Food additives are one major hallmark of ultra-processed food in the Western-diet, a food habit often associated with metabolic disorders. Among these additives, the whitener and opacifying agent titanium dioxide (TiO₂) raises public health issues due to the ability of TiO₂ nanoparticles (NPs) to cross biological barriers and accumulate in different systemic organs like spleen, liver and pancreas. However before their systemic passage, the biocidal properties of TiO₂ NPs may alter the composition and activity of the gut microbiota, which play a crucial role for the development and maintenance of immune functions. Once absorbed, TiO₂ NPs may further interact with immune intestinal cells involved in gut microbiota regulation. Since obesity-related metabolic diseases such as diabetes are associated with alterations in the microbiota-immune system axis, this raises questions about the possible involvement of long-term exposure to food-grade TiO₂ in the development or worsening of these diseases. The current purpose is to review the dysregulations along the gut microbiota-immune system axis after oral TiO₂ exposure compared to those reported in obese or diabetic patients, and to highlight potential mechanisms by which foodborne TiO₂ NPs may increase the susceptibility to develop obesity-related metabolic disorders.

Background: Platelet transfusion can be life-saving in some situations, but, if unnecessary, it puts the patients at risk and increases health system costs. Previous reports of audits performed on platelet transfusion practice in hospitals from different countries show a low adherence of physicians to the current recommendation. The objective of this article is to describe our patient blood management strategy to improve platelet transfusion practice of hematologic inpatients and outpatients, focusing on the impact on platelet transfusion activity and appropriateness rate. Methods: We developed a specific platelet transfusion guideline for hematological patients at our hospital. Platelet transfusion activity was audited after implementing the guide in mid-2024 and mid-2025, and these data were compared to the previous audits performed before the intervention. We also reviewed the platelet transfusion activity and adverse effects related to from 2021 to 2024. Results: Audit 1 reviewed 128 inpatients and 49 outpatients transfused from March 2022 to September 2023. Audit 2 studied 130 inpatients and 45 outpatients requiring platelet transfusion from March 2025 to July 2025. Annual platelet transfusions decreased from 8028 before intervention to 6880 in 2024 (14% decrease). In the hematological area, where the intervention has been made, the reduction in platelet transfusions was of 15.6% in hospitalized patients and 34.5% in outpatients as compared to 2023 (p < 0.001). The platelet supply decreased from 8407 in 2023 to 7138 in 2024. Adverse events related to PLT transfusion occurred in 51 patients in 2023 and 35 patients in 2024. Conclusions: Implementing patient blood management strategies focused on platelets led to a more rational and standardized use of platelet transfusions and decreased transfusion burden. Each organization should establish thresholds for platelet transfusion based on available evidence and guidelines, and also audit adherence to guidelines. In view of the scarce available evidence, research on platelet transfusion practice is mandatory.