The transplantation donation process in the Centro de Investigaciones Medico Quirurgicas of Cuba: 1999-2002

OBJECTIVE

In 1998 in the Centro de Investigaciones Medico Quirurgicas the Transplant Coordination Office (TCO) was created, with the aim to organize a system to support a hepatic transplantation program. This organization, which changed the transplantation-donation process not only in our center but in the whole country, is described in this article.

METHOD

The files of donors generated in our hospital were studied together with the transplant coordination records, from 1999 till the first half of 2002.

RESULTS

In the period studied, 21 potential donors were diagnosed with brain death, yielding a donation rate of 71.4%. Brain death was most frequently caused by vascular brain disease; however, in the realized donor group, the cranioencephalic trauma predominated. The typical donor was a man of average age 39.2 years (range, 18-86 years). Among the potential donors, 24% were excluded based on medical criteria, and 5% due to family objections. Forty liver transplantation were performed in 36 patients including 1 liver-kidney simultaneous procedure. The principal etiologies for transplant included hepatitis C virus cirrhosis, 22%; alcoholic, 19%; and acute hepatic failure, 13%. Kidney transplantations were performed in 70 patients, including 41 from cadaveric donors (53.6%) and 29 from living related donors (41.4%). In 2001, a pancreas-kidney transplantation program was started.

CONCLUSION

The creation of the TCO has been of paramount importance to optimize transplantation program functions.

Effect of tinidazole on the cellular immune response

A single 500 mg dose of tinidazole was given to fourteen healthy volunteers. Cellular immune functions were studied, before and 2 and 24 h after drug ingestion. Blast transformation of lymphocytes to Con-A was significantly lower (P less than 0.01) in samples obtained 2 h after ingestion. No significant changes were found in the other immunological parameters studied. We conclude that these findings could be caused by reversible blockage of lectin binding receptors on the lymphocyte surface.

Origin makes a difference: Alternative responses of an AM-dependent plant to mycorrhizal inoculum from invaded and native soils under abiotic stress

The presence of invasive alien plants (IAPs) alters the composition of soil arbuscular mycorrhizal (AM) fungal communities. Although fundamental for plant development, plant responses to AM from invaded soils have not been widely explored, especially under environmental stress. We compared plant growth, P accumulation, root colonization and the photosynthetic responses of the native AM-dependent Plantago lanceolata growing in contact with AM fungi from communities invaded by Acacia dealbata Link (AMinv) or non-invaded communities (AMnat) exposed to water and light restriction (shade). Under optimal growing conditions, plants in contact with AMnat produced higher leaf biomass and accumulated more P. However, plant responses to different AM inocula varied as the level of stress increased. Inoculation with AMinv promoted plant growth and root length under light restriction. When plants grew in contact with AMnat under drought, leaf P increased under severe water restriction, and leaf and root P increased under intermediate water irrigation. Growing in contact with the AMnat inoculum promoted root P content in both full light and light restriction. Colonization rates of P. lanceolata roots were comparable between treatments, and plants maintained photosynthetic activity within similar ranges, regardless of the level of stress applied. Our results suggest that origin of the inoculum (native soils versus invaded soils) did not affect the ability of AM species therein to establish effective mutualistic associations with P. lanceolata roots but did influence plant responses depending on the type and level of the abiotic stress.

Liver Transplantation at the Cuban Center for Medical and Surgical Research

From July 4, 1999, when a liver transplantation program was started in Cuba, to October 2003, 66 procedures had been performed in 60 patients. The most frequent reason was cirrhosis caused by hepatitis C virus (29%), and alcoholic cirrhosis (22%). Two patients received simultaneous liver-kidney transplants. Half of the patients were men. Patient ages ranged from 12 to 62 years; the average surgical time was 6 hours; and cold ischemia time was 4 to 14 hours. The average blood consumption was 2033 mL; 2900 mL of plasma and 8 units of platelets were used in 7 cases. Immunosuppression was mainly cyclosporine (Neoral), mycophenolate mofetil or azathioprine, and prednisone. Acute cellular rejections were treated in almost all cases with 3 doses of methylprednisolone. The most frequent complications were biliary (24%), hepatic arterial thrombosis (12%), post-surgical bleeding (10%), acute cellular rejection (24%), and ductopenic rejection (2%). The overall 1-year survival rate was 73.7%.

