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Background Continuous renal replacement therapy (CRRT) is common practice in critical care patients with acute renal failure. Objectives To evaluate the adequacy of antimicrobial doses calculated based on the total drug clearance and dose recommended by different guides in critically ill patients undergoing CRRT. Methods Retrospective observational study. Patients admitted to a critical care unit during May 2014 to May 2016 and subjected to CRRT were included. The recommended dose was established as the product of the usual dose of the drug by total drug clearance. Results 177 antimicrobial agents, used in 64 patients were analysed; 45 (25.4%) antimicrobials were given in an insufficient dose (

Thin films of Co-rich transition metal or metal Co–MT (MT = V, Cr, Cu, Zn, Cd, Hf) compounds were fabricated as a superposition of oblique nano-sheets (≈300 x 80 × 5 nm for each nano-sheet) from a mixture of Co and MT plasmas. Because the X-ray diffraction patterns of all of the films showed a similar nano-crystalline microstructure, the oblique nano-sheets were visualized by high-resolution transmission electron microscopy. This nano-morphology generated strong in-plane uniaxial magnetic anisotropy, UMA, as we explained in this work, for all the as-deposited films. The evolution of this magnetic anisotropy was studied at temperatures up to 450 °C. Three different cases were observed after these heat treatments depending on the MT component of the film: (1) UMA was lost for temperatures ≈ 400 °C, (2) UMA retained the same value until the highest temperature was reached, or (3) UMA was enhanced by a factor greater than 2 for the highest temperature. This behavior can be explained by considering of the various processes of structural relaxation and crystallization produced by heat treatment and affected by the nano-sheet morphology.

ResumenIntroducciónLa elección la solución cardiopléjica óptima sigue siendo motivo de debate en la actualidad. La cardioplejía Del Nido (diseñada originariamente para la población pediátrica) está ganando popularidad en el campo de la cirugía cardiaca del adulto.MétodosSerie consecutiva de 30 pacientes que recibieron cardioplejía Del Nido como estrategia de protección miocárdica. Se registraron parámetros demográficos y de perfil de riesgo quirúrgico, tipo de procedimiento realizado, supervivencia perioperatoria; así como los principales parámetros de perfusión, variación de hematocrito intraoperatorio y liberación de enzimas de daño miocárdico durante el postoperatorio. Se determinaron los costes de elaboración de la formulación con respecto a los preparados comerciales convencionales.ResultadosLa serie presentó una supervivencia hospitalaria del 100%. La parada electromecánica del corazón fue efectiva en todos los casos. Los grupos de procedimientos realizados fueron cirugía combinada valvular/coronaria (43,34%), cirugía valvular simple (30%), cirugía coronaria aislada (13,34%) e intervenciones de más de 2 procedimientos (13,34%). Tras la reperfusión del miocardio se observó una tasa de desfibrilación espontánea del corazón del 83,34%. El destete de circulación extracorpórea se realizó con éxito en el 100%, sin necesidad de soporte circulatorio mecánico y con dosis bajas de soporte inotrópico con dobutamina. El coste estimado de elaboración se situó en 7,39 euros por cada unidad.ConclusionesLa cardioplejía Del Nido es de uso habitual en la práctica clínica tanto en la población pediátrica como en la adulta en centros de elevado volumen quirúrgico. Podría constituir una estrategia de protección miocárdica segura, eficaz y económica de aplicación universal en cirugía cardiaca. Son necesarios estudios adicionales de corte prospectivo para corroborar estos datos.AbstractIntroductionThe choice of the optimal cardioplegic solution is still under debate. Del Nido cardioplegia (originally designed for the paediatric population) is gaining popularity in the field of adult cardiac surgery.MethodsA study was conducted on a consecutive series of 30 patients who received Del Nido cardioplegia as myocardial protection strategy. Demographic and risk profile parameters, procedure performed, and surgical survival were registered, as well as main the perfusion variables, intraoperative haematocrit variation, and myocardial injury enzymatic release during the postoperative period. Formulation costs compared with conventional commercial solutions were determined.ResultsSurvival of the series was 100%. Electromechanical arrest of the heart was achieved in all cases. The group of procedures performed were combined valvular/coronary surgery (43.34%), isolated valve surgery (30.00%), coronary artery bypass graft surgery (13.34%), and interventions with more than 2 procedures (13.34%). After myocardial reperfusion, spontaneous defibrillation of the heart occurred in 83.34%. Weaning from cardiopulmonary bypass was successful in 100% with no mechanical circulatory support, and low-dose inotropic support with dobutamine. The estimated preparation costs were set at 7.39 euros per unit.ConclusionsDel Nido cardioplegia is routinely used in clinical practice both in paediatric and adult population in high volume centres. It could be a safe, effective and cheap myocardial protection strategy of universal implementation in cardiac surgery. Additional prospective studies are needed to confirm these data.

