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Abstract In the domain of continuous variable quantum key distribution (CV-QKD), a significant challenge arises in achieving precise frequency synchronization, an issue commonly termed as frequency locking. This involves matching the optical frequencies of both the quantum signal laser and the local oscillator laser for accurate symbol demodulation during the exchange of quantum keys. As such, implementations today still grapple with maintaining precise synchronization between sender and receiver frequencies, occasionally hindering the efficiency and reliability of the information exchange. Addressing this challenge, we present and empirically validate a novel approach to CV-QKD by incorporating a pilot tone-assisted frequency locking algorithm to enhance stability when using a locally generated local oscillator (LLO) at the receiver. The proposed design leverages software-based optimization techniques, thereby eliminating the need for high-speed electronic stabilization devices and achieving efficient performance at typical repetition rates. Specifically, the introduction of the pilot tone algorithm allows us to effectively mitigate phase fluctuations and preserve the integrity of the quantum signals during transmission without resorting to time-multiplexed reference pulses or fast-locking electronics in the lasers. Our results suggest the potential for achieving secure key rates of up to 1 Mb/s over a 50 km single-mode fiber when using these techniques, offering promising insights into the feasibility of high-rate, low-complexity CV-QKD implementations under realistic conditions.

Recuperative thermal oxidizers, consisting of a single combustion chamber where volatile organic compounds are oxidized, and regenerative thermal oxidizers comprising several ceramic beds where the oxidation takes place, are the most common abatement technologies applied in vehicle paint shops to reduce formaldehyde emissions. In this work, a “cradle-to-grave” Life Cycle Assessment and an eco-efficiency analysis were carried out for a real paint shop to compare these two abatement technologies and identify the most environmentally sustainable option. The results show that the regenerative oxidizer leads to a decrease of the human toxicity impact category from 1329 kg 1,4-DB eq. in the initial situation without abatement to 1284 kg 1,4-DB eq., while an alternative with recuperative oxidizers achieves a significantly higher reduction to 1176 kg 1,4-DB eq. Considering the most relevant selected impact categories, the results demonstrate that the recuperative oxidizers cause a reduction from the initial situation of 2.6% of the normalized index, whereas the regenerative oxidizer implies a raise of 3.1%. This indicates that the installation of recuperative oxidizers is the most environmentally sustainable alternative from the two investigated technologies. Nevertheless, the eco-efficiency analysis confirms that the costs of the recuperative oxidizers option are 2.2 times higher.

Quantum Key Distribution (QKD) is a cutting-edge communication method that enables secure communication between two parties. Continuous-variable QKD (CV-QKD) is a promising approach to QKD that has several advantages over traditional discrete-variable systems. Despite its potential, CV-QKD systems are highly sensitive to optical and electronic component impairments, which can significantly reduce the secret key rate. In this research, we address this challenge by modeling a CV-QKD system to simulate the impact of individual impairments on the secret key rate. The results show that laser frequency drifts and small imperfections in electro-optical devices such as the beam splitter and the balanced detector have a negative impact on the secret key rate. This provides valuable insights into strategies for optimizing the performance of CV-QKD systems and overcome limitations caused by component impairments. By offering a method to analyze them, the study enables the establishment of quality standards for the components of CV-QKD systems, driving the development of advanced technologies for secure communication in the future.

Pyruvate kinase deficiency (PKD) is a rare autosomal recessive disorder caused by mutations in the PKLR gene. PKD is characterized by non-spherocytic hemolytic anemia of variable severity and may be fatal in some cases during early childhood. Although not considered the standard of care, allogeneic stem cell transplantation has been shown as a potentially curative treatment, limited by donor availability, toxicity, and incomplete engraftment. Preclinical studies were conducted to define conditions to enable consistent therapeutic reversal, which were based on our previous data on lentiviral gene therapy for PKD. Improvement of erythroid parameters was identified by the presence of 20%–30% healthy donor cells. A minimum vector copy number (VCN) of 0.2−0.3 was required to correct PKD when corrected cells were transplanted in a mouse model for PKD. Biodistribution and pharmacokinetics studies, with the aim of conducting a global gene therapy clinical trial for PKD patients (RP-L301-0119), demonstrated that genetically corrected cells do not confer additional side effects. Moreover, a clinically compatible transduction protocol with mobilized peripheral blood CD34+ cells was optimized, thus facilitating the efficient transduction on human cells capable of repopulating the hematopoiesis of immunodeficient mice. We established conditions for a curative lentiviral vector gene therapy protocol for PKD.

