Tailoring of Mesoporous Silica-Based Materials for Enhanced Water Pollutants Removal.

The adsorptive performance of mesoporous silica-based materials towards inorganic (metal ions) and organic (dyes) water pollutants was investigated. Mesoporous silica materials with different particle size, surface area and pore volume were prepared and tailored with different functional groups. These materials were then characterised by solid-state techniques, namely vibrational spectroscopy, elemental analysis, scanning electron microscopy and nitrogen adsorption-desorption isotherms, allowing the successful preparation and structural modifications of the materials to be confirmed. The influence of the physicochemical properties of the adsorbents towards the removal of metal ions (Ni2+, Cu2+ and Fe3+) and organic dyes (methylene blue and methyl green) from aqueous solutions was also investigated. The results reveal that the exceptionally high surface area and suitable ζ-potential of the nanosized mesoporous silica nanoparticles (MSNPs) seem to favour the adsorptive capacity of the material for both types of water pollutants. Kinetic studies were performed for the adsorption of organic dyes by MSNPs and large-pore mesoporous silica (LPMS), suggesting that the process follows a pseudo-second-order model. The recyclability along consecutive adsorption cycles and the stability of the adsorbents after use were also investigated, showing that the material can be reused. Current results show the potentialities of novel silica-based material as a suitable adsorbent to remove pollutants from aquatic matrices with an applicability to reduce water pollution.

An Overview of PRR- and NLR-Mediated Immunities: Conserved Signaling Components across the Plant Kingdom That Communicate Both Pathways.

Cell-surface-localized pattern recognition receptors (PRRs) and intracellular nucleotide-binding domain and leucine-rich repeat receptors (NLRs) are plant immune proteins that trigger an orchestrated downstream signaling in response to molecules of microbial origin or host plant origin. Historically, PRRs have been associated with pattern-triggered immunity (PTI), whereas NLRs have been involved with effector-triggered immunity (ETI). However, recent studies reveal that such binary distinction is far from being applicable to the real world. Although the perception of plant pathogens and the final mounting response are achieved by different means, central hubs involved in signaling are shared between PTI and ETI, blurring the zig-zag model of plant immunity. In this review, we not only summarize our current understanding of PRR- and NLR-mediated immunities in plants, but also highlight those signaling components that are evolutionarily conserved across the plant kingdom. Altogether, we attempt to offer an overview of how plants mediate and integrate the induction of the defense responses that comprise PTI and ETI, emphasizing the need for more evolutionary molecular plant-microbe interactions (EvoMPMI) studies that will pave the way to a better understanding of the emergence of the core molecular machinery involved in the so-called evolutionary arms race between plants and microbes.

"We left the crop there lying in the field": Agricultural worker experiences with the COVID-19 pandemic in a rural US-Mexico border region.

California agricultural workers are predominately Latino/a, are medically underserved, and reside in larger households, placing them at elevated COVID-19 risk at work and at home. While some research has examined COVID-19 among agricultural workers in the interior of the United States, little research exists on experiences of COVID-19 along the US-Mexico border. Grounded in resilience thinking, this study aims to understand how agricultural workers navigated their heightened risk to COVID-19 at work and at home, and made use of available resources in the context of a bi-national community. Our study utilized qualitative interviews with 12 agricultural workers to understanding the COVID-19 experiences of resident and daily migrant agricultural workers in Imperial County, California, located along the US-Mexico border. Findings suggest that agricultural workers faced significant impacts and risks at work (work stoppages, stress about bringing COVID-19 home to family) and at home (contracting COVID-19, loss of friends and family, and mental health challenges). Agricultural workers and their employers often implemented COVID-19 precautions such as social distancing measures, personal protective equipment, hand washing and hand sanitizers, and isolation. Many agricultural workers did access testing resources on either side of the US-Mexico border and worked with US-based Spanish-speaking community-based organizations to register for vaccine appointments. To better support agricultural workers and their employers in the future, we recommend the following: 1. Prioritize agricultural workplace conditions to increase agricultural worker physical and mental health, 2. Extend public health services into agricultural work sites of transit and the workplace, and 3. Lastly, trusted Spanish-speaking community-based organizations can play a critical role in public health outreach.

