Recombinant ADAMTS13 for Immune Thrombotic Thrombocytopenic Purpura.

In patients with immune thrombotic thrombocytopenic purpura (iTTP), autoantibodies against the metalloprotease ADAMTS13 lead to catastrophic microvascular thrombosis. However, the potential benefits of recombinant human ADAMTS13 (rADAMTS13) in patients with iTTP remain unknown. Here, we report the clinical use of rADAMTS13, which resulted in the rapid suppression of disease activity and complete recovery in a critically ill patient whose condition had proved to be refractory to all available treatments. We also show that rADAMTS13 causes immune complex formation, which saturates the autoantibody and may promote its clearance. Our data support the role of rADAMTS13 as a novel adjunctive therapy in patients with iTTP.

Abordaje terapéutico del colapso transversal del maxilar superior con microimplantes (TAD´s) / Therapeutic approach of transverse maxillary collapse with microimplants (TAD's)

Introducción. La atresia o estrechez del maxilar superior es una patología de origen multifactorial que genera un colapso transversal, el mismo e implica la carencia de espacio necesario para la disposición correcta de las piezas dentales. Objetivo. El presente artículo está enmarcado en una revisión narrativa de la literatura, con el objetivo de describir el abordaje terapéutico del colapso transversal del maxilar superior con microimplantes (TAD´s), determinando los efectos esqueléticos y dentoalveolares en el maxilar superior, así como las ventajas y desventajas del tratamiento. Método. La búsqueda de artículos se realizó a través de mediante las plataformas de: Scielo, PubMed, Google Académico y Medline. Se seleccionaron 21 artículos cuyos textos completos fueron descargados para examinarlos a detalle y verificar que cumplieran con todos los criterios de inclusión, de los cuales se obtuvieron 16 artículos para elaborar esta revisión narrativa. Conclusiones. El abordaje terapéutico del colapso transversal se produce por medio de la expansión rápida del maxilar (ERM) o disyunción maxilar, en pacientes jóvenes en crecimiento; y en los pacientes adultos se suele emplear un tratamiento con técnica MARPE con microimplantes (TAD´s). El principal efecto esquelético es la apertura de la sutura maxilar que varía de 2 a 10 mm, muchos autores coinciden en que el manejo del colapso transversal del maxilar superior con microimplantes no genera efectos dentoalveolares negativos, al contrario, tiene ventajas biomecánicas debido al anclaje con el hueso, reduciendo el riesgo de movimiento dentales indeseados y permitiendo un control del crecimiento vertical.

Introduction. The atresia or narrowness of the upper jaw is a pathology of multifactorial origin that generates a transverse collapse, it implies the lack of space necessary for the correct arrangement of the dental pieces. Objective. This article is framed in a narrative review of the literature, with the aim of describing the therapeutic approach of transverse maxillary collapse with microimplants (TAD's), determining the skeletal and dentoalveolar effects in the maxilla, as well as the advantages and disadvantages of treatment. Method. The search for articles was carried out through the following platforms: Scielo, PubMed, Google Scholar and Medline. 21 articles whose full texts were downloaded were selected to examine them in detail and verify that they met all the inclusion criteria, of which 18 articles were obtained to prepare this narrative review. Conclusions. The therapeutic approach to transverse collapse occurs through rapid maxillary expansion (RME) or maxillary disjunction, in young growing patients; and in adult patients, treatment with the MARPE technique with microimplants (TAD's) is usually used. The main skeletal effect is the opening of the maxillary suture, which varies from 2 to 10 mm. Many authors agree that the management of the transverse collapse of the maxilla with microimplants does not generate negative dentoalveolar effects, on the contrary, it has biomechanical advantages due to the anchorage with the bone, reducing the risk of unwanted dental movement and allowing control of vertical growth.

Obstructive Sleep Apnea in Neonates.

Neonates have distinctive anatomic and physiologic features that predispose them to obstructive sleep apnea (OSA). The overall prevalence of neonatal OSA is unknown, although an increase in prevalence has been reported in neonates with craniofacial malformations, neurological disorders, and airway malformations. If remained unrecognized and untreated, neonatal OSA can lead to impaired growth and development, cardiovascular morbidity, and can even be life threatening. Polysomnography and direct visualization of the airway are essential diagnostic modalities in neonatal OSA. Treatment of neonatal OSA is based on the severity of OSA and associated co-morbidities. This may include medical and surgical interventions individualized for the affected neonate. Based on this, it is expected that infants with OSA have more significant healthcare utilization.