Solvent-Driven Supramolecular Wrapping of Self-Assembled Structures

Self‐assembly relies on the ability of smaller and discrete entities to spontaneously arrange into more organized systems by means of the structure‐encoded information. Herein, we show that the design of the media can play a role even more important than the chemical design. The media not only determines the self‐assembly pathway at a single‐component level, but in a very narrow solvent composition, a supramolecular homo‐aggregate can be non‐covalently wrapped by a second component that possesses a different crystal lattice. Such a process has been followed in real time by confocal microscopy thanks to the different emission colors of the aggregates formed by two isolated PtII complexes. This coating is reversible and controlled by the media composition. Single‐crystal X‐ray diffraction and molecular simulations based on coarse‐grained (CG) models allowed the understanding of the properties displayed by the different aggregates. Such findings could result in a new method to construct hierarchical supramolecular structures

Consenso Mexicano de Hepatitis Alcohólica

La hepatitis alcohólica es una condición frecuente en la población mexicana, se caracteriza por insuficiencia hepática aguda sobre crónica, importante reacción inflamatoria sistémica y fallo multiorgánico, que en la variante grave de la enfermedad implica una elevada mortalidad. Por lo anterior, la Asociación Mexicana de Gastroenterología y la Asociación Mexicana de Hepatología conjuntaron un equipo multidisciplinario de profesionales de la salud para elaborar el primer consenso mexicano de hepatitis alcohólica. El consenso fue elaborado con la metodología Delphi, emitiendo 37 recomendaciones. La enfermedad hepática relacionada con el consumo de alcohol comprende un amplio espectro, que incluye esteatosis, esteatohepatitis, fibrosis en diferentes grados, cirrosis y sus complicaciones. La hepatitis alcohólica grave se define por una función modificada de Maddrey ≥ 32 o por un puntaje de MELD (Model for End- Stage Liver Disease) igual o mayor a 21. Actualmente no existe un biomarcador específico para el diagnóstico. La presencia de leucocitosis con neutrofilia, hiperbilirrubinemia (> 3 mg/dL),AST > 50 U/L ( 1.5-2 pueden orientar al diagnóstico. La piedraangular del tratamiento es la abstiencia junto con el soporte nutricional. Los esteroides estanindicados en la forma grave, en donde han resultado efectivos para reducir la mortalidad a28 días. El trasplante hepático es en la actualidad la única opción con que se cuenta parasalvar la vida de pacientes que no responden a los esteroides. Ciertos fármacos, como la N-acetilcisteína, el factor estimulante de colonias de granulocitos y la metadoxina, pueden seruna terapia adyuvante que puede mejorar la supervivencia de los pacientes

The Mexican consensus on alcoholic hepatitis

Alcoholic hepatitis is a frequent condition in the Mexican population. It is characterized by acute-on-chronic liver failure, important systemic inflammatory response, and multiple organ failure. The severe variant of the disease implies elevated mortality. Therefore, the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Hepatología brought together a multidisciplinary team of health professionals to formulate the first Mexican consensus on alcoholic hepatitis, carried out utilizing the Delphi method and resultingin 37 recommendations. Alcohol-related liver disease covers a broad spectrum of patholo-gies that includes steatosis, steatohepatitis, different grades of fibrosis, and cirrhosis and itscomplications. Severe alcoholic hepatitis is defined by a modified Maddrey’s discriminant func-tion score ≥ 32 or by a Model for End-Stage Liver Disease (MELD) score equal to or above 21.There is currently no specific biomarker for its diagnosis. Leukocytosis with neutrophilia, hyper-bilirubinemia (>3 mg/dl), AST > 50 U/l ( 1.5-2 can guide thediagnosis. Abstinence from alcohol, together with nutritional support, is the cornerstone oftreatment. Steroids are indicated for severe disease and have been effective in reducing the28-day mortality rate. At present, liver transplantation is the only life-saving option for patientsthat are nonresponders to steroids. Certain drugs, such as N-acetylcysteine, granulocyte-colonystimulating factor, and metadoxine, can be adjuvant therapies with a positive impact on patientsurvival

Consenso Mexicano para el Tratamiento de la Hepatitis C

El objetivo del Consenso Mexicano para el Tratamiento de la Hepatitis C fue el de desarrollar un documento como guía en la práctica clínica con aplicabilidad en México. Se tomó en cuenta la opinión de expertos en el tema con especialidad en: gastroenterología, infectología y hepatología. Se realizó una revisión de la bibliografía en MEDLINE, EMBASE y CENTRAL mediante palabras claves referentes al tratamiento de la hepatitis C. Posteriormente se evaluó la calidad de la evidencia mediante el sistema GRADE y se redactaron enunciados, los cuales fueron sometidos a voto mediante un sistema modificado Delphi, y posteriormente se realizó revisión y corrección de los enunciados por un panel de 34 votantes. Finalmente se clasificó el nivel de acuerdo para cada oración. Esta guía busca dar recomendaciones con énfasis en los nuevos antivirales de acción directa y de esta manera facilitar su uso en la práctica clínica. Cada caso debe ser individualizado según sus comorbilidades y el manejo de estos pacientes siempre debe ser multidisciplinario. Abstract The aim of the Mexican Consensus on the Treatment of Hepatitis C was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitis C treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary

Prevalence of gastrointestinal disorders in adults with common variable immunodeficiency at Specialty Hospital Dr. Bernardo Sepulveda

