LRRK2 Expression Is Deregulated in Fibroblasts and Neurons from Parkinson Patients with Mutations in PINK1.

Mutations in PINK1 (PARK6), a serine/threonine kinase involved in mitochondrial homeostasis, are associated with early onset Parkinson's disease. Fibroblasts from Parkinson's disease patients with compound heterozygous mutations in exon 7 (c.1488 + 1G > A; c.1252_1488del) showed no apparent signs of mitochondrial impairment. To elucidate changes primarily caused by lack of functional PINK1, we over-expressed wild-type PINK1, which induced a significant downregulation of LRRK2 (PARK8). Indeed, we found that LRRK2 protein basal levels were significantly higher in the mutant PINK1 fibroblasts. To examine the interaction between the two PARK genes in a disease-relevant cell context, we generated induced pluripotent stem cell (iPSC) lines from mutant, carrier and control fibroblasts by lentiviral-mediated re-programming. Efficiency of neural induction and dopamine differentiation using a floor-plate induction protocol was similar in all genotypes. As observed in fibroblasts, PINK1 mutant neurons showed increased LRRK2 expression both at the RNA and protein level and transient over-expression of wild-type PINK1 efficiently downregulated LRRK2 levels. Additionally, we confirmed a dysregulation of LRRK2 expression in fibroblasts from patients with a different homozygous mutation in PINK1 exon 4, c.926G > A (G309D). Thus, our results identify a novel role of PINK1 modulating the levels of LRRK2 in Parkinson's disease fibroblasts and neurons, suggest a convergent pathway for these PARK genes, and broaden the role of LRRK2 in the pathogenesis of Parkinson's disease.

Tuberculosis Pulmonar: estudio clínico-epidemiológico / Lung tuberculosis: Clinical and epidemic study

Introducción: la tuberculosis pulmonar es una de las enfermedades reemergentes actuales, afecta a una parte importante de la población mundial y causa millones de muertes evitables. Objetivo: describir el comportamiento clínico-epidemiológico de la tuberculosis pulmonar y de los indicadores operacionales seleccionados del Programa Nacional de Control de la Tuberculosis en la provincia de Cienfuegos desde el año 2006 al 2015. Métodos: se realizó un estudio descriptivo, retrospectivo de serie de casos. Se calcularon las tasas de incidencia por 105 habitantes y posteriormente, tomando las tasas de incidencia por 105 habitantes por el método de regresión lineal, se describió la tendencia de la incidencia por tuberculosis pulmonar en la provincia en el periodo 2006-2015. Resultados: el mayor número de casos nuevos diagnosticados fue del sexo masculino (169 pacientes), la tendencia de la enfermedad fue fluctuante, con la mayor incidencia en el año 2014. De todos los pacientes 128 fueron diagnosticados como BK+; la evaluación de los indicadores de pesquisa y de lugar de diagnóstico así como los de demora diagnóstica y de tratamiento, tuvieron fluctuaciones, pero en su mayoría fueron evaluados de mal; el indicador que mejor se cumplía era tiempo entre los primeros síntomas y primera consulta. Conclusiones: la tendencia de las tasas de incidencia de la tuberculosis pulmonar se mantuvo fluctuante con un deterioro progresivo del cumplimiento de los indicadores operacionales, problemas en la pesquisa y en la red diagnóstica, lo que evidencia la posibilidad de subdiagnóstico y transmisión comunitaria(AU)

Introduction: Pulmonary tuberculosis is one of the current reemerging diseases. It affects a significant part of the world population and causes millions of deaths that may be avoided. Objective: To describe the clinical-epidemiological behavior of pulmonary tuberculosis and the operational indicators chosen from the National Program for Tuberculosis Control in Cienfuegos Province from 2006 to 2015. Methods: A descriptive, retrospective study of a cases series was carried out. The incidence rates for 105 inhabitants were calculated. Subsequently, the incidence rates were taken for 105 inhabitants by the linear regression method. We described the tendency of the incidence of pulmonary tuberculosis in the province in the period 2006-2015 was described. Results: The highest number of new cases diagnosed corresponded to the male sex (169 patients). The disease trend was fluctuating, with the highest incidence in 2014. Of all the patients, 128 were diagnosed as BK+. The assessment of screening and diagnosis sites indicators, as well as those of diagnostic delay and treatment, had fluctuations, but were mostly evaluated as poor. The indicator best met was time between the first symptoms and first consultation. Conclusions: The tendency of pulmonary tuberculosis' incidence rates remained fluctuating with a progressive deterioration, in compliance with operational indicators, problems regarding research and the diagnostic network, evidencing the possibility of underdiagnoses and community transmission(AU)

