A Simple Frailty Score Predicts Survival and Early Mortality in Systemic AL Amyloidosis.

Systemic AL amyloidosis is a challenging disease for which many patients are considered frail in daily clinical practice. However, no study has so far addressed frailty and its impact on the outcome of these patients. We built a simple score to predict mortality based on three frailty-associated variables: age, ECOG performance status (<2 vs. ≥2) and NT-proBNP (<8500 vs. ≥8500 ng/L). Four-hundred and sixteen consecutive newly diagnosed patients diagnosed at ten sites from the Spanish Myeloma Group were eligible for the study. The score was developed in a derivation cohort from a referral center, and it was externally validated in a multicenter cohort. Multivariate analysis showed that the three variables were independent predictors of survival. The score was able to discriminate four groups of patients in terms of overall survival and early mortality in both cohorts. Comorbidity was also analyzed with the Charlson comorbidity index, but it did not reach statistical significance in the model. A nomogram was created to easily estimate the mortality risk of each patient at each time point. This score is a simple, robust, and efficient approach to dynamically assess frailty-dependent mortality both at diagnosis and throughout follow-up. The optimal treatment for frail AL amyloidosis patients remains to be determined but we suggest that the estimation of frailty-associated risk could complement current staging systems, adding value in clinical decision-making in this complex scenario.

Influence of Host Plants and Tending Ants on the Cuticular Hydrocarbon Profile of a Generalist Myrmecophilous Caterpillar.

In myrmecophilous organisms, which live in symbiosis with ants, cuticular hydrocarbons (CHCs) play a pivotal role in interspecific communication and defense against chemical-oriented predators. Although these interactions form complex information webs, little is known about the influence of biotic environmental factors on the CHC profiles of myrmecophiles. Here, we analyzed the effect of different host plants and tending ants on the larval CHC profile of Synargis calyce (Lepidoptera: Riodinidae), a polyphagous species with facultative myrmecophily. Groups of caterpillars were fed individually with three host plant species (without tending ants), and with two tending ant species. Through gas chromatography analysis, we compared the cuticular profiles of treatments and found a high similarity between plants and caterpillars (65-82%), but a low similarity between caterpillars and their tending ants (30 - 25%). Cluster analysis showed that caterpillars, ants, and plants form distinct groups, indicating that S. calyce caterpillars have their own chemical profile. These results are similar to those observed for Lycaenidae caterpillars indicating that there is functional convergence in the chemical strategies used by myrmecophilous caterpillar species with similar ecology. Also, the results suggest that the cuticular compounds of S. calyce are primarily influenced by their host plants rather than their tending ants. Thus, we propose that these caterpillars present a trade-off between camouflage and directly informing their presence to ants, maintaining their unique chemical profile, though slightly affected by biotic environmental factors.

Chemical Camouflage Induced by Diet in a Pest Treehopper on Host Plants.

Ants patrol foliage and exert a strong selective pressure on herbivorous insects, being their primary predators. As ants are chemically oriented, some organisms that interact with them (myrmecophiles) use chemical strategies mediated by their cuticular hydrocarbons (CHCs) to deal with ants. Thus, a better understanding of the ecology and evolution of the mutualistic interactions between myrmecophiles and ants depends on the accurate recognition of these chemical strategies. Few studies have examined whether treehoppers may use an additional strategy called chemical camouflage to reduce ant aggression, and none considered highly polyphagous pest insects. We analyzed whether the chemical similarity of the CHC profiles of three host plants from three plant families (Fabaceae, Malvaceae, and Moraceae) and the facultative myrmecophilous honeydew-producing treehopper Aetalion reticulatum (Hemiptera: Aetalionidae), a pest of citrus plants, may play a role as a proximate mechanism serving as a protection against ant attacks on plants. We found a high similarity (>80%) between the CHCs of the treehoppers and two of their host plants. The treehoppers acquire CHCs through their diet, and the chemical similarity varies according to host plant. Chemical camouflage on host plants plays a role in the interaction of treehoppers with their ant mutualistic partners.

Case-control study assessing the impact of COVID19 in advanced kidney cancer patients treated with antiangiogenics or immunotherapy: the COVID-REN study.

