Wintertime tales: How the lizard Liolaemus lineomaculatus endures the temperate cold climate of Patagonia, Argentina.

In temperate, polar and montane environments, ectotherms must find ways to endure throughout the coldest months of the year. Lizards search for microsites where temperatures remain warm or alter their biochemical balance to tolerate freezing or avoid it by supercooling. We evaluated the cold hardiness and potential winter refuges of two populations of Liolaemus lineomaculatus, from a temperate site (42°S) and a cold site (50°S). We analysed the role of possible cryoprotectants by comparing a group of cooled-down lizards with a control group of lizards that were not exposed to cold. The populations of this study are not freeze tolerant and the biochemical analysis showed no evidence of metabolites significantly changing concentration after exposure to cold. However, the species remained several hours at their Supercooling Point (SCP), suggesting they can supercool. The analysis of potential winter refuges showed that lizards using these potential refuges would spend almost no time at all at temperatures close to or below their SCP. Furthermore, lizards from the cold site were able to survive below 0°C temperatures with a lower SCP than lizards from the temperate site. Liolaemus lineomaculatus developed physiological mechanisms that can help them survive when temperatures drop sharply, even when lizards are in suitable shelters.

Pemphigus Vulgaris Localized to the Scalp with Complete Response to Topical Steroids.

Pemphigus vulgaris (PV) is an anti-cadherin autoimmune disease, characterized by the production of anti-desmoglein 3 (and to a lesser extent anti-desmoglein 1) antibodies, producing acanthosis, typically suprabasal, which clinically translates into flaccid blisters and erosions, generally starting on mucous membranes, with subsequent appearance of skin lesions. Only about 25 cases of PV of exclusively cutaneous location have been described in the literature. Treatment with potent topical steroids is usually sufficient to control the symptoms. We present the case of a 68-year-old female patient with localized PV in the scalp, presenting as alopecic and scabby plaque, with excellent response and hair regrowth with topical corticotherapy.

Integrating Autism Spectrum Disorder Pathophysiology: Mitochondria, Vitamin A, CD38, Oxytocin, Serotonin and Melatonergic Alterations in the Placenta and Gut.

BACKGROUND: A diverse array of data has been associated with autism spectrum disorder (ASD), reflecting the complexity of its pathophysiology as well as its heterogeneity. Two important hubs have emerged, the placenta/prenatal period and the postnatal gut, with alterations in mitochondria functioning crucial in both. METHODS: Factors acting to regulate mitochondria functioning in ASD across development are reviewed in this article. RESULTS: Decreased vitamin A, and its retinoic acid metabolites, lead to a decrease in CD38 and associated changes that underpin a wide array of data on the biological underpinnings of ASD, including decreased oxytocin, with relevance both prenatally and in the gut. Decreased sirtuins, poly-ADP ribose polymerase-driven decreases in nicotinamide adenine dinucleotide (NAD+), hyperserotonemia, decreased monoamine oxidase, alterations in 14-3-3 proteins, microRNA alterations, dysregulated aryl hydrocarbon receptor activity, suboptimal mitochondria functioning, and decreases in the melatonergic pathways are intimately linked to this. Many of the above processes may be modulating, or mediated by, alterations in mitochondria functioning. Other bodies of data associated with ASD may also be incorporated within these basic processes, including how ASD risk factors such as maternal obesity and preeclampsia, as well as more general prenatal stressors, modulate the likelihood of offspring ASD. CONCLUSION: Such a mitochondria-focussed integrated model of the pathophysiology of ASD has important preventative and treatment implications.

Autism Spectrum Disorders: Role of Pre- and Post-Natal GammaDelta (γδ) T Cells and Immune Regulation.

BACKGROUND: It is widely accepted that alterations in immune functioning are an important aspect of the pathoetiology and pathophysiology of autism spectrum disorders (ASD). A relatively under-explored aspect of these alterations is the role of gammaDelta (γδ) T cells, prenatally and in the postnatal gut, which seem important hubs in driving the course of ASD. METHODS: The present article describes the role of γδ T cells in ASD, including their interactions with other immune cells shown to be altered in this spectrum of conditions, including natural killer cells and mast cells. RESULTS: Other risk factors in ASD, such as decreased vitamins A & D, as well as toxin-associated activation of the aryl hydrocarbon receptor, may also be intimately linked to γδ T cells, and alterations in the regulation of these cells. A growing body of data has highlighted an important role for alterations in mitochondria functioning in the regulation of immune cells, including natural killer cells and mast cells. This is an area that requires investigation in γδ T cells and their putative subtypes. CONCLUSION: It is also proposed that maternal stress may act through alterations in the maternal microbiome, leading to changes in how the balance of short-chain fatty acids, such as butyrate, which may act to regulate the placenta and foetal development. Following an overview of previous research on immune, especially γδ T cells, effects in ASD, the future research implications are discussed in detail.