[Factors associated with the lack of adherence to treatment among patients with type 2 diabetes mellitus]. / Falta de adherencia al tratamiento farmacológico y factores asociados en pacientes mexicanos con diabetes mellitus tipo 2.

BACKGROUND: Adherence to pharmacological treatment (APT) is crucial for patients with type 2 diabetes mellitus (T2DM) to achieve metabolic control and decrease complications. AIM: To establish the proportion of APT in patients with T2DM, the influence of the same on blood glucose, and the factors involved in a lack of ATP. MATERIAL AND METHODS: Diabetic patients were interrogated about sociodemographic factors, the evolution of the disease, their fasting blood glucose levels, and the use of other treatments. APT was evaluated with the Morisky-Green questionnaire, patient beliefs about treatments with the Beliefs about Medicines Questionnaire (BMQ), and patient knowledge about T2DM with the standard questionnaire. RESULTS: A representative sample of 400 individuals of both sexes was studied, finding a lack of APT in 74.5% of patients. The latter patients showed a significantly greater level of blood glucose while being more preoccupied and less informed about the disease. A lack of APT was associated with the refusal to undergo the blood glucose test among men (Odds ratio (OR)=3.70; 95% confidence intervals (CI), 1.58-8.66) and with the consumption of medicinal plants among women (OR=2.53; IC 95%, 1.23-5.23). CONCLUSIONS: A lack of APT in patients with T2DM is a serious problem and associated with a lack of knowledge about the disease. It is urgent to strengthen the educational programs in relation to T2DM to promote adherence to treatment.

The construction of high-magnification homemade lenses for a simple microscope: an easy "DIY" tool for biological and interdisciplinary education.

The rise of microscopy in the seventeenth century allowed scientists to discover a new world of microorganisms and achieve great physiological advances. One of the first microscopes of the epoch was Antonie van Leeuwenhoek's microscope, a deceptively simple device that contains a single ball lens housed in a metal plate allowing the observation of samples at up to ×250 magnification. Such magnification was much greater than that achieved by rudimentary compound microscopes of the era, allowing for the discovery of microscopic, single-celled life, an achievement that marked the study of biology up to the nineteenth century. Since Leeuwenhoek's design uses a single ball lens, it is possible to fabricate variations for educational activities in physics and biology university and high school classrooms. A fundamental problem, however, with home-built microscopes is that it is difficult to work with glass. We developed a simple protocol to make ball lenses of glass and gelatin with high magnification that can be done in a university/high school classroom, and we designed an optimized support for focusing and taking photographs with a smartphone. The protocol details a simple, easily accessible, low-cost, and effective tool for the observation of microscopic samples, possible to perform anywhere without the need for a laboratory or complex tools. Our protocol has been implemented in classrooms in Chile to a favorable reception.

Deficient glucose uptake is linked to impaired Glut1 expression upon CD3/CD28 stimulation in memory T cells from pleural effusions secondary to lung cancer.

