Influence of implant strategy on the transition from temporary left ventricular assist device to durable mechanical circulatory support.

OBJECTIVES: Bridging from a temporary microaxial left ventricular assist device (tLVAD) to a durable left ventricular assist device (dLVAD) is playing an increasing role in the treatment of terminally ill patients with heart failure. Scant data exist about the best implant strategy. The goal of this study was to analyse differences in the dLVAD implant technique and effects on patient outcomes. METHODS: Data from 341 patients (19 European centres) who underwent a bridge-to-bridge implant from tLVAD to dLVAD between January 2017 and October 2022 were retrospectively analysed. The outcomes of the different implant techniques with the patient on cardiopulmonary bypass, extracorporeal life support or tLVAD were compared. RESULTS: A durable LVAD implant was performed employing cardiopulmonary bypass in 70% of cases (n = 238, group 1), extracorporeal life support in 11% (n = 38, group 2) and tLVAD in 19% (n = 65, group 3). Baseline characteristics showed no significant differences in age (P = 0.140), body mass index (P = 0.388), creatinine level (P = 0.659), the Model for End-Stage Liver Disease (MELD) score (P = 0.190) and rate of dialysis (P = 0.110). Group 3 had significantly fewer patients with preoperatively invasive ventilation and cardiopulmonary resuscitation before the tLVAD was implanted (P = 0.009 and P < 0.001 respectively). Concomitant procedures were performed more often in groups 1 and 2 compared to group 3 (24%, 37% and 5%, respectively, P < 0.001). The 30-day mortality data showed significantly better survival after an inverse probability of treatment weighting in group 3, but the 1-year mortality showed no significant differences among the groups (P = 0.012 and 0.581, respectively). Postoperative complications like the rate of right ventricular assist device (RVAD) implants or re-thoracotomy due to bleeding, postoperative respiratory failure and renal replacement therapy showed no significant differences among the groups. Freedom from the first adverse event like stroke, driveline infection or pump thrombosis during follow-up was not significantly different among the groups. Postoperative blood transfusions within 24 h were significantly higher in groups 1 and 2 compared to surgery on tLVAD support (P < 0.001 and P = 0.003, respectively). CONCLUSIONS: In our analysis, the transition from tLVAD to dLVAD without further circulatory support did not show a difference in postoperative long-term survival, but a better 30-day survival was reported. The implant using only tLVAD showed a reduction in postoperative transfusion rates, without increasing the risk of postoperative stroke or pump thrombosis. In this small cohort study, our data support the hypothesis that a dLVAD implant on a tLVAD is a safe and feasible technique in selected patients.

A machine learning tool for the diagnosis of SARS-CoV-2 infection from hemogram parameters.

Monocytes and neutrophils play key roles in the cytokine storm triggered by SARS-CoV-2 infection, which changes their conformation and function. These changes are detectable at the cellular and molecular level and may be different to what is observed in other respiratory infections. Here, we applied machine learning (ML) to develop and validate an algorithm to diagnose COVID-19 using blood parameters. In this retrospective single-center study, 49 hemogram parameters from 12,321 patients with clinical suspicion of COVID-19 and tested by RT-PCR (4239 positive and 8082 negative) were analysed. The dataset was randomly divided into training and validation sets. Blood cell parameters and patient age were used to construct the predictive model with the support vector machine (SVM) tool. The model constructed from the training set (5936 patients) achieved an accuracy for diagnosis of SARS-CoV-2 infection of 0.952 (95% CI: 0.875-0.892). Test sensitivity and specificity was 0.868 and 0.899, respectively, with a positive (PPV) and negative (NPV) predictive value of 0.896 and 0.872, respectively (prevalence 0.50). The validation set model (4964 patients) achieved an accuracy of 0.894 (95% CI: 0.883-0.903). Test sensitivity and specificity was 0.8922 and 0.8951, respectively, with a positive (PPV) and negative (NPV) predictive value of 0.817 and 0.94, respectively (prevalence 0.34). The area under the receiver operating characteristic curve was 0.952 for the algorithm performance. This algorithm may allow to rule out COVID-19 diagnosis with 94% of probability. This represents a great advance for early diagnostic orientation and guiding clinical decisions.

