Cardiac Platypnea-Orthodeoxia Syndrome: A Rare Case of Flow-Directed, Right-to-Left Shunt via a Patent Foramen Ovale Exacerbated by Aortic Root Enlargement.

Cardiac platypnea-orthodeoxia is a unique clinical syndrome characterized by dyspnea and deoxygenation when moving from a supine to an upright position. In this case report, we detail the experience of a 78-year-old male with persistent hypoxemia following a paradoxical embolic ischemic stroke. Despite proper management of his respiratory symptoms, the patient continued to be affected by marked dyspnea and hypoxemia, particularly when upright or in a right-sided decubitus position. Subsequent investigation revealed that his hypoxemia was a result of cardiac platypnea-orthodeoxia syndrome (POS). This condition was attributed to the enlargement of his aortic root and ascending aorta, coupled with a counterclockwise rotation of the heart axis. These factors facilitated a flow-directed, right-to-left interatrial shunt through a patent foramen ovale, even in the absence of elevated right heart pressures.

Disonancia cognitiva y educación universitaria en tiempo demigración venezolana / Cognitive dissonance and university education in Venezuelanmigration time

La disonancia cognitiva (DC) representa un elemento psicológico bastante común en la sociedad. Las personas, sin importar edades ni condición social y mucho menos niveles de estudios, suelen caer permanentemente en este juego de ideas entre valores y realidades. Esto hace que el desarrollo moral y ético de una sociedad muchas veces se vea empañado por circunstancias que inciden directamente en el bien propio y común. La disonancia cognitiva, con base en las representaciones simbólicas de cada actor social, puede ser estudiada desde el campo universitario, visto éste como un espacio en el que los individuos se reúnen con base a un pensamiento libre y donde la construcción y de construcción delas ideas complejiza la propia realidad del individuo lo que hace incida en su entorno. La disonancia cognitiva, en una realidad venezolana donde la migración ha causado desolación en las universidades, pasa a formar parte de las discusiones dialógicas del estamento docente y ocupa la atención de numerosos investigadores, políticos y economistas del país. En este escrito, el objetivo se orienta a develar las representaciones simbólicas del pensamiento estudiantil y docente en consideración a la disonancia cognitiva y al tema de migración venezolana. Sus ideas, sus opiniones y sus sentires son expuestas como una forma de expresión sobre sus mundos internos como participantes pertenecientes a una sociedad con características propias. El método es la hermenéutica basada en la metodología cualitativa. Se utilizó la entrevista como técnica principal de recolección de información. Conclusión: el ambiente social venezolano se ve envuelto por una crisis de análisis, personalidad y de valores, los cuales hacen presencia gracias a la gran disonancia cognitiva (y auto engaño que la misma conlleva) en casi todos los aspectos dela vida diaria, convirtiéndose así en una nación triste, despectiva y poco comprometida(AU)

Cognitive dissonance (CD) represents a fairly common psychological element in society. People, regardless of age or social status and much less levels of education, often fall permanently in this game of ideas between values andrealities. This means that the moral and ethical development ofa society is often marred by circumstances that directly affect the own and common good. Cognitive dissonance, based on the symbolic representations of each social actor, can be studied from the university field, seen as a space in which individuals meet based on free thinking and where the construction and deconstruction of ideas and that complicates the individual'sown reality which makes an impact on his environment. Cognitive dissonance, in a Venezuelan reality where migration has caused desolation in universities, becomes part of the dialogic discussions of the teaching staff and occupies the attentionof numerous researchers, politicians and economists in the country. In this paper, the objective is to reveal the symbolic representations of student and teacher thinking in consideration of cognitive dissonance and the issue of Venezuelan migration.Their ideas, their opinions and their feelings are exposed as a form of expression about their internal worlds as participants belonging to a society with their own characteristics. the method is hermeneutics based on qualitative methodology. The interview was used as the main information gathering technique. Conclusion: the Venezuelan social environment is surroundedby a crisis of analysis, personality and values, which they presentthanks to the great cognitive dissonance (and self-deception thatit entails) in almost all aspects of daily life, thus becoming in asad nation, contemptuous and little compromised(AU)

A case-control study of HLA alleles in Brazilian patients with Melkersson-Rosenthal syndrome.

