Pregnancy-associated atypical hemolytic uremic syndrome. Case report.

Pregnancy-associated atypical hemolytic uremic syndrome (P-aHUS) is a rare disease. There are only few reports in the literature, and most are in the puerperium period. It is a thrombotic microangiopathy (TMA) characterized for microangiopathic hemolytic anemia, thrombocytopenia, and renal dysfunction. We report the case of a pregnant patient at 26.3 gestation weeks, who developed clinical features of TMA, neurological alterations, and septic shock; then after fetus and placental delivery, no clinical improvement was observed; a diagnostic protocol was performed due to suspicion of P-aHUS, showing improvement after the plasma exchange sessions and eculizumab. We present here a brief review of the case since it is an entity that needs to be suspected during pregnancy when TMA features and requires an immediate diagnosis to provide timely treatment.

Caracterización del dengue con bradicardia en adolescentes

Introducción: El dengue es una enfermedad infecto contagiosa de variada intensidad, oriunda de climas tropicales como los que predominan en la región de las Américas. Es trasmitida por el mosquito Aedes aegypti y afecta a la población pediátrica. Su espectro clínico incluye alteraciones de la conducción cardíaca y de bradicardia. Objetivo: Caracterizar el dengue con bradicardia en adolescente. Métodos: Se realizó un estudio observacional descriptivo, longitudinal y retrospectivo en el Hospital Pediátrico Provincial Universitario Dr. Eduardo Agramonte Piña de la provincia Camagüey en el periodo comprendido desde enero a diciembre de 2021. El universo quedó conformado por 28 pacientes con diagnóstico de dengue que presentaron bradicardia. Los datos se recogieron en un formulario y se procesaron en una base de datos creada con SPSS versión 22. Resultados: Los resultados mostraron predominio de los pacientes del sexo masculino, del municipio Camagüey, entre los síntomas iniciales más frecuentes fue el dengue sin signos de alarma, el inicio de la bradicardia es durante la hospitalización, la bradicardia sinusal se presenta en todos los pacientes, en la mayoría de los casos la duración es en la etapa de recuperación. Conclusiones: Entre los síntomas encontrados predominaron los pacientes que no presentaron signos de alarma de dengue, la aparición de estos signos se asoció con bradicardia sinusal en la etapa de recuperación.

Introduction: Dengue is a contagious infectious disease of varying intensity that originates from tropical climates such as those that predominate in the region of the Americas. It is transmitted by the Aedes aegypti mosquito and affect the pediatric population. Its clinical spectrum includes alterations in cardiac conduction and bradycardia. Objective: To characterize dengue with bradycardia in adolescents. Methods: A descriptive, longitudinal and retrospective observational study was carried out at the Dr. Eduardo Agramonte Piña University Provincial Pediatric Hospital in Camagüey province in the period from January to December 2021.The universe was made up of 28 patients diagnosed with dengue who presented bradycardia. The data was collected in a from and processed in a database created with SPSS version 22. Results: The results grouped in the form of tables, showed a predominance of male patients, from the municipality of Camagüey, among the most frequent initial symptoms is dengue without warning signs, the onset of bradycardia is during hospitalization, it occurs in all patients, in most cases the duration is in the recovery stage. Conclusions: Among the symptoms found, patients who did not present dengue alarm signs was associated with sinus bradycardia during recovery.

Widespread Gene Expression Divergence in Butterfly Sensory Tissues Plays a Fundamental Role During Reproductive Isolation and Speciation.

Neotropical Heliconius butterflies are well known for their intricate behaviors and multiple instances of incipient speciation. Chemosensing plays a fundamental role in the life history of these groups of butterflies and in the establishment of reproductive isolation. However, chemical communication involves synergistic sensory and accessory functions, and it remains challenging to investigate the molecular mechanisms underlying behavioral differences. Here, we examine the gene expression profiles and genomic divergence of three sensory tissues (antennae, legs, and mouthparts) between sexes (females and males) and life stages (different adult stages) in two hybridizing butterflies, Heliconius melpomene and Heliconius cydno. By integrating comparative transcriptomic and population genomic approaches, we found evidence of widespread gene expression divergence, supporting a crucial role of sensory tissues in the establishment of species barriers. We also show that sensory diversification increases in a manner consistent with evolutionary divergence based on comparison with the more distantly related species Heliconius charithonia. The findings of our study strongly support the unique chemosensory function of antennae in all three species, the importance of the Z chromosome in interspecific divergence, and the nonnegligible role of nonchemosensory genes in the divergence of chemosensory tissues. Collectively, our results provide a genome-wide illustration of diversification in the chemosensory system under incomplete reproductive isolation, revealing strong molecular separation in the early stage of speciation. Here, we provide a unique perspective and relevant view of the genetic architecture (sensory and accessory functions) of chemosensing beyond the classic chemosensory gene families, leading to a better understanding of the magnitude and complexity of molecular changes in sensory tissues that contribute to the establishment of reproductive isolation and speciation.

Bloqueo auriculoventricular de segundo grado por fiebre reumática / Atrioventricular block secondary to rheumatic fever

RESUMEN Fundamento: la fiebre reumática tiene una incidencia alta en los países en vías de desarrollo. Es un padecimiento inflamatorio que afecta el tejido celular subcutáneo, sistema nervioso, piel y corazón, donde el bloqueo auriculoventricular de segundo grado Mobitz tipo 1 como expresión de una fiebre reumática es poco frecuente. Su diagnóstico constituye un gran desafío. Objetivo: presentar el caso de un adolescente sin historia de manifestaciones clínicas cardiovasculares de un bloqueo auriculoventricular de segundo grado Mobitz tipo Presentación del caso: paciente de 17 años de edad, masculino, sin antecedentes de amigdalitis reciente, al cual se le realizó un electrocardiograma como parte del seguimiento de la hipertensión arterial diagnosticada en el 2016, confirmándose un bloqueo auriculoventricular de segundo grado Mobitz tipo 1 en la consulta de Cardiología, sin manifestaciones clínicas cardiovasculares ni aumento de volumen en las articulaciones. Conclusiones: se debe sospechar en un paciente con un bloqueo auriculoventricular de segundo grado Mobitz tipo 1 sin manifestaciones clínicas cardiovascular en una carditis subclínica en el paciente pediátrico. Se observó que no hay progresión del bloqueo auriculoventricular de segundo grado Mobitz tipo 1 luego de comenzar con la benzatina.

ABSTRACT Background : rheumatic fever had a high incidence in developing countries. It is an inflammatory disease that affects the subcutaneous tissues, the central nervous system, the skin and the heart. The atrioventricular block second degree Mobitz type 1 as expression of rheumatic fever is unusual. Its diagnosis is a big challenge today. Objective : to present the case of a teenager with no previous history of cardiovascular manifestations of atrioventricular block second degree Mobitz type 1. Case report: 17- years-old male patient, without background of recent tonsillitis, who received an electrocardiogram as part of the checking of hypertension diagnosed in 2016, where atrioventricular of second degree a blockage Mobitz type 1, without clinical manifestations neither increase of volume in the articulations, was diagnosed in Cardiology consult. Conclusions: an atrioventricular block Mobitz type 1 without clinical cardiovascular manifestations could be suspected in a subclinical carditis in pediatric patients. The treatment with specific antibiotics avoids the progression of the disease.