Glucose and nutrient uptake is essential in supporting T cell activation and is increased upon CD3/CD28 stimulation. As T cells from pleural effusions secondary to lung cancer show impaired function, we hypothesized that these cells might have altered expression of nutrient transporters. Here, we analysed by flow cytometry the expression of the transferrin receptor CD71, amino acid transporter CD98 and glucose transporter Glut1 and glucose uptake in pleural effusion-derived T cells from lung cancer patients, after stimulation via CD3/CD28 under normoxia or hypoxia (2% O2 ). We compared the response of T cells from pleural effusions secondary to lung cancer with that of T cells from nonmalignant effusions. In memory T cells from both groups, anti-CD3/CD28-stimulation under normoxia upregulated CD98 and CD71 expression (measured as median fluorescence intensity, MFI) in comparison with anti-CD3-stimulation. Costimulation under hypoxia tended to increase CD98 expression compared to CD3-stimulation in memory T cells from both groups. Remarkably, in the cancer group, memory T cells stimulated via CD3/CD28 under hypoxia failed to increase CD71 and Glut1 expression levels compared to the cells receiving anti-CD3 stimulation, a phenomenon that contrasted with the behaviour of memory T cells from nonmalignant effusions. Consequently, glucose uptake by memory T cells from the cancer group was not increased after CD3/CD28 stimulation under hypoxia, implying that their glycolytic metabolism is defective. As this process is required for inducing an antitumoural response, our study suggests that memory T cells are rendered dysfunctional and are unable to eliminate lung tumour cells.

WalkSafe Keeps Walking for 15 Years: A Program Review.

Unintentional injury is the leading cause of death among children aged 5 to 14 years. The WalkSafe program was developed in response to the number of children admitted to Miami-Dade County, Florida, level-1 trauma centers. WalkSafe was piloted in an initially high-risk neighborhood, which now exhibits a low density of pedestrian crashes. Following countywide implementation of WalkSafe, trauma data exhibit a 78% decrease in pediatric injuries. This article provides a 15-year review of WalkSafe and its role in decreasing pediatric pedestrian injuries in Miami-Dade County. Every year, an alarming number of child pedestrians are injured on the nation's roadways. In Miami-Dade County, Florida, the WalkSafe program aims to reduce pediatric injury through targeted education and multitiered collaboration with community partners.

A novel subgroup 16SrVII-D phytoplasma identified in association with Erigeron witches' broom.

Erigeron sp. plants showing symptoms of witches' broom and stunting were found near orchards of passion fruit in São Paulo state, Brazil. These symptoms were indicative of infection by phytoplasmas. Thus, the aim of this study was to detect and identify possible phytoplasmas associated with diseased plants. Total DNA was extracted from symptomatic and asymptomatic plants and used in nested PCR conducted with the primer pairs P1/Tint and R16F2n/16R2. Amplification of genomic fragments of 1.2 kb from the 16S rRNA gene confirmed the presence of phytoplasma in all symptomatic samples. The sequence identity scores between the 16S rRNA gene of the phytoplasma strain identified in the current study and those of previously reported 'Candidatus Phytoplasma fraxini'-related strains ranged from 98% to 99% indicating the phytoplasma to be a strain affiliated with 'Candidatus Phytoplasma fraxini'. The results from a phylogenetic analysis and virtual RFLP analysis of the 16S rRNA gene sequence with 17 restriction enzymes revealed that the phytoplasma strain belongs to the ash yellows phytoplasma group (16SrVII); the similarity coefficient of RFLP patterns further suggested that the phytoplasma represents a novel subgroup, designated 16SrVII-D. The representative of this new subgroup was named EboWB phytoplasma (Erigeron bonariensis Witches' Broom).

Vaccines against bovine babesiosis: where we are now and possible roads ahead.

SUMMARY Bovine babesiosis caused by the tick-transmitted haemoprotozoans Babesia bovis, Babesia bigemina and Babesia divergens commonly results in substantial cattle morbidity and mortality in vast world areas. Although existing live vaccines confer protection, they have considerable disadvantages. Therefore, particularly in countries where large numbers of cattle are at risk, important research is directed towards improved vaccination strategies. Here a comprehensive overview of currently used live vaccines and of the status quo of experimental vaccine trials is presented. In addition, pertinent research fields potentially contributing to the development of novel non-live and/or live vaccines are discussed, including parasite antigens involved in host cell invasion and in pathogen-tick interactions, as well as the protective immunity against infection. The mining of available parasite genomes is continuously enlarging the array of potential vaccine candidates and, additionally, the recent development of a transfection tool for Babesia can significantly contribute to vaccine design. However, the complication and high cost of vaccination trials hinder Babesia vaccine research, and have so far seriously limited the systematic examination of antigen candidates and prevented an in-depth testing of formulations using different immunomodulators and antigen delivery systems.