Botulinum toxin type A in the treatment of Raynaud's phenomenon: A three-year follow-up study.

OBJECTIVE: Raynaud's phenomenon consists of vasospastic disease of the digital arteries after exposure to cold or stress. It causes an important reduction in the patient's quality of life when severe. The available treatments do not always offer favorable results. METHODS: A 3-year retrospective study was presented. A total of 15 patients with severe Raynaud's phenomenon who required infiltration with botulinum toxin type A participated in the study. In the first and follow-up visits (30 min, 7 days, 3 months, 6 months, and annual), the overall response by the patient was assessed as was the reduction in the number of weekly episodes of Raynaud's phenomenon, improvement in pain by means of the Visual Analogue Scale, and resolution of ulcers and necrosis as efficacy variables. RESULTS: A total of 15 patients were included in the study. After 30 min of infiltration, the immediate results showed a very good perception of response in four patients. After 1 month of treatment, eight patients had obtained and maintained a very good response, persisting throughout the study. A statistically significant reduction in pain was obtained, as well as the number of weekly episodes of Raynaud's phenomenon. Of the seven patients with basal ulcers, five were completely healed at 3 months. Of the patients, 64.3% showed an overall satisfaction level of >8 at the end of treatment. No serious adverse events were observed. CONCLUSION: Botulinum toxin is a useful treatment for severe Raynaud's phenomenon that is generally well tolerated. Its mechanism of action is not based exclusively on vasodilation. Further studies are necessary to define the ideal patient for this treatment, the most appropriate method of administration, and the number of units and frequency of the infiltrations.

Merkel cell carcinoma: An algorithm for multidisciplinary management and decision-making.

Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of the skin. Therapeutic approach is often unclear, and considerable controversy exists regarding MCC pathogenesis and optimal management. Due to its rising incidence and poor prognosis, it is imperative to establish the optimal therapy for both the tumor and the lymph node basin, and for treatment to include sentinel node biopsy. Sentinel node biopsy is currently the most consistent predictor of survival for MCC patients, although there are conflicting views and a lack of awareness regarding node management. Tumor and node management involve different specialists, and their respective decisions and interventions are interrelated. No effective systemic treatment has been made available to date, and therefore patients continue to experience distant failure, often without local failure. This review aims to improve multidisciplinary decision-making by presenting scientific evidence of the contributions of each team member implicated in MCC management. Following this review of previously published research, the authors conclude that multidisciplinary team management is beneficial for care, and propose a multidisciplinary decision algorithm for managing this tumor.

Post-bone-marrow-transplant leukemia cutis.

Granulocytic sarcoma or chloroma is a tumor of immature cells from the granulocyte line that is generally associated with acute myeloid leukemia. The skin is one of the most affected organs. This lesion may complicate hematological dyscrasias, which is generally indicative of a poor prognosis. We present a case of a 51-year-old patient who was diagnosed with acute myeloid leukemia with a complex karyotype that debuted with a post-transplant cutaneous and hematological relapse, a very rare occurrence in the literature given that no extramedullary involvement was present prior to the transplant.

La percepción de soledad como factor de riesgo en la adolescencia / The perception of loneliness as a risk factor in adolescence

Se investigó la prevalencia de autopercepción de soledad y aislamiento en adolescentes de distintos contextos socioeconómicos de la ciudad de Santiago del Estero (Argentina). Se trata de un estudio descriptivo-comparativo, no experimental de tipo transversal. Participantes: 337 adolescentes entre 10 y 16 escolarizados en escuelas públicas y privadas de la ciudad de Santiago del Estero. Objetivos: a) describir la percepción de soledad y aislamiento de los adolescentes participantes y b) comparar la percepción de soledad según las variables nivel socioeconómico y género. Se administró la Escala de soledad y aislamiento (CAS) de Casullo y una encuesta sociodemográfica. Resultados: si bien la mayor parte de los participantes tanto de nivel socioeconómico bajo como alto no presentaron déficits en sus comportamientos sociales, el 23% autopercibía soledad y el 20% aislamiento. Se encontraron diferencias estadísticamente significativas en la dimensión aislamiento en los adolescentes de NES bajo. Se formulo hipótesis acerca de la relación entre los resultados encontrados y el contexto socioeconómico. Por cuanto la soledad es un factor de riesgo que se asocia con morbimortalidad, los datos presentados adquieren particular utilidad para diseñar programas de intervención que restauren las insuficientes redes de apoyo social del adolescente y permitan su inclusión social.