Relación entre Factores Individuales y Familiares de Riesgo para Desórdenes Alimenticios en Alumnos de Enseñanza Media

La presente investigación explora la relación entre los distintos factores de riesgode la anorexia nerviosa. Específicamente, considera edad, peso, altura, autoestima,depresión, cohesión familiar, conflicto familiar, adaptabilidad familiar. El análisisbivariado arroja las correlaciones más significativas entre autoestima y depresión(–0.728), Depresión y Anorexia (0.710), Autoestima y Anorexia (–0.699). Tambiénaparecen como significativas las correlaciones entre Anorexia Nerviosa y conflicto(0.406), cohesión (-0.289) y peso (0.285). En el análisis multivariado, la predicción de riesgo está determinada por Depresión, Autoestima, Peso, Conflicto, Cohesión, Altura y el tipo de establecimiento. Además, se discuten resultados y posibles líneas de investigación a partir de los hallazgos.

Rosette formation between T and autologous B lymphocytes. I. Characterization of a T cell subpopulation

The ability of some T cells to form rosettes with autologous B lymphocytes (TrB cells) appears to be a marker of a subpopulation of T cells, a majority of which have high avidity receptors for sheep red blood cells. TrB cells have a higher proportion of suppressor cell surface markers (OKT-8+ and receptor for the Fc fraction of IgG), as well as higher suppressor activity than other T cell populations. TrB cells also help in B lymphocyte transformation under the stimulation of a T-dependent B mitogen. The TrB cells seem to express the Fc gamma receptor after ecotatic association with B cells, since T gamma cells previously isolated from total T cells form rosettes with B cells in the same proportion in which total T cells do. Studies on TrB cells subpopulation may explain some of the defects in functional cell-cell interactions.

[Ancillary studies in the differential diagnosis of epithelial renal cell tumors with granular cells]

INTRODUCTION AND OBJECTIVES

Differential diagnosis of renal neoplasms with granular cells may pose difficulties and implications on ontogeny and prognosis. Our aims are to characterize the pattern of immunostaining and to search for a useful diagnosis panel.

METHODS

We studied with colloidal iron staining (Mowry's modified method) and 22 commonly used immunomarkers 22 conventional carcinomas (CC), 37 chromophobe carcinomas (CPC), 8 oncocytomas (OC), and 7 collecting duct carcinomas (CDC) with granular cells. Cases with not entirely clear diagnosis were excluded.

RESULTS

Colloidal iron staining was diffuse, strong, reticular, and cytoplasmic in 32 CPC cases, the diffuse and strong pattern was not observed in other tumors. The more useful diagnostic panel was cytokeratin 7 (CK7)/CD10/vimentine (vim). The 8 OC were negative for the three antibodies. The most common profile for CC was CK7-/CD10+/vim+, the CPC profile was CK7+/CD10-/vim-, and CDC did not show a particular profile. With these three antibodies specificity was >90% for the differential diagnosis. Adding colloidal iron staining specificity was 100%.

CONCLUSIONS

Morphologic features, colloidal iron staining (modified Mowry's method), and immunostaining with CK7/CD10/vim permit the final diagnosis with high specificity. However, a 100% specific marker does not exist at the present time.

XV-2c/KM-19 haplotype analysis of cystic fibrosis mutations in Mexican patients

We analyzed 97 unrelated Mexican cystic fibrosis (CF) patients and their first-degree relatives to study the association of XV2C/TaqI/KM19/PstI haplotypes with CF mutations in this population. Haplotype phases could be established in 148 CF and 110 normal chromosomes, and haplotype distributions of normal and CF chromosomes differed significantly (P < 0.001). DeltaF508 and G542X mutations accounted for 56% of CF chromosomes and were found to be associated with haplotype B in 97.2% and 72.7% of chromosomes, respectively. The haplotype distribution of CF chromosomes carrying other rare and unknown mutations was similar to that of normal chromosomes (P > 0.05), haplotypes A and C being the most frequent. This is in accordance with the extensive heterogeneity and the spectrum of mutations reported in Mexican CF patients. We also report the haplotype distribution of all informative chromosomes bearing rare mutations; some were found to be associated with previously reported haplotypes, whereas others were found on different haplotypes. Recombination or recurrence of mutations may explain these different associations, although other intragenic markers must be used to better understand the origin and dispersion of CF mutations in our country. XK haplotype analysis allowed carrier detection among sibs in 24.3% of families, showing that this method may be useful for carrier detection in populations with high allelic heterogeneity.