[Risk factors for binge eating disorders and its association with obesity in adolescents]. / Factores de riesgo para los trastornos por atracón (TA) y su asociación con la obesidad en adolescentes.

Binge eating disorder (BED) is the most frequent alteration in eating behavior and can affect adolescents. The aim was to determine the prevalence of BED, risk factors, and its association with obesity in adolescents in a secondary education institution of Barquisimeto, Venezuela, between September 2013 and February 2014. A sample of 500 adolescents of both sexes (252 male), between 11 and 18 years of age was studied. A questionnaire was applied and anthropometric measurements were performed: weight, height, body mass index, waist circumference, and waist-height index. According to criteria of the Diagnostic and Statistical Manual of Mental Disorders - V, the prevalence of BED was 7.80%. Risk factors were male gender, age > 14 years, body image dissatisfaction, family dysfunction, depressive symptoms and perceived stress. Binge eating disorder was a risk factor for global obesity and central obesity. The prevalence of BED was higher than internationally found for the general population. Important psychosocial risk factors that should be considered in the implementation of prevention and control strategies were identified.

Reversed priapism, thrombosis of the dorsal penile vein: A case report.

Priapism is an unintentional prolonged penile erection, lasting equal to or greater than 4 hours, in the absence of sexual stimulation or after having finished it. It is a rare pathology that can represent a urological emergency. The present report describes the case of a 25-year-old patient who presented priapism after suffering a one-meter fall on the genital area. Patient is a 25-year-old male with macroscopic hematuria without clots, testicular pain 4/10 on the numerical pain scale, stabbing type, without irradiation, secondary to a fall that occurred 3 months earlier, which resulted in a blow to the genital area. He presented an evolution of 20 days with detumescence and erectile dysfunction. Penile Doppler was performed and inverted priapism, arteriolacunar fistula at the base of the left corpus cavernosum, plus severe erectile dysfunction, were diagnosed. After a cavernography and an arteriography, a thrombolysis was performed. The patient continued with anticoagulant treatment with clopidogrel and enoxaparin and did not present complications after thrombolysis. A detailed clinical history, physical examination and a Doppler ultrasound study can provide a clear and timely diagnosis for the patient. Cavernography and arteriography have shown satisfactory results. In the present case, thrombolysis treatment with alteplase provided favorable results.

"We All Have a Job to Do in This World, It's up to Us": Farmworker and Farmer Mental Health in a Rural US-Mexico Border Region.

Improving mental health outcomes for agricultural populations is dependent on understanding the unique farming related stressors in context of the local culture and community. This study was designed to assess the prevalence of stressors and mental health risks among farmers and farmworkers in a rural, medically underserved US-Mexico border region. Of 135 study respondents, 55.6% (n = 18) farmers had clinical depression symptomatology based on the Center for Epidemiologic Studies depression screening scale (CES-D) and 40.2% (n = 117) farmworkers had stress levels that pose significant mental health risks based on the Migrant Farmworker Stress Inventory. Farmworker females were 2.3 times more likely to have a score of clinical concern. Results provide an understanding of the distinct sources of stress for both farmers and farmworkers and the mental health challenges across the industry. With an understanding that suicide is the third leading cause of injury death in Imperial County and depression associated with an increased risk of suicidality, the agricultural workforce in Imperial County is particularly vulnerable. Local farm organizations, employers, and community organizations can help increase mental health access, acceptability, and availability to achieve greater safety and health in the region's largest workforce.

Work-Life Stress during the Coronavirus Pandemic among Latina Farmworkers in a Rural California Region.