Melkersson-Rosenthal syndrome (MRS) is a neuromucocutaneous disease that manifests by the triad of recurrent orofacial edema (frequently as cheilitis granulomatosa), relapsing facial paralysis and plicated tongue. The cause of MRS remains unknown, but genetic predisposal and a relationship with inflammatory bowel disease are suspected. The objective of this research was to compare the frequency of class I and II HLA alleles in patients with a confirmed diagnosis of MRS with those of a healthy control group. We conduct a case-control study and typed of HLA A, B, C, DR, and DQ using molecular techniques. The study included 36 patients with MRS and 297 patients in the control group. There was an increase in the expression of HLA A*02 (p = 0.0269; OR: 1,79 [1,045-2,973]), HLA DRB1*11 (p < 0,0001; OR: 4,009 [2,214-7,277]), HLA DRB1*13 (not statistically significant) and HLA DQB1*03 (p = 0,0177; OR: 1,829 [1,122-2,978]) and low levels of HLA A*01 (p = 0.0046; OR: 0,097 [0,009-0,538]), HLA DRB1*04 (p = 0.0274; OR: 0,228 [0,053-0,844]), HLA DRB1*07 (p = 0,0091; OR: 0,183 [0,043-0,670]) and HLA DQB1*02 (p = 0.0051; OR: 0,312 [0,143-0,721]) in MRS patients compared with the control group. Crohn disease (CD) patients had disparate genetic profiles versus those with MRS. This single-institution study had a small cohort, because this disease is rare. Conclusions: There is a genetic predisposition toward MRS, involving associated and protective genes.

HLA-C*17, DQB1*03:01, DQA1*01:03 and DQA1*05:05 Alleles Associated to Bullous Pemphigoid in Brazilian Population.

BACKGROUND: Bullous pemphigoid (BP) is an autoimmune disease with bullous vesicles and an incidence of 0.2 to 1.4 per 100,000 inhabitants. Many studies have been published demonstrating the association of pemphigoid with HLA class II system alleles in different populations, however there are no data on the BP, one of the most heterogeneous in the world. OBJECTIVE: To typify HLA alleles in Brazilians with Bullous pemphigoid. METHODS: The study group included 17 Brazilian patients with a confirmed diagnosis of BP from a hospital in Sao Paulo city, southeast Brazil. DNA was extracted from peripheral blood using Qiagen kits and HLA A, B, C, DR and DQ typing was performed using polymerase chain reaction. The control group was composed of a database of 297 deceased donors from the city of Sao Paulo. The statistical significance level was adjusted using the Bonferroni correction depending on the phenotypic frequencies evaluated for HLA class I (A, B and C) and class II (DRB1, DQB1 and DQA1). RESULTS: Our findings show that alleles HLA C*17, DQB1*03:01, DQA1*01:03 and DQA1*05:05 are associated with the onset of the disease in the Brazilian population, with relative risks of 8.31 (2.46 to 28.16), 3.76 (1.81 to 7.79), 3.57 (1.53 to 8.33), and 4.02 (1.87 to 8.64), respectively (p<0.005). CONCLUSION: Our data indicate that Brazilian patients with BP present the same genetic predisposition linked to HLA-DQB1*03:01 previously reported in Caucasian and Iranian individuals and our study introduces three new alleles (C*17, DQA1*01:03 and DQA1*05:05) involved in the pathophysiology of BP.

Study of the association between human leukocyte antigens (HLA) and pemphigus vulgaris in Brazilian patients.

BACKGROUND: Pemphigus vulgaris is a mucocutaneous blistering autoimmune disease that manifests as painful blisters or erosions on the skin and/or mucosal surfaces. IgG autoantibodies target desmoglein, playing a major role in disease pathogenesis. Genetic predisposal to pemphigus vulgaris, especially the HLA DR and DQ alleles, has been known since the 1980s. The unique constitution of the Brazilian population favors exploratory genetic studies. METHODS: The study group included 51 patients with a confirmed diagnosis of pemphigus vulgaris from a tertiary hospital in Sao Paulo city, Sao Paulo, southeast Brazil. DNA was extracted from peripheral blood, and HLA A, B, C, DR, and DQ typing was performed. The control group was composed of a database of 297 deceased donors from the city of São Paulo typed with the same method. The statistical significance level was adjusted using the Bonferroni correction depending on the phenotypic frequencies evaluated for HLA A, HLA B, HLA C, HLA DRB1, DQA1, and HLA DQB1. RESULTS: The alleles HLA-B*57, HLA-C*15, HLA-DRB1*04:02, HLA-DRB1*08:04, HLA-DRB1*14:01, DQA1*03:01, DQB1*03:02, and DQB1*05:03 were associated with susceptibility. Alleles HLA DRB1*04:02 and HLA-DRB1*14:01 and their respective haplotypes DRB1*04-DQA1*03:01-DQB1*03:02, and DRB1*14-DQA1*01:01-DQB1*05:03 conferred a risk of the disease. CONCLUSIONS: The DRB1*04:02 and DQB1*05:03 alleles are associated with pemphigus vulgaris in our study as well as in various populations. The association with HLA-DRB1*08:04 in our study was confirmed to be specific to this allele and not to linkage disequilibrium to any adjacent gene. The association between HLA-B*57 and pemphigus vulgaris is reported for the first time in the present study.