Tuberculosis Pulmonar: estudio clínico-epidemiológico / Lung tuberculosis: Clinical and epidemic study

Introducción: la tuberculosis pulmonar es una de las enfermedades reemergentes actuales, afecta a una parte importante de la población mundial y causa millones de muertes evitables. Objetivo: describir el comportamiento clínico-epidemiológico de la tuberculosis pulmonar y de los indicadores operacionales seleccionados del Programa Nacional de Control de la Tuberculosis en la provincia de Cienfuegos desde el año 2006 al 2015. Métodos: se realizó un estudio descriptivo, retrospectivo de serie de casos. Se calcularon las tasas de incidencia por 105 habitantes y posteriormente, tomando las tasas de incidencia por 105 habitantes por el método de regresión lineal, se describió la tendencia de la incidencia por tuberculosis pulmonar en la provincia en el periodo 2006-2015. Resultados: el mayor número de casos nuevos diagnosticados fue del sexo masculino (169 pacientes), la tendencia de la enfermedad fue fluctuante, con la mayor incidencia en el año 2014. De todos los pacientes 128 fueron diagnosticados como BK+; la evaluación de los indicadores de pesquisa y de lugar de diagnóstico así como los de demora diagnóstica y de tratamiento, tuvieron fluctuaciones, pero en su mayoría fueron evaluados de mal; el indicador que mejor se cumplía era tiempo entre los primeros síntomas y primera consulta. Conclusiones: la tendencia de las tasas de incidencia de la tuberculosis pulmonar se mantuvo fluctuante con un deterioro progresivo del cumplimiento de los indicadores operacionales, problemas en la pesquisa y en la red diagnóstica, lo que evidencia la posibilidad de subdiagnóstico y transmisión comunitaria(AU)

Introduction: Pulmonary tuberculosis is one of the current reemerging diseases. It affects a significant part of the world population and causes millions of deaths that may be avoided. Objective: To describe the clinical-epidemiological behavior of pulmonary tuberculosis and the operational indicators chosen from the National Program for Tuberculosis Control in Cienfuegos Province from 2006 to 2015. Methods: A descriptive, retrospective study of a cases series was carried out. The incidence rates for 105 inhabitants were calculated. Subsequently, the incidence rates were taken for 105 inhabitants by the linear regression method. We described the tendency of the incidence of pulmonary tuberculosis in the province in the period 2006-2015 was described. Results: The highest number of new cases diagnosed corresponded to the male sex (169 patients). The disease trend was fluctuating, with the highest incidence in 2014. Of all the patients, 128 were diagnosed as BK+. The assessment of screening and diagnosis sites indicators, as well as those of diagnostic delay and treatment, had fluctuations, but were mostly evaluated as poor. The indicator best met was time between the first symptoms and first consultation. Conclusions: The tendency of pulmonary tuberculosis' incidence rates remained fluctuating with a progressive deterioration, in compliance with operational indicators, problems regarding research and the diagnostic network, evidencing the possibility of underdiagnoses and community transmission(AU)

Actinomicosis pulmonar. Presentación de un caso / Pulmonary Actinomycosis. A Case Report

La actinomicosis pulmonar es una enfermedad bacteriana infrecuente. Se presenta el caso de un paciente de 17 años de edad, procedente del África, con antecedentes de diabetes mellitus y malnutrición proteico-energética, atendido por médicos cubanos de misión en ese continente. El paciente presentó un absceso submandibular en la región lateral izquierda de la cara, posterior a varias manipulaciones odontológicas, con extensión a la porción superior anterior del tórax, trayecto fistuloso a este nivel y presencia de adenopatías en el cuello. Se realizó estudio de la lesión e inició tratamiento con antibióticoterapia, pero el cuadro no remitió y aparecieron nuevos síntomas, que junto a los exámenes imagenológicos sugirieron un proceso neumónico o neoplasia. Se decidió efectuar punción con aspiración por aguja fina que estableció el diagnóstico de actinomicosis pulmonar. Se instauró tratamiento antibiótico de elección con lo que se observó mejoría clínica y radiológica. Por ser una entidad que tiene una presentación clínica muy variada, pues puede simular desde un cuadro infeccioso banal hasta una neoplasia, y ser poco frecuente su localización en el pulmón, se decidió la presentación del caso.

