RESUMO
BACKGROUND: The World Health Organization (WHO) recommends a method to estimate nationally representative pretreatment HIV drug resistance (PDR) in order to evaluate the effectiveness of first -line treatments. The objective of the present study was to determine the prevalence of PDR in Cuban adults infected with HIV-1. MATERIALS AND METHODS: A cross-sectional study in Cuban adults infected with HIV-1 over 18 years was conducted. The probability proportional to size method for the selection of municipalities and patients without a prior history of antiretroviral treatment during the period from January 2017 to June 2017 was used. The plasma from 141 patients from 15 municipalities for the determination of viral subtype and HIV drug resistance was collected. Some clinical and epidemiological variables were evaluated. RESULTS: 80. 9% of the patients corresponded to the male sex and 76.3% were men who have sex with other men (MSM). The median CD4 count was 371 cells / mm3 and the median viral load was 68000 copies / mL. The predominant genetic variants were subtype B (26.9%), CRF19_cpx (24.1%), CRF 20, 23, 24_BG (23.4%) and CRF18_cpx (12%). Overall, the prevalence of PDR was 29.8% (95%, CI 22.3-38.1). The prevalence was 12.8% (95%, CI 6.07-16.9) for any nucleoside reverse transcriptase inhibitor (NRTI), 23.4% (95%, CI 16.7-31.3) for any non-reverse transcriptase inhibitor (NNRTI) and 1.4% (95%, CI 0.17-5.03) for any protease inhibitor (PI). The most frequent mutations detected were K103N (12.9%), G190A (6.4%) and Y181C (4.8%). CONCLUSIONS: The NNRTI prevalence above 10% in our study indicates that the first-line antiretroviral therapy in Cuba may be less effective and supports the need to look for new treatment options that contribute to therapeutic success and help the country achieve the global goals 90-90-90 set forth by UNAIDS.
Assuntos
Infecções por HIV/tratamento farmacológico , HIV-1 , Adolescente , Adulto , Idoso , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Estudos Transversais , Cuba/epidemiologia , Farmacorresistência Viral/genética , Feminino , Genes pol , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , HIV-1/classificação , HIV-1/efeitos dos fármacos , HIV-1/genética , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Filogenia , Prevalência , Adulto JovemRESUMO
BACKGROUND: Definitive surgical interventions for Dominican children with congenital heart disease, like those of other low- and middle-income countries, have been historically limited. METHODS: We undertook review of a case series focusing on the surgical correction of complex forms of tetralogy of Fallot at a single center, CEDIMAT Centro Cardiovascular, in the Dominican Republic, over a 30-month period. RESULTS: According to our criteria, 43 cases were determined to be complex tetralogy of Fallot repairs from the two-year period. Besides tetralogy of Fallot, the cohort had an additional 55 anatomic anomalies that had to be addressed at the time of surgery. Median age at the time of surgery was notably 30 months, and an average of 42 months elapsed from the time of diagnosis to the time of surgery for this group. Only 33% of the cases reviewed had no hypercyanotic crises before repair. Median time to extubation for this group of patients was one day, with a three-day median length of stay in the intensive care setting. CONCLUSIONS: Our study importantly captures the present experience of a surgical congenital heart program that has recently transitioned from a traditional "mission model" to a now self-sustaining local practice. Both the number and the complexity of the lesions corrected in this caseload represent an advance from the level of care previously provided to children in the Dominican Republic.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Gerenciamento Clínico , Tetralogia de Fallot/cirurgia , Fatores Etários , Pré-Escolar , República Dominicana/epidemiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Tetralogia de Fallot/epidemiologiaRESUMO
La amiodarona es uno de los antiarrítmicos de uso más extendido, pero de la misma forma es un medicamento con efectos adversos bien conocidos y a múltiples niveles; uno de los más importantes es el que se describe para el tejido tiroideo. Cerca de 80 porciento de los pacientes que la toman de forma indefinida, presentarán algún efecto adverso; sin embargo, menos de 15 porciento la suspenderán. En la glándula tiroides, los mecanismos de lesión se relacionan, por su semejanza estructural, con la levotiroxina, la liberación de altas concentraciones de yodo y la inducción de reactividad inmune, entre otras. No obstante, la mayoría de los pacientes permanece eutiroideos.Este estudio describe la variación de la función tiroidea a corto plazo, en 77 pacientes que recibieron diferentes tipos de antiarrítmicos, que no tenían factores de riesgo asociados a disfunción tiroidea, y que se reclutaron en el servicio de hospitalización. Se tomaron muestras de TSH al inicio y al cabo de tres meses de seguimiento. Se observaron niveles de TSH normales en 26 porciento (43 pacientes) y tendencia a valores más altos en el control al tercer mes en el grupo medicado con amiodarona. De manera adicional, se describió una proporción mayor de trastornos de la función de la glándula tiroides en la población masculina.
Assuntos
Amiodarona , Antiarrítmicos , Hipotireoidismo , Testes de Função TireóideaRESUMO
Se presneta un caso de Síndrome de Sjögren primario de aproximadamente 10 años de evolución por historia clínica, que se confirma por estudio anatomopatológico de las glándulas salivales menores, y el desarrollo de un linfoma primario de pulmón demostrado por estudios anatomopatológicos convencionales. Desde el punto de vista histoquímico se trata de una proliferación maligna de células B, lo que confirma su origen en el tejido linfoide asociado a las mucosas (MALT), cuya localización más frecuente es en estómago, pero también puede verse en el pulmón, dependiente del tejido linfoide asociado a la mucosa bronquial (BALT)