Efficient methodologies for recreating cancer-associated chromosome translocations are in high demand as tools for investigating how such events initiate cancer. The CRISPR/Cas9 system has been used to reconstruct the genetics of these complex rearrangements at native loci while maintaining the architecture and regulatory elements. However, the CRISPR system remains inefficient in human stem cells. Here, we compared three strategies aimed at enhancing the efficiency of the CRISPR-mediated t(11;22) translocation in human stem cells, including mesenchymal and induced pluripotent stem cells: (1) using end-joining DNA processing factors involved in repair mechanisms, or (2) ssODNs to guide the ligation of the double-strand break ends generated by CRISPR/Cas9; and (3) all-in-one plasmid or ribonucleoprotein complex-based approaches. We report that the generation of targeted t(11;22) is significantly increased by using a combination of ribonucleoprotein complexes and ssODNs. The CRISPR/Cas9-mediated generation of targeted t(11;22) in human stem cells opens up new avenues in modeling Ewing sarcoma.

Supporting neurodivergent‐inclusive workplaces is an increasingly important consideration in Human Resource Management (HRM). While a strengths‐based approach to neurodivergence has been advocated, empirical evidence regarding the effectiveness of HRM practices that support high‐quality employment outcomes for neurodivergent people is lacking. Drawing on a nationally representative sample of over 25,000 people in the United Kingdom, we examine the influence of neurodivergence on multiple employment outcomes, including employment status, underemployment, employment precarity, job tenure, and hourly wages. We theorize and empirically examine how flexible‐ and homeworking practices moderate the effects of neurodivergence on employment outcomes. Our findings show that neurodivergent people are twice as likely to be in precarious employment and more than 10 times as likely to be in temporary employment compared to neurotypical people. Neurodivergent individuals are also significantly more likely to experience underemployment and have lower employment tenure; however, controlling for other factors, we find no significant differences in hourly wages. We find that flexible working practices can substantially improve employment outcomes for neurodivergent people, raising significant questions regarding the role of HRM in enabling more neurodiverse workplaces. We critically reflect on the implications of our findings for policy, practice, and future research. [ABSTRACT FROM AUTHOR]

Summary: Primary hyperoxaluria type 1 (PH1) is a rare inherited metabolic disorder characterized by oxalate overproduction in the liver, resulting in renal damage. It is caused by mutations in the AGXT gene. Combined liver and kidney transplantation is currently the only permanent curative treatment. We combined locus-specific gene correction and hepatic direct cell reprogramming to generate autologous healthy induced hepatocytes (iHeps) from PH1 patient-derived fibroblasts. First, site-specific AGXT corrected cells were obtained by homology directed repair (HDR) assisted by CRISPR-Cas9, following two different strategies: accurate point mutation (c.731T>C) correction or knockin of an enhanced version of AGXT cDNA. Then, iHeps were generated, by overexpression of hepatic transcription factors. Generated AGXT-corrected iHeps showed hepatic gene expression profile and exhibited in vitro reversion of oxalate accumulation compared to non-edited PH1-derived iHeps. This strategy set up a potential alternative cellular source for liver cell replacement therapy and a personalized PH1 in vitro disease model.