Thin films of Co-Hf (≈ 86-14 % at.) were grown over Si micro-cantilevers using a glancing-angle deposition technique. A controlled easy direction of magnetisation (anisotropy field μoHk ≈ 0.1 T) in the longitudinal or in the transverse direction of the micro-cantilevers was generated. The mechanical properties of the films under the action of a magnetic field were opposite depending on the magnetisation’s easy direction: i) their deflection was either zero or the maximum value depending on the direction of the applied magnetic field with respect to the parallel or transverse easy direction of magnetisation; ii) the shift in the resonance frequency under a longitudinal or transverse magnetic field was also different depending on the longitudinal or transverse easy direction of magnetisation. The use of these coated devices with micromagnet-like films for sensors and transducers is discussed.

Background Progressive multifocal leukoencephalopathy(PML) is caused by JC virus (JCV) and has severe consequences for the central nervous system. PML is an opportunistic infection, affecting HIV positive patients. There is no curative treatment, and the current approach is focused on immune reconstitution and antiviral therapy. 1 Purpose This is a case report of two patients with PML associated with HIV infection treated with aldesleukin/interleukin-2 (IL-2). Material and methods We report two cases, both men, aged 48 years (patient A) and 57 years (patient B), HIV diagnosed in 1992 and 1993, who developed LMP opportunistic JCV infection. Antiretrovirals were the only therapy previously employed. Patient A developed progressive neurological impairment, slow psychic reactions and right upper limb strength loss. Symptoms in patient B were progressive cognitive impairment, memory loss, lack of coordination, dysarthria, strength loss and right facial paralysis. Both patients showed hypodensity of white matter in the semi-oval centre on cranial CT. Results IL-2 was administered intravenously to both patients at 0.5 MU/m²/day for 4 weeks. Patient-A: IL-2 treatment (from 8 February 2010 to 7 March 2010) was well tolerated, although a self-limited fever and eosinophilia were reported without clinical correlations. The patient showed improvements in image tests (disappearance of signal hyperintensity and cytotoxic oedema on CT and MRI) and clinical outcomes (improvement of neurological symptoms), although progressive spasticity and dysarthria were maintained. JCV load was undetectable in February 2011. Patient A was treated for 1 year with mefloquine 250 mg/24 hours with good tolerance and stabilisation of PML, but without resolution. The patient died in December 2012 following intraparenchymal cerebral haemorrhage. Patient-B: therapy with IL-2 and mirtazapine (from 8 September 2016 to 5 October 2016) was well tolerated, but the infusion was discontinued once by a fever episode. Cranial CT showed no significant changes. The patient´s neurological impairment, hemiparesis and dysarthria persisted, but a slight improvement was observed. JCV load declined from >100 million to 12 million copies/mL, HIV from 645 to 147 copies/mL and CD4 T lymphocytes increased. Conclusion IL-2 could be an effective and well tolerated therapy in LMP, without severe adverse events. Patient A showed improvements in neurological and image tests, and undetectable viral load, whereas the response in patient B was only partial, with a decline in JCV and HIV, but maintaining neurological deterioration. References and/or acknowledgements 1. Pavlovic D, et al. Ther Adv Neurol Disord2015;8:255–73. No conflict of interest