Unveiling the tartrazine binding mode with ds-DNA by UV-visible spectroscopy, electrochemical, and QM/MM methods.

Here, we studied the interaction between the food colorant tartrazine (TZ) and double stranded DNA (dsDNA), using spectroscopic, electrochemical, and computational methods such as QM/MM combined with TD-DFT. Despite the UV-vis spectroscopy is widely used to study the interaction between molecules, for the case of TZ there are discrepancies in the analyses presented in the literature available, presenting both hyperchromic and hypochromic effects and consequently different rationalizations for their results. Herein we propose the combination of UV-vis experiments with the design of high-level computational models capable of reproducing the experimental behavior to finally define the proper binding mode at the molecular scale together with the rationalization of the experimental optical response due to the complex formation. To complement the UV-vis experiments, we propose the use of electrochemical measurements, to support the results obtained through UV-vis spectroscopy, as it has been successfully used for the determination of interaction modes between small molecules and biomolecules in any condition. Our UV-vis spectroscopy experiments showed only a hypochromic effect of the absorption spectra of TZ after interaction with DNA, indicative of TZ being deeply buried in the DNA structure. The effect of ionic strength in the experimental procedures led to the dissociation of TZ, thus indicating that the interaction mode was groove binding. On the other hand, the electrochemical studies showed an irreversible reduction peak of TZ, which after the interaction with DNA exhibited a positive shift in potential that can be attributed to groove binding. The binding constant for TZ-DNA was calculated as 4.45x104M-1 (UV-vis) and 5.75x104M-1 (electrochemistry), in line with other groove binder azo dyes. Finally, through the QM/MM calculations we found that the minor-groove binding mode interacting in zones rich in adenine and thymine was the model best suited to reproduce the experimental UV-vis response.

Forest buffer-strips mitigate the negative impact of oil palm plantations on stream communities.

The global area cultivated with oil palm has doubled in the past two decades, causing deforestation, land-use change, freshwater pollution, and species loss in tropical ecosystems worldwide. Despite the palm-oil industry been linked to severe deterioration of freshwater ecosystems, most studies have focused on terrestrial environments, while freshwaters have been significantly less studied. We evaluated these impacts by contrasting freshwater macroinvertebrate communities and habitat conditions in 19 streams from primary forests (7), grazing lands (6), and oil palm plantations (6). In each stream, we measured environmental characteristics, e.g., habitat composition, canopy cover, substrate, water temperature, and water quality; and we identified and quantified the assemblage of macroinvertebrates. Streams in oil palm plantations lacking riparian forest strips showed warmer and more variable temperatures, higher turbidity, lower silica content, and poorer macroinvertebrate taxon richness than primary forests. Grazing lands showed higher conductivity and temperature, and lower dissolved oxygen and macroinvertebrate taxon richness than primary forests. In contrast, streams in oil palm plantations that conserved a riparian forest, showed a substrate composition, temperature, and canopy cover more similar to the ones in primary forests. These habitat improvements by riparian forests in the plantations increased macroinvertebrate taxon richness and maintained a community resembling more the one in primary forests. Therefore, the conversion of grazing lands (instead of primary forests) to oil palm plantations can increase freshwater taxon richness only if riparian native forests are safeguarded.

A loss function to evaluate agricultural decision-making under uncertainty: a case study of soil spectroscopy.