BACKGROUND: Cancer is a risk factor for developing severe COVID19. Additionally, SARS-CoV2 has a special tropism for renal cells and complications like thrombosis or cytokine storm could be enhanced by standard treatments in kidney cancer (i.e., antiangiogenics or immunotherapy). Thus, understanding the impact of COVID19 in patients with this tumor is key for their correct management. METHODS: We designed a retrospective case-control study comparing the outcome of three groups of advanced kidney cancer patients on systemic treatment: cohort A (developed COVID19 while on antiangiogenics), cohort B (developed COVID19 while on immunotherapy) and cohort C (non-infected). Matching factors were age, gender, and treatment. RESULTS: 95 patients were recruited in 16 centers in Spain from September 2020 to May 2021. Finally, 85 were deemed as eligible (23 cohort A, 21 cohort B, 41 cohort C). Patients with COVID required more dose interruptions (25 vs. six) and hospitalizations (10 vs. none) than those without COVID (both p = 0.001). No difference between cohorts A and B was observed regarding hospitalization or length of stay. No ICU admission was registered and one patient in cohort B died due to COVID19. Regarding cancer evolution, three patients in cohort A presented progressive disease after COVID19 compared to two in cohort B. One case in cohort B, initially deemed as stable disease, achieved a partial response after COVID19. CONCLUSIONS: Kidney cancer patients who developed COVID19 while on systemic therapy required more treatment interruptions and hospitalizations than those non-infected. However, no significant impact on cancer outcome was observed. Also, no difference was seen between cases on antiangiogenics or immunotherapy.

Enhanced thrombin generation detected with ST-Genesia analyzer in patients with newly diagnosed multiple myeloma.

The issue of how to identify newly diagnosed multiple myeloma (NDMM) patients requiring thromboprophylaxis remains unsolved. Several changes in thrombin generation (TG)-derived parameters have been described in multiple myeloma (MM) patients recently. Assessment of prothrombotic risk with a fully automated TG analyzer could reduce interlaboratory variability. Our objective was to determine whether ST-Genesia® could reveal a hypercoagulable state in NDMM compared to healthy controls. We conducted a multicenter observational study of NDMM requiring initial treatment to compare TG parameters obtained with ST-Genesia® analyzer and ST-ThromboScreen® reagent with a control group. Clinical data were obtained from medical records and blood samples were collected before initial anti-myeloma therapy. A thrombophilia panel was performed in all patients. Compared to age- and sex-matched controls (n = 83), NDMM patients (n = 83) had significantly higher peak height, higher velocity index, shorter time-to-peak and lower percentage of endogenous thrombin potential (ETP) inhibition after adding thrombomodulin (TM) (ETP%inh). NDMM on prophylactic low molecular weight heparin (LMWH) showed reduced both peak height and velocity index compared to NDMM who had not yet started VTE prophylaxis, similar to that of controls. Moreover, partial correction of ETP%inh was observed in MM patients on LMWH. The presence of a thrombophilia did not modify the TG phenotype. Untreated NDMM patients showed an enhanced TG, regardless of their thrombophilia status. They generate a higher peak of thrombin, take less time to produce it, and exhibit resistance to TM inhibition. Our findings suggest that standard prophylactic dose of LMWH may reduce TG at levels of healthy controls.

Asociación entre el fenotipo hipertrigliceridemia-obesidad abdominal, la resistencia a la insulina y las variables cardiometabólicas en el síndrome de ovario poliquístico / Association among the hypertriglyceridemic waist phenotype, insulin resistance and the cardiometabolic variables in the polycystic ovary syndrome

Introducción: El síndrome de ovario poliquístico se asocia con frecuencia a alteraciones cardiometabólicas; y su asociación con el fenotipo hipertrigliceridemia-obesidad abdominal ha sido poco estudiada en Cuba. Objetivo: Identificar la frecuencia del fenotipo hipertrigliceridemia-obesidad abdominal en mujeres de edad mediana con síndrome de ovario poliquístico y su asociación con la resistencia a la insulina, trastornos del metabolismo de la glucosa y ateroesclerosis subclínica. Método: Estudio descriptivo, transversal, en 30 mujeres. Se tomaron variables clínicas: edad, peso, talla, índice de masa corporal, circunferencia de cintura y cadera, índice cintura/cadera, tensión arterial, además de concentraciones de glucosa, insulina, colesterol total, triglicéridos, HDL-c y LDL-c, e índice HOMA-IR. La aterosclerosis subclínica se evaluó por doppler carotideo y ecocardiograma (hipertrofia ventricular izquierda y grasa epicárdica). El fenotipo hipertrigliceridemia-obesidad abdominal se definió como triglicéridos elevados (≥ 1,7 mmol/L) y circunferencia de la cintura ≥ 80 cm. Resultados: La frecuencia del fenotipo hipertrigliceridemia-obesidad abdominal fue 43,3 por ciento (13/30). Los valores medios de circunferencia abdominal, tensión arterial, así como de glucemia (p < 0,003), insulinemia (p = 0,028), triglicéridos (p < 0,0001), e índice HOMA-IR (p = 0,012) fueron más elevados en el grupo de mujeres con esa condición. A pesar de no haber diferencias significativas la frecuencia de mujeres con incremento del grosor íntima-media carotídeo y de grasa epicárdica fue superior en aquellas con el fenotipo. Conclusiones: La presencia del fenotipo hipertrigliceridemia-obesidad abdominal es frecuente en mujeres con síndrome de ovario poliquístico, y se asocia con alteraciones del metabolismo de la glucosa y la resistencia a la insulina. Este pudiera ser utilizado en la práctica clínica como un marcador de riesgo para alteraciones cardiometabólicas(AU)

