evolución y la cual 3 años antes notó nuevas lesiones en otras partes de su cuerpo ( axilas , región periumbilical, vaginal y rectal ), dichas lesiones tienen el aspecto de ?piel de naranja?, rodeadas de pápulas puntiformes amarillentas. Se llegó al diagnóstico de un pseudoxantoma elástico por la clínica, histopatología y campimetría. Se presenta el caso por ser una enfermedad poco frecuente, y por la importancia de la detección temprana de lesiones cutáneas de una enfermedad sistémica.

A case of waterborne otitis in a patient with AIDS was report, who got infected with Vibrio fluvialis by swimming in a pool sea water. This is the first case reported in Cuba and as far as we know in the world. We describe the clinical features associated with this an unusual case and discuss its significance.