Modern sensor technologies can provide detailed information about soil variation which allows for more precise application of fertiliser to minimise environmental harm imposed by agriculture. However, growers should lose neither income nor yield from associated uncertainties of predicted nutrient concentrations and thus one must acknowledge and account for uncertainties. A framework is presented that accounts for the uncertainty and determines the cost-benefit of data on available phosphorus (P) and potassium (K) in the soil determined from sensors. For four fields, the uncertainty associated with variation in soil P and K predicted from sensors was determined. Using published fertiliser dose-yield response curves for a horticultural crop the effect of estimation errors from sensor data on expected financial losses was quantified. The expected losses from optimal precise application were compared with the losses expected from uniform fertiliser application (equivalent to little or no knowledge on soil variation). The asymmetry of the loss function meant that underestimation of P and K generally led to greater losses than the losses from overestimation. This study shows that substantial financial gains can be obtained from sensor-based precise application of P and K fertiliser, with savings of up to £121 ha-1 for P and up to £81 ha-1 for K, with concurrent environmental benefits due to a reduction of 4-17 kg ha-1 applied P fertiliser when compared with uniform application. Supplementary Information: The online version contains supplementary material available at 10.1007/s11119-022-09887-2.

Comparing the effect of different sample conditions and spectral libraries on the prediction accuracy of soil properties from near- and mid-infrared spectra at the field-scale.

The prediction accuracy of soil properties by proximal soil sensing has made their application more practical. However, in order to gain sufficient accuracy, samples are typically air-dried and milled before spectral measurements are made. Calibration of the spectra is usually achieved by making wet chemistry measurements on a subset of the field samples and local regression models fitted to aid subsequent prediction. Both sample handling and wet chemistry can be labour and resource intensive. This study aims to quantify the uncertainty associated with soil property estimates from different methods to reduce effort of field-scale calibrations of soil spectra. We consider two approaches to reduce these expenses for predictions made from visible-near-infrared ((V)NIR), mid-infrared (MIR) spectra and their combination. First, we considered reducing the level of processing of the samples by comparing the effect of different sample conditions (in-situ, unprocessed, air-dried and milled). Second, we explored the use of existing spectral libraries to inform calibrations (based on milled samples from the UK National Soil Inventory) with and without 'spiking' the spectral libraries with a small subset of samples from the study fields. Prediction accuracy of soil organic carbon, pH, clay, available P and K for each of these approaches was evaluated on samples from agricultural fields in the UK. Available P and K could only be moderately predicted with the field-scale dataset where samples were milled. Therefore this study found no evidence to suggest that there is scope to reduce costs associated with sample processing or field-scale calibration for available P and K. However, the results showed that there is potential to reduce time and cost implications of using (V)NIR and MIR spectra to predict soil organic carbon, clay and pH. Compared to field-scale calibrations from milled samples, we found that reduced sample processing lowered the ratio of performance to inter-quartile range (RPIQ) between 0% and 76%. The use of spectral libraries reduced the RPIQ of predictions relative to field-scale calibrations from milled samples between 54% and 82% and the RPIQ was reduced between 29% and 70% for predictions when spectral libraries were spiked. The increase in uncertainty was specific to the combination of soil property and sensor analysed. We conclude that there is always a trade-off between prediction accuracy and the costs associated with soil sampling, sample processing and wet chemical analysis. Therefore the relative merits of each approach will depend on the specific case in question.

Severe perinatal hemolytic disease due to anti-e.

Maternal antibody-mediated fetal red blood cell destruction secondary to non-D Rh system antibodies is a significant cause of hemolytic disease of the fetus and newborn. Here, we report a rare case of severe perinatal hemolytic disease associated with maternal antibody to the e antigen. In addition to severe anemia, the infant developed hyperbilirubinemia. Resolution of the infant's anemia and hyperbilirubinemia occurred after treatment with phototherapy, intravenous immunoglobulin, and transfusion.Maternal antibody-mediated fetal red blood cell destruction secondary to non-D Rh system antibodies is a significant cause of hemolytic disease of the fetus and newborn. Here, we report a rare case of severe perinatal hemolytic disease associated with maternal antibody to the e antigen. In addition to severe anemia, the infant developed hyperbilirubinemia. Resolution of the infant's anemia and hyperbilirubinemia occurred after treatment with phototherapy, intravenous immunoglobulin, and transfusion.