Introduction: The polycystic ovary syndrome is frequently associated to cardiometabolic alterations; and its relation with the hypertriglyceridemic waist phenotype has been poorly studied in Cuba. Objective: Identify the frequency of the hypertriglyceridemic waist phenotype in middle age women with polycystic ovary syndrome and its association with insulin resistance, disorders in the glucose metabolism and subclinical atherosclerosis. Methods: Descriptive, cross-sectional study in 30 women. As clinical variables there were used: age, weight, size, body mass index, waist-hip circumference, waist/hip index, blood pressure; glucose, insulin, total cholesterol, triglycerides, HDL-c and LDL-c concentrations, and HOMA-IR index. Subclinical atherosclerosis was assessed by a carotid doppler and an echocardiogram (left ventricular hypertrophy and epicardial fat). The hypertriglyceridemic waist phenotype was defined as high triglycerides levels (≥ 1.7 mmol/L) and CC ≥ 80 cm. Results: The frequency of the hypertriglyceridemic waist phenotype was 43.3 percent (13/30). The mean values of abdominal circumference, blood pressure, as well as glycemia (p < 0.003), insulinaemia (p = 0.028), triglycerides (p < 0.0001), and HOMA-IR index (p = 0.012) were higher in the group of women with that condition. Although there were not significant differences, the frequency of women with increase of the carotid intima-media thickness and epicardical fat was higher in those with the phenotype. Conclusions: The presence of the hypertriglyceridemic waist phenotype is frequent in women with the polycystic ovary syndrome, and it is associated with alterations of the glucose metabolism and insulin resistance. This can be used in the clinical practice as a marker of risk for cardiometabolic alterations(AU)

Risk Factors and Mortality of COVID-19 in Patients With Lymphoma: A Multicenter Study.

Patients with cancer are poorly represented in coronavirus disease 2019 (COVID-19) series, and heterogeneous series concerning hematology patients have been published. This study aimed to analyze the impact of COVID-19 in patients with lymphoma. We present a multicenter retrospective study from 19 centers in Madrid, Spain, evaluating risk factors for mortality in adult patients with COVID-19 and lymphoma. About 177 patients (55.9% male) were included with a median follow-up of 27 days and a median age of 70 years. At the time of COVID-19 diagnosis, 49.7% of patients were on active treatment. The overall mortality rate was 34.5%. Age >70 years, confusion, urea concentration, respiratory rate, blood pressure, and age >65 score ≥2, heart disease, and chronic kidney disease were associated with higher mortality risk (P < 0.05). Active disease significantly increased the risk of death (hazard ratio, 2.43; 95% confidence interval, 1.23-4.77; P = 0.01). However, active treatment did not modify mortality risk and no differences were found between the different therapeutic regimens. The persistence of severe acute respiratory syndrome coronavirus 2-positive polymerase chain reaction after week 6 was significantly associated with mortality (54.5% versus 1.4%; P < 0.001). We confirm an increased mortality compared with the general population. In view of our results, any interruption or delay in the start of treatment should be questioned given that active treatment has not been demonstrated to increase mortality risk and that achieving disease remission could lead to better outcomes.

A second administration of glucarpidase in a different cycle of high-dose methotrexate: Is it safe and effective in adults?

INTRODUCTION: Methotrexate intoxication following high-dose methotrexate-induced acute kidney injury is a life-threatening complication. Glucarpidase can quickly reduce extracellular methotrexate to safe levels, but the effectiveness and safety of its use in different episodes of nephrotoxicity remain an unknown area. CASE REPORT: A 30-year-old male diagnosed with acute lymphoblastic T-cell lymphoma received methotrexate 5 g/m2 intravenous (IV) as part of the first consolidation cycle. On Consolidation 3, he restarted methotrexate at a dose of 3 g/m2 IV showing slow methotrexate elimination, associated myelosuppression, and hepatic toxicity. Glucarpidase was administered (total dose of 2000 International Units (IU)). No adverse events were observed, and his renal function returned to normal. One hundred and six days later, he was diagnosed with leptomeningeal and cerebellar relapse and treatment with methotrexate 3,5 g/m2 IV day 1 and cytosine arabinoside (Ara-C) 2 g/m2 IV twice per day days 1, 3, and 5 was started. At 36 h from methotrexate infusion, serum creatinine increased up to 1.89 mg/dL and methotrexate concentration was 100 µmol/L.Management and Outcome: Ara-C was suspended, and a second administration of glucarpidase (2000 IU) was dispensed. No adverse events were noticed, methotrexate levels decreased and renal function progressively improved, recovering completely three weeks later. DISCUSSION: The effectiveness and safety of the use of glucarpidase in different episodes of nephrotoxicity remain an unknown area, and the rate and consequences of antiglucarpidase antibody formation remain poorly understood. This case report is, to our knowledge, the first case of a second administration of glucarpidase in a different cycle of high-dose methotrexate in an adult patient.

