Practical access to planar chiral 1,2-(α-Ketotetramethylene)- ferrocene by non-enzymatic kinetic resolution and conclusive confirmation of its absolute configuration

The asymmetric transfer hydrogenation (ATH) of racemic 1,2-(α-ketotetramethylene)ferrocene using the [N-(tosyl)-1,2-diphenylethylendiamine]ruthenium(II) complex [TsDPEN-Ru(II)] as catalyst takes place with a high level of kinetic resolution to deliver the ketone in up to 99% ee. The X-ray crystallographic structure of a derivative of the alcohol co-product serves to confirm conclusively both the absolute configuration of 1,2-(α-ketotetramethylene)ferrocene and the endo-reduction selectivity

Tratamiento combinado con antitrombóticos en la prevención secundaria del ictus isquémico

El ictus isquémico constituye un problema sanitario de primer orden debido a su alto riesgo de recurrencia. La búsqueda de estrategias efcaces y seguras para la prevención de eventos vasculares en los  pacientes con ictus isquémico debe ser una prioridad con el objetivo de disminuir la mortalidad y  discapacidad asociada con el mismo. Diversos estudios han analizado el tratamiento combinado con antitrombóticos para intentar mejorar la efcacia de estos fármacos en la prevención secundaria de eventos vasculares tras un primer ictus isquémico. En este trabajo se revisa el estado actual de la evidencia científca en cuanto a la terapia combinada con antitrombóticos en pacientes con un primer ictus isquémico.  Palabras clave: Ictus isquémico. Prevención secundaria. Antitrombóticos. Antiagregantes plaquetarios. Anticoagulación.     Ischemic stroke constitutes a fundamental health issue due to its high level of recurrence. Developing effcient and safe strategies to prevent vascular episodes in patients with ischemic stroke must be a top priority, with the purpose of diminishing associated mortality and disability. Several studies have examined combined antithrombotic therapy in depth, trying to improve its effcacy in secondary prevention of vascular events after a frst ischemic stroke. This work reviews the current state of clinical evidence related to combined antithrombotic therapy in patients presenting a frst ischemic stroke.  Key words. Ischemic stroke. Secondary prevention. Antithrombotics. Antiplatelets. Anticoagulation

Plexopatía braquial secundaria a tumor maligno de la vaina del nervio periférico

  Brachial plexopathy secondary a malignant tumor of the peripheral nerve sheath.Introduction. Malignant peripheral nerve sheath tumor (MPNST) are sarcomas that are rarely located in the upper limb. Clinical case. We present a 31- year-old woman with progressive dysesthesia and weakness of the left upper limb. The neurophysiological study showed damage in the left brachial plexus. A soft tissue mass that was invading the plexus was observed in the magnetic resonance image. The anatomopathological study was compatible with MPNST diagnosis. Conclusions. Intrinsic tumors of the brachial plexus are uncommon. A MPNST is an extremely aggressive mesenchymal tumor that is seldom rooted in the brachial plexus. Key words: Brachial plexus. Brachial plexopathy. Neoplasm. Malignant tumor. Peripheral nerve sheath.  Introducción: el plexo braquial puede verse afectado por patología neoplásica tanto primaria como secundaria. Los tumores primarios del plexo braquial son entidades poco frecuentes, aunque algunos, como el tumor maligno de la vaina del nervio periférico pueden tener un comportamiento agresivo. Caso clínico: se presenta una mujer de 31 años con disestesias y debilidad progresiva en el miembro superior izquierdo. El estudio neurofisiológico mostró afectación del plexo braquial izquierdo. En la resonancia magnética se observó una masa de tejido blando que invadía el plexo braquial. El estudio histológico fue compatible con un tumor maligno de la vaina del nervio periférico. Conclusiones: el tumor maligno de la vaina del nervio periférico es un tumor altamente agresivo que puede aparecer en pacientes sin datos clínicos de neurofibromatosis tipo 1. Debe mantenerse un elevado nivel de sospecha con el objetivo de no retrasar el diagnóstico para así poder realizar un tratamiento lo más conservador posible. Palabras clave: Plexo braquial. Plexopatía braquial. Neoplasia. Tumor maligna. Vaína del nervio periférico. &nbsp