Background The preparation of total parenteral nutrition (TPN) is subject to a great deal of variability in clinical practice due to the complexity of TPN and the variety of professionals involved. Nutritional support is an important care activity in a pharmacy service. Purpose To evaluate the activity of a parenteral nutrition unit in a hospital pharmacy. Material and methods This was a retrospective study analysing TPN during 2015 in a pharmacy service of a tertiary hospital. Data were obtained from the pharmacy service’s nutritional database and the pharmacy service’s dashboard of activity and quality. Pharmaceutical care in adults patients is based on validating the indication to assess the patient’s nutritional status, calculating the nutritional requirements, developing a nutritional plan and deciding on the composition of the TNP. In paediatric patients, the clinical pharmacist´s functions with regard to TPN are to ensure the quality (stability and osmolarity) and safety of the solutions prepared. The formulations were prepared by the hospital pharmacy, in totally or from three compartment bags (commercial preparations), or prepared by an external service. Results During the study period, 1510 patients (698 adults, 812 children) were treated with TPN. 21 008 TPN were dispensed from the hospital pharmacy. In institutionalised patients, 16 576 TPN were dispensed (42% adults, 58% children); 4432 TPN were delivered to home patients (9% adults, 91% children). A total of 11 146 formulations were prepared in whole by the hospital pharmacy (37% adults, 63% children); 1197 TPN were commercial preparations (all in adults) and 8665 TPN were prepared by an external service (24% adults, 76% children). The prescribing units in adult TPN were: anaesthesia–intensive care medicine (40%); oncologic-haematologic patients (26%); surgery patients (26%); haemodialysis patients (2%); and other units (6%). In paediatric patients, the prescribing units were: neonatal–intensive care unit (71%); oncologic and haematologic patients (11%); surgery patients (11%); and other units (7%). Conclusion Most TPN (60%) were prepared by the hospital pharmacy and 40% of TPN were acquired through an external service. Most TPN were dispensed to paediatric patients (65%). They were mainly prepared for critically ill patients (46%). The department of pharmacy was involved in the management of TPN to support the clinical and therapeutic needs of the patient. No conflict of interest

Ni2MnGa thin films, with thickness between 30 and 60 nm, were pulsed-laser deposited at room temperature on Si micro-cantilevers and glass substrates. Two different deposition processes were performed: normal deposition and off¬-normal. After annealing in an inert atmosphere, in-plane isotropic magnetic hysteresis loops were measured for the normal deposited films. In contrast, in-plane anisotropic hysteresis loops were obtained from the off-normal deposited ones. An in-plane easy direction for the magnetisation, perpendicular to the incidence plane of the plasma during deposition, was measured with an anisotropy field of ≈100 Oe and an easy coercive field of ≈24 Oe. The mechanical behaviour of the magnetically anisotropic coated micro-cantilevers and their response to a decreasing temperature permitted observing the martensitic transformation of the Ni2MnGa thin films.

Non-crystalline Co films have been deposited on the cylindrical surface of copper wires by pulsed laser ablation deposition. These films are magnetoelastic. In particular, they exhibit the inverse Wiedemann effect (IWE): when they are twisted and an electrical current flows through the wires, a longitudinal component of the magnetization is observed. The value of the spontaneous magnetization, M s , of these films is achieved by the measurement of this effect. The dependence of the IWE on the torsion as well as on the circular magnetic field has been measured. The magnetostriction constant, λ s , has been found to be negative and λ s ≈−(9.5±0.8)×10 −6 .