Molecular Insights in Transmission of Cancer From an Organ Donor to Four Transplant Recipients.

Organ donors are systematically screened for infection, whereas screening for malignancy is less rigorous. The true incidence of donor-transmitted malignancies is unknown due to a lack of universal tumor testing in the posttransplant setting. Donor-transmitted malignancy may occur even when not suspected based on donor or recipient factors, including age and time to cancer diagnosis. We describe the detection of a gastrointestinal adenocarcinoma transmitted from a young donor to 4 transplant recipients. Multidimensional histopathologic and genomic profiling showed a CDH1 mutation and MET amplification, consistent with gastric origin. At the time of writing, one patient in this series remains alive and without evidence of cancer after prompt organ explant after cancer was reported in other recipients. Because identification of a donor-derived malignancy changes management, our recommendation is to routinely perform short tandem repeat testing (or a comparable assay) immediately upon diagnosis of cancer in any organ transplant recipient. Routine testing for a donor-origin cancer and centralized reporting of outcomes are necessary to establish a robust evidence base for the future development of clinical practice guidelines.

Estudio de la deformación miocárdica longitudinal en pacientes con cardiopatía isquémica / Study of longitudinal myocardial deformation in patients with ischemic cardiopathy

Resumen Introducción: Las enfermedades cardiovasculares constituyen la primera causa de muerte en Cuba y la mayoría de los países desarrollados. La ecocardiografía con speckle tracking bidimensional (ST 2D) es una técnica reciente en la evaluación de la función cardíaca. Objetivos: Determinar la relación entre la deformación miocárdica medida por ST 2D y el estado de la circulación coronaria en pacientes con cardiopatía isquémica, en el CIMEQ, durante un año. Material y método: Se realizó un estudio analítico y transversal con 55 pacientes con indicación de coronariografía sometidos a ecocardiograma bidimensional y estudio de ST 2D con medición de la deformación longitudinal (DLG). Se crearon dos grupos: enfermedad coronaria significativa (ECS = 32) y no significativa (ECNS = 23). Se utilizó SSPS para análisis de los resultados. Resultados: La edad promedio fue mayor en la ECS (55.6 ± 9.3 vs. 61.8 ± 8.8; p = 0.014). Predominaron los hombres con ECS (47.3%), los hipertensos (ECS = 90.6% y ENCS = 65.2%; p = 0.02) y los fumadores (ECS = 59.4% y ENCS = 17.4%; p = 0.002). El diagnóstico más frecuente fue la angina crónica estable (87%). En la ECS predominó la enfermedad de tres vasos (75%). La DLG fue menor en la ECS [(-20.0 ± 3.2 vs. -22.1 ± 3.6; p = 0.035); AUC = 0.458]. No hubo diferencias en la DLG según el número de vasos significativamente afectados. Conclusiones: Los resultados encontrados no justifican el empleo del ST 2D para diferenciar la ECS.

Abstract Introduction: Cardiovascular diseases are the leading cause of death in Cuba and most of the developed countries. Two-dimensional speckle tracking echocardiography (2D ST) is a recent technique in the evaluation of cardiac function. Objectives: To determine the relationship between myocardial deformation measured by 2D ST and coronary circulation in patients with ischemic heart disease, in the CIMEQ, for 1 year. Material and method: An analytical, cross-sectional study was carried out with 55 patients with an indication for coronary angiography who underwent 2D echocardiography and 2D ST study with longitudinal strain measurement (LSM). Two groups significant coronary disease (SCD = 32) and not significant (NSCD = 23) were created. SSPS was used to analyze the results. Results: The average age was higher in SCD (55.6 ± 9.3 vs. 61.8 ± 8.8, p = 0.014). Men with SCD (47.3%), hypertensive (SCD = 90.6% and NSCD = 65.2%, p = 0.02) and smokers (SCD = 59.4% and NSCD = 17.4%, p = 0.002) predominated. The most frequent diagnosis was chronic stable angina (87%). Three-vessel disease (75%) prevailed in SCD. The LMS was lower in SCD ([−20.0 ± 3.2 vs. −22.1 ± 3.6, p = 0.035]; AUC = 0.458). There were no differences in LSM according to the number of significantly diseased vessels. Conclusions: The results found do not justify the use of 2D ST to discriminate SCD.