Pulmonary actinomycosis is a rare bacterial disease. We present the case of a 17-year-old African patient with a history of diabetes mellitus and protein-energy malnutrition, treated by Cuban doctors collaborating in that continent. The patient presented with a submandibular abscess on the left side of the face after dental manipulation, which had extended into the upper anterior chest with a fistulous pathway, and enlarged lymph nodes in the neck. The lesion was analyzed and treated with antibiotics, but the patient did not recover and new symptoms appeared, which together with the imaging tests, suggested a pneumonic process or neoplasia. A fine-needle aspiration led to the diagnosis of pulmonary actinomycosis. Antibiotic treatment of choice was applied resulting in clinical and radiological improvement. We decided to present this case given the varied clinical presentation of this entity, which can simulate a banal infection or a neoplasm, and its rare location.

Actinomicosis pulmonar: presentación de un caso / Pulmonary actinomycosis: a case report

La actinomicosis pulmonar es una enfermedad bacteriana infrecuente. Se presenta el caso de un paciente de 17 años de edad, procedente del África, con antecedentes de diabetes mellitus y malnutrición proteico-energética, atendido por médicos cubanos de misión en ese continente. El paciente presentó un absceso submandibular en la región lateral izquierda de la cara, posterior a varias manipulaciones odontológicas, con extensión a la porción superior anterior del tórax, trayecto fistuloso a este nivel y presencia de adenopatías en el cuello. Se realizó estudio de la lesión e inició tratamiento con antibióticoterapia, pero el cuadro no remitió y aparecieron nuevos síntomas, que junto a los exámenes imagenológicos sugirieron un proceso neumónico o neoplasia. Se decidió efectuar punción con aspiración por aguja fina que estableció el diagnóstico de actinomicosis pulmonar. Se instauró tratamiento antibiótico de elección con lo que se observó mejoría clínica y radiológica. Por ser una entidad que tiene una presentación clínica muy variada, pues puede simular desde un cuadro infeccioso banal hasta una neoplasia, y ser poco frecuente su localización en el pulmón, se decidió la presentación del caso(AU)

Pulmonary actinomycosis is a rare bacterial disease. We present the case of a 17-year-old African patient with a history of diabetes mellitus and protein-energy malnutrition, treated by Cuban doctors collaborating in that continent. The patient presented with a submandibular abscess on the left side of the face after dental manipulation, which had extended into the upper anterior chest with a fistulous pathway, and enlarged lymph nodes in the neck. The lesion was analyzed and treated with antibiotics, but the patient did not recover and new symptoms appeared, which together with the imaging tests, suggested a pneumonic process or neoplasia. A fine-needle aspiration led to the diagnosis of pulmonary actinomycosis. Antibiotic treatment of choice was applied resulting in clinical and radiological improvement. We decided to present this case given the varied clinical presentation of this entity, which can simulate a banal infection or a neoplasm, and its rare location(AU)

Oxidative stress and aminopeptidases in Parkinson's disease patients with and without treatment.

BACKGROUND/OBJECTIVE: Mitochondrial dysfunction, oxidative stress and protein metabolism impairment are the main molecular events underlying the pathogenesis of Parkinson's disease (PD). However, only few studies have addressed the changes produced by these phenomena in the blood of PD patients. Our purpose was to compare oxidative stress between newly diagnosed PD patients (ntPD) and PD patients under treatment (tPD). We also analyzed changes in plasma activity of several aminopeptidases (AP) involved in the metabolism of various active peptides. METHODS: Plasma lipid peroxide (LPO) and lactate (LAC) concentrations were measured by colorimetric methods, and plasma AP activities were determined by fluorometric assay. RESULTS: LPO and LAC concentrations were significantly elevated in ntPD and tPD patients versus controls, but there were no differences between the PD groups. Alanine-, cystine- and aspartate-AP activities were significantly lower in tPD versus ntPD patients. Nondenaturing electrophoresis and Western blot results confirmed these findings. CONCLUSIONS: The plasma LPO and LAC levels were high in both PD groups, indicating that they are elevated at an early stage of PD and are not affected by anti-PD treatment. The higher AP activities in ntPD versus tPD patients suggest that anti-PD treatment may improve protein metabolism while not altering oxidative stress. A therapy directed to reduce oxidative stress and normalize AP activity may be useful in the treatment of PD.

Oxidative stress and plasma aminopeptidase activity in Huntington's disease.