Predicting the growth of lettuce from soil infrared reflectance spectra: the potential for crop management.

How well could one predict the growth of a leafy crop from reflectance spectra from the soil and how might a grower manage the crop in the light of those predictions? Topsoil from two fields was sampled and analysed for various nutrients, particle-size distribution and organic carbon concentration. Crop measurements (lettuce diameter) were derived from aerial-imagery. Reflectance spectra were obtained in the laboratory from the soil in the near- and mid-infrared ranges, and these were used to predict crop performance by partial least squares regression (PLSR). Individual soil properties were also predicted from the spectra by PLSR. These estimated soil properties were used to predict lettuce diameter with a linear model (LM) and a linear mixed model (LMM): considering differences between lettuce varieties and the spatial correlation between data points. The PLSR predictions of the soil properties and lettuce diameter were close to observed values. Prediction of lettuce diameter from the estimated soil properties with the LMs gave somewhat poorer results than PLSR that used the soil spectra as predictor variables. Predictions from LMMs were more precise than those from the PLSR using soil spectra. All model predictions improved when the effects of variety were considered. Predictions from the reflectance spectra, via the estimation of soil properties, can enable growers to decide what treatments to apply to grow lettuce and how to vary their treatments within their fields to maximize the net profit from the crop.

Responses of monogenean species to variations in abiotic parameters in tilapiculture.

Fish farming is becoming an increasingly popular agricultural activity, and water quality in these environments is a major concern. Fish parasites, such as monogeneans, respond to changes in abiotic conditions, either with an increase or decrease in population. This study aimed to identify gill monogeneans and analyse their relationships with abiotic factors during the ontogenetic development of Nile tilapia over the fish culture cycle in Mato Grosso do Sul, Brazil. Fish were sampled monthly for eight months, and a total of 200 fish were collected. The physical and chemical water parameters were measured and correlated with the abundance of each monogenean species. Over the fish culture cycle, the physical and chemical parameters fluctuated, and the water quality decreased. The parasites found included Cichlidogyrus tilapiae, Cichlidogyrus thurstonae, Cichlidogyrus sclerosus, Cichlidogyrus halli and Scutogyrus longicornis. The abundances of all species showed significant differences during ontogenetic development (body size) and C. tilapiae, C. sclerosus, C. thurstonae and S. longicornis were correlated with changes in abiotic conditions. However, C. halli was not significantly correlated with any of the evaluated physical or chemical parameters. Understanding how different monogenean species respond to changes in the physical and chemical parameters of water during a production cycle can prevent peaks in abundance and subsequent sanitary problems.

[Consent management and workflows for cross-sectoral patient records and teleconsultations]. / Consent Management und Workflows für intersektorale Patientenakten und Telekonsile.

Cross-enterprise electronic patient records are a key element in the design of interoperable medical care networks and process chains. However, the different requirements concerning type, performance and quality assurance of available communication services within the different healthcare sectors still require that the hospitals participate in various secure communication networks which have to be bridged for cross-sectoral communication. Cross-institutional pathways for telemedicine, however, can be mapped both within and across sectoral boundaries via automated process chains using the IHE (Integrating the Healthcare Enterprise) defined integration profile CrossEnterprise Document Sharing (XDS) and associated integration profiles. The provision of medical documents in a cross-institutional patient record outside of defined medical pathways requires differentiated authorization management. In this respect, consent documents according to the IHE APPC (Advanced Patient Privacy Consents) profile enable the documentation of the patient's consent, including information about planned authorized people, document types, period and type of document access allowed. Providing access control to medical documentation by the patients themselves is an essential part of the required focusing of medical services on patients. New interoperability standards optimized for use on mobile devices, such as FHIR (Fast Healthcare Interoperability Resources), will enable simplified delivery of patient-centered health records and other medical services on mobile platforms in the future.