Postoperative Exacerbation of Oxaliplatin-induced Neurotoxicity in Gastrointestinal Cancers: A Case Series.

BACKGROUND/AIM: Oxaliplatin-induced neurotoxicity (OIN) can be severe and dose-limiting with clinically significant symptoms that persist for years. Few published reports have described postoperative exacerbation of OIN and more longitudinal data are needed to better characterize the phenomenon. PATIENTS AND METHODS: We identified 13 patients diagnosed with colon (n=7), rectal (n=4) or pancreatic (n=2) cancer who experienced postoperative OIN exacerbation at our medical center. Charts were reviewed for demographic and clinical data regarding OIN. RESULTS: OIN exacerbation was documented 0.5-7.0 months after the first surgery following oxaliplatin exposure, with a median duration of 10.6 months (range=1.4-86.1 months). OIN exacerbation persisted in 3/13 patients at last follow-up, and improved to pre-operative levels in 6/13 patients (with complete resolution in 4/13) within a median of 3.6 months from initial exacerbation. CONCLUSION: Given the widespread use of oxaliplatin in neoadjuvant and first-line treatment for gastrointestinal cancers, further study is warranted to prospectively and systematically define risks for postoperative OIN exacerbation.

Structural and functional alterations of the heart in Parkinson's disease.

Parkinson's disease (PD) patients have most frequently heart failure. The cause of this increased prevalence is not known. We designed a study to assess the cardiac function and cardiac structure in patients with PD compared to a control group. METHODS: Cross-sectional study with 50 PD patients and 50 healthy matched controls. We performed electro and echocardiograms to all patients and controls. The measurements were blind. In addition, we performed a neurological assessment. RESULTS: PD patients had higher left ventricular mass index (114.2 ± 38.4 vs. 94.1 ± 26.4 g/m2; P = 0.003) and higher left atrial volume (30.1 ± 7.9 vs. 26.7 ± 6.2 ml/m2; P = 0.01). PD was an independent risk factor for elevated left ventricular filling pressures (OR = 2.7, CI 95% 2.2-6.3; P = 0.004). Concentric remodeling and left ventricular hypertrophy were associated with more advanced Hoehn and Yahr stages. Moreover, patients with more dysautonomia symptoms showed more left ventricular hypertrophy. Finally, PD group had longer QT interval than control group regardless of the drugs. CONCLUSIONS: PD is significantly associated with increased concentric left ventricular hypertrophy and diastolic dysfunction. Advanced stages of PD are associated with a more severe cardiac affection. These findings can explain the increase of heart failure in PD patients. Cardiomyopathy could be a non-motor parkinsonian symptom.

Contrast-enhanced Voiding Urosonography for Vesicoureteral Reflux Diagnosis in Children.

Contrast-enhanced voiding urosonography (ceVUS) is a dynamic imaging technique that makes it possible to study the structure of the urinary tract after the administration of intravesical contrast material. Initially, ceVUS was indicated mainly to study vesicoureteral reflux (VUR); however, since the ability of ceVUS to depict the structure of the urethra was demonstrated in both sexes, ceVUS is now indicated for examination of the entire urinary tract. The main benefit of ceVUS is that it does not use ionizing radiation. In recent years, fundamental changes have occurred in the understanding of VUR. The lessening effect of VUR and the low rate of occurrence of urethral pathologic conditions have given rise to changes in the indications for tests for these conditions. In addition to being able to help confirm a diagnosis of VUR, the ceVUS technique can be used to depict obstructive and nonobstructive urethral pathologic conditions, as well as normal variants, on high-quality images. Furthermore, ceVUS enables real-time assessment of voiding function. For these reasons, ceVUS should be not only an alternative to voiding cystourethrography, but also the technique of choice for the study of the entire urinary tract in pediatric patients. Online supplemental material is available for this article. ©RSNA, 2017.

Late-onset Familial Amyloidotic Polyneuropathy with Bence Jones Proteinuria and Cardiomyopathy.

Familial amyloidotic polyneuropathy is a genetically determined disease characterized by deposition of an anomalous transthyretin. A high index of suspicion is needed for this multisymptomatic and lethal disease to be diagnosed. The patient was a 70-year-old male examined due to hypesthesia in the hands and feet, plus difficulty walking. A neurophysiological study delivered the diagnosis of axonal sensorimotor polyneuropathy. He later developed cardiac symptoms and diarrhea. Urine laboratory analyses revealed a monoclonal spike of light chains (kappa). Biopsies of abdominal fat and bone marrow yielded normal results. The genetic study was compatible with a heterozygous Val30Met-transthyretin mutation. Very few case studies have described an association between familial amyloidotic polyneuropathy and monoclonal gammopathy. We stress that genetic confirmation is important regardless of the type of amyloid deposition revealed by the biopsy.

