Cuban Patients Research Articles

Assessment of infection with polyomaviruses BKV, JCV and SV40 in different groups of Cuban individuals

We investigated the frequency of BKV, JCV and SV40 reactivation in three groups of Cuban patients by multiplex nested PCR assay of 40 paraffin-embedded colorectal neoplasm tissues, 113 urine samples, and 125 plasma samples from 27 transplant recipients, and cerebrospinal fluid (CSF) from 67 HIV-1-infected individuals with central nervous system (CNS) disorders. None of these polyomaviruses were detected in colorectal neoplasms. JCV DNA was detected in 2 of 67 patients (2.9%) with CNS disorders, but neither BKV nor SV40 was identified. BKV was found in urine from 38.5% and 28.6% of adult and pediatric transplant recipients, respectively. In adult renal transplant recipients, excretion of BKV in urine was significantly associated with episodes of acute rejection (p=0.012) and with excretion of HCMV in urine (p= 0.008). In Cuba, the polyomaviruses studied here could not be related to colorectal neoplasms, and JCV was rarely detected in CSFs of HIV-1-infected individuals, whilst BKV reactivation was found to occur frequently in organ transplant recipients.

Oral Zinc Sulphate Supplementation for Six Months in SCA2 Patients: A Randomized, Double-Blind, Placebo-Controlled Trial

Cuban patients with Spinocerebellar Ataxia type 2 (SCA2) have reduced concentrations of zinc in serum and cerebrospinal fluid (CSF). To assess the effect and safety of zinc supplementation, 36 Cuban SCA2 patients were randomly assigned to receive daily either 50 mg ZnSO(4) or placebo, together with neurorehabilitation therapy in a randomized, double-blind, placebo-controlled clinical trial during 6 months. Outcome measures included the changes of zinc levels in CSF and serum, ataxia score, oxidative stress and saccadic eye movements. At the end of the study, the Zinc-treated group showed: (i) a significant increase of the Zn levels in the CSF, (ii) mild decrease in the ataxia scale subscores for gait, posture, stance and dysdiadochocinesia (iii) reduction of lipid's oxidative damage, and (iv) reduction of saccadic latency when compared with the placebo group. The treatment was safe and well tolerated by all subjects. This study demonstrated the efficacy and safety of Zn supplementation, combined with neurorehabilitation for SCA2 patients and therefore it may encourage further studies on the clinical effect of zinc supplementation in SCA2 based in the conduction of future clinical trials with higher number of subjects.

Comparison of Major Immunoglobulins Intrathecal Synthesis Patterns in Ecuadorian and Cuban Patients with Angiostrongyliasis

Angiostrongylus cantonensis meningitis was first reported in Cuba in 1981, and it was recently reported in South America. The aim of this paper is to evaluate the intrathecal immunoglobulin synthesis patterns from Cuba's and Ecuador's patients with angiostrongyliasis; 8 Ecuadorian patients from two different outbreaks and 28 Cuban patients were studied. Simultaneous blood and cerebrospinal fluid samples were taken. Immunoglobulin (Ig) A, IgM, IgG, and albumin were quantified by radial immunodiffusion. Corresponding Reibergrams were applied. A three-Ig pattern was the most frequent in the two groups, but IgM was presented in all Ecuadorian young mature patients; however, in the Cuban children, only 12 of 28 patients had intrathecal IgM, but about 90% had an IgA and IgG synthesis at time of later puncture. This indicates that, with a larger amount of parasites ingested, clinical symptoms are more severe, and a higher frequency of intrathecal IgM synthesis could be observed. This is discussed as a similarity with the intrathecal IgM synthesis in African trypanosomiasis.

Efecto del consumo de tres huevos de gallina diarios sobre el perfil lipídico en pacientes dislipidémicos

Introduction Although limiting consumption of chicken eggs is recommended to avoid increased plasma cholesterol, there is no definitive evidence to support this recommendation. The aim of this study was to evaluate changes in plasma lipoprotein profile in Cuban patients consuming an egg-rich diet. Methods We studied eight patients recruited from the Lipids Clinic of the Hermanos Ameijeiras Hospital (Cuba). After 6 weeks on an antilipidemic diet, the patients ate three whole eggs daily for 3 months. Lipid profiles were studied at baseline, and at 6 and 12 weeks. Results The only significant changes were an increase in low-density lipoprotein-cholesterol (LDLc) and high-density lipoprotein-cholesterol (HDLc) levels at 6 weeks vs baseline levels. However, triglycerides, total cholesterol, non-HCL-cholesterol, and the total cholesterol/HDLc ratio showed no change at 6 and 12 weeks vs baseline levels. Interindividual changes in lipid profile were observed, probably because of the individual regulation of cholesterol metabolism after a diet rich in eggs. Conclusions Eggs are a nutritionally complete food. Consequently, consumption of other cholesterol-rich foods should be reduced, in addition to that of egg consumption, before identifying lipoprotein metabolism status in each patient.

