Shortened Version of the Token Test: Normative data for Spanish-speaking pediatric population.

OBJECTIVE: To generate normative data for the Shortened Version of the Token Test in Spanish-speaking pediatric populations. METHOD: The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the Shortened Version of the Token Test as part of a larger neuropsychological battery. Shortened Version of the Token Test total scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. RESULTS: The final multiple linear regression models showed main effects for age in all countries, such that score increased linearly as a function of age. In addition, age2 had a significant effect in all countries, except Guatemala and Puerto Rico. Models showed that children whose parent(s) had a MLPE >12 years obtained higher score compared to children whose parents had a MLPE ≤12 years in Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, Puerto Rico, and Spain. The child's sex did not have an effect in the Shortened Version of the Token Test total score for any of the countries. CONCLUSIONS: This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate interpretation of the Shortened Version of the Token Test when used in pediatric populations.

Analysis of hepatitis C virus core encoding sequences in chronically infected patients reveals mutability, predominance, genetic history and potential impact on therapy of Cuban genotype 1b isolates.

BACKGROUND AND OBJECTIVES: Hepatitis C virus (HCV) genotypes are relevant to epidemiological questions, vaccine development, and clinical management of chronic HCV infection. In the present work, we aimed at investigating HCV genotype, variability and genetic history of HCV isolates in Cuba from a sample of chronically infected patients. MATERIAL AND METHODS: A prospective study, involving 73 Cuban anti-HCV positive patients, was carried out. RT-PCR and phylogenetic analysis was employed to determine HCV genotypes. Divergence dates and demographic parameters in a Bayesian coalescent framework were estimated, as implemented in BEAST v1.4.8. RESULTS: HCV RNA was undetectable in 15 patients that received antiviral therapy. All HCV RNA positive patients, 58, were infected with genotype 1, three of them with subtype 1a and 55 with subtype 1b. The analysis of the DNA sequence coding for a core fragment, spanning nt positions 435-816 (relative to strain H77), revealed high percent (96.7% +/- 0.8%) nucleotide identity within Cuban HCV subtype 1b sequences. However, 56.7% and 20% of 30 analyzed individuals had changes in the core region in a six-month interval, at the nucleotide and amino acid level, respectively. Mutations involving aa changes were mainly found in the region encompassed between aa 70 and 106 of the core protein, with only one isolate showing a point mutation at position 43. Interestingly, some of the observed changes seem to be reversions and might in fact contribute to reducing the variability of this region. The estimated date for the most recent common ancestor of HCV genotype 1b Cuban isolates is 1969 (CI, 1953 to 1977). DISCUSSION: Analysis of HCV core encoding sequences from chronic patients reveals mutability of genotype 1b isolates in Cuba, which seem to be predominant and rapidly multiplied during the eighty decade of last century, and might limit the benefits obtained from current antiviral therapy.

Immunogenicity of CIGB-230, a therapeutic DNA vaccine preparation, in HCV-chronically infected individuals in a Phase I clinical trial.

SUMMARY: Hepatitis C virus (HCV) is a worldwide health problem. No vaccine is available against this pathogen and therapeutic treatments currently in use are of limited efficacy. In the present study, the immunogenicity of the therapeutic vaccine candidate CIGB-230, based on the mixture of pIDKE2, a plasmid expressing HCV structural antigens, with a recombinant HCV core protein, Co.120, was evaluated. CIGB-230 was administered by intramuscular injection on weeks 0, 4, 8, 12, 16 and 20 to 15 HCV-chronically infected individuals, non-responders to previous treatment with interferon (IFN) plus ribavirin. Interestingly, following the final immunization, neutralizing antibody responses against heterologous viral pseudoparticles were modified in eight individuals, including six de novo responders. In addition, 73% of vaccinees exhibited specific T cell proliferative response and T cell IFN-gamma secretory response 24 weeks after primary immunization with CIGB-230. Furthermore, 33.3% of individuals developed de novo cellular immune response against HCV core and the number of patients (46.7% at the end of treatment) with cellular immune response against more than one HCV structural antigen increased during vaccination (P = 0.046). In addition, despite persistent detection of HCV RNA, more than 40% percent of vaccinated individuals improved or stabilized liver histology, particularly reducing fibrosis, which correlated with cellular immune response against more than one HCV antigen (P = 0.0053). In conclusion, CIGB-230 is a promising candidate for effective therapeutic interventions based on its ability for enhancing the immune response in HCV chronically infected individuals.

