Neumonía por virus influenza A (H1N1) y su evolución atípica en la Unidad de Cuidados Intensivos

It is presented a patient of 50 years old, atypical in its evolution and its complications, he was hospitalized in February 2014 in the Intensive Care Unit of the  "Arnaldo Milian Castro"Surgical Hospital, City of Santa Clara, Villa Clara Province. He presented fever, dry cough, arthralgia, myalgia, and dyspnea. He was diagnosed with community-acquired pneumonia caused by influenza A virus (H1N1) to test -confirmed chain reaction reversa- transcriptase-polymerase; he had an unusual evolution, with complications such as spontaneous pneumothorax right, necrotizing pneumonia and empyema caused by Pseudomonas of the same side. The patient progressed satisfactorily despite the complications and was discharged at 30 days.Se presenta un paciente de 50 años, atípico por su evolución y sus complicaciones, hospitalizado en febrero de 2014 en la Unidad de Cuidados Intensivos del Hospital Clínico Quirúrgico “Arnaldo Milián Castro”, de la Ciudad de Santa Clara, Provincia de Villa Clara, por presentar fiebre, tos seca, artralgia, mialgia y disnea. Se le diagnosticó neumonía adquirida en la comunidad causada por el virus de influenza A (H1N1) -confirmado con la prueba de reacción en cadena de la polimerasa-transcriptasa reversa-; tuvo una evolución poco común, con complicaciones como neumotórax espontáneo derecho, neumonía necrotizante y empiema por pseudomona de ese mismo hemitórax. El paciente evolucionó satisfactoriamente pese a las complicaciones y fue egresado a los 30 días

Hipotermia terapéutica en el paro cardiorrespiratorio recuperado

Introduction: Applying hypothermia in the first hours to a comatose patient who has survived cardiopulmonary arrest helps minimizing brain injury and improves survival.Objective: To determine the use-effectiveness of therapeutic hypothermia after cardiac arrest. Method: Quasi-experimental research on hospitalized patients in the Intensive Care Unit at the «Hospital Arnaldo Milián Castro» in Santa Clara, Cuba, between January 2013 and September 2015. The sample consisted of 26 patients: 13 treated (study) and 13 non-treated (control). Variables studied were: age, sex, arrest scenario, comorbidities and Glasgow coma scale (on admission, during neurological recovery at 72 hours and at discharge).Results: No significant differences were found between both groups. The average age was 63 and 57 years, respectively. Male (more than 60%) and out-of-hospital arrest location predominated. Higher incidence comorbidities were: high blood pressure, heart disease and diabetes mellitus; as well as initial Glasgow coma scale score of 3 in both groups, often greater than 50%. Conclusions: Therapeutic hypothermia-treated patients presented fewer neurological complications and lower mortality, despite having, in most cases, an initial non-shockable rhythm and longer arrest time.Introducción: La hipotermia, aplicada en las primeras horas a un paciente en coma que ha sobrevivido a un paro cardiorrespiratorio, tiende a minimizar el daño cerebral y mejora la sobrevida.Objetivo: Determinar la efectividad del uso de la hipotermia terapéutica en el estado posparada cardíaca.Método: Investigación cuasi experimental en pacientes hospitalizados en la Unidad de Cuidados Intensivos del Hospital Arnaldo Milián Castro de Santa Clara, Cuba, entre enero de 2013 y septiembre de 2015. La muestra quedó conformada por 26 enfermos: 13 intervenidos (estudio) y 13 no intervenidos (control), donde se estudiaron las variables: edad, sexo, condiciones de la parada, comorbilidades y escala de Glasgow (al ingreso, en recuperación neurológica a las 72 horas y al egreso).Resultados: No se encontraron diferencias significativas entre ambos grupos. La edad promedio fue de 63 y 57 años, respectivamente; predominaron el sexo masculino con más del 60%, el lugar extrahospitalario de la parada, la hipertensión arterial, la cardiopatía y la diabetes mellitus como comorbilidades de mayor incidencia, y Glasgow inicial de 3 puntos, en ambos grupos, con frecuencia mayor del 50%.Conclusiones: Los pacientes tratados con hipotermia terapéutica presentaron menos complicaciones neurológicas y menor mortalidad, a pesar de presentar, en su mayoría, un ritmo inicial no desfibrilable y un tiempo mayor de parada

Novel and known MYOC exon 3 mutations in an admixed Peruvian primary open-angle glaucoma population

Purpose: The aim of this study was to characterize a representative sample of the Peruvian population suffering openangle glaucoma (OAG) with respect to the myocilin gene (MYOC) mutations, glaucoma phenotype, and ancestry for future glaucoma risk assessment. Methods: DNA samples from 414 unrelated Peruvian subjects, including 205 open-angle glaucoma cases (10 juvenile glaucoma [JOAG], 19 normal-tension glaucoma [NTG], and 176 POAG) and 209 randomly sampled controls, were screened for nucleotide changes in MYOC exon 3 by conformational sensitive gel electrophoresis (CSGE) and mutation screening. Results: We identified a probable causative novel MYOC missense mutation, Gly326Ser, in one POAG case and found a consistent genotype-phenotype correlation in eight of his relatives. We also found the known causative MYOC mutation Trp286Arg in one JOAG case and one POAG case. A known causative single base MYOC deletion, T1357, was found in one POAG case. Two previously reported silent polymorphisms, Thr325Thr and Tyr347Tyr, were found in both the case and the control populations. A novel missense variant, Met476Arg, was identified in two unrelated controls. Conclusions: The screening of exon 3 of MYOC in a representative sample of 205 independent POAG patients from Peru and 209 matched controls identified novel and previously reported mutations (both pathogenic and nonpathogenic) from other global regions. These results reflect the complex admixture of Amerindian and Old World ancestry in urban populations of Latin America, in general, and in Peru, in particular. It will be important to gather information about the ancestral origin of MYOC and other POAG gene mutations to develop screening panels and risk assessment for POAG in Peru.National Eye Institute, National Institutes of Health, Bethesda, MD (J.E.R.), Research to Prevent Blindness (EY011671- J.E.R.), Universidad de San Martín de Porres Funds E10012009016, E10012009011, E10012009027, E10012012011, Consejo Nacional de Ciencia y Tecnología (Concytec) proyecto OAJ-2003