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BACKGROUND: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome is a severe adverse drug reaction marked by delayed hypersensitivity reactions causing skin and systemic complications. DRESS diagnosis is challenging due to the variety of clinical presentations and symptom overlap with other conditions. The perioperative period in these patients requires precise pharmacological strategies to prevent complications associated with this syndrome. The treatment of DRESS induced by unfractionated heparin during cardiopulmonary bypass (CPB) surgery presents some challenges that must be considered when selecting an anticoagulant to avoid side effects. In this case, bivalirudin, a direct thrombin inhibitor, is indicated as an alternative to heparin in patients undergoing CPB. However, in contrast to heparin/protamine, there is no direct reversal agent for bivalirudin. CASE PRESENTATION: We report the case of an 11-year-old male diagnosed with native aortic valve endocarditis and thrombosis in his left lower extremity. During valvular replacement surgery, systemic unfractionated heparin was administered. Postoperatively, the patient developed fever, eosinophilia and pruritic rash. Warm shock and elevated alanine transaminase (ALT) and aspartate transaminase (AST) levels followed, leading to the diagnosis of DRESS syndrome. Treatment with methylprednisolone resulted in complete resolution of symptoms. Seven years later, the patient was readmitted due to insufficient anticoagulation and a thrombus in the prosthetic aortic valve, presenting a recurrent DRESS episode due to the administration of unfractionated heparin, which was later replaced with low-molecular-weight heparin during hospitalization. Treatment with corticosteroids and antihistamines was initiated, resulting in the resolution of this episode. Ultimately, the patient required the Ross procedure. During this intervention the anticoagulation strategy was modified, unfractionated heparin was replaced with bivalirudin during the procedure and fondaparinux was administered during the postoperative period. This resulted in stable transaminases levels and no eosinophilia. CONCLUSION: The severity of DRESS Syndrome underscores the importance of early recognition, heightened monitoring, and a comprehensive approach tailored to each patient's needs. This particular case highlights the significance of this approach and may have a substantial clinical impact since it provides alternatives to heparin, such as bivalirudin and fondaparinux, in the anticoagulation strategy of CPB for patients who have a hypersensibility reaction to this medication; thus, enhancing clinical outcomes by minimizing risks linked to adverse drug reactions.

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BACKGROUND: Splenic abscess is a serious complication associated with infective endocarditis. There is still contradicting evidence regarding the optimal treatment pathway including timing of valve intervention and the approach for managing splenic foci. CASE PRESENTATION: We present a case of a hybrid staged approach in which we successfully performed a laparoscopic splenectomy following percutaneous abscess drainage and a delayed aortic valve replacement. CONCLUSIONS: A multidisciplinary teamwork is fundamental in providing optimal care for patients with distant complications associated with infective endocarditis. Our hybrid approach seems safe and feasible.

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Hydrogel-type absorbent materials are currently a technological alternative for improving water retention in the soil and reducing nutrient loss by leaching and evaporation. This study aimed to evaluate the application of a new hydrogel based on silk sericin (SS) as a water retention material in soil. The morphology of the hydrogel was characterized using Scanning Electron Microscopy (SEM), and its impact on moisture retention in sandy loam soil (SLS) under different levels of matric pressure (MP) was evaluated. Additionally, water content data were collected over time for both SLS and SLS with hydrogel (SLS + H), and the data were used to fit predictive models. The results indicate that the hydrogel had a porous morphology that promoted water retention and soil release. Under a MP of 0.3 bar, the use of the hydrogel increased water retention by 44.70% with respect to that of SLS. The predictive models developed were adequately adjusted to the behavior of the moisture data over time and evidenced the incidence of the absorbent material on the dynamics of the moisture content in the soil. Therefore, these models could be useful for facilitating subsequent simulations or for designing automatic soil moisture control systems oriented to smart farming.