Huntington's disease (HD) is a genetic neurodegenerative disorder. Oxidative stress, mitochondrial dysfunction, and protein metabolism impairment have been implicated in its pathogenesis. However, the contribution of these phenomena to HD onset or progression is not well known, and they have been less studied in peripheral blood. We analyzed plasma lipid peroxide (LPO) and lactate (LAC) concentrations as indicators of oxidative stress and mitochondrial dysfunction in symptomatic HD patients (sHD) and asymptomatic HD gene carriers (aHD). We also measured the plasma activity of aminopeptidases (APs), an important group of proteolytic enzymes. LPO and LAC concentrations were significantly elevated in sHD patients but not in aHD carriers. Aspartate and glutamate AP activities were significantly reduced in sHD patients and aHD carriers. These findings demonstrate that sHD patients are under oxidative stress, which may favor progression of the disease. Plasma AP activity was decreased before the appearance of HD symptoms and oxidative stress and may be related to protein metabolism impairment. These results indicate that therapy directed to improve oxidative stress and normalize AP activity may be useful in the treatment of HD. They also suggest that decreased plasma AP activity in aHD carriers may predict the future onset of HD symptoms.

Plasma alpha-synuclein in patients with Parkinson's disease with and without treatment.

Alpha-synuclein (alpha-syn) is an intracellular protein with a high tendency to aggregation. It is the major component of Lewy bodies and may play a key role in the pathogenesis of Parkinson's disease (PD). alpha-Syn is also released by neurons and can be detected in biological fluids, such as plasma. The purpose of this study was to determine whether plasma alpha-syn concentrations are elevated in newly diagnosed PD patients before treatment (nontreated PD group, ntPD; n = 53) and to compare them with concentrations in PD patients with at least 1 year of specific treatment (tPD; n = 42) and in healthy controls (n = 60). Plasma alpha-syn concentrations in the ntPD and tPD groups were similar and significantly higher than in healthy controls. In conclusion, alpha-syn was elevated early in the development of PD and specific PD treatment did not change plasma alpha-syn levels.

Carpal tunnel syndrome and HIV infection. A case report and literature review.

The first clinical case of carpal tunnel syndrome (CTS) in Cuban HIV-infected patient was described, and the scientific literature indexed in: PUBMED/MEDLINE, LILACS and BIREME were revised. The case presented was a male with HIV infection without preceding opportunistic illnesses, CD4(+) T cell count over 200 cells/mm(3) and clinical symptoms of pain, tingling and numbness in the right hand and wrist for three months. The electrophysiological study was compatible with CTS. The pharmacological treatment did not modify the symptoms and the patient received specific surgical treatment with absolute resolution of symptoms. CTS is a compressive neuropathy that can occur in HIV-positive individuals with as similar frequency as in the general population. The association between HIV infection and CTS is scarcely described in the medical scientific literature and probably does not represent a different phenomenon from what happens in the HIV-negative population. Nevertheless, its clinical recognition among other neurological and muscle-skeletal manifestations in HIV-infected patients is important.

Coinfección VIH-hepatitis B y C en la provincia de Cienfuegos / HIV/hepatitis B and C co-infection in Cienfuegos province

Objetivo: identificar la prevalencia de la infección por los virus de la hepatitis B (VHB) y C (VHC) en individuos infectados por VIH en la provincia de Cienfuegos. Métodos: se realizó un estudio de corte transversal hasta el mes del abril de 2005 y se analizaron variables clínicas y el recuento de linfocitos TCD4+ (LTCD4+). Resultados: la prevalencia de la infección por el VHB resultó 14,4 por ciento y por el VHC 20 por ciento. La frecuencia del SIDA fue superior en los pacientes con hepatitis B (77,8 por ciento) respecto a los infectados por el VHC (28,6 por ciento). El porcentaje de casos con menos de 500 LTCD4+ resultó superior en los coinfectados por el VHC (57,4 por ciento); 4 enfermos (14,8 por ciento) tenían realizado estudio histológico hepático. Conclusión: la coinfección de los VHB/VHC y el VIH es un problema frecuente en la provincia, sin embargo, se desconocen aspectos clínicos y epidemiológicos que ameritan nuevos estudios(AU)

Objective: To identify the prevalence of hepatitis B and C virus infections (HVB) and (HVC) in individuals infected by HIV in Cienfuegos province. Methods: A cross-sectional study was performed till April 2005 in which clinical variables and TCD4+ lymphocyte count were analyzed. Results: the prevalence of HVB infection was 14,4 percent and of HVC was 20 percent. AIDS frequency was higher in patients suffering from hepatitis B (77,8 percent) than in those with hepatitis C (28,6 percent). Percentage of cases under 500 TCD4+ count was higher in patients coinfested with HVC (57,4 percent); also 4 patients (14,8 percent) had been performed a hepatic histological study. Conclusion: HVB/HVC co-infection and HIV is a common problem in the province; however, clinical and epidemiological aspects that are yet unknown call for new studies(AU)

Coinfección VIH-hepatitis B y C en la provincia de Cienfuegos / HIV/hepatitis B and C co-infection in Cienfuegos province

