Marcadores trombogénicos en pacientes con trombofilia hereditaria

Fundamento: la trombofilia hereditaria se define como la tendencia genéticamente determinada al tromboembolismo venoso, entidad con una incidencia importante a nivel mundial. Desde el laboratorio pudieran explicarse un gran porcentaje de estos eventos de trombosis. Objetivo: caracterizar desde el punto de vista clínico humoral las trombofilias hereditarias e identificar la posible relación entre marcadores bioquímicos alterados de trombosis y su recurrencia. Método: se realizó un estudio descriptivo y transversal en el laboratorio de hemostasia del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba, en el periodo de un año. Se tuvo como referencia 39 pacientes: 26 con eventos trombóticos egresados de los Servicios de Angiología, Cirugía Cardiovascular y Neurología, y 13 sin evento conocido, familiares de primera línea de aquellos pacientes que resultaron con marcadores de trombofilia positivos durante el estudio. Las variables clínicas analizadas fueron: edad, sexo, antecedentes personales y familiares de trombosis y número de eventos trombóticos en el paciente. Se calcularon media, desviación estándar y porcentajes. Resultados: el déficit de proteína S ocupó el primer lugar con 22 (56,4 %). La combinación de parámetros alterados que predominó fue el déficit de proteína C y S con 8 (20,5 %). En el 64,1 % se encontraron dos o más marcadores alterados; se muestran similares porcentajes en pacientes con 1, con 2 dos o más eventos de trombosis. Conclusión: la trombofilia se presentó como una enfermedad que afecta fundamentalmente a mujeres, en edades intermedias de la vida. En pacientes asintomáticos con antecedentes familiares de evento trombótico, sin aparente causa, los marcadores de laboratorio orientan el enfoque diagnóstico. La presencia de dos o más marcadores trombogénicos positivos inclina a la ocurrencia de eventos trombóticos en esta población.

Foundation: hereditary thrombophilia is defined as the genetically determined tendency to venous thromboembolism, an entity with a significant incidence worldwide. A large percentage of these thrombosis events could be explained from the laboratory. Objective: to characterize hereditary thrombophilias from a humoral clinical point of view and to identify the possible relationship between altered biochemical markers of thrombosis and its recurrence. Method: a descriptive and cross-sectional study was carried out in the hemostasis laboratory of the Saturnino Lora Provincial Teaching Hospital of Santiago de Cuba, over a period of one year. 39 patients were used as a reference: 26 with thrombotic events discharged from the Angiology, Cardiovascular Surgery and Neurology Services, and 13 without a known event, first-line relatives of those patients who had positive thrombophilia markers during the study. The clinical variables analyzed were: age, sex, personal and family history of thrombosis and number of thrombotic events in the patient. Mean, standard deviation and percentages were calculated. Results: protein S deficiency ranked first with 22 (56.4 %). The combination of altered parameters that predominated was protein C and S deficiency with 8 (20.5 %). Two or more altered markers were found in 64.1 %; similar percentages are shown in patients with 1, 2 or more thrombosis events. Conclusion: thrombophilia was presented as a disease that mainly affects women, at intermediate ages of life. In asymptomatic patients with a family history of thrombotic event, without apparent cause, laboratory markers guide the diagnostic approach. The presence of two or more positive thrombogenic markers suggests the occurrence of thrombotic events in this population.

Measuring Knowledge of Cancer Screening and Prevention Strategies in HIV Healthcare Professionals.

OBJECTIVE: Due to advances in the care of people living with HIV/AIDS (PLWHA), life expectancy significantly increased, putting this group vulnerable to age-related comorbidities, such as cancer. The objective of this study was to describe the knowledge of cancer screening (cervical, breast, anal, colon, prostate) and other cancer prevention strategies (HPV vaccination, HPV testing) among HIV care professionals in Puerto Rico (PR). METHODS: Cross-sectional study using a sample of 104 HIV healthcare professionals in PR. Descriptive analyses were used to characterize the study sample. Logistic regression analysis was used to determine the relation of sociodemographic and work-related factors with cancer screening knowledge. RESULTS: On average, the healthcare professionals interviewed had been working for more than 10 years with the HIV/AIDS population (11.5±7.6 years). Multivariate analysis showed that physicians had a higher likelihood of having extensive knowledge of cervical (OR=3.96; 95% CI=1.23, 12.77) and anal cancer (OR=9.4; 95% CI=2.2, 41.0) screening than other healthcare professionals. For anal cancer in particular, as the number of years a given participant had been working with people living with HIV/AIDS increased, the likelihood that this participant would have extensive knowledge of anal cancer screening significantly increased (10% year). CONCLUSION: Health education interventions, tailored to healthcare professionals who recently finished their formal education should be developed in HPV-related cancers. Such training would improve cancer prevention and control efforts, thereby benefitting the HIV population in Puerto Rico.