La investigación científica y la práctica preprofesional médica constituyen aspectos que son de alta significación para el egresado de esta carrera universitaria. La atención a pacientes con diabetes mellitus establece para el profesional de la salud un reto en su enfrentamiento sobre todo cuando se asocia a complicaciones y a situaciones especiales. Los aportes desde el punto de vista cognoscitivo y metodológico en relación con el comportamiento de los estudiantes de medicina en su actividad preprofesional y el aporte de experiencias en residentes de la especialidad de Medicina Interna relacionados con dicha enfermedad, constituyen la base para organizar las actividades de la práctica médica. Se constató un ascenso del nivel de contenidos de enseñanza al culminar los trabajos de la referida especialidad y que tienen un impacto en la superación profesional e intercambio de experiencias con los estudiantes de medicina para mejorar la atención del paciente diabético, por ello el objetivo del artículo es argumentar que la investigación científica se desarrolla a través de trabajos investigativos en la culminación de estudios de la especialidad en medicina interna y contribuyen al desarrollo de la práctica preprofesional en la carrera de Medicina con énfasis a los problemas de salud del paciente diabético.

It has been proposed that lipid oxidation reactions in edible oils primarily occur in reverse micelles (RM) of amphiphilic components. While the prooxidative effect of RM has been demonstrated, the mechanism involved is not fully understood. Both reductions and enhancements in the antioxidant efficacy (AE) of α-tocopherol and Trolox have been observed in different studies when phosphatidylcholine (PC) was added and PC RM were formed. However, most of these investigations employed lipid systems consisting of stripped vegetable oil diluted in saturated medium-chain triacylglycerols (MCT) and utilized antioxidant concentrations well below those found in edible oils. These two specific factors were investigated in the present study. The effect of RM of purified egg yolk PC on the AE of 1.16 mmol kg−1 α-tocopherol or Trolox in stripped sunflower oil (SSO) was studied by the Rancimat (100 °C) and oven (50 °C) tests. Increasing PC concentrations (50–1000 ppm) had no significant impact on α-tocopherol, but substantial reductions in AE were observed for Trolox. This phenomenon may be attributed to the partitioning of Trolox into the pre-existing PC micelles, suggesting that primary oxidation reactions occurred in the continuous lipid phase. In addition, the effectiveness of both antioxidants decreased significantly in the presence of PC when a low antioxidant concentration (0.06 mmol kg−1) was assayed in SSO:MCT (1:3, w/w).

Introduction: Sleep deprived people have difficulties to perform daily activities. Their performance depends on three basic cognitive processes: attention, working memory, and executive functions. Objectives: The aim of this study was to identify which specific components of these cognitive processes are more susceptible to a 24-h sleep deprivation period. Material and Methods: Participants were 23 undergraduate students assigned to one of two groups: a control group (n=11, age=18.73±1.62 years) and a sleep deprivation group (n=12, age=18.08±1.16 years). After sleeping freely, control group participants performed a continuous performance task to evaluate the components of attention, a phonological and a visuospatial tasks to record these components of working memory, and a Stroop-like task to assess cognitive inhibition and flexibility, two components of executive functions, at noon for 3 days. Whereas, the sleep deprivation group participants performed the same tasks at noon: after sleeping freely for one night, after a 24-h sleep deprivation, and after one recovery night. Results: After the sleep deprivation, participants had a significant reduction in tonic alertness, selective and sustained attention, components of attention; and in cognitive inhibition, component of executive functions. Conclusion: A 24-h sleep deprivation period reduces several specific components of the basic cognitive processes, which are crucial for performing many everyday activities, thus increasing the risk of errors and accidents.

Recent nutritional studies have shown that the regular consumption of olive pomace oil (OPO) contributes to cardiovascular and cardiometabolic disease prevention. OPO could be a healthier alternative to the polyunsaturated oils employed in a number of bakery foods. However, little is known about the quality and nutritional changes of OPO in these products, especially the amounts of its bioactive components that finally reach consumers. The aim of this research was to evaluate refined OPO as a substitute for sunflower oil (SO) in cupcakes specially manufactured with a 6-month shelf-life. The influence of processing and storage on lipid oxidative changes and the levels of OPO bioactive components was studied. OPO samples exhibited much higher resistance to oxidative degradation in the processing and especially after storage, which had a greater oxidative impact. OPO reduced considerably the levels of oxidised lipids. HPLC analysis showed hydroperoxide triglyceride concentrations of 0.25 (±0.03) mmol/kg fat against 10.90 (±0.7) mmol/kg in the control containing SO. Sterols, triterpenic alcohols and triterpenic acids remained unchanged, and only slight losses of squalene (8 wt%) and α-tocopherol (13 wt%) were observed in OPO after processing and storage, respectively. Therefore, OPO preserved its nutritional properties and improved the quality and nutritional value of the cupcakes.