Afro-centric religious consultations as treatment for psychotic disorders among day hospital patients in Santiago de Cuba

We investigated the utilisation of Afro-centric religious treatments for psychotic disorders among a sample of Cuban day hospital patients. Most (55%) had used such treatments and this practice was more common among older persons, although unassociated with any particular religious background or racial heritage. Persons who preferred Afro-centric religious practices to medical ones were more likely to be of African descent or to have received an Afro-centric religious ritual bath as treatment. A case is made for destigmatising Afro-centric religious treatments and for exploring treatment approaches that combine both medical and religious practices in order to achieve more holistic care.

Microsatellite typing and susceptibilities of serial Cryptococcus neoformansisolates from Cuban patients with recurrent cryptococcal meningitis

BackgroundCryptococcus neoformans is commonly associated with meningoencephalitis in immunocompromised patients and occasionally in apparently healthy individuals. Recurrence of infection after initial treatment is not uncommon. We studied C. neoformans isolates from 7 Cuban patients with recurrent cryptococcal meningitis. Antifungal susceptibility and genotyping with microsatellite molecular typing were carried out.MethodsIsolates (n = 19) were recovered from cerebrospinal fluid, blood, urine and semen. Antifungal susceptibilities for amphotericin B, fluconazole, flucytosine, itraconazole, voriconazole, posaconazole and isavuconazole were tested by CLSI M27A3 broth microdilution method. Genotyping was done using a panel of 9 microsatellite (STR) markers: (CT)n, (TG)n, (TA)n, (CTA)n, (TCT)n, (CCA)n, (TTAT)n, (ATCC)n and (TATT)n.ResultsThe average number of isolates/patient was 2.71. The mean time interval between the collection of any two isolates was 52.5 days. All strains were identified as C. neoformans var. grubii (serotype Aα). Although none of the strains were resistant to the studied drugs, in serial isolates from two patients, MICs values of triazoles increased 4-5 log2 dilutions over time. STR patterns showed 14 distinctive profiles. In three patients the recurrent infection was associated with genotypically identical isolates. The four other patients had relapse isolates which were genotypically different from the initial infecting strain.ConclusionRecurrences of cryptococcal meningitis in our series of patients was not associated with development of drug resistance of the original strain but by an initial infection with different strains or a reinfection with a new strain.

Kaposi’s sarcoma-associated herpesvirus load in asymptomatic contacts of Cuban epidemic KS patients

To evaluate the pathogenic mechanisms and transmission routes involved in KSHV infection in 22 Cuban individuals who maintained close contact with epidemic KS patients, real-time PCR was used to quantify KSHV-DNA in clinical samples of plasma, saliva and peripheral blood mononuclear cells (PBMC). KSHV-DNA was detected in 72.7% (16/22) of the contacts. The highest levels of KSHV load were detected in saliva, followed by PBMC (average log copies/100ng DNA=1.28 and 1.12), while significantly lower levels were detected in plasma (average log copies/ml=0.37). Two of three intra-domiciliary and two serodiscordant sexual contacts of AIDS-KS patients were infected with KSHV. The rate of KSHV-DNA detection in saliva and PBMC samples in men who have sex with men (MSM) was significantly higher than in heterosexuals (HT) (p=0.014). MSM were more likely to harbor KSHV-DNA in saliva when compared with HT individuals (OR 4.33; 95% CI 1.117-16.8). These results emphasize that, in Cuba, KSHV horizontal transmission through saliva may occur, although homosexual behavior may predispose an individual to KSHV acquisition. Even in the absence of disease, KSHV could cause an asymptomatic systemic infection in individuals who maintain close contact with AIDS-KS patients.

Modifications in saccadic pulse and step components in Cuban ataxia SCA2 patients

Modifications in saccadic pulse and step components in Cuban ataxia SCA2 patients

Estimation of the age at onset in spinocerebellar ataxia type 2 Cuban patients by survival analysis

Previous studies have investigated the close association that exists between CAG repeat number and the age at onset in SCA2 = spinocerebellar ataxia type 2. These studies have focused on affected individuals. To further characterize this association and estimate the risk of a carrier developing SCA2 at a particular age as a function of a specific CAG repeat size, we have analyzed a large group of 924 individuals, including 394 presymptomatic and 530 affected individuals with a CAG repeat length of 32-79 units. Using a Kaplan-Meier survival analysis, we obtained cumulative probability curves for disease manifestation at a particular age for each CAG repeat length in the 34-45 range. These curves were significantly different (p < 0.001) and showed small overlap. All these information may be very valuable in predictive-testing programs, in the planning of studies for the identification of other genetic and environmental factors as modifiers of age at onset, and in the design of clinical trials for people at enlarged risk for SCA2.