OBJECTIVES: To examine the type and severity of stressors experienced among Latina farmworkers during the COVID-19 pandemic. METHODS: A survey containing the Migrant Farmworker Stress Inventory was administered to 77 female-identifying Latina farmworkers working in a US-Mexico border region. A sub-sample of five participants participated in key-informant interviews. Data collection occurred in Summer 2021. RESULTS: Nearly 40% of Latina farmworkers reported high stress levels indicative of clinical mental health risks. Health and safety concerns and experienced stressors identified included visible substance abuse and poor bathroom conditions at the field site, language barriers, and balancing work and home life demands. CONCLUSIONS: Latina farmworkers have unique health and safety needs, and COVID-19 has contributed to the experienced stressors. Understanding the familial and working environment sources of stress specific to female agriculture workers is imperative to implementing culturally and gender-responsive strategies to better support the health and safety of farming populations in future pandemics.

[Voriconazole monitorization in pediatric patients, difficulties in dose adjustment]. / Importancia de la monitorización de concentraciones plasmáticas de voriconazol y dificultad en ajuste de dosis en un paciente pediátrico.

We present a 10-year-old male patient with a diagnosis of relapsed acute myeloid leukemia (AML), presenting with high-risk febrile neutropenia (HRFN), after a cycle of intensive chemotherapy, evolving with an invasive fungal infection demonstrated by histopathology. Treatment with intravenous voriconazole was started, with erratic plasmatic levels, which require successive dose adjustments which also occurred with oral administration. Finally, he had a favorable response to treatment, despite of the dosing difficulties to reach therapeutic levels. Active search as well as preemptive antifungal therapy, together with plasmatic level monitorization of voriconazole allowed a prompt recovery and improved the patient prognosis.

Occupational Stressors and Access to COVID-19 Resources among Commuting and Residential Hispanic/Latino Farmworkers in a US-Mexico Border Region.

Hispanic/Latino and migrant workers experience high degrees of occupational stress, constitute most of California's agricultural workforce, and were among the most impacted populations by the COVID-19 pandemic. However, relatively little is known about the occupational stress experienced by farmworkers who commute daily between the US and Mexico. Occupational stress is considered an imbalance between the demands at work and the capabilities to respond in the context of the workforce. The goal of this study is to determine the type and severity of stressors in daytime and resident farmworkers and how COVID-19 vaccination status contributes to these stressors. Interviews containing the Migrant Farmworker Stress Inventory (MSWSI) were administered to a sample of 199 Hispanic/Latino farmworkers in Imperial County, a multi-billion-dollar agriculture sector in the US. Principal factor analysis differentiated latent factors in the MFSWI. Simple linear regression models and correlations identified associations between MFWSI scores and sample characteristics. The MFWSI reduced to five stressor domains: Health and Well-Being Vulnerabilities, Inadequate Standards of Living/Unknown Conditions of Living, Working Conditions, Working Environment, and Language Barriers. Approximately 40 percent of the respondents reported significant stress levels, with foreign-born (p = 0.014) and older respondents (p = 0.0415) being more likely to experience elevated stress regardless of their nighttime residence. We found that Spanish-language COVID-19 outreach might have been particularly effective for workers who reported high stress from English-language communication (p = 0.001). Moreover, our findings point to the importance of worker and human rights to mitigate the high-stress foreign-born workers who live in Mexico and the US experience.

Decision-making for dental pulp exposure: a survey in graduate programs at Brazilian universities.