In this study, we document the practices of ethnoveterinary medicine and ethnopharmacology in the context of traditional transhumance routes that cross Castilla La Mancha from north to south. Transhumance is a type of grazing system that allows advantage to be taken of winter pastures (wintering places) and summer pastures by seasonal movement, twice a year, of cattle and their shepherds. Our study is based on over 200 interviews (from 1994 to 2021) conducted in 86 localities along eight major transhumance routes “cañadas reales” and 25 other minor transhumance routes, and involved 210 informants, 89 single and 121 groups, and 562 individuals, of which the majority were men. Sixty-three recorded pathologies and their treatments are discussed. Two hundred and two species and substances, belonging to 92 different families, have been recorded from the interviews, of which most are plants. Amid the toxic plant species, the most cited in the interviews are Erophaca baetica (L.) Boiss., Lupinus angustifolius L., and Oenanthe crocata L. Some of the species reported as toxic were reservoirs of pathogens or markers for dangerous areas. One of the fields most widely covered in our study is that of prevention, protection, and control of endo- and ectoparasites. This control is carried out mainly by means of aromatic plants. As a polyvalent species, Daphne gnidium L. is outstanding, and it contributes one-tenth of the records of our study. Among the species of fundamentally therapeutic use, Cistus ladanifer L. stands out by far. Principal Coordinate Analysis (PCoA) based on the repertories of ingredients, separates the routes whose most important sections run through siliceous terrain with its characteristic flora, especially in the provinces of Ciudad Real and Toledo, from the routes that run through the limestone terrain of Albacete and Cuenca, and link the Eastern Mancha and the “Serranía de Cuenca” with Andalusia and the Spanish Levant.

The development of advanced gene and cell therapies for the treatment of genetic diseases requires reliable animal and cellular models to test their efficacy. Moreover, the availability of the target human primary cells of these therapies is reduced in many diseases. The development of endonucleases that can cut into specific sites of the cell genome, as well as the repair of the generated break by non-homologous end-joining, results in a variety of outcomes, insertions, deletions, and inversions that can induce the disruption of any specific gene. Among the many methods that have been developed for gene editing, CRISPR-Cas9 technology has become one of the most widely used endonuclease tools due to its easy design and its low cost. It has also been reported that the use of two guides, instead of just the one required, reduces the outcomes of non-homologous end joining mainly to the precise genomic sequences between the cutting sites of the guides used. We have explored this strategy to generate useful cellular and animal models. Different distances between the two guides have been tested (from 8 to 500 bp apart), and using the optimal range of 30–60 bp we have obtained a human primary cellular model of a genetic disease, pyruvate kinase deficiency, where the availability of the target cells is limited. We have also generated an in vivo model of glycolate oxidase (GO) deficiency, which is an enzyme involved in the glyoxylate metabolism following the same strategy. We demonstrate that the use of two-guide CRISPR-Cas9-induced non-homologous end joining is a feasible and useful tool for disease modeling, and it is most relevant to those diseases in which it is difficult to get the cells that will be genetically manipulated.

New phytosterol (PS)-enriched sunflower seeds, which are higher in campesterol and ∆7-stigmastenol, have recently been developed. Crude oils obtained from these new sunflower seeds in 2015 and 2017 were used in this study. Oils extracted only by press (PO) and with subsequent solvent extraction (SO) were characterized. Physical refining (PhR) was used to obtain edible PO by minimal processing and to keep the PS levels as high as possible. Oils obtained by chemical processing were also studied for comparative purposes. Different bleaching treatments were examined to reduce the contents of phospholipids in the PO to levels required for PhR (−1). Phosphorous levels in PO from 2015 (9–12 mg kg−1) were reduced to optimal levels by bleaching with 0.1% Trisyl and 1% Tonsil 278 FF. Contrarily, treatments with Trisyl and Tonsil (278 FF or 114 FF) were not sufficient to reduce the higher levels in PO from 2017 (15–36 mg/kg−1), thereby they were subjected to chemical refining (ChR). The PhR applied to PO from 2015 did not lead to substantial changes in the composition and total content of PS. In contrast, losses of up to approximately 30% of total PS were found owing to ChR, although the oils preserved their unique PS profiles.