Helicobacter pylori cagA and vacA genotypes in Cuban and Venezuelan populations

The aim of this study was to determine the presence of Helicobacter pylori cytotoxin-associated gene (cagA)/vacuolating cytotoxin gene (vacA) among patients with chronic gastritis in Cuba and Venezuela. Gastric antrum biopsies were taken for culture, DNA extraction and PCR analysis. Amplification of vacA and cagA segments was performed using two regions of cagA: 349 bp were amplified with the F1/B1 primers and the remaining 335 bp were amplified with the B7629/B7628 primers. The VA1-F/VA1-R set of primers was used to amplify the 259-bp (s1) or 286-bp (s2) product and the VAG-R/VAG-F set of primers was used to amplify the 567-bp (m1) or 642-bp (m2) regions of vacA. cagA was detected in 87% of the antral samples from Cuban patients and 80.3% of those from Venezuelan patients. All possible combinations of vacA regions were found, with the exception of s2/m1. The predominant combination found in both countries was s1/m1. The percentage of cagA+ strains was increased by the use of a second set of primers and a greater number of strains was amplified with the B7629/B7628 primers in the Cuban patients (p = 0.0001). There was no significant difference between the presence of the allelic variants of vacA and cagA in both populations. The predominant genotype was cagA+/s1m1 in both countries. The results support the necessary investigation of isolates circulating among the human population in each region.

Damage in Cuban patients with systemic lupus erythematosus. Relation with disease features

ObjectiveTo determine damage presence and predictors factors for its appearance in a cohort of Cuban patients with systemic lupus erythematosus (SLE). Patients and methodsA retrospective cohort study included 80 patients presenting with SLE seen in Rheumatology Service of “Hermanos Ameijeiras” Clinical Surgical Hospital in Havana City, Cuba. Damage was assessed using The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (ACR) Damage Index (SLIC/ACR), a tool approved for damage measurement. Damage presence was related to initial disease features to diagnose this condition, to sociodemographic elements, to treatments used, and to the disease course time. Statistical analysis had two variants: the univariate and multivariate type using Chi2 and statistical significance was established in P<.05. ResultsWe found that 39 patients (48.8%) had some degree of damage. More involved domains were the musculoskeletal (18.8%), neuropsychiatric, and skin, 16.3%, pulmonary and ocular, present in 15% of cases. In the multivariate analysis, damage was associated with the use of higher than 30mg/day Prednisone doses for more of 4 weeks (OR=54.68, CI 95%=3.56–97.45, P=.001), presence of leukopenia (RO=18.73, CI 95%=2.74–62.23 m P=.004), and time course of disease (OR=1.02, CI 95%=1.00 2–1.09, P=.006). ConclusionsDamage was practically present in half of the study patients, the most involved domain was the musculoskeletal, and use of higher than 30mg prednisone doses were the factor most associated with the presence of damage.

Simultaneous quantification of human herpesvirus 8 DNA by real time PCR in different tissues of HIV infected cuban patients with Kaposi's sarcoma

In Cuba, previous reports have shown an increase of epidemic KS, reaching a total of 120 cases by the end of 2007, despite the use of HAART. To evaluate and compare the role of human herpes virus 8 (HHV-8) viral loads in different compartments of AIDS-related Kaposi's sarcoma (AIDS-KS) patients real-time polymerase chain reaction (RT-PCR) was used to determine the genome copy number of HHV-8 in plasma, saliva, tissue and peripheral blood mononuclear cells (PBMC) of 49 AIDS-KS patients. Overall, 98% of AIDS-KS patients harbored detectable HHV-8. HHV-8 could be detected in 91.6% of KS tissue lesions showing the highest viral load (median log = 3.14 copies/100 ng DNA) followed by saliva and PBMC which were positive in 78%, and 69.2%; respectively. In contrast, HHV-8 was detected in only 37% of plasma samples, which also showed lower viral loads. Men who had sex with men (MSM) were more likely to have three-times higher HHV-8 genome copies in KS lesions when compared with tissues from heterosexuals individuals (OR 3; 95% CI 1.1 to 12.5). These results emphasize the systemic nature of HHV-8-infection and demonstrate the possible role of saliva in HHV-8 transmission among MSM.