Clinical decision-making tends to be based on what clinicians have been taught during undergraduate and graduate programs. The aim of the present study was to assess the clinical approach and to identify the factors that influence the decision-making for dental pulp exposure among graduate students and coordinating professors in endodontics programs offered at Brazilian universities. The study used a mail-out survey developed in the Qualtrics platform, based on seven clinical reports in which dental pulp exposure was evidenced. Descriptive statistics showing vital pulp therapy (VPT) and root canal treatment (RCT) were calculated for each clinical report. Data on the participants' (n = 113) profile and variables related to clinical and radiographic characteristics of the cases were evaluated as to their potential to affect decision-making and analyzed by logistic regression (p < 0.05). VPT was likely to be indicated in cases of patients with immature teeth (OR = 0.017; 95%CI = 0.004 -0.073). RCT indications were related to the presence of symptoms (OR = 5.326; 95%CI = 1.429-19.852) and old age (OR = 21.057; 95%CI=6.809-65.120). In pulp exposure secondary to trauma, time of pulp exposure was significantly associated with RCT indication (OR=3.267; 95%CI=1.332-8.012). The present study demonstrated that patient age, root development, and symptom features were the main factors affecting participants' decision-making.

Lindqvist@Nanoporous MOF-Based Catalyst for Effective Desulfurization of Fuels.

An effective and sustainable oxidative desulfurization process for treating a multicomponent model fuel was successfully developed using as a heterogeneous catalyst a composite material containing as an active center the europium Lindqvist [Eu(W5O18)2]9- (abbreviated as EuW10) encapsulated into the nanoporous ZIF-8 (zeolitic imidazolate framework) support. The EuW10@ZIF-8 composite was obtained through an impregnation procedure, and its successful preparation was confirmed by various characterization techniques (FT-IR, XRD, SEM/EDS, ICP-OES). The catalytic activity of the composite and the isolated EuW10 was evaluated in the desulfurization of a multicomponent model fuel containing dibenzothiophene derivatives (DBT, 4-MDBT and 4,6-DMDBT) with a total sulfur concentration of 1500 ppm. Oxidative desulfurization was performed using an ionic liquid as extraction solvent and aqueous hydrogen peroxide as oxidant. The catalytic results showed a remarkable desulfurization performance, with 99.5 and 94.7% sulfur removal in the first 180 min, for the homogeneous active center EuW10 and the heterogeneous EuW10@ZIF-8 catalysts, respectively. Furthermore, the stability of the nanocomposite catalyst was investigated by reusing and recycling processes. A superior retention of catalyst activity in consecutive desulfurization cycles was observed in the recycling studies when compared with the reusing experiments. Nevertheless, the nanostructure of ZIF-8 incorporating the active POM (polyoxometalate) was shown to be highly suitable for guaranteeing the absence of POM leaching, although structural modification was found for ZIF-8 after catalytic use that did not influenced catalytic performance.

Identification by computer-simulated RFLP of phytoplasmas associated with eggplant giant calyx representative of two subgroups, a lineage of 16SrIII-J and the new subgroup 16SrIII-U.

Symptoms resembling giant calyx, a graft-transmissible disease, were observed on 1-5 % of eggplant (aubergine; Solanum melongena L.) plants in production fields in Sao Paulo state, Brazil. Phytoplasmas were detected in 12 of 12 samples from symptomatic plants that were analysed by a nested PCR assay employing 16S rRNA gene primers R16mF2/R16mR1 followed by R16F2n/R16R2. RFLP analysis of the resulting rRNA gene products (1.2 kb) indicated that all plants contained similar phytoplasmas, each closely resembling strains previously classified as members of RFLP group 16SrIII (X-disease group). Virtual RFLP and phylogenetic analyses of sequences derived from PCR products identified phytoplasmas infecting eggplant crops grown in Piracicaba as a lineage of the subgroup 16SrIII-J, whereas phytoplasmas detected in plants grown in Bragança Paulista were tentatively classified as members of a novel subgroup 16SrIII-U. These findings confirm eggplant as a new host of group 16SrIII-J phytoplasmas and extend the known diversity of strains belonging to this group in Brazil.

Characterization of GASA-1, a new vaccine candidate antigen of Babesia bovis.