Sleep reduction impairs the performance of many tasks, so it may affect a basic cognitive process, such as working memory, crucial for the execution of a broad range of activities. Working memory has two storage components: a phonological and a visuospatial component. The objective of this study was to analyze the effects of sleep reduction for 5 days on the storage components of working memory. Thirteen undergraduate students (18.77±2.20 years of age), 5 men and 8 women, responded two N-Back tasks (auditory and visual), with three sections each (0-Back, 1-Back, and 2-Back). These tasks were performed at 13:00 h under the following conditions: before sleep reduction (control; C); on the first (SR1), fourth (SR4), and fifth (SR5) days of sleep reduction (4 h of sleep per night); and one day after they slept freely (recovery, R). Sleep reduction produced a decrement in accuracy on the auditory 2-Back section the fifth day of sleep reduction (C=87.86±13.35%; SR5=74.76±16.37%; F=14.57, p

El síndrome antifosfolipídico como causa de disfunción endotelial múltiple suele asociarse a muchas enfermedades autoinmunes y, en ocasiones, preceder en años a las mismas. Se presentó un caso de una paciente de 36 años de edad, con antecedentes de salud, que ingresa en el hospital por un cuadro convulsivo asociado a una hemiparesia derecha, con toma facial central e imágenes tomográficas frontaparietales izquierdas compatibles con un posible tumor cerebral metastásico. En busca de su lesión primaria, se le realizan múltiples estudios hematológicos, ultrasonográficos y radiológicos, siendo todos negativos. Durante su estadía intrahospitalaria debuta con un derrame pleural izquierdo y con trombosis venosa profunda de ambos miembros inferiores. Tras 46 días de estadía y ante su mejoría y regresión de todos los síntomas, se le realiza resonancia magnética evolutiva, y al desaparecer totalmente la lesión neurológica se concluye como un seudotumor cerebral en el curso de un síndrome antifosfolipídico primario.

Se analiza críticamente la experiencia de Brasil, Chile y México con la política monetaria de objetivos de inflación del Nuevo Consenso Macroeconómico (ncm). Mediante modelos de cointegración y corrección de errores y la discusión de los principales hechos estilizados contrastamos el ncm con la evidencia empírica disponible. Una característica esencial de su modus operandi en estas economías estriba en que: el control de la inflación depende crucialmente de la apreciación del tipo de cambio; la hipótesis esencial del ncm no es aceptable. Así, su política monetaria, que hace depender la inflación de la brecha de producto, constituye una contradicción para el modelo de crecimiento exportador de estos países y representa un método recesivo de estabilización de precios.

La hemoglobinuria paroxística nocturna, también conocida como síndrome de Marchiafava-Micheli, es una enfermedad clonal y adquirida, causada por una mutación somática en el gen PIG-A que se encuentra en el cromosoma X y codifica una proteína involucrada en la síntesis del glicosilfosfatidilinositol, el cual le sirve como anclaje a muchas proteínas de la membrana celular; es la única anemia hemolítica adquirida por defecto de la membrana del eritrocito. Se caracteriza por una anemia hemolítica crónica intravascular, hemoglobinuria, hipercoagulabilidad, citopenia debido al fallo de la médula ósea, trombosis y raramente transformación leucémica. Al tener un paciente con estas características se decidió presentarlo.