Background Cytomegalovirus disease is an important cause of morbidity and mortality in haematopoietic stem cell transplantation (HSCT) recipients. Foscarnet, an intravenous drug active against cytomegalovirus, represents an increasingly widespread alternative when there is resistance or intolerance to conventional treatments (ganciclovir/valganciclovir, acyclovir). More data about its use, effectiveness and safety in the clinical practice are necessary. Purpose To analyse the effectiveness and safety of the use of foscarnet against cytomegalovirus in HSCT recipients, and its adaptation to clinical practice guidelines and expert recommendations in order to optimise future treatment strategies. Material and methods Observational, retrospective, single centre study including all adult HSCT recipients treated with foscarnet for pre-emptive therapy or treatment of cytomegalovirus in a tertiary hospital between January 2013 and June 2015. Demographic, effectiveness and safety data about the treatment were collected and analysed using Access and Excel. After a literature search, results were compared with clinical trials and retrospective studies published, as well as with clinical practice guidelines and expert recommendations. Results 43 episodes in 34 patients were included (50% women) with a median age of 52 years (range 47–57). In 9 cases (31%) of pre-emptive therapy, no patient experienced reactivation of cytomegalovirus. In 34 cases of treatment after reactivation, 85.7% (n = 29) started with a positive cytomegalovirus viral load. Of them, 72.4% reach negative viral load, 20.7% died and 6.9% were considered resistant. The remaining 14.3% (n = 5) maintained negative for viral load during treatment. All patients experienced at least one adverse effect but only 3% discontinued treatment. There were electrolytic disorders (100%), creatinine alterations (32.6%) and gastrointestinal disturbances (9%). Concomitant drugs causing electrolyte alterations or renal toxicity were not registered. Conclusion Foscarnet was shown to be effective with acceptable toxicity in cytomegalovirus treatment in HSCT recipients. The results are not entirely comparable with other published studies1,2 due to differences between populations and therapeutic regimens. The use of foscarnet (indications, dosage and treatment duration) in hospital mainly follows recommendations of experts and guidelines. More studies should be carried out in order to get the most beneficial treatment regimen with the minimum adverse effects. References and/or Acknowledgements Reusser P, et al. Randomised multicenter trial of foscarnet versus ganciclovir for preemptive therapy of cytomegalovirus infection after allogeneic stem cell transplantation. Blood 2002;99:1159–64 Asakura M, et al. Use of foscarnet for cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation from a related donor. Int J Hematol 2010;92:351–9 No conflict of interest.

Si micro-cantilevers were coated with Co nano-strings, which were simultaneously grown and sculpted during off-normal pulsed laser deposition. The surface morphology of micro-cantilevers with longitudinal or transverse nano-strings was analysed by scanning tunnelling microscopy. Magnetic anisotropy was detected with a magnetization direction parallel to the nano-strings. The two micro-cantilever types exhibited different mechanical behaviours when placed in a non-uniform magnetic field. By varying the relative position of the micro-cantilever with respect to the gradient direction of this field, a split in the resonant frequency shift of the micro-cantilevers was generated, depending on the direction of magnetic anisotropy. Discrimination was achieved between the micro-cantilevers with transverse nano-strings and the micro-cantilevers with longitudinal nano-strings. The lowest limit of magnetic moment for distinction between these covered micro-cantilevers was 10 − 8 emu. The possible benefits of these magneto-mechanical properties for the biological, chemical and physical applications of some nano-mechanical devices are pointed out.