[Cross-enterprise interoperability : Challenges and principles for technical implementation]. / Einrichtungsübergreifende Interoperabilität : Herausforderungen und Grundlagen für die technische Umsetzung.

Demographic change, the migration of medical professionals and economic constraints are leading to an increasing specialisation and concentration of resources in the healthcare sector. The digital mapping of cross-enterprise process chains between different medical care levels in turn requires digital networking and syntactical and semantical interoperability in information exchange. Cross-enterprise electronic patient records based on the Cross-Enterprise Document Sharing (XDS.b) integration profile defined by the Integrating the Healthcare Enterprise (IHE) initiative are the basis of the digital exchange of medical information between patients and service providers. Syntactical interoperability is ensured by the object definitions in the XDS Affinity domain and the Clinical Document Architecture (CDA) document format. Semantical interoperability is achieved by the use of standardized terminology and code systems. Terminology servers make it easy to deploy standard ontologies and translate proprietary code systems. New interoperability standards, e.g. based on Fast Healthcare Interoperability Resources (FHIR), are being developed to facilitate the exchange of structured medical information objects on mobile platforms in the future.

Thermoluminescence emission on lead oxychloroborate glasses under UV exposure.

Glassy materials were prepared using two different systems: 50B2 O3 - (50 - x)PbO - xPbCl2, with x = 0, 2 and 5 in mol % (System BPCl-I) and 50BO1.5 - (50 - x)PbO - xPbCl2 with x = 0, 2, 5 and 7 in cationic % (System BPCl-II). Structural and optical characterization showed that PbCl when substituted for PbO changed the structure of the glass network by replacing nonbridging oxygens for chlorine ions. This substitution also caused a change in the number of defects responsible for thermoluminescence (TL) emission (electrons and hole trap centres). Thermoluminescence emissions were observed for the first time in lead oxychloroborate glasses after exposure to UV radiation. Sample BPCl-I-2 (x = 2 from System I) demonstrated better TL emission compared with other glass samples. One intense peak in the glow curve, centred at ~122°C followed by a shoulder at ~180°C, was highly sensitive to UV radiation. There were also good linear responses at dose range ~0.4 to ~2 J/cm2 for the first peak (low temperature) and ~0.4 to ~4 J/cm2 for the second peak (high temperature).

Predictors of short- and long-term recurrence of suicidal behavior in borderline personality disorder.

OBJECTIVE: To evaluate the incidence of suicidal outcomes and risk factors for short- and long-term recurrence of suicidal behavior (SB) among high-risk borderline personality disorder (BPD) patients during a 24-month prospective follow-up period. METHODS: A multicenter prospective cohort study was designed to compare data obtained from 136 patients admitted to the emergency department for current suicidal ideation (SI) or a recent suicide attempt (SA). Subjects were clinically evaluated and monitored for a new SA or suicide. RESULTS: The incidence of a new SA was 25.63 events/100 persons-year, and one patient died by suicide. Child sexual abuse (CSA) was the only significant predictor throughout the complete follow-up period. The absence of prior psychiatric treatment predicts the recurrence of SB in the first 6 months of follow-up. Patient age, poor psychosocial functioning before hospitalization, age at first SA, and having multiple suicide attempts increased risk of SB recurrence at the long-term period (24th months). In addition, there was an interaction between CSA and poor psychosocial functioning that increased risk of SB. CONCLUSION: The risk of recurrence was higher during the first 6 months. Risk factors at 6 and 24 months vary. These findings are important for implementing suicide strategies.