Recombinase mediated cassette exchange (RMCE) is a two-step process leading to genetic modification in a specific genomic target sequence. The process involves insertion of a docking genetic cassette in the genome followed by DNA transfer of a second cassette flanked by compatible recombination signals and expression of the recombinase. Major technical drawbacks are cell viability upon transfection, toxicity of the enzyme, and the ability to target efficiently cell types of different origins. To overcome such drawbacks, we developed an RMCE assay that uses an integrase-deficient lentivirus (IDLV) vector in the second step combined with promoterless trapping of double selectable markers. Additionally, recombinase expression is self-limiting as a result of the exchangeable reaction, thus avoiding toxicity. Our approach provides proof-of-principle of a simple and novel strategy with expected wide applicability modelled on a human cell line with randomly integrated copies of a genetic landing pad. This strategy does not present foreseeable limitations for application to other cell systems modified by homologous recombination. Safety, efficiency, and simplicity are the major advantages of our system, which can be applied in low-to-medium throughput strategies for screening of cDNAs, non-coding RNAs during functional genomic studies, and drug screening.

Durante un brote epidémico de trasmisión hídrica de hepatitis viral A en el área de Versalles, Matanzas, ocurrido entre octubre 2006 y marzo 2007 se incluyó con diagnóstico presuntivo de esta enfermedad al paciente P.A.P M/B, de 45 años de edad, que ingresó en el Servicio de Medicina Interna del Hospital Provincial “José Ramón López Tabrane” por presentar además de los síntomas típicos, un síndrome febril prolongado; como dato de interés se recogió su dedicación al cuidado de aves de corral. Se realizaron estudios virológicos para virus A,B,C y E los cuales resultaron negativos, el resto de los complementarios confirmaban lesión hepática por lo que se indicó laparoscopia con biopsia hepática y se llegó al diagnóstico de histoplasmosis hepática. Se comenzó tratamiento con Itraconazol con evolución clínica satisfactoria y regresión de las lesiones hepáticas.During an epidemic sprout of hydric transmission of hepatitis A occurred in Matanzas, Versalles's area., between October 2006 and March 2007, the patient P.A.P male, white of 45 years old, which one entered in Medicine's Service of the José Ramón López Tabrane Hospital was included with presumptive diagnosis of this disease. The patient presented in addition to typical symptoms, a feverish prolonged syndrome and as fact of interest gathered his dedication to care of poultry bird. The virological studies for virus A, B, C, and E proved to be negative, the rest of the complementary were confirming hepatic lesion, that's why laparoscopia with hepatic biopsy was indicated and it took place the diagnosis of hepatic histoplasmosis. Treatment began with Itraconazol with clinical satisfactory evolution and regression of hepatic injuries.

La tiroiditis de Quervain es probablemente de origen viral. Los síntomas suelen aparecer después de una infección de las vías respiratorias altas, y se caracterizan por malestar general, febrícula y dolor, generalmente unilateral, sobre el tiroides o referido hacia los oídos o la mandíbula. En la exploración se destaca una gran sensibilidad a la palpación del tiroides, que se encuentra aumentado de tamaño y nodular. En algunas ocasiones no aparece dolor, siendo raro que debute con signos de hipertiroidismo grave. Lo característico es el aumento de la velocidad de sedimentación y la disminución de la captación tiroidea de yodo radiactivo. Respecto a los niveles hormonales, en una primera etapa, T4, T3 están elevadas y TSH suprimida; posteriormente, a medida que se vacía la glándula de hormona se produce una fase de hipotiroidismo. El diagnóstico diferencial debe establecerse con la enfermedad de graves y con la tiroiditis silente, entre otras. El proceso evoluciona a lo largo de varios meses produciéndose recuperación completa de la función tiroidea. En aquellos casos más leves, los síntomas se suelen controlar con antiinflamatorios, siendo necesaria la utilización de esteroides en los casos que presentan más gravedad. No está indicado el tratamiento con antitiroideos y se puede utilizar el propanolol para controlar los síntomas de hipertiroidismo. Al tener un paciente con estas características decidimos presentarlo.

El absceso del músculo psoas ilíaco suele ser causa infrecuente de fiebre de origen desconocido en pacientes sanos. Sin embargo, su incidencia asciende en pacientes portadores de enfermedades debilitantes como la diabetes mellitus. Se presentó a una paciente diabética portadora de fiebre de origen desconocido, de seis meses de evolución, con diagnóstico final de absceso del psoas. La paciente, de 52 años de edad, ES portadora de diabetes mellitus tipo 1, complicada con uropatía litiásica obstructiva bilateral, infecciones urinarias a repetición, operada de pionefrosis y absceso renal derecho a los 33 años de edad, secundario a infección urinaria ascendente por Klebsiella pneumoniae. Se reintervinió por absceso recidivante a Klebsiella, adquirida por igual vía urinaria, pero esta vez con un absceso por contigüidad del músculo psoas ilíaco izquierdo, tras un período de fiebre de origen desconocido, de seis meses de evolución. La atipicidad de este caso radica en la recidiva de abscesos retroperitoneales profundos por Klebsiella y la forma insidiosa de presentación del actual absceso del psoas.