Objetivo: identificar la prevalencia de la infección por los virus de la hepatitis B (VHB) y C (VHC) en individuos infectados por VIH en la provincia de Cienfuegos. Métodos: se realizó un estudio de corte transversal hasta el mes del abril de 2005 y se analizaron variables clínicas y el recuento de linfocitos TCD4+ (LTCD4+). Resultados: la prevalencia de la infección por el VHB resultó 14,4 por ciento y por el VHC 20 por ciento. La frecuencia del SIDA fue superior en los pacientes con hepatitis B (77,8 por ciento) respecto a los infectados por el VHC (28,6 por ciento). El porcentaje de casos con menos de 500 LTCD4+ resultó superior en los coinfectados por el VHC (57,4 por ciento); 4 enfermos (14,8 por ciento) tenían realizado estudio histológico hepático. Conclusión: la coinfección de los VHB/VHC y el VIH es un problema frecuente en la provincia, sin embargo, se desconocen aspectos clínicos y epidemiológicos que ameritan nuevos estudios.

Objective: To identify the prevalence of hepatitis B and C virus infections (HVB) and (HVC) in individuals infected by HIV in Cienfuegos province. Methods: A cross-sectional study was performed till April 2005 in which clinical variables and TCD4+ lymphocyte count were analyzed. Results: the prevalence of HVB infection was 14,4 percent and of HVC was 20 percent. AIDS frequency was higher in patients suffering from hepatitis B (77,8 percent) than in those with hepatitis C (28,6 percent). Percentage of cases under 500 TCD4+ count was higher in patients coinfested with HVC (57,4 percent); also 4 patients (14,8 percent) had been performed a hepatic histological study. Conclusion: HVB/HVC co-infection and HIV is a common problem in the province; however, clinical and epidemiological aspects that are yet unknown call for new studies.

Meningoencefalitis eosinofílica: presentación y enseñanzas del primer caso de un brote / Eosinophilic meningoencephalitis: presentation and teachings of the first case of an outbreak

Paciente masculino, de 35 años de edad, procedente de la comunidad rural 5 de Septiembre, Rodas, admitido en el hospital Dr Gustavo Aldereguía Lima, por cefalea pulsátil persistente, con proyección ocular de 5 sem de evolución, hiperestesia cutánea en regiones occipital, lateral derecha del cuello, dorsal izquierda y muslo derecho. Se realizó examen físico que sólo mostró ligero dolor a la flexión del cuello. Se constató eosinofilia de 11 por ciento. Se halló líquido cefalorraquídeo de 950 leucocitos x mm3, con predominio de linfocitos y 10 por ciento de eosinófilos. Se planteó el diagnóstico de meningitis eosinofílica por Angiostrongylus cantonensis. Se conoció que varios compañeros de trabajo del enfermo tenían síntomas parecidos y que existía alarma en la comunidad. Se estudió el caso, con el planteamiento de una entidad que no se piensa en ella en la práctica cotidiana, por lo cual se pudo desenredar la madeja tejida alrededor de varios casos cuyo origen inicialmente no estaba muy claro (AU)

The case of a 35-year-old male from 5 de Septiembre rural community, Rodas, admitted in Dr Gustavo Aldereguía Lima Hospital due to persistent pulsatile headache, with ocular projection of 5 weeks of evolution, cutaneous hyperesthesia in occipital region, right lateral region of the neck, left dorsal region and right thigh, was presented. The physical examination only showed mild pain on flexing the neck. 11 percent of eosinophilia was confirmed. CSF of 950 leukocytes x mm3, with predominance of lymphocytes and 10 percent of eosinophiles was found. The diagnosis of eosinophilic meningitis caused by Angiostrongylus cantonensis was established. It was known that several work mates of the patient had similar symptoms and that there was alarm in the community. The case was studied with the presentation of an entity that is not considered in the daily practice, which made possible to clarify some cases whose origin was not very clear at the beginning (AU)

Meningoencefalitis eosinofílica: presentación y enseñanzas del primer caso de un brote / Eosinophilic meningoencephalitis: presentation and teachings of the first case of an outbreak

Paciente masculino, de 35 años de edad, procedente de la comunidad rural 5 de Septiembre, Rodas, admitido en el hospital Dr Gustavo Aldereguía Lima, por cefalea pulsátil persistente, con proyección ocular de 5 sem de evolución, hiperestesia cutánea en regiones occipital, lateral derecha del cuello, dorsal izquierda y muslo derecho. Se realizó examen físico que sólo mostró ligero dolor a la flexión del cuello. Se constató eosinofilia de 11 por ciento. Se halló líquido cefalorraquídeo de 950 leucocitos x mm3, con predominio de linfocitos y 10 por ciento de eosinófilos. Se planteó el diagnóstico de meningitis eosinofílica por Angiostrongylus cantonensis. Se conoció que varios compañeros de trabajo del enfermo tenían síntomas parecidos y que existía alarma en la comunidad. Se estudió el caso, con el planteamiento de una entidad que no se piensa en ella en la práctica cotidiana, por lo cual se pudo desenredar la madeja tejida alrededor de varios casos cuyo origen inicialmente no estaba muy claro.