Pruebas de laboratorio en el síndrome de Gilbert consecutivo a hepatitis / Laboratory tests in Gilbert's syndrome subsequent to hepatitis

Se efectuó un estudio descriptivo y transversal de 40 pacientes con síndrome de Gilbert consecutivo a hepatitis viral aguda, admitidos en el Servicio de Medicina Interna del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba o en la consulta especializada de Hepatología del Policlínico de Especialidades de esta institución, desde junio del 2011 hasta igual mes del 2012, a fin de determinar las características clínico humorales y la respuesta al tratamiento médico en estos. En la casuística se evaluaron las medias, medianas y desviaciones estándares, y entre los resultados se observaron una mayor representación de los hombres menores de 36 años (90,0 por ciento del total), así como un predominio de las manifestaciones de somnolencia, seguida de la astenia, ictericia leve y ausencia de síntomas; asimismo, se confirmó la elevación de la bilirrubina indirecta y su posterior disminución al aplicar la terapia con un inductor enzimático, en este caso el fenobarbital, con el cual se obtuvo, finalmente, mejoría clínica y humoral de los afectados

A descriptive and cross-sectional study was carried out in 40 patients with Gilbert's syndrome subsequent to viral hepatitis, admitted to the Internal Medicine Department of Saturnino Lora Torres Provincial Clinical Surgical Teaching Hospital of Santiago de Cuba or to the specialized hepatology service of the Polyclinic of Specialties in this institution, from June 2011 to the same month of 2012, to determine the clinical and humoral characteristics and the response to medical treatment in them. Means, medians and standard deviations were evaluated in the case material, and among the results was a greater representation of males younger than 36 years (90.0 percent of the total), and a prevalence of manifestations of drowsiness, followed by sleepiness, mild jaundice and absence of symptoms was observed. Also, the elevation of indirect bilirrubin and its subsequent reduction when applying therapy with an enzyme inducer, phenobarbital in this case, were confirmed, eventually obtaining clinical and humoral improvement of patients

Niveles de respuesta autoinmunitaria por anticuerpos antinucleares en pacientes con infecciones virales / Levels of autoimmune response by antinuclear antibodies in patients with viral infections

Se realizó un estudio observacional, descriptivo e inmunológico de 42 pacientes con diagnóstico de enfermedad autoinmune o sospecha de esta, atendidos en la consulta de Inmunología del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde marzo del 2010 hasta mayo del 2011, quienes presentaron hepatitis virales u otras infecciones, a fin de demostrar la posible asociación entre la entidad clínica y los virus. Fueron empleados otros sueros de integrantes del plan de trasplante renal, por su alta incidencia de hepatitis B o C (o ambas), de los estudios de histocompatibilidad y se determinaron los niveles de autoanticuerpos por medio del método inmunodiagnóstico para detectar anticuerpos antinucleares de la inmunoflourescencia indirecta (cualitativamente), de manera que se pudiera identificar la influencia de los virus en los procesos autoinmunes y, a la vez, recuperar la utilización de la citada técnica. Los resultados mostraron que 28 % de la casuística tenían positividad de anticuerpos antinucleares.

A descriptive observational and immunological study was carried out in 42 patients with diagnosis of autoimmune disease or suspicion of this, attended at the Immunology Department of "Saturnino Lora Torres" Provincial Clinical Surgical Teaching Hospital of Santiago de Cuba, from March 2010 to May 2011, who presented with viral hepatitis or other infections, in order to demonstrate the possible association between the clinical entity and viruses. Other serums of members of renal transplantation plan, belonging to histocompatibility studies, were used because of their high incidence of hepatitis B or C (or both), and levels of autoantibodies were determined by means of the immunodiagnosis method to detect antinuclear antibodies of the indirect immunofluorescence (qualitatively), so that the influence of viruses could be identified in autoimmune processes and, simultaneously, to recover the use of this technique. The results showed 28% of antinuclear antibodies-positive cases.

Caracterización de las respuestas inmunocelular y humoral en pacientes con virus del papiloma humano / Characterization of humoral and cellular immune responses in patients with human papilloma virus

Se realizó un estudio descriptivo y transversal de 30 féminas con infección por el virus del papiloma humano, atendidas en la consulta de Inmunología del Policlínico de Especialidades perteneciente al Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde junio del 2009 hasta igual mes del 2010, a fin de caracterizarlas según la respuesta inmunitaria. Para evaluar la respuesta inmune celular y humoral se empleó el test de rosetas y la cuantificación de inmunoglobulinas, respectivamente. En la serie prevaleció la infección por el virus antes mencionado en las mujeres de 25-35 años (40,0 %), en especial las procedentes de la zona urbana y se evidenció una disminución de la respuesta celular significativa con relación a la humoral.

A descriptive and cross-sectional study was carried out in 30 females infected with the human papilloma virus, attended in the office of Immunology of the Specialty Polyclinic belonging to "Saturnino Lora" Provincial Clinical Surgical Teaching Hospital in Santiago de Cuba, from June 2009 to June 2010, in order to characterize them according to immune response. To evaluate the humoral and cellular immune response rosetting assay and quantification of immunoglobulines were used respectively. Women between 25-36 years of age (40 %) infected with this virus, especially those coming from urban areas, prevailed in the series, and a significant decrease of the cellular response as compared to the humoral response was evidenced.

Leukocyte-stimulating effect and phytochemical screening of Trichilia hirta extracts.

Trichilia hirta (Family Meliaceae) is a tree traditionally used in the folk medicine of Cuba to treat asthma, cancer, and ulcers. The objective of this study was to determine the phytochemical composition of ethanol extracts obtained from leaves, roots, and stem bark and to evaluate the leukocyte-stimulating effect of T. hirta root extracts on BALB/c mice. The chemical composition of the extracts was determined by phytochemical screening. Saponins, tannins, flavonoids, and coumarins were detected in extracts of T. hirta. The leukocyte-stimulating effect was evaluated by oral application of ethanol extracts (81.8 and 976 mg/kg) in BALB/c mice for 7 days. The application of 976 mg of extract/kg increased the total leukocyte count up to 15-33%; this effect was significant for neutrophil counts compared with control animals (P<.05). In addition, a dose of 82 mg/kg significantly increased total leukocytes at day 4 of the study (P<.05). The results indicated that T. hirta extracts contain phytochemicals reported as immunostimulants. The administration of these extracts to BALB/c mice indicated that ethanol extract could exhibit leukocyte-stimulating properties and makes it a promising alternative for the development of an immunoprotective agent.