Identification of bacterial and fungal species in human cadavers used in anatomy teaching / Identificación de especies bacterianas y fúngicas en cadáveres humanos utilizados en la enseñanza de la anatomía

Within the framework of undergraduate and postgraduate medical education, cadavers have been used to teach anatomy by dissection or by using prosected specimens. To accomplish this, an appropriated preservation process must guarantee that the cadaver is kept safe for harm, destruction, and decomposition. Embalming fluid contains fixatives, disinfectants, surfactants, buffers, salt, and water, making the cadaver safe for teaching anatomy. However, it remains unclear if there is any risk of dissemination of microorganisms during anatomy teaching, research, and dissection procedures on fixed cadavers. The purpose of this study is to identify bacterial and fungal species in fixed cadaveric material used in anatomy teaching. Samples of cadavers and anatomical sections were cultured and biochemical tests and molecular identification by polymerase chain reaction (PCR) were performed to identify the microorganisms. The results indicate that fixed cadaveric material has viable bacteria on its surfaces and almost all these correspond to gram-negative bacilli of the Enterobacteriaceae family. In conclusion, fixed cadavers could be a reservoir of bacteria. This study underscores the importance of generating safe manipulation protocols to avoid eventual contamination and disease.

Dentro del curriculum de los programas de postgrado y pregrado de las carreras de la salud, los cadáveres han sido utilizados para la enseñanza de la anatomía mediante la disección o utilizando preparados anatómicos. Para poder llevar a cabo esto, el cadáver debe pasar por un adecuado proceso de preservación; en el que se utilizan fluidos que contienen fijadores, desinfectantes, surfactantes, buffers, sal y agua, los cuales lo protegen del deterioro y la descomposición. Las soluciones fijadoras y conservadoras contienen desinfectantes, surfactantes, fijadores, buffers, sal y agua, que hacen que el cadáver sea seguro para la enseñanza de la anatomía. Sin embargo, no está claro si existe algún riesgo de diseminación de microorganismos durante la enseñanza, investigación y/o disección en estos cadáveres. El propósito del estudio es identificar especies bacterianas y/o fúngicas en material cadavérico previamente fijado, usado en la enseñanza de la anatomía. Se realizaron cultivos y técnicas de identificación molecular mediante reacción en cadena de polimerasa de muestras tomadas desde material cadavérico para identificar los microorganismos encontrados. Los resultados indican que el material cadavérico previamente fijado posee bacterias en sus superficies, la mayoría corresponde a bacilos gram negativos de la familia de las Enterobacteriaceae. En conclusión, los cadáveres previamente fijados pueden ser reservorio de bacterias. Este estudio destaca la importancia de generar protocolos de manipulación con el fin de evitar una posible contaminación y enfermedad.

[Heart failure: ventricular assist devices and cardiac transplantation : A review of current surgical innovations]. / Kardiales Pumpversagen: Herzunterstützungssysteme und Herztransplantation : Eine Übersicht aktueller chirurgischer Innovationen.

BACKGROUND: End-stage heart failure is one of the leading causes of death in Germany. Cardiac transplantation is still considered the gold standard for the treatment of terminal heart failure; however, there is a discrepancy between patients on the waiting list and yearly performed transplantations. As an alternative, ventricular assist devices have achieved a high level of importance but treatment is still associated with challenges. Novel systems as well as innovative surgical techniques contribute to improving the safety and effectiveness of the treatment. OBJECTIVE: To generate an overview of current surgical innovations in cardiac transplantation and mechanical circulatory support. MATERIAL AND METHODS: A Medline search was conducted regarding innovations in cardiac transplantation and mechanical circulatory support. RESULTS AND CONCLUSION: Not only the number of yearly performed cardiac transplantations has changed but also recipient profiles. While in the pioneering era of transplantation the typical candidate was young, not previously operated on and with lower levels of comorbidities, today's patients are significantly older, have been fitted with ventricular assist devices and have increased operative risk profiles. Modern methods of organ preservation enable longer transportation and operation times as well as an improved assessment of graft function and perspectives for graft optimization in the future. In the area of ventricular assist devices, advances in the reduction of the stroke rate seem to have been achieved by the latest generation devices. From a surgical perspective, less invasive surgical techniques with promising initial results have been established at numerous centers.