Carcinoma verrucoso de laringe. Caso clínico / Verrucous carcinoma of the larynx

El carcinoma verrucoso es una variante inusual del carcinoma escamoso, representando entre el 1-11 por ciento de todas las neoplasias laríngeas. Presentamos un caso de carcinoma verrucoso.

Tuberculosis estrapulmonar en el Hospital Nacional Daniel A. Carrión, años 1990 a 1995 / Extrapulmonar tuberculosis study at Daniel A. Carrion Hospital 1990-1995

Para demostrar que la frecuencia de tuberculosis extrapulmonar en nuestro hospital es mayor que lo comunicado en la literatura se realizó un trabajo retrospectivo, revisando los archivos del Programa de Control de Tuberculosis (PCT) del Hospital Nacional Daniel A. Carrión (HNDAC) y las historias clínicas de los pacientes hospitalizados desde enero de 1990 a diciembre de 1995. Se excluyó los casos en que se demostró co-infección VIH. Se incluyó 3304 casos de tuberculosis (TBC), de los cuales 2301 correspondieron a TBC pulmonar (69,65 por ciento) y 1003 a TBC extrapulmonar (30,35 por ciento). Entre los casos de TBC extrapulmonar se incluyó a 629 mujeres (62,71 por ciento) y 374 varones (37,29 por ciento). Las localizaciones pleural (48,75 por ciento), ganglionar (14,86 por ciento) y la meningoencefálica (7,68 por ciento) fueron las más frecuentes. Se concluye que la frecuencia de TBC extrapulmonar en el HNDAC es mayor que lo comunicado en la literatura nacional y se encuentra entre la más altas tasas reportadas a nivel mundial, aún sin la influencia de la co-infección con HIV. Sería importante implementar estudios prospectivos exclusivamente para evaluar la evolución final de este grupo de pacientes.

Atención centrada en el paciente en el Servicio de Emergencia del Hospital "Víctor Larco Herrera" / Attention of the patient at Emergency Service of the \"Victor Larco Herrera\" Hospital

En este trabajo se presenta la forma de atención de la Emergencia Psiquiátrica centrada en el paciente que permite comprender las circunstancias, situaciones, experiencias y conflictos que determinaron la aparición del episodio que motivó la consulta. Se presenta a un paciente epiléptico con gran perturbación del comportamiento y aumento de la frecuencia de convulsiones, en un ambiente familiar agresivo y disfuncional que mejora con la atención dada en el Servicio de Emergencia del Hospital "Víctor Larco Herrera".

Síndrome por estres post*traumático en secuestrado por subversivos / Post traumatic stress sindrome in secuestrateb by subversives

Se presenta el caso de un paciente que estuvo secuestrado durante 6 meses por subversivos en la zona de Ayacucho. Durante su cautiverio presenta insonmio, hiporexa, desconfianza, síntomas neurovegetativos y temor de que lo maten. Al ser liberado presenta recuerdos y pesadillas recurrentes del acontecimiento, estados de hiperalerta, anestesia emocional, sentimientos repentinos como si el acontecimiento traumático estuviera presente, deficit de memoria, dificultad para concentrarse y completar las tareas, comportamiento paramoide e ideas delusivas

Osteomielitis crónica hematógena / Chronic hematogenus osteomielitis

Presentamos el estudio de 37 casos de Osteomielitis Crónica Hematógena, hospitalizados en la Clínica Hortencia Espinoza de Salinas de Arequipa entre Enero 86 y Agosto 87. El 78% son varones, de mayor incidencia entre los 7-12 años (68%), siendo su localización preferencial tibia y fémur (78%), a focos multiples en el 11% de los casos, procedentes de toda la región Sur del Perú.En cuanto a la etiología el 92% son piogenos, con cultivo de estafilococo (48.7%), estreptococo (2,7%) y negativo a gérmenes comunes (37.8%); osteomielitis tífica (5.4%) y tuberculosa (2.7%). Fueron sometidos a intervención quirúrgica el 78.1%; las complicaciones más importantes son fractura patológica (8.1%) uno de los cuales evolucionó a pseudoartrosis y dos casos de osteortritis de colera

Secuelas de poliomielitis en la clínica San Juan de Dios de Arequipa / Sequelae steages of polimielytis in the San Juan de Dios of Arequipa

Se realiza el estudio de 17 casos de poliomielitis, en la fase crónica o de secuelas, hospitalizados de junio de 1986 a junio de 1987 en la clínica San Juan de Dios de Arequipa, Perú. Se hace un análisis de su tratamiento quirúrgico en las secuelas de miembros inferiores. no está erradicada la enfermedad y debe proseguirse en su lucha mediante campañas de vacunación permanentes