[Therapeutic monitoring of antibiotics: New methodologies: biosensors]. / Monitorización terapéutica de antibióticos: Nuevas metodologías: biosensores.

The pharmacokinetics of antibiotics, especially in severely ill patients, may be profoundly altered due to multiple pathophysiological changes. Recent studies have shown that empiric dosing recommendations for ICU patients are inadequate to effectively treat a broad range of susceptible organisms and need to be reconsidered. Therapeutic drug monitoring (TDM) is an important mean for optimizing drug utilization and doses for the purpose of improving the clinical effectiveness. However, it is very challenging to quantify plasma antibiotic concentrations in clinical situations as a routine practice, because of the high costs and complexities associated with advanced instrumental techniques. Currently there are not routine and low cost methods to determine the presence and concentration of ß-lactam antibiotics in plasma patients in a clinical setup. Indeed, such analytical methods are based on chromatographic techniques mainly used in research. Here we describe and comment different techniques, focusing on our preliminary experience using biosensors.

[Thrombolytic therapy for submassive/ intermediate risk Pulmonary Embolism Evidence and suggestions after PEITHO trial]. / Terapia trombolítica en TEP submasivo/riesgo intermedio: Evidencias y sugerencias post estudio Pulmonary Embolism Thrombolysis (PEITHO).

Therapy for submassive pulmonary embolism (intermediate risk), remains controversial. New evidence has appeared that may help us in the process of decision making. We review the relevant literature, outline prognostic factors, and discuss current recommendations and controversies regarding the available alternatives such as systemic and catheter-directed thrombolytic use.

Terapia trombolítica en TEP submasivo/riesgo intermedio: Evidencias y sugerencias post estudio Pulmonary Embolism Thrombolysis (PEITHO) / Thrombolytic therapy for submassive/ intermediate risk Pulmonary Embolism Evidence and suggestions after PEITHO trial

Therapy for submassive pulmonary embolism (intermediate risk), remains controversial. New evidence has appeared that may help us in the process of decision making. We review the relevant literature, outline prognostic factors, and discuss current recommendations and controversies regarding the available alternatives such as systemic and catheter-directed thrombolytic use.

Aspergilosis traqueobronquial necrotizante en paciente crítico / Necrotizing tracheobronchial aspergillosis in an immunosuppressed patient. Report of one case

Necrotizing tracheobronchitis due to Aspergillus spp is a rare form of invasive aspergillosis. This infection is limited to or predominant in the bronchial tree. The clinical evolution is gradual: from mild non-specific manifestations of acute tracheobronchitis to severe acute respiratory insufficiency determined by a bronchial obstruction syndrome. We report a 38 years old female with systemic lupus erythematosus treated with methylprednisolone and cyclophosphamide. She developed an invasive aspergillosis, severe respiratory failure with predominant tracheobronchial damage and upper respiratory complications.