Aneurisma de la vena de Galeno: diagnóstico prenatal y manejo / Vein of Galen aneurysm: prenatal diagnosis and management

RESUMEN Las malformaciones vasculares cerebrales son infrecuentes, dentro de ellas, el aneurisma de la vena de Galeno (AVG) tiene una incidencia de 1 en 25.000 recién nacidos. El ultrasonido obstétrico de rutina ha permitido el diagnóstico prenatal de dicha alteración, permitiendo establecer el pronóstico del recién nacido. En la exploración mediante ultrasonido del cerebro fetal, la presencia de una imagen quística supratentorial con flujo turbulento al Doppler color permite establecer el diagnóstico. La asociación con signos de insuficiencia cardiaca ha mostrado altas tasas de mortalidad neonatal. Se presenta el caso de un feto al que se realiza el diagnóstico prenatal mediante ultrasonido y su confirmación por neuroimagenes al nacimiento.

ABSTRACT Cerebral vascular abnormalities are rare. The vein of Galen aneurysmal malformation (VGAM) has an incidence of 1 in 25,000 newborns. The routine obstetric ultrasound has allowed the prenatal diagnosis and establish the prognosis of the newborn. In the ultrasound examination of the fetal brain, the presence of a supratentorial cystic image with turbulent flow to the color Doppler makes the diagnosis. The association with signs of heart failure have shown high neonatal mortality. We present a case of a fetus with prenatal diagnosis of VGAM by 2D ultrasound and confirmation by neuroimaging at birth.

One-pot preparation of a novel CO-releasing material based on a CO-releasing molecule@metal-organic framework system.

A novel CO releasing material has been prepared via a one-pot synthesis-encapsulation strategy using the hierarchical metal organic framework [Zn2(dhtp)] (dhtp = 2,5-dihydroxyterephthalate) as a host of the photoactivable molybdenum tricarbonyl complex [Mo(CNCMe2CO2H)3(CO)3].

PTI y embarazo: una experiencia con rituximab / ITP and pregnancy: an experience with rituximab

El Púrpura Trombocitopénico Idiopático (PTI) es una patología asociada a una de cada 500 a 1000 gestantes. Su reconocimiento oportuno y adecuado manejo durante el embarazo, permite reducir la morbimortalidad tanto materna como fetal. Los corticoides como tratamiento de primera línea para PTI en embarazadas, es igual que en población general, con respuestas observadas entre el 5° y 7° día, alcanzando un 50 - 60% de éxito. El caso que presentamos se trata de una gestante en el 2° trimestre tardío con PTI refractario al tratamiento con corticoides, con muy bajos niveles de plaquetas y alto riesgo de hemorragia, por lo cual se decide el uso de Rituximab, un anticuerpo monoclonal (categoría C de la FDA) con escasa prescripción en el embarazo. Exponemos nuestra experiencia en este caso.

Idiopathic thrombocytopenic purpura ( ITP) is a condition associated with each 500-1000 pregnancies . Its early recognition and proper management during pregnancy, can reduce both maternal and fetal morbidity and mortality. Corticosteroids as first-line treatment for ITP in pregnant women is the same as in the general population, with responses observed between the 5th and 7th day, approximately 50-60 % of patients respond favorably. The case presented is a pregnant patient in the 2th trimester with refractory ITP treatment with corticosteroids, very low levels of platelets and high risk of bleeding so the use of Rituximab is decided, a monoclonal antibody (category C FDA) with little prescription in pregnancy. We describe our experience in this case.

Metal organic frameworks based on bioactive components.

One of the more recent and promising domains of the application of Metal Organic Frameworks (MOFs) is the biomedical one. To fulfil the keystone requirements of bioapplications, i.e. biosafety and activity, endogenous and/or bioactive motifs (cations, organic ligands or both) have been successfully used as constitutive building blocks to construct Metal Biomolecule Frameworks (also known as bioMOFs). This review highlights the latest advances in 3D bioMOF structures, from their synthesis to their biorelated activities in different biorelated areas including drug delivery, imaging, and sensing, classifying them by the nature of the active component.