Phylogeography of Heliconius cydno and its closest relatives: disentangling their origin and diversification.

The origins of the extraordinary diversity within the Neotropics have long fascinated biologists and naturalists. Yet, the underlying factors that have given rise to this diversity remain controversial. To test the relative importance of Quaternary climatic change and Neogene tectonic and paleogeographic reorganizations in the generation of biodiversity, we examine intraspecific variation across the Heliconius cydno radiation and compare this variation to that within the closely related Heliconius melpomene and Heliconius timareta radiations. Our data, which consist of both mtDNA and genome-scan data from nearly 2250 amplified fragment length polymorphism (AFLP) loci, reveal a complex history of differentiation and admixture at different geographic scales. Both mtDNA and AFLP phylogenies suggest that H. timareta and H. cydno are probably geographic extremes of the same radiation that probably diverged from H. melpomene prior to the Pliocene-Pleistocene boundary, consistent with hypotheses of diversification that rely on geological events in the Pliocene. The mtDNA suggests that this radiation originated in Central America or the northwestern region of South America, with a subsequent colonization of the eastern and western slopes of the Andes. Our genome-scan data indicate significant admixture among sympatric H. cydno/H. timareta and H. melpomene populations across the extensive geographic ranges of the two radiations. Within H. cydno, both mtDNA and AFLP data indicate significant population structure at local scales, with strong genetic differences even among adjacent H. cydno colour pattern races. These genetic patterns highlight the importance of past geoclimatic events, intraspecific gene flow, and local population differentiation in the origin and establishment of new adaptive forms.

Sharp genetic discontinuity across a unimodal Heliconius hybrid zone.

Hybrid zones are powerful natural systems to study evolutionary processes to gain an understanding of adaptation and speciation. In the Cauca Valley (Colombia), two butterfly races, Heliconius cydno cydnides and Heliconius cydno weymeri, meet and hybridize. We characterized this hybrid zone using a combination of mitochondrial DNA (mtDNA) sequences, amplified fragment length polymorphisms (AFLPs), microsatellites and sequences for nuclear loci within and outside of the genomic regions that cause differences in wing colour pattern. The hybrid zone is largely composed of individuals of mixed ancestry. However, there is strong genetic discontinuity between the hybridizing races in mtDNA and, to a lesser extent, in all nuclear markers surveyed. The mtDNA clustering of H. c. cydnides with the H. cydno race from the Magdalena Valley and H. c. weymeri with the H. cydno race from the pacific coast suggests that H. c. cydnides colonized the Cauca Valley from the north, whereas H. c. weymeri did so by crossing the Andes in the southern part, implying a secondary contact origin. Colonization of the valley by H. cydno was accompanied by mimicry shift. Strong ecological isolation, driven by locally adaptive differences in mimetic wing patterns, is playing an important role in maintaining the hybrid zone. However, selection on wing pattern alone is not sufficient to explain the genetic discontinuity observed. There is evidence for differences in male mating preference, but the contribution of additional barriers needs further investigation. Overall, our results support the idea that speciation is a cumulative process, where the combination of multiple isolation barriers, combined with major phenotypic differences, facilitates population divergence in face of gene flow.

Evolution of dengue virus in Mexico is characterized by frequent lineage replacement.