Mirando la ciudad: Madrid

Artículos en revistasReflexión sobre el desequilibrio territorial y vulnerabilidad social de Madrid.Reflection on territorial and social inequalities in the city of Madrid.info:eu-repo/semantics/publishedVersio

Pregnancy outcomes and vaccine effectiveness during the period of omicron as the variant of concern, INTERCOVID-2022: a multinational, observational study.

BACKGROUND: In 2021, we showed an increased risk associated with COVID-19 in pregnancy. Since then, the SARS-CoV-2 virus has undergone genetic mutations. We aimed to examine the effects on maternal and perinatal outcomes of COVID-19 during pregnancy, and evaluate vaccine effectiveness, when omicron (B.1.1.529) was the variant of concern. METHODS: INTERCOVID-2022 is a large, prospective, observational study, involving 41 hospitals across 18 countries. Each woman with real-time PCR or rapid test, laboratory-confirmed COVID-19 in pregnancy was compared with two unmatched women without a COVID-19 diagnosis who were recruited concomitantly and consecutively in pregnancy or at delivery. Mother and neonate dyads were followed until hospital discharge. Primary outcomes were maternal morbidity and mortality index (MMMI), severe neonatal morbidity index (SNMI), and severe perinatal morbidity and mortality index (SPMMI). Vaccine effectiveness was estimated, adjusted by maternal risk profile. FINDINGS: We enrolled 4618 pregnant women from Nov 27, 2021 (the day after WHO declared omicron a variant of concern), to June 30, 2022: 1545 (33%) women had a COVID-19 diagnosis (median gestation 36·7 weeks [IQR 29·0-38·9]) and 3073 (67%) women, with similar demographic characteristics, did not have a COVID-19 diagnosis. Overall, women with a diagnosis had an increased risk for MMMI (relative risk [RR] 1·16 [95% CI 1·03-1·31]) and SPMMI (RR 1·21 [95% CI 1·00-1·46]). Women with a diagnosis, compared with those without a diagnosis, also had increased risks of SNMI (RR 1·23 [95% CI 0·88-1·71]), although the lower bounds of the 95% CI crossed unity. Unvaccinated women with a COVID-19 diagnosis had a greater risk of MMMI (RR 1·36 [95% CI 1·12-1·65]). Severe COVID-19 symptoms in the total sample increased the risk of severe maternal complications (RR 2·51 [95% CI 1·84-3·43]), perinatal complications (RR 1·84 [95% CI 1·02-3·34]), and referral, intensive care unit (ICU) admission, or death (RR 11·83 [95% CI 6·67-20·97]). Severe COVID-19 symptoms in unvaccinated women increased the risk of MMMI (RR 2·88 [95% CI 2·02-4·12]) and referral, ICU admission, or death (RR 20·82 [95% CI 10·44-41·54]). 2886 (63%) of 4618 total participants had at least a single dose of any vaccine, and 2476 (54%) of 4618 had either complete or booster doses. Vaccine effectiveness (all vaccines combined) for severe complications of COVID-19 for all women with a complete regimen was 48% (95% CI 22-65) and 76% (47-89) after a booster dose. For women with a COVID-19 diagnosis, vaccine effectiveness of all vaccines combined for women with a complete regimen was 74% (95% CI 48-87) and 91% (65-98) after a booster dose. INTERPRETATION: COVID-19 in pregnancy, during the first 6 months of omicron as the variant of concern, was associated with increased risk of severe maternal morbidity and mortality, especially among symptomatic and unvaccinated women. Women with complete or boosted vaccine doses had reduced risk for severe symptoms, complications, and death. Vaccination coverage among pregnant women remains a priority. FUNDING: None

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Vascular risk factors in patients with ischaemic stroke

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Preadmission use of statins as treatment for strokes [3]

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