Trombosis de seno cavernoso causada por zigomicosis invasiva fulminante: A propósito de un caso / Cavernous sinus Thrombosis caused by fulminant invasive zygomycosis: A case report

Zygomycosis is an opportunistic fungal infection caused by fungi of the Mucorales order. It’s potentially lethal infection which generally affects diabetic or inmunocomprised patients. Cavernous sinus thrombosis is uncommon complication. We report the case of a 67 year old woman with invasive zycomycosis who present cranial nerves dysfunction (III, IV, VI, V1 and V2 branches of the trigeminal nerve), proptosis and retroorbital pain as initial manifestation. Brain magnetic resonance imaging evidence early indirect signs. Biopsy of the cavernous sinus revealed Rhizopus as the offending agent. A high index of suspicion is needed to correctly diagnose this condition for its optimal management.

La zigomicosis es una infección oportunista y potencialmente letal producida por hongos del orden Mucorales. Afecta a pacientes diabéticos e inmunocomprometidos. La trombosis del seno cavernoso es una complicación poco frecuente. Presentamos el caso de una paciente mujer de 67 años diagnosticada de zigomicosis invasiva que debutó con compromiso de pares craneales (III, IV, VI además de las ramas V1 y V2 del nervio trigémino), proptosis y dolor retroorbitario derecho. La resonancia magnética craneal, en fase aguda, mostró signos indirectos característicos. La biopsia de seno cavernoso confirmó la presencia de Rhizopus. Se precisa un alto índice de sospecha clínica que favorezca una intervención terapéutica precoz y agresiva.

Asociación de los resultados positivos del SPECT de Perfusión Miocárdica con 99mTc-MIBI, con la presencia de Dislipidemia en pacientes ≥40 años de edad / Association of the positive results of the myocardial perfusion SPECT with 99mTc-MIBI, with the presence of Dyslipidemia in patient with 40 years or more age

El trabajo tuvo como objetivo conocer la asociación de la dislipidemia con los resultados positivos del SPECT de perfusión miocárdica para la optimización del uso. Se analizaron 152 SPECTPM, días diferentes; la media de edad de 58,32 años; 86 (56,6%) fueron masculinos. Se dividieron en dos grupos según la presencia de dislipidemia; dislipidémicos, n=37 (24,3%) y no dislipidémicos, n=115 (75,7%). No presentaron diferencias significativas en las medias de edad (59,59/57,90 p=0,284) e índice de masa corporal (24,85/25,03, p=0,739), ni de la frecuencia de maduro/ra; por tanto el riesgo adicional solo lo aporta la dislipidemia. Los resultados 102 (67,10%) SPECT fueron positivos; en la comparación íntergrupos no se observó diferencia significativa de resultados positivos (67,60/67,00, p=0,945), que se mantuvo cuando se subdividieron los grupos en sintomáticos y asintomáticos. Se concluyó que la dislipidemia no aporta riesgo significativo de cardiopatía isquémica en pacientes en edad de riesgo, por tanto no hay asociación significativa con resultados positivos del SPECTPM en pacientes en edad de riesgo.

The paper is aimed at establishing the association of the dyslipidemia with the positive results of the myocardial perfusion SPECT, for the optimization of the use. 152 MPSPECT were analyzed, different day, for an average age: 58.32 years, 86 (56.6%), were males. Considerating the presence of dyslipidemia , the patients were divided into two groups: dyslipidemia n=37(24.3%) and not-dyslipidemia, n=115 (75.7%). No significant differences were present in the age average (59.59/57.90 p=0.284), in body mass index (24.85/25.03, p=0.739), nor in the frequency of mature. Therefore , only dyslipidemia contributes to therefore the additional risk. Result: 102 (67.1%) MPSPECT were positive. In the comparison among groups no significant difference in the incidence of positive results was observed (67.60/67.00, p=0.945) and the same situation remained when the groups were subdivided into symptomatic and asymptomatic: As a result of the study, it was concluded that dyslipidemia does not represent a significant risk of ischemic cardiopathy in patient within the ages of risk, therefore there is no significant association with the positive results of the SPECTPM, within patient in ages of risk.

[Demyelinating disease and vaccination of the human papillomavirus]. / Trastornos neurológicos desmielinizantes y vacunación del papilomavirus humano.