Las reacciones adversas medicamentosas más frecuentes son las cutáneas, ocurriendo en un 2% de los tratamientos. La mayoría de las veces se alcanza el diagnóstico por exclusión. La más temida es la necrólisis epidérmica tóxica, de la que se presentan anualmente hasta 4 casos por millón de habitantes, con una mortalidad que alcanza en ocasiones hasta el 70 %. El objetivo fue presentar un paciente con necrólisis epidérmica tóxica por lo infrecuente de esta enfermedad, su alta mortalidad y su evolución clínica característica. Paciente gambiano, de 29 años de edad, con antecedentes de salud, que después de comenzar tratamiento ambulatorio con antibiótico oral para una piodermitis facial, presentó lesiones ampollares que se extendieron por todo el cuerpo. El paciente llevó tratamiento de sostén, esteroideo oral, antibiótico de amplio espectro oral, parenteral y tópico; después de una evolución desfavorable de 30 días, fallece. Resultó llamativa la ausencia de lesiones mucosas a pesar de la extensión total de las lesiones cutáneas. Fue difícil el manejo de este paciente en un hospital de periferia sin el arsenal terapéutico adecuado, ni la unidad idónea para su cuidado.

The sleep onset process (SOP) happens every time a person falls asleep, regardless of the time of day or if they are doing an activity. Basic cognitive processes, such as attention, differ between wakefulness and sleep. The components of attention - tonic alertness, phasic alertness, selective, and sustained attention - are known to decrease during sleep, however they have not been analyzed during the sleep onset process. This study analyses the state of three of the four components of attention during the sleep onset process through electroencephalographic (EEG) activity and task performance in young people. Nine undergraduate students (18.54±1.24 years old) underwent a control session which was compared to the average of four sleep-inducing sessions. During all sessions, the EEG activity of the subjects was recorded to assess the effect of the SOP on electroencephalographic activity while they answered a continuous performance task (CPT) to assess the effect of the SOP on the components of attention. Comparisons of the EEG recordings of the control and the sleep inducing sessions demonstrated that there is lower activity in fast beta, as well as a higher theta and delta activity right before the sleep onset. There was a decrease in tonic alertness, phasic alertness, and selective attention. This study shows that there is an increase in EEG slow activity and a decrease in fast activity, as well as in attentional capacity during the SOP. This decrease can become a safety hazard since it could happen while performing daily activities.

El síndrome de plaquetas pegajosas es una entidad en la que se presentan hiperagregabilidad plaquetaria y manifestaciones clínicas trombóticas. Fue observada hace más de 30 años en personas jóvenes con eventos oclusivos, arteriales, venosos, miorcárdicos, cerebrales y, años más tarde, se describió en mujeres con pérdidas recurrentes de embarazos y complicaciones obstétricas. El tratamiento de elección es la aspirina, con la cual se logra revertir la hiperagregabilidad plaquetaria. Se presenta el seguimiento de una gestante con diagnóstico de síndrome de plaquetas pegajosas tipo II, con antecedentes de dos pérdidas de embarazos. Durante la gestación recibió terapia antiagregante plaquetaria y heparina de bajo peso molecular. A pesar de esta terapéutica surgieron complicaciones en el tercer trimestre de la gestación que condujeron a la interrupción temprana del embarazo. Se logró una recién nacida viva, con bajo peso, sin otras complicaciones perinatales. Actualmente la paciente se mantiene con aspirina y no ha referido eventos oclusivos. Este trabajo demuestra que la atención a estas pacientes por un equipo multidisciplinario permite obtener resultados alentadores.