For neurologists in Cuba, hope is not embargoed

For neurologists in Cuba, hope is not embargoed

Daño en pacientes cubanos con lupus eritematoso sistémico. Relación con características de la enfermedad

Objective To determine damage presence and predictors factors for its appearance in a cohort of cuban patients with systemic lupus erythematosus (SLE). Patients and methods A retrospective cohort study included 80 patients presenting with SLE seen in Rheumatology Service of “Hermanos Ameijeiras” Clinical Surgical Hospital in Havana City, Cuba. Damage was assessed using The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (ACR) Damage Index (SLIC/ACR), a tool approved for damage measurement. Damage presence was related to initial disease features to diagnose this condition, to sociodemographic elements, to treatments used, and to the disease course time. Statistical analysis had two variants: the univariate and multivariate type using Chi2 and statistical significance was established in p<0, 05. Results We found that 39 patients (48,8%) had some degree of damage. More involved domains were the musculoskeletal (18,8%), neuropsychiatric, and skin, 16,3%, pulmonary and ocular, present in 15% of cases. In the multivariate analysis, damage was associated with the use of higher than 30 mg/day Prednisone doses for more of 4 weeks (OR=54,68, CI 95%=3,56–97,45, p=0.001), presence of leukopenia (RO=18,73, CI 95%=2,74–62,23 m p=0,004), and time course of disease (OR=1,02, CI 95%=1,00 2–1,09, p=0.006). Conclusions: Damage was practically present in half of the study patients, the most involved domain was the musculoskeletal, and use of higher than 30 mg prednisone doses were the factor most associated with the presence of damage.

FOLFOX-4 Regimen as a First-line Therapy for Cuban Patients with Metastatic Colorectal Cancer

Introduction In Cuba, colorectal cancer (CRC) is the malignant neoplasm with the fourth-highest incidence and third-highest mortality. Over one-third of CRC patients exhibit metastatic disease at the time of diagnosis. Standard treatment for metastatic CRC is a 5-fluorouracil (5-FU) + Folinic Acid (FA) continuous infusion regimen. International studies have shown, however, that systemic therapy using oxaliplatin combined with 5-FU and FA (FOLFOX-4) improves results in terms of both tumor response and survival in patients with inoperable metastatic CRC. Objective Evaluate the FOLFOX-4 regimen as a first-line therapy for patients with inoperable metastatic CRC in Cuba. Methods FOLFOX-4 therapy was administered to 56 patients with metastatic CRC, in a treatment cycle repeated every 2 weeks for 6-8 cycles. Patients were followed up for a period of 2 years. Results Objective response was attained in 44.6% of patients, and complete response in 12.5%. Median duration of response and of progression-free survival was 9.6 and 8.9 months, respectively. Estimated survival at 2 years was 17% (95% CI: 6.89-26.8). The most frequent adverse events were nausea, vomiting, diarrhea and neutropenia, the majority grade 1-2, according to Common Terminology Criteria for Adverse Events (CTCAE) classification. Conclusions In patients studied, the FOLFOX-4 combination was shown to be an effective and well-tolerated therapeutic option for treating inoperable metastatic colorectal cancer.

Normal SCA2 alleles influences age at onset of spinocerebellar ataxia type 2 in Cuban patients

Normal SCA2 alleles influences age at onset of spinocerebellar ataxia type 2 in Cuban patients

Age at onset in spinocerebellar ataxia type 2 Cuban patients is affected by junctophilin-3 CTG repeat polymorphism

Age at onset in spinocerebellar ataxia type 2 Cuban patients is affected by junctophilin-3 CTG repeat polymorphism

Multidimensional Problems Among Advanced Cancer Patients in Cuba: Awareness of Diagnosis Is Associated with Better Patient Status

Cancer is one of the major causes of death in Cuba, and in current practice, patients are not usually informed of their diagnosis. Palliative care is an emerging discipline in this country. Cuban cancer patients with advanced disease completed the Palliative Outcome Scale (POS), and the researcher elicited patients' knowledge of their condition and prognosis. The POS consists of 12 items that address the clinical, psychosocial, spiritual, family, and service delivery elements considered relevant to patients with advanced disease. Ten items are scored 0 (no problem) to 4 (worst problem), with one open-response question about the main problems experienced and one question about whether the questionnaire was completed with help or alone. Mann-Whitney tests were used to compare POS item scores by patient awareness. Of the 91 patients who participated in the study, 41% knew they had cancer and 9% were believed to be aware that they were dying. The most burdensome problems recorded on the POS were wasted time on appointments (70% of patients scored 3 or 4), pain (42%), patient anxiety (39%), and family anxiety (37%). Those patients who were aware of their diagnosis had statistically significantly better scores with respect to symptoms, patient anxiety, receiving information, and receiving support from family and friends. This study adds to knowledge about characteristics of terminal cancer patients in Cuba and the factors contributing to patient burden. It is the first study to explore the palliative care needs of Cuban patients with advanced cancer. An association has been demonstrated between patient knowledge and quality of life in Cuba, a setting where disclosure is contrary to current clinical practice.

148. Survival analysis for the estimation of age at onset in spinocerebellar ataxia type 2 Cuban patients

148. Survival analysis for the estimation of age at onset in spinocerebellar ataxia type 2 Cuban patients

Sergio del Valle Jimenez

Sergio del Valle Jimenez