Background: The common variable immunodeficiency (CVID) shows a variable incidence, from 1:15,000 to 1:117,000, whitout gender predominance. The incidence of gastrointestinal manifestations in these patients ranges from 20-60%, and these may be the first and only clinical mafifestation of CVID, while other patients develop gastrointestinal complicatons during the course of it. Objective: To determinate the prevalence of gastrointestinal manifestations in adult patients with CVID. Material and method: A descriptive, cross-sectional and observational study was made including patients with CVID attending Primary Immunodeficiency Clinic of Allergy and Clinical Immunology Department, Specialties Hospital, National Medical Center SXXI, Mexico City. All patients underwent gastrointestinal symptoms questionnaire, laboratory, cabinet, endoscopy and breath test for bacterial overgrowth. Results: We evaluated 17 patients, 8 men and 9 women with an average age of 36 years with a definitive diagnosisi of CVID according to international criteria; 59% had abdominal pain, 53% abdominal distension; only 3 patients (17.6%) reported constipatión; 47% had chronic diarrhea, of wich only 2 (11.8%) had rectal pushing. The diagnoses of gastrointestinal manifestations of this population were: 18% cronic diarrhea, celic disease and bacterialovergrowth, 24% gatrointestinal functional disorder, 12% contipation and 6% dyspepsia. One patient (6%) had nogastrointestinal symptoms. Conclusions: Prevalence of gastrointestinal diseases in adult patients with common variable immunodeficiency was 94%. There was no gender predominance. It is therefore important the patients with Cvid will conduct a study protocol that includes a complete medical history considering gastrointestinal symptoms and sings, in order todeterminate timely diagnosis and therapeutic approach

Beyond conventional physical examination in hepatology: POCUS

Point-of-care ultrasound (POCUS) refers to the use of ultrasound imaging through pocket-sized sonographic devices at the patient’s bedside, to make a diagnosis or direct a procedure and immediately answer a clinical question. Its goal is to broaden the physical examination, not to replace conventional ultrasound studies. POCUS has evolved as a complement to physical examination and has been adopted by different medical specialties, including hepatology. A narrative synthesis of the evidence on the applications of POCUS in hepatology was carried out, describing its usefulness in the diagnosis of cirrhosis of the liver, metabolic dysfunction-associated steatotic liver disease (MASLD), decompensated cirrhosis, and portal hypertension. The review also encompasses more recent applications in the hemodynamic evaluation of the critically ill patient with cirrhosis of the liver, patients with other liver diseases, as well as in the ultrasound guidance of procedures.POCUS could make up part of the daily clinical practice of gastroenterologists and hepatologists, simplifying the initial evaluation of patients and optimizing clinical management. Its accessibility, ease of use, and low adverse event profile make POCUS a useful tool for the properly trained physician in the adequate clinical setting. The aim of this review was to describe the available evidence on the usefulness of POCUS in the daily clinical practice of gastroenterologists and hepatologists. Resumen: La ecografía en el punto de atención (POCUS) se refiere a la utilización del ultrasonido (US) mediante dispositivos ultrasonográficos de bolsillo, al pie de la cama del paciente, con el objetivo de establecer un diagnóstico o dirigir un procedimiento y responder a una cuestión clínica de forma inmediata, su finalidad es ampliar la exploración física, no sustituir la evaluación ultrasonográfica convencional. POCUS ha evolucionado como un complemento del examen físico siendo adoptado por distintas especialidades médicas, incluyendo la hepatología. Se elaboró una síntesis de evidencia narrativa sobre las aplicaciones de POCUS en hepatología, describiendo la utilidad de POCUS en el diagnóstico de cirrosis hepática, enfermedad hepática esteatósica asociada a disfunción metabólica (MASLD, por sus siglas en inglés), cirrosis descompensada y el diagnóstico de hipertensión portal, así como las más recientes aplicaciones de POCUS en la evaluación hemodinámica del paciente con cirrosis hepática en estado crítico, otras enfermedades hepáticas y guía ultrasonográfica de procedimientos.POCUS podría formar parte de la práctica clínica diaria de gastroenterólogos y hepatólogos, simplificando la evaluación inicial de los pacientes y optimizando el manejo clínico. Su accesibilidad, facilidad de uso y bajo perfil de efectos adversos la hacen una herramienta útil para el médico propiamente entrenado en el escenario clínico adecuado, por lo que el objetivo de esta revisión fue describir la evidencia que existe sobre la utilidad de POCUS en la práctica clínica diaria de gastroenterólogos y hepatólogos

Structural Diversity and Argentophilic Interactions in Small Phosphine Silver(I) Thiolate Clusters

10 pags., 5 figs., 4 tabs.Silver(I) coordination compounds display an interesting geometrical diversity, the possibility of having distinct coordination numbers (typically from 2 to 4) and the capability of forming argentophilic (Ag⋅⋅⋅Ag) interactions. These properties complicate the accurate prediction of structures of silver complexes under certain experimental conditions. In this work, we show how subtle modifications in thiolate and phosphine ligands exert important effects on the nuclearity and geometry of phosphine caped clusters [Ag(SR)] (n=4, 6 and 8). We rationalize these effects in terms of the electronic environment of silver centers by analyzing the electronic density of the single-crystal X-ray structures via the Quantum Theory of Atoms in Molecules (QTAIM) and the Non-Covalent Interaction (NCI)-Index. Furthermore, we characterized attractive and repulsive argentophilic contacts by means of the Interacting Quantum Atoms (IQA) energy partition. Our results provide insights on the effects of ancillary ligands in controlling the structure of silver-thiolate clusters. Such control is relevant towards a bottom-up approach to the atomic precise construction of higher nuclearity clusters.We acknowledge fundingby DGAPA-UNAM project IN210818,andby CONACYT-Mexico through the postdoctoral grant 740732. We are also thankful for the instrumental support of the Unit for Industryand Research Support (USAII)at the School of Chemistry at UNAM, Mexico and for the computer time provided by DGTIC/UNAMproject LANCAD-DGTIC-UNAM-250.G.M.-A acknowledges the RSC-Chemists’CommunityFund suppor