Surface proteins bound to the cell membrane by glycosylphosphatidylinositol (GPI) anchors are considered essential for the survival of pathogenic protozoans. In the case of the tick-transmitted hemoparasite Babesia bovis, the most virulent causative agent of bovine babesiosis, the GPI-anchored proteome was recently unraveled by an in silico approach. In this work, one of the identified proteins, GASA-1 (GPI-Anchored Surface Antigen-1), was thoroughly characterized. GASA-1 is 179 aa long and has the characteristic features of a GPI-anchored protein, including a signal peptide, a hydrophilic core and a hydrophobic tail that harbors a GPI anchor signal. Transcriptomic analysis shows that it is expressed in pathogenic and attenuated B. bovis strains. Notably, the gasa-1 gene has syntenic counterparts in B. bigemina and B. ovata, which also encode GPI-anchored proteins. This is highly unusual since all piroplasmid GPI-anchored proteins described so far have been found to be species-specific. Sequencing of gasa-1 alleles from B. bovis geographical isolates originating from Argentina, USA, Brazil, Mexico and Australia showed over 98 % identity in both nucleotide and amino acid sequences. A recombinant form of GASA-1 (rGASA-1) was generated in E. coli and anti-rGASA-1 antibodies were raised in mice. Fixed and live immunofluorescence assays showed that GASA-1 is expressed in in vitro cultured B. bovis merozoites and surface-exposed. Moreover, incubation of B. bovis in vitro cultures with anti-GASA-1 antibodies partially, but significantly, reduced erythrocyte invasion, indicating that this protein bears neutralization-sensitive antibody epitopes. Splenocytes of rGASA-1-inoculated mice showed a specific proliferative response when exposed to the recombinant protein, indicating that GASA-1 bears T-cell epitopes. Finally, sera from a group of B. bovis-infected cattle reacted with the recombinant protein, demonstrating that GASA-1 is expressed during natural infection of bovines with B. bovis, and suggesting that it is immunodominant. The high degree of conservation among B. bovis isolates and the presence of syntenic genes in other Babesia species suggest a relevant role of GASA-1 and GASA-1-like proteins for parasite survival, especially considering that, due to their surface location, they are exposed to the selection pressure of the host immune system. The highlighted features of GASA-1 make it an interesting candidate for the development of vaccines against bovine babesiosis.

Importancia de la monitorización de concentraciones plasmáticas de voriconazol y dificultad en ajuste de dosis en un paciente pediátrico / Voriconazole monitorization in pediatric patients, difficulties in dose adjustment

Resumen Presentamos el caso de un escolar de 10 años, con el diagnóstico de una recaída de una leucemia mieloide aguda que cursó con un episodio de una neutropenia febril de alto riesgo, posterior a un ciclo intensivo de quimioterapia, evolucionando con una infección fúngica invasora demostrada por histopatología. Se inició tratamiento con voriconazol intravenoso, evolucionando con concentraciones plasmáticas erráticas que requirieron sucesivos ajustes de dosis, lo que también ocurrió con la administración oral del medicamento. Finalmente, tuvo una respuesta favorable al tratamiento, a pesar de la dificultad de la dosificación para alcanzar niveles terapéuticos. La búsqueda activa y la terapia antifúngica anticipada, así como la monitorización seriada de concentraciones terapéuticas de voriconazol, permitieron un tratamiento antifúngico óptimo y oportuno, mejorando el pronóstico del paciente.

Abstract We present a 10-year-old male patient with a diagnosis of relapsed acute myeloid leukemia (AML), presenting with high-risk febrile neutropenia (HRFN), after a cycle of intensive chemotherapy, evolving with an invasive fungal infection demonstrated by histopathology. Treatment with intravenous voriconazole was started, with erratic plasmatic levels, which require successive dose adjustments which also occurred with oral administration. Finally, he had a favorable response to treatment, despite of the dosing difficulties to reach therapeutic levels. Active search as well as preemptive antifungal therapy, together with plasmatic level monitorization of voriconazole allowed a prompt recovery and improved the patient prognosis.