Effectiveness and use of linezolid in hospitalisation wards

OBJECTIVE

To describe the use and effectiveness of linezolid as an alternative treatment for methicillin-resistant Staphylococcus aureus.

METHOD

Demographic, clinical and safety data were collected from hospitalised patients. The information sources were the clinical records and the pharmacy programme.

RESULTS

Thirty patients were treated with linezolid (median age 69.3, 63% male). The median duration of treatment was 8 days. The most prevalent indication was soft tissues and skin infections (46.7%). The indications were off-label in 40% of cases. Linezolid was used as a targeted therapy in 53%, especially for coagulase-negative Staphylococcus. Clinical healing occurred in 83.3%, and microbiological healing in 40%. Three patients (10%) experienced side effects from using linezolid.

CONCLUSION

The effectiveness and safety of linezolid is similar to that described in the trials. Its off-label use and the high number of empirical treatments mean that new strategies must be developed.

Site-controlled lateral arrangements of InAs quantum dots grown on GaAs(001) patterned substrates by atomic force microscopy local oxidation nanolithography

In this work, we present a fabrication process that combines atomic force microscopy (AFM) local oxidation nanolithography and molecular beam epitaxy (MBE) growth techniques in order to control both the nucleation site and number of InAs quantum dots (QDs) inside different motifs printed on GaAs(001) substrates. We find that the presence of B-type slopes (As terminated) inside the pattern motifs is the main parameter for controlling the selectivity of the pattern for InAs growth. We demonstrate that either single InAs QDs or multiple InAs QDs in a lateral arrangement (LQDAs) can be obtained, with a precise control in their position and QD number, simply by varying the fabricated oxide length along the [110] direction.

Surface Localization of Buried III-V Semiconductor Nanostructures

In this work, we study the top surface localization of InAs quantum dots once capped by a GaAs layer grown by molecular beam epitaxy. At the used growth conditions, the underneath nanostructures are revealed at the top surface as mounding features that match their density with independence of the cap layer thickness explored (from 25 to 100 nm). The correspondence between these mounds and the buried nanostructures is confirmed by posterior selective strain-driven formation of new nanostructures on top of them, when the distance between the buried and the superficial nanostructures is short enough (d = 25 nm).

[Home versus inpatient therapy for deep venous thrombosis. A cost-comparative analysis]

AIMS

To compare the home-care management of deep vein thromboses (DVT) by a Home Care Unit (HCU) respect to conventional inpatient treatment.

METHODS

Twenty-one patients with a doppler-ecography diagnosis of DVT were managed by the HCU during 2002. In 7 out 13 a concomitant diagnosis of pulmonary embolism (PE) was made by lung scan. Median age was 81 years, 52% were women and all, except one case, showed severe medical concomitant conditions. All patients received low-weight molecular heparin, followed by oral anticoagulants in 3 patients. No patients died and only one was hospitalized briefly due to a poor thrombosis-related pain control. Costs of this patient were added to those of HCU. A comparison was made between ambulatory and hospitalary costs for EP and DVT. Pharmacological treatment costs were calculated for a 10-days period.

RESULTS

The length of inhospital stay was 1 day for HCU vs. 8 days (DVT) and 13 days (EP). There was a estimated cost-saving of 1680 per patient.

CONCLUSIONS

The management of DVT in patients with serious conditions, can be accomplished safely and in a cost-saving manner by a Home Care Unit.

[Low cholesterol egg powder. Nutritive and quality characteristics of the product]

The purpose of this study is to obtain a low cholesterol egg powder for the preparation of different foods for persons whose egg consumption is restricted. Egg white and yolk mixtures prepared in different proportions were dehydrated; the following dried mixtures were obtained: A (1:1), B (2:1) and C (3:1) of egg white:yolk respectively. These mixtures were evaluated using the following parameters: proximal analysis, microbiological assay and protein quality evaluation. Physical characteristics of the powder and the sensorial tests of foods prepared with these mixtures were carried out. The fat and the cholesterol content in the mixture C were decreased by 40% and 20% respectively. The microbiological tests showed that the three mixtures were safe for human consumption. The PER of sample A (whole egg) was 3.65 and for the mixture C 3:1 egg white:yolk was 3.05. The PER of the 50:50 protein mixtures eggs white and yolk: with corn lime treated flour (HMN) were higher than that of the casein standard. The sensorial tests of the foods prepared with all the mixtures were acceptable.