Control de hipertensión arterial en el centrode Atención Primaria Arona-Costa II.Isla de Tenerife / Control of arterial hypertension in the Arona-Costa II. Primary Health Care Center. Tenerife Island

Si bien existen amplios estudios que indican que controlamos deficientemente a nuestros enfermos, éstos no están referidos a nuestro entorno, por lo que decidimos evaluar nuestro programa de hipertensión arterial. Se realizó un estudio descriptivo-transversal basado en la revisión de las historias clínicas de los pacientes registrados como hipertensos en 5 cupos del centro de salud Arona-Costa II, de la isla de Tenerife. De los 697 pacientes registrados fueron excluidos 280 por no cumplir los criterios previstos en el programa de hipertensión. El grado de control óptimo de nuestra muestra (< 13085 mmHg en diabéticos y < 140-90 mmHg en el resto) fue del 44,6 por ciento, cifras de las más altas encontradas en estudios con base poblacional de hipertensos en nuestro país. Los pacientes hipertensos sin otros factores de riesgo presentaron un control similar a los que tenían uno o dos factores asociados; sólo cuando se asociaron tres o más factores de riesgo el grado de control descendió de forma significativa (p<0,05).Los pacientes hipertensos diabéticos presentaron el grado de control más bajo; en nuestra muestra resultó ser un 24,4 por ciento (<130-85 mmHg).El grado de control de los pacientes sometidos a medidas higiénico-dietéticas exclusivamente (79,4 por ciento), fue significativamente mayor que el de aquellos con tratamiento farmacológico (41,6 por ciento). No encontramos diferencias en los grados de control obtenidos con la administración de los distintos fármacos, tanto si eran administrados en régimen de monoterapia o de politerapia (AU)

Ingestión de caustico en niños: experiencia de 5 años en el Hospital Dr. Miguel Pérez Carreño / Ingestion of caustic in children: 5 year-old experience in the hospital Dr. Miguel Pérez Carreño

Se estudiaron 187 pacientes, entre 2 - 72 meses, 104/187 (55.61 por ciento) varones y 83/187 (44.38 por ciento) hembras. 173/187 (92.51 por ciento) se incluyeron en el grupo A (evaluación temprana) y 14/187 (7.48 por ciento) en el B (evaluación tardía). En ambos, el cáustico ingerido principalmente fue el hidróxido de sodio (lejía) (52 por ciento y 21.43 por ciento, respectivamente). El hidróxido de sodio (soda caústica, easy off), el amoníaco, el ácido sulfúrico y la nieve carbónica (hielo seco) son los agentes productores de lesiones más severas en orofaringe y esófago. El grupo A presentó vómitos (48.55 por ciento), sialorrea (20.23 por ciento) y disfagia (10.40 por ciento), y el B disfagia (92.85 por ciento), vómitos (57.14 por ciento) y odinofagia (35.71 por ciento). A todos se les relizó endoscopia digestiva superior, dilataciones precoces en esofagitis grado II-III y dilataciones terapéuticas en los pacientes de evaluación tardía. El grupo A se resolvió con éxito. Ningún paciente ameritó intevención quirúrgica. Concluímos, que la endoscopia digestiva superior y las dilataciones precoces constituyen un método adecuado para manejar pacientes con lesiones sofágicas por cáusticos antes de las 48 horas de avolución