Both dengue fever and its more serious clinical manifestation, dengue hemorrhagic fever, represent major public health concerns in the Americas. To understand the patterns and dynamics of virus transmission in Mexico, a country characterized by a marked increase in dengue incidence in recent years, we undertook a molecular evolutionary analysis of the largest sample of Mexican strains of dengue virus compiled to date. Our E gene data set comprises sequences sampled over a period of 27 years and representing all of the Mexican states that are endemic for dengue. Our phylogenetic analysis reveals that, for each of the four dengue viruses (DENV-1 to DENV-4), there have been multiple introductions of viral lineages in Mexico, with viruses similar to those observed throughout the Americas, but there has been strikingly little co-circulation. Rather, dengue virus evolution in Mexico is typified by frequent lineage replacement, such that only a single viral lineage dominates in a specific serotype at a specific time point. Most lineage replacement events involve members of the same viral genotype, although a replacement event involving different genotypes was observed with DENV-2, and viral lineages that are new to Mexico are described for DENV-1, DENV-3 and DENV-4.

[Intacytoplasmic sperm injection: reproductive reality in couples with sterility]. / Inyección intracitoplasmática de espermatozoides: realidad reproductiva en la pareja con esterilidad.

BACKGROUND: The intacytoplasmic sperm injection (ICSI) is the assisted reproduction technique (ART) that currently offers satisfactory results to infertile couples. The use of epididymal surgical retrieval (percutanean epydidimal sperm aspiration: PESA) and testicular sperm retrieval (testicular sperm extraction: TESE) combined with ICSI has come to bring a high response to azoospermic male. OBJECTIVE: To communicate the results obtained from the Institute for the Study of Human Conception, in Monterrey, NL, with the application of the ICSI technique with ejaculate sperm and in azoospermic patients using sperm obtained from PESAor by testicular sperm extraction TESE. METHODS: From January 1999 to December 2003 1,436 couples were studied at the Institute for the Study of Human Conception, Monterrey, Mexico; 729 cases underwent to ICSI (50.8%), 670 used the ejaculate sperm, in 37 cases (5%) PESA and 22 cases (3%) TESE. These patients were treated as usual: controlled ovarian hyperstimulation (COH) with FSHr alone or combined with HMG or LHr, use of GnRH analogs (agonist o antagonist), follicular monitoring up to the presence of 3 follicles longer than 18 mm; ovular retrieval 34 h after HGC application and embryo transfer in days 3 or 5 of development. RESULTS: No statistically significant difference was noted in the woman's age (p = 0.623), type and time of sterility (p = 0.446, 0.150), neither in FSH, LH and estradiol levels (p = 0.549, 0.623, 0.685). The middle age of the male had significant difference between PESA (38.9 +/- 7.3) and ejaculated sperm (36.1 +/- 6.4) (p = 0-024). The pregnancy rates among groups of the ejaculate sperm, PESA and TESE were 32.8%, 43.2% and 40.9% respectively, without significant difference (p = 0.327), neither in implantation rates: 11.2%, 26% and 11%, respectively (p = 0.153). CONCLUSIONS: The technique of ICSI and use of PESA and TESE offer satisfactory results in infertile couples, including azoospermic male.

Análise comparativa da determinaçäo de antígenos HLA-DR por métodos sorológicos e por PCR-SSP / Comparative analysis of the HLA-DR antigen determination by serologic methods and by PCR-SSP

O objetivo deste trabalho foi comparar a determinaçäo dos antígenos HLA-DR por sorologia, utilizando-se A) anti-soros policlonais ou B) anticorpos monoclonais, com a determinaçäo em nível de DNA em amostras de sangue de receptores e doadores de rim e medula óssea. Observamos que os anticorpos monoclonais apresentam maior concordância com o PCR-SSP. Podemos concluir que as determinaçöes sorológicas têm menor precisäo, acarretando aproximadamente 48 por cento de imprecisoes com anti-soros policlonais e 21 por cento com anticorpos monoclonais. O PCR-SSP permite melhor definiçäo da compatibilidade HLA-DR entre receptor e doador, o que será, em última análise, adjuvante de melhor sobrevida do enxerto.

Onicomicosis y tiña de los pies. Estudio de 31 casos en edad pediátrica / Onychomycosis and tinea pedis. A study on 31 cases of pediatric population

Se presentan los datos clínicos, micológicos y epidemiológicos de 31 años con tiña en los pies y onicomicosis, estudiados en un lapso de 17 meses. Trece tuvieron tiña de los pies, 12 onicomicosis, y 6 tiña de los pies y onicomicosis. Estos padecimientos predominaron ligeramente en varones y el agente causal en la mayoría fue T. rubrum