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.

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.

La clomipramina en el tratamiento de la eyaculación prematura: eficacia y efectos secundarios / The clomipramina in the treatment of the ejaculation premature: effectiveness and secondary effects

Evaluar la eficacia y efectos secundarios de la clomipramina como tratamiento de la eyaculación prematura. Se revisaron las historias clínicas de 71 pacientes que acudieron a nuestro servicio quejándose de eyaculación prematura (EP), durante un programa de consulta sexual realizado en el mes de mayo de 2001. Fueron incluidos todos los pacientes indistintamente la clasificación de la EP. El tiempo de la latencia para la eyaculación o tiempo de eyaculación (TE) fue registrado y referido por el mismo paciente. Se revisó el TE antes y después de la administración del medicamento, así como la eficacia y los efectos secundarios. Los resultados fueron clasificados como mejoría y sin mejoría y se calculó también el TE promedio antes y después de la ingesta del medicamento. Ventiocho pacientes recibieron 25mg de clomipramina. La edad promedio fue de 46,5 ± 12,9 años (23-73). Ventitrés pacientes (82,1 por ciento) respondieron haber tenido mejoría con el tratamienton y 5 pacientes (17,9 por ciento) respondieron no haber tenido mejoría. El TE antes del tratamiento fue de 25,1 ± 35,9 segundos (1-180) y el TE posterior al tratamiento fue de 25,1 ± 39,5 segundos (1-180) y el TE posterior al tratamiento fue de 336,6 ± 219,4 segundos (3 s - aneyaculación)(p<0.01). dieciocho pacientes (64,3 por ciento) presentaron efectos secundarios siendo la cefalea, las nauseas y los mareos los más comúnes. La clomipramina demostró ser un buen tratamiento en los pacientes con EP, sin embargo, un gran número de pacientes presentó efectos secundarios por lo que se debe individualizar el tratamiento