Background The increasing prevalence, morbidity and mortality rates of Clostridium difficile infection (CDI) turn its treatment into a challenge for researchers. Fidaxomicin is a new treatment option which has been shown to be effective for treating both primary and recurrent CDI in clinical trials but there is limited clinical experience. Purpose To evaluate the use and outcome in patients with CDI treated with fidaxomicin in a tertiary hospital. Material and methods Between May 2013 and September 2014 patients undergoing treatment with fidaxomicin were assessed. Demographic and clinical data were collected from the patient electronic medical record. The outcome measure was Symptom-Free Interval (SFI), calculated in patients who were monitored for at least 1 month. Results Thirteen patients were analysed (n = 13), 53.8% male, median age 54 years (range 27–83) and all had baseline disease which increased the risk of recurrent CDI, so fidaxomicin treatment was indicated by current clinical guidelines. Seven had a history of recurrent CDI and eleven had received previous treatment with vancomycin and/or metronidazole. Treatments with fidaxomicin were 200 mg twice daily for 10 days. Recurrence was found in 30.8% patients after the first treatment with fidaxomicin, but 6 patients were lost to follow-up (died). SFI varied with number of courses received. After the first treatment, the median SFI was 75 days (range 15–395). After the second course (2 patients) SFI was 66 and 180 days and following the third treatment (2 patients) SFI was 133 and 64 days. Conclusion Use of fidaxomicin is more common in patients with recurrence or non-responders to standard treatment (84.6%); the recurrence rate was high (30.8%). This study was limited by the number lost to follow-up and high inter-individual variability in SFI. More clinical experience is needed to determinate which patients may benefit most. Alternative dose regimens should be considered to improve treatment outcomes. References and/or Acknowledgements No conflict of interest

Background Sinusoidal obstruction syndrome (SOS) is an important non-haematological toxicity in patients who have received chemotherapy for haematopoietic stem cell transplantation (HSCT). In March 2013, European Medicines Agency refused marketing authorisation for the orphan drug defibrotide to prevent and treat SOS. In July 2013, after re-examination, defibrotide had a new positive opinion for marketing authorisation but only for treatment. Purpose To investigate the effectiveness, safety and cost of defibrotide for SOS. Materials and methods Retrospective observational study (Period: January 2009–September 2013). We analysed patients with SOS treated with defibrotide. Response criteria were defined as total serum bilirubin Results Eleven patients (five adults (mean age: 55.7(SD = 4.3) years) and four children (3.1(SD = 1.3)) received defibrotide at a dose of 6.25 mg/kg every 6 h (two patients received 10 mg/kg/6 h). Median duration of treatment was 9 days (range: 5–25). Overall complete response was achieved in seven patients (63.6%), all four children and only three adults. 45.5% of patients had completely recovered from hepatomegaly at the end of defibrotide administration. Six of the eight patients with ascites and one patient with encephalopathy recovered their normal status. All patients reduced their weight gain after defibrotide treatment. 100 day post-HSCT survival was 72.7%. Three patients presented haemorrhagic episodes during defibrotide treatment (two gastrointestinal episodes and one nasal bleeding). Median cost per patient was 19,180 € (range 5,480–41,100 €). Conclusions According to our limited results, defibrotide is an effective option for SOS treatment in children, although cost per patient is high. Cost-effectiveness studies comparing treatment for SOS with and without defibrotide are needed. No conflict of interest.

The magnetic domain configurations of soft magnetic, nanostructured, pulsed laser-deposited Co films were investigated. Their dependence on both the thickness t (20 nm ≤ t ≤ 200 nm) and the anisotropy was studied. Charged zigzag walls, with a characteristic saw-tooth vertex angle θ, were observed. θ changed with t from θ ≈ 17° to ≈25°, presenting an intermediate sharp maximum that has not been described before. The reduced length of the zigzag walls also exhibited a peak at t ≈ 70 nm. The relationship between the total reduced length and the density energy of the magnetic wall allowed us to establish a change from a Néel-type to a Bloch-type core of the zigzag walls at this thickness, t ≈ 70 nm. We also accounted for the magnetic energy arising from the surface roughness of the thinner films after imaging the film surface morphologies. Moreover, this distinctive behaviour of the zigzag walls of these low-anisotropy films was compared to that of high-anisotropy films.

CoP electrolytic monolayers and multilayers were grown over copper wires using a constant or pulsed electrical current density, exhibiting radial or planar anisotropy, respectively. Over the surface of a monolayer, multilayers of different thicknesses were deposited. The surface radial anisotropy evolves to a planar one as the overlayer thicknesses increase. The surface magnetization is coupled with the bulk anisotropy for overlayer thickness up to ≈ 2 μm.