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BACKGROUND: The survival of patients with congenital heart disease has increased in the recent years, because of enhanced diagnostic capabilities, better surgical techniques, and improved perioperative care. Many patients will require reoperation as part of staged procedures or to treat grafts deterioration and residual or recurrent lesions. Reoperations favor the formation of cardiac adhesions and consequently increase surgery time; however, the impact on morbidity and operative mortality is certain. The objective of the study was to describe the risk factors for mortality in pediatric patients undergoing a reoperation for congenital heart disease. METHODS: Historic cohort of patients who underwent reoperation after pediatric cardiac surgery from January 2009 to December 2015. Operations with previous surgical approach different to sternotomy were excluded from the analysis. RESULTS: In seven years, 3,086 surgeries were performed, 481 were reoperations, and 238 patients fulfilled the inclusion criteria. Mean number of prior surgeries was 1.4 ± 0.6. Median age at the time of reoperation was 6.4 years. The most common surgical procedures were staged palliation for functionally univentricular heart (17.6%). Median cross-clamp time was 66 minutes. Younger age at the moment of resternotomy, longer cross-clamp time, and Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) Mortality Categories risk category greater than three were risk factors for mortality. The number of resternotomies was not associated with mortality. Mortality prior to hospital discharge was 4.6%, and mortality after discharge but prior to 30 days after surgery was 0.54%. Operative mortality was 5.1%. CONCLUSIONS: Resternotomy in pediatric cardiac surgery is a safe procedure in our center.

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The genus Blechnum has 13 species that are common plants, well-distributed in Chile. Here, we report a phytochemical analysis of B. chilense (Kaulf.) Mett., as well as the insecticidal effects of extracts of this plant. From the n-hexane fraction four phytoecdysones were isolated: ecdysone, ponasterone, shidasterone and 2-deoxycrustecdysone. A bioassay with Drosophila melanogaster larvae was used to evaluate insecticidal activity. The EtOAc and n-hexane fractions at 800 ppm caused 66.7 and 50.0% larval mortality, respectively. Treatments with both extracts at 800 ppm caused the greatest larval mortality, whereas treatments with 500 and 200 ppm induced premature pupation compared with the control and the highest adult mortality, probably due to interference with ecdysteroid metabolism and inhibition of ecdysis triggering hormone (ETH). The dead adult flies exhibited malformations.

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Because of the increasing interest in improving human health worldwide, phytochemical antioxidants from medicinal and food plants are of great interest. The search for new sources of antioxidants is important for the best use of biodiversity. The objective of this work was to evaluate the antioxidant activity and the total phenolic compounds with DPPH and Folin-Ciocalteu assays for extracts and fractions of Blechnum chilense, Curcuma domestica and Tagetes verticillata. B. chilense water-methanolic and EtOAc fractions, follows of C. domestica EtOAc extract showed an important quantity of total phenolic compounds. Compared with Aristotelia chilensis MeOH extract, T. verticillata extract showed good activity, follows by EtOAc fraction from B. chilense and by EtOAc extract from C. domestica, with very similar results with n-hexane fraction from B. chilense and petroleum ether extract from C. domestica. All of these results were greater than alpha-tocopherol DPPH scavenging activity. The results suggest that all plants studied could be are new sources of antioxidants and the work are following with the identification of these compounds.

Debido al creciente interés mundial en el mejoramiento de la salud humana los antioxidantes provenientes de plantas medicinales y alimenticias se han convertido en compuestos de gran interés. La búsqueda de nuevas fuentes de antioxidantes es importante para el mejor uso de la biodiversidad. El objetivo de este trabajo fue evaluar la actividad antioxidante y el contenido de fenoles totales usando el método de Folin-Ciocalteu y la actividad inhibitoria del radical DPPH de fracciones y extractos de Blechnum chilense (Kaulf.) Mett, Curcuma domestica Valeton y Tagetes verticillata Lag. & Rodr. Las fracciones acuosa-metanólica y EtOAc de B. chilense, seguida del extracto EtOAc de C. domestica, mostraron una cantidad importante de compuestos fenólicos. La prueba con DPPH mostró que la actividad secuestrante más importante, comparada con la del extracto metanólico de Aristotelia chilensis (Molina) Stuntz, fue la del extracto de T. verticillata, seguido de la fracción EtOAc de B. chilense y el extracto EtOAc de C. domestica, con resultados similares a la fracción hexánica de B. chilense y el extracto obtenido con éter de petróleo de C. domestica, superando todas la actividad secuestrante de DPPH del alfa-tocoferol. Los resultados sugieren que todas las plantas estudiadas podrían ser nuevas fuentes de antioxidantes y se está trabajando para la identificación de los compuestos responsables de la actividad.

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