INTRODUCTION: Primary prevention by prophylactic vaccination against the major cause of cervical cancer, the carcinogenic human papillomavirus (HPV) types 16 and 18, is now available worldwide. Postlicensure adverse neurological effects have been described. The studies realized after the license are descriptive and limited by the difficulty to obtain the information, despite most of the statistical indexes show that the adverse effects by the vaccine of the HPV are not upper compared with other vaccines, the substimation must be considered. CASE REPORTS: We describe the cases of four young women that developed demyelinating disease after the vaccination of the HPV, with a rank of time between the administration of the dose and the development of the clinical of seven days to a month, with similar symptoms with the successive doses. We have described six episodes coinciding after the vaccination. CONCLUSIONS: Have been described seizures, autoimmune disorders such as Guillain-Barre syndrome, transverse myelitis, or motor neuron disease, probably adverse effects following immunization by HPV vaccine. So we suggest that vaccine may trigger an immunological mechanism leading to demyelinating events, perhaps in predisposed young.

Experiencia cubana con el uso terapéutico de células madre adultas / Cuban experience with the therapeutic use of adult stem cells

Las investigaciones básicas y clínicas realizadas en los últimos años sobre las células madre y sus posibilidades terapéuticas, son en la actualidad uno de los temas más excitantes de la medicina contemporánea. Ya se han obtenido importantes avances en el estudio y aplicación de las células madre adultas que muestran notables ventajas sobre las embrionarias, pues su manipulación resulta más simple, económica y se pueden obtener del propio individuo que va a ser tratado. Para la introducción en Cuba de la terapia celular regenerativa, en el Instituto de Hematología e Inmunología se seleccionaron como fuentes celulares las células madre adultas derivadas de la médula ósea y las movilizadas a la sangre periférica. Para facilitar la extensión del tratamiento a otros centros hospitalarios, se estandarizó una técnica para la movilización de las células madre hematopoyéticas a la sangre periférica, mediante un factor estimulador de colonias de granulocitos (Filgrastim, de producción nacional) y se desarrolló un método simple, económico y también más tolerable para los enfermos. De esta forma, se ha extendido la terapia celular a 6 provincias cubanas y hasta abril del año 2009 se habían tratado 563 casos con trasplante de células madre adultas autólogas, de los cuales el 81,7 por ciento corresponde a pacientes con enfermedades angiológicas, en los que se ha logrado disminuir significativamente la indicación de amputaciones mayores. También los resultados han sido muy prometedores en las lesiones óseas y procesos periodontales, entre otras enfermedades tratadas. Los resultados obtenidos hasta el momento se pueden considerar como un nuevo logro de la ciencia revolucionaria y de nuestros sistemas nacionales de salud y de ciencia y técnica. El método empleado es un proceder económico y factible para instituciones con recursos limitados

The basic and clinical researches carried out during past years on the stem cells and its therapeutic possibilities are at present times, one of the most interesting subjects of the contemporaneous medicine. There are advances in the study and application of adult stem cells showing remarkable advantages on the embryonic ones, since its handling is more simple, economic and they are obtained from the own subject to be treated. For the introduction in Cuba of the regenerative cellular therapy in the Institute of Hematology and Immunology the cellular sources selected were the adult stem cells derived from bone marrow and the mobilized ones to the peripheral blood. To make easy the expansion of treatment to other hospital centers, authors standardized a technique for the mobilization of the hematopoietic stem cells to peripheral blood using a granulocyte colony-stimulating factor (Filgrastim, of national production) developing a simple, economic and more tolerable method for patients. In this way, the cellular therapy has been expanded to 6 Cuban provinces and until April, 2009 562 cases with autologous adult stem cells transplant have been treated, from which the 81.7 percent to correspond to patients presenting with Angiology diseases with a significant reduction of major amputations. Also, the results have been very promising in the bone lesions and periodontal processes among other diseases treated. The results obtained until now may be considered as a new achievement of revolutionary science and of our national health systems and of science and technique. The method used is an economic and feasible procedure for the institutions with scarce resources

Asociación de los resultados positivos del SPECT de perfusión miocárdica con 99mTc-MIBI, con la presencia de hipertensión arterial en pacientes de 40 o más años de edad / Association of arterial hypertension with positive results on myocardial perfusion SPECT in patients over 40 years

Objetivo: Conocer la asociación de la hipertensión arterial (HTA) con los resultados positivos del SPECT de perfusión miocárdica (SPECTPM), para la optimización del uso del mismo. Material y Método: Se analizaron 227 SPECTPM, usando un protocolo de días diferentes, media de edad de 57,92 años, 119 (52,4 por ciento) fueron masculinos. La muestra se dividió en H (hipertensos) n=155 y NH (no-hipertensos) n=72. Los grupos no presentaron diferencias significativas en las medias de edad (57,34 vs. 59,17, p=0,094), aunque sí en el índice de masa corporal (H=28,98 vs. NH=26,63, p<0,001), pero no relevante (diferencia de medias=2,35), pues ambos grupos globalmente presentaron índices de sobrepeso, por lo que el riesgo adicional sólo lo aportaba la HTA. Resultados: Fueron positivos 183 (80,6 por ciento) SPECTPM; en la comparación íntergrupos no se observó diferencia significativa en la incidencia de resultados positivos (81,90 por ciento vs. 77,80 por ciento, p=0,461), que se mantuvo cuando se subdividieron los grupos en sintomáticos y asintomáticos. Conclusiones: Según estos resultados, no existe asociación alguna entre el resultado positivo del SPECTPM y la HTA, por tanto los pacientes sintomáticos con esta tríada de factores de riesgo ateroscleróticos (HTA, sobrepeso y edad >40 años), deberían ser explorados con SPECTPM y los asintomáticos con ergometría diagnóstica, en tanto los pacientes no hipertensos, independientemente de la sintomatología, podrían ser explorados solamente con ergometría diagnóstica.