The case of a 35-year-old male from 5 de Septiembre rural community, Rodas, admitted in Dr Gustavo Aldereguía Lima Hospital due to persistent pulsatile headache, with ocular projection of 5 weeks of evolution, cutaneous hyperesthesia in occipital region, right lateral region of the neck, left dorsal region and right thigh, was presented. The physical examination only showed mild pain on flexing the neck. 11 percent of eosinophilia was confirmed. CSF of 950 leukocytes x mm3, with predominance of lymphocytes and 10 percent of eosinophiles was found. The diagnosis of eosinophilic meningitis caused by Angiostrongylus cantonensis was established. It was known that several work mates of the patient had similar symptoms and that there was alarm in the community. The case was studied with the presentation of an entity that is not considered in the daily practice, which made possible to clarify some cases whose origin was not very clear at the beginning.

Impacto de la terapia antirretroviral de alta eficacia en la respuesta clínica e inmunovirológica en enfermos SIDA / Impact of highly active antiretroviral therapy in the clinical, immunological and virological response from AIDS patients

Se realizó un estudio propectivo y longitudinal con el propósito de evaluar la respuesta clínica, inmunológica y virológica de una cohorte de 34 enfermos de SIDA en la provincia de Cienfuegos tratados con terapia antirretroviral de alta eficacia (TARVAE). Del sexo masculino eran 67,6 por ciento y la media de edad 32 años. La vía de infección sexual se identificó en 91,2 por ciento. Del total de individuos, 79,4 por ciento definieron el SIDA por recuento de LTCD4+ < 200 células. Padecieron de infecciones oportunistas menores 26 enfermos (76,5 por ciento) y 32,4 por ciento enfermó por alguna oportunista mayor antes de la TARVAE. Posterior a esta, las frecuencias se redujeron a 20,6 y 11,8 por ciento, respectivamente. El recuento medio de LTCD4+ al inicio de la TARVAE fue 196 células/mm3, y superó las 400 células en el resto de las mediciones. De una media de CVP de 15 251 copias/mL al año de la terapia, disminuyó a 8 048 copias a los 2 años. Solo 10 casos requirieron hospitalización después de la TARVAE (29,4 por ciento). La adherencia a la terapia superó 80 por ciento y se correlacionó con la restauración inmunológica. La supervivencia al año fue de 100 por ciento y durante los 4 años fallecieron 2 enfermos. Se demostró el impacto positivo de la TARVAE en la frecuencia de infecciones oportunistas, la restauración inmunológica y la supervivencia(AU)

A longitudinal prospective study was made to evaluate the clinical, immunological and virological response of a cohort of 34 AIDS patients in Cienfuegos provinces, who had been treated with highly active antiretroviral therapy (HAART). Males comprised 67.6percent of the total number and average age was 32 years. Sexual infection path was identified in 91.2 percent of cases. The CD4+ T counting under 200 cells defined AIDS in 79.4 percent of individuals. Twenty six patients suffered minor opportunistic infections (76.5 percent) whereas 32.4 percent got sick due to some major opportunistic disease prior to the therapy. After this therapy, these frequencies lowered to 20.6 percent and 11.8 percent respectively. Average CD4+ counting at the starting of HAART was 196 cell/mm3 and exceeded 400 cells in the rest of further countings. From a PVC average of 15 251 copies/ml one year after therapy, this figure reduced to 8 048 copies at 2 years. Only 10 cases required hospitalization after a HAART (29.4 percent). Treatment adherence reached over 80 persent and was correlated to immunological restoration. Survival after one year was 100 percent and only 2 patients died in the following 4 years. The positive impact of HAART on the frequency of opportunistic infections, immunological restoration and survival was proved(AU)

Impacto de la terapia antirretroviral de alta eficacia en la respuesta clínica e inmunovirológica en enfermos SIDA / Impact of highly active antiretroviral therapy in the clinical, immunological and virological response from AIDS patients

