Prospective, comprehensive, and effective viral monitoring in Cuban children undergoing solid organ transplantation.

PURPOSE: In Cuba, viral monitoring in the post-transplant period was not routinely performed. The aim of this research is to identify the most frequent viruses that affect transplanted Cuban children, by implementing a viral follow-up during the post-transplant period. METHODS: The study population included all Cuban pediatric patients who underwent solid organ transplantation (SOT) between November 2009 and December 2012. A total of 34 transplanted pediatric patients of kidney (n = 11) and liver (n = 23) were prospectively monitored during a 34-week period for viral DNAemia and DNAuria by simultaneous detection of cytomegalovirus (CMV), Epstein-Barr virus, herpes simplex virus type 1 and 2, varicella zoster virus, human herpesvirus 6, human adenovirus, and polyomaviruses (BKV and JCV) using quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: Viral genome of at least one virus was detected in 21 of 34 recipients, 18 patients excreted virus in urine while 12 presented DNAemia. CMV (41.2%) and BKV (35.3%) were the most frequent viruses detected during the follow-up. CMV was the virus mainly associated with clinical symptoms and DNAemia. Its excretion in urine (with cut off value of 219 copies/mL) was associated with detection in plasma (p < 0.001); furthermore, CMV viruria was predictive of CMV viremia (OR:8.4, CI:2.4-29.1, p = 0.001). There was no association between high viral load and clinical complications, due to the prompt initiation of preemptive ganciclovir. CONCLUSION: This comprehensive viral monitoring program effectively prevents the development of critical viral disease, thus urge the implementation of qRT-PCR as routine for viral monitoring of transplanted Cuban organ recipients.

Coagulación intravascular diseminada crónica como forma de presentación de un caso con aneurisma de la aorta / Chronic disseminated intravascular coagulation as the form of presentation of a case with aortic aneurysm

El término coagulación intravascular diseminada (CID) define un proceso patológico que complica la evolución clínica de diversas enfermedades, es inducida por procoagulantes introducidos o producidos en la circulación sanguínea que llegan a superar los mecanismos anticoagulantes naturales. Entre las posibles causas más frecuentes para el desarrollo de la enfermedad están la infecciosa y la tumoral; menos frecuente es la existencia de un aneurisma aórtico, entre otras. Su incidencia en pacientes con aneurismas aórticos grandes es del 0,5 -1 por ciento. Diferentes causas inciden en la aparición de estas grandes dilataciones vasculares, pero en los pacientes de edad avanzada, su mecanismo de producción está estrechamente vinculado con la ateroesclerosis. Se presenta un paciente de 88 años de edad con antecedentes de diabetes mellitus tipo II e hipertensión arterial, que presenta manifestaciones purpúrico petequiales en abdomen y miembros inferiores, además de hematuria de 2 meses de evolución. Los exámenes de laboratorio mostraron evidencias de CID y los imagenológicos, presencia de lesiones vasculares de localización aórtico torácica y abdominal. Por la edad avanzada del paciente y las enfermedades subyacentes que apoyaban el carácter irresecable de las lesiones, se inició tratamiento con heparina de bajo peso molecular, opción terapéutica importante para el manejo en los grandes aneurismas, mucho más cuando son irresecables, el riesgo quirúrgico es muy alto, o ambos. Su evolución clínica ha sido favorable con control mantenido de la coagulopatía durante 2 años

The term disseminated intravascular coagulation (DIC) defines a pathological process complicating the clinical evolution of various diseases. It is caused by procoagulants introduced into or produced in blood circulation which may exceed natural anticoagulant mechanisms. The most common causes of the disease are infectious and tumoral. A less common cause is the presence of an aortic aneurysm, among others. Its incidence in patients with large aortic aneurysms is 0.5 -1 percent. Various factors influence the emergence of these large vascular dilatations, but in elderly patients their development is closely related to atherosclerosis. A case is presented of an 88-year old patient with a background of type 2 diabetes mellitus and hypertension, who shows purpuric petechial manifestations on his abdomen and lower limbs, and has had hematuria for two months. Laboratory tests showed evidence of DIC, and imagenologic testing showed the presence of vascular lesions of aortic thoracic and abdominal location. Due to the advanced age of the patient and the underlying illnesses supporting the undryable nature of the lesions, treatment was started with heparin of low molecular weight, an important therapeutic management option for large aneurysms, particularly when they are undryable, surgical risk is high, or both. The patient's clinical evolution has been favorable, with a sustained control of coagulopathy for 2 years