To know the association of arterial hypertension (AH) with positive results on myocardial perfusion SPECT (MPSPECT), in order to optimize the use of this technique. Material and Method: We analyzed 227 MPSPECT studies, two-day protocol, average age of patients = 57.92 years, 119 (52.4 percent) males. According to the presence of AH the population was divided in H (hypertensives) n=155 and NH (non-hypertensives) n=72. Both groups did not differ in age average (57.34 vs.59.17, p=0.094), but they did in body mass index (H=28.98 vs. NH=26.63, p<0.001), however not outstandingly (difference of means = 2.35), being both groups classified as overweighted. Therefore, the only additional risk was the presence of AH. Results: One-hundred and eighty three (80.6 percent) SPECTMP studies were positive. In the intergroup comparison no significant difference was observed in the incidence of positive results (81.90 percent vs. 77.80 percent, p=0.461), which persisted when the groups were subdivided into symptomatic and asymptomatic. Conclusion: No association between AH and the result of MPSPECT was observed, therefore symptomatic patients with this triad of atherosclerotic risk factors (AH, overweight and age >40 years), should be explored with MPSPECT while asymptomatic patients should undergo exercise testing. Non-hypertensive patients should be first evaluated with exercise teststing independently of the presence of symptomatology.

Asociación del hábito de fumar con los resultados positivos del SPECT de perfusión miocárdica con 99mTc-MIBI, en pacientes ≥ 40 años de edad / Correlation of the smoking habit with the positive results of myocardial perfusion SPECT with 99mTc-MIBI in patients over 40 years

Objetivo. Conocer la asociación del hábito de fumar (HF) con los resultados positivos del SPECT de perfusión miocárdica (SPECTPM), para la optimización del uso del mismo. Material y método Analizamos 99 SPECTPM, media de edad: 59,86 años, 70 (70,7 por ciento) fueron masculinos. Sólo se diferenciaron en el HF, acorde a lo cual se dividieron en F (fumadores, n=36) y NF (no-fumadores, n=63) los cuales no presentaron diferencias significativas en las medias de edad (58,31 vs. 60,75 p=0,147) ni en el índice de masa corporal (26,44 vs. 26,57 p=0.903), por tanto el riesgo adicional solo fue aportado por el HF. Resultados. Ochenta y cinco (85,90 por ciento) SPECTPM fueron positivos; en la comparación intergrupos existió mayor incidencia de resultados positivos en el grupo F (diferencia de incidencia de 13,4 por ciento), con odds ratio=4,000 y un Likelihood ratio=3,890, que se mantuvo cuando se subdividieron los grupos en sintomáticos y asintomáticos. Conclusiones. Los pacientes sintomáticos con esta triada de factores de riesgo aterosclerótico (HF, sobrepeso y edad) pueden ser explorados coronariográficamente y los asintomáticos con SPECTPM, en tanto los pacientes no-fumadores independientemente de la sintomatología podrían ser estudiados con ergometría diagnóstica.

Objective. To analyze the correlation of the smoking habit (HF) with the positive results of myocardial perfusion SPECT (SPECTPM), for the optimization of the use of this test. Material and method.We analyzed 99 SPECTPM, 70 (70.7 percent) were males, mean age of 59.86 years. They differed only by the presence of HF. With this criterion the population was divided in F (smokers, n=36) and NF (non-smokers, n=63). The groups did not present significant differences in the mean age (58.31 vs. 60.75, p=0.147) and body mass index (26.44 vs. 26.57, p=0.903), therefore the additional risk alone was contributed by HF. Results. Eighty-five (85.90 percent) SPECTPM were positive; in the comparison between groups, there was greater incidence of positive results among patients of group F (difference of incidence of 13.4 percent), with odds ratio=4.000 and a Likelihood ratio=3.890, which stayed equally abnormal when the groups were subdivided in symptomatics and asymptomatics. Conclusions The symptomatic patients with this triad of atherosclerotic risk factors (HF, overweight, age) should be possibly explored with coronariography and the asymptomatic with SPECTPM, while non-smokers could be studied with exercise test first independently of the symptomatology.