Se realizó un estudio propectivo y longitudinal con el propósito de evaluar la respuesta clínica, inmunológica y virológica de una cohorte de 34 enfermos de SIDA en la provincia de Cienfuegos tratados con terapia antirretroviral de alta eficacia (TARVAE). Del sexo masculino eran 67,6 por ciento y la media de edad 32 años. La vía de infección sexual se identificó en 91,2 por ciento. Del total de individuos, 79,4 por ciento definieron el SIDA por recuento de LTCD4+ < 200 células. Padecieron de infecciones oportunistas menores 26 enfermos (76,5 por ciento) y 32,4 por ciento enfermó por alguna oportunista mayor antes de la TARVAE. Posterior a esta, las frecuencias se redujeron a 20,6 y 11,8 por ciento, respectivamente. El recuento medio de LTCD4+ al inicio de la TARVAE fue 196 células/mm3, y superó las 400 células en el resto de las mediciones. De una media de CVP de 15 251 copias/mL al año de la terapia, disminuyó a 8 048 copias a los 2 años. Solo 10 casos requirieron hospitalización después de la TARVAE (29,4 por ciento). La adherencia a la terapia superó 80 por ciento y se correlacionó con la restauración inmunológica. La supervivencia al año fue de 100 por ciento y durante los 4 años fallecieron 2 enfermos. Se demostró el impacto positivo de la TARVAE en la frecuencia de infecciones oportunistas, la restauración inmunológica y la supervivencia.

A longitudinal prospective study was made to evaluate the clinical, immunological and virological response of a cohort of 34 AIDS patients in Cienfuegos provinces, who had been treated with highly active antiretroviral therapy (HAART). Males comprised 67.6percent of the total number and average age was 32 years. Sexual infection path was identified in 91.2 percent of cases. The CD4+ T counting under 200 cells defined AIDS in 79.4 percent of individuals. Twenty six patients suffered minor opportunistic infections (76.5 percent) whereas 32.4 percent got sick due to some major opportunistic disease prior to the therapy. After this therapy, these frequencies lowered to 20.6 percent and 11.8 percent respectively. Average CD4+ counting at the starting of HAART was 196 cell/mm3 and exceeded 400 cells in the rest of further countings. From a PVC average of 15 251 copies/ml one year after therapy, this figure reduced to 8 048 copies at 2 years. Only 10 cases required hospitalization after a HAART (29.4 percent). Treatment adherence reached over 80 persent and was correlated to immunological restoration. Survival after one year was 100 percent and only 2 patients died in the following 4 years. The positive impact of HAART on the frequency of opportunistic infections, immunological restoration and survival was proved.

Estudio de 145 episodios de meningoencefalitis aguda bacteriana en adultos cubanos / Study of 145 episodes of acute bacterial meningitis in cuban adults

Objetivo: Caracterizar 145 episodios de meningoencefalitis aguda bacteriana en adultos en el Hospital General Universitario “Dr. Gustavo Aldereguía Lima” en el decenio 1995-2004. Pacientes y métodos: Se trató de un estudio retrospectivo obervacional que describió la frecuencia de variables epidemiológicas, clínicas y microbiológicas, las cuales se relacionaron con la mortalidad mediante un análisis de múltiples variables por regresión logística. Resultados y conclusiones: En 43 episodios la MEB estuvo precedida de otras enfermedades (29.7%); neumonía (13.1%), otitis media supurada (14.5%). Los síntomas y signos más frecuentes fuerron: fiebre (94.5%), cefalea (95.9%), vómitos (73.1%), desorientación (42.8%) y degradación de consciencia (40.7%) y meningismo (83.5%). 45 episodios (31%) se complicaron en las primeras 24 horas, siendo las convulsiones (13.1%), la hipertensión endocraneana (11.7%), la hipertermia (11.7%) y el coma (9.7%) las más frecuentes. Predominó la pleocitosis neutrófila (91.7%), el Streptococcus pneumoniae resultó el microorganismo aislado con más frecuencia (47.6%), mientras que en 59 ocasiones no se demostró microorganismo en el LCR (37.2%) Ocurrieron 29 fallecimientos (20%), 9 en las primeras 24 horas y el resto luego de 24 horas, el 100% de las muertes dependieron de la MEB. La media de edad fue significativamente superior en los fallecidos (58.6 DS = 20 vs 47.7 DS = 18 años), de otra parte la estadía y la celularidad en el LCR promedios, resultaron significativamente inferiores en los fallecidos. Luego del análisis de múltiples variables, haber padecido de neumonía antes de la meningitis (OR = 6.01), tener degradación de consciencia al ingreso (OR = 4.72), convulsionar en las primeras 24 horas (OR = 5.99) y una celularidad menor a 500 células en el LCR (OR = 4.13), se asociaron de forma independiente con el riesgo de morir.Palabras clave: Meningoencefalitis aguda bacteriana, adultos, diagnóstico, mortalidad.

Mitochondrial dysfunction, peroxidation damage and changes in glutathione metabolism in PARK6.

Oxidative stress and protein aggregation are biochemical hallmarks of Parkinson's disease (PD), a frequent sporadic late-onset degenerative disorder particularly of dopaminergic neurons in the substantia nigra, resulting in impaired spontaneous movement. PARK6 is a rare autosomal-recessively inherited disorder, mimicking the clinical picture of PD with earlier onset and slower progression. Genetic data demonstrated PARK6 to be caused by mutations in the protein PINK1, which is localized to mitochondria and has a serine-threonine kinase domain. To study the effect of PINK1 mutations on oxidative stress, we used primary fibroblasts and immortalized lymphoblasts from three patients homozygous for G309D-PINK1. Oxidative stress was evident from increases in lipid peroxidation and in antioxidant defenses by mitochondrial superoxide dismutase and glutathione. Elevated levels of glutathione reductase and glutathione-S-transferase were also observed. As a putative cause of oxidation, a mild decrease in complex I activity and a trend to superoxide elevation were detectable. These data indicate that PINK1 function is critical to prevent oxidative damage and that peripheral cells may be useful for studies of progression and therapy of PARK6.

[Impact of highly active antiretroviral therapy in the clinical, immunological and virological response from AIDS patients]. / Impacto de la terapia antirretroviral de alta eficacia en la respuesta clinica e inmunovirológica en enfermos SIDA.

A longitudinal prospective study was made to evaluate the clinical, immunological and virological response of a cohort of 34 AIDS patients in Cienfuegos provinces, who had been treated with highly active antiretroviral therapy (HAART). Males comprised 67.6% of the total number and average age was 32 years. Sexual infection path was identified in 91.2% of cases. The CD4+ T counting under 200 cells defined AIDS in 79.4% of individuals. Twenty six patients suffered minor opportunistic infections (76.5%) whereas 32.4% got sick due to some major opportunistic disease prior to the therapy. After this therapy, these frequencies lowered to 20.6% and 11.8% respectively. Average CD4+ counting at the starting of HAART was 196 cell/mm3 and exceeded 400 cells in the rest of further countings. From a PVC average of 15 251 copies/mL one year after therapy, this figure reduced to 8 048 copies at 2 years. Only 10 cases required hospitalization after a HAART (29.4%). Treatment adherence reached over 80% and was correlated to immunological restoration. Survival after one year was 100% and only 2 patients died in the following 4 years. The positive impact of HAART on the frequency of opportunistic infections, immunological restoration and survival was proved.

Plasma lipid peroxidation in sporadic Parkinson's disease. Role of the L-dopa.

Oxidative stress plays an important role in the pathogenesis of neurodegenerative diseases, such as Parkinson's disease (PD). There are several methods to measure oxidative stress, being lipid peroxidation (LPO) one of the most frequently used. Endogenous plasma LPO was determined by a spectrofluorimetric method in fifty two patients with sporadic PD and in forty controls. To know the maximum capacity of lipids to peroxidate, LPO was also measured after co-incubation with Fe2+/H2O2 (exogenous LPO). All PD patients were taken L-dopa and the effect of this treatment on LPO levels was additionally studied. Urine catecholamines and their main metabolites were also analyzed, and their possible correlation to LPO statistically studied. Endogenous plasma LPO levels were 33% higher in PD group than in control group (P<0.001). Exogenous plasma or oxidizability was also higher in PD patients compared to controls (20%, P<0.05). The intake of L-dopa was negatively dose-related to endogenous and exogenous plasma LPO. In conclusion, plasma of PD patients has elevated levels of LPO and also is more prone to peroxidation than that in the control group. The results also suggest an antioxidant effect of L-dopa.

Steele-Richardson-Olszewski syndrome in a patient with a single C212Y mutation in the parkin protein.

Steele-Richardson-Olszewski syndrome (SROS) is a neurodegenerative disorder of unknown aetiology, most frequently sporadic. Familial cases of SROS have been described. An intronic polymorphism of the tau gene is associated with sporadic SROS and mutations of the tau gene are present in atypical cases of SROS. The role of tau has been excluded in other families with pathology proven SROS, suggesting that this syndrome may have multiple causes. An 82-year-old patient, father of 3 children with autosomal recessive juvenile parkinsonism due to combined heterozygous mutations of the parkin gene, developed clinical features of SROS 2 years before death. The diagnosis was confirmed by pathology. He carried the C212Y mutation of the parkin gene and was homozygous for the A0 polymorphism and for the H1 haplotype. The role of parkin in the processing of tau is discussed.