Silyl-Osmium(IV)-Trihydride Complexes Stabilized by a Pincer Ether-Diphosphine: Formation and Reactions with Alkynes.

Complex OsH4{κ3-P,O,P-[xant(PiPr2)2]} (1) activates the Si-H bond of triethylsilane, triphenylsilane, and 1,1,1,3,5,5,5-heptamethyltrisiloxane to give the silyl-osmium(IV)-trihydride derivatives OsH3(SiR3){κ3-P,O,P-[xant(PiPr2)2]} [SiR3 = SiEt3 (2), SiPh3 (3), SiMe(OSiMe3)2 (4)] and H2. The activation takes place via an unsaturated tetrahydride intermediate, resulting from the dissociation of the oxygen atom of the pincer ligand 9,9-dimethyl-4,5-bis(diisopropylphosphino)xanthene (xant(PiPr2)2). This intermediate, which has been trapped to form OsH4{κ2-P,P-[xant(PiPr2)2]}(PiPr3) (5), coordinates the Si-H bond of the silanes to subsequently undergo a homolytic cleavage. Kinetics of the reaction along with the observed primary isotope effect demonstrates that the Si-H rupture is the rate-determining step of the activation. Complex 2 reacts with 1,1-diphenyl-2-propyn-1-ol and 1-phenyl-1-propyne. The reaction with the former affords Os{C≡CC(OH)Ph2}2{=C=CHC(OH)Ph2}{κ3-P,O,P-[xant(PiPr2)2]} (6), which catalyzes the conversion of the propargylic alcohol into (E)-2-(5,5-diphenylfuran-2(5H)-ylidene)-1,1-diphenylethan-1-ol, via (Z)-enynediol. In methanol, the hydroxyvinylidene ligand of 6 dehydrates to allenylidene, generating Os{C≡CC(OH)Ph2}2{=C=C=CPh2}{κ3-P,O,P-[xant(PiPr2)2]} (7). The reaction of 2 with 1-phenyl-1-propyne leads to OsH{κ1-C,η2-[C6H4CH2CH=CH2]}{κ3-P,O,P-[xant(PiPr2)2]} (8) and PhCH2CH=CH(SiEt3).

Repercussion of a 1,3-Hydrogen Shift in a Hydride-Osmium-Allenylidene Complex.

An unusual 1,3-hydrogen shift from the metal center to the Cß atom of the C3-chain of the allenylidene ligand in a hydride-osmium(II)-allenylidene complex is the beginning of several interesting transformations in the cumulene. The hydride-osmium(II)-allenylidene complex was prepared in two steps, starting from the tetrahydride dimer [(Os(H···H){κ3-P,O,P-[xant(P i Pr2)2]})2(µ-Cl)2][BF4]2 (1). Complex 1 reacts with 1,1-diphenyl-2-propyn-1-ol to give the hydride-osmium(II)-alkenylcarbyne [OsHCl(≡CCH=CPh2){κ3-P,O,P-[xant(P i Pr2)2]}]BF4 (2), which yields OsHCl(=C=C=CPh2){κ3-P,O,P-[xant(P i Pr2)2]} (3) by selective abstraction of the Cß-H hydrogen atom of the alkenylcarbyne ligand with K t BuO. Complex 3 is metastable. According to results of DFT calculations, the migration of the hydride ligand to the Cß atom of the cumulene has an activation energy too high to occur in a concerted manner. However, the migration can be catalyzed by water, alcohols, and aldehydes. The resulting alkenylcarbyne-osmium(0) intermediate is unstable and evolves into a 7:3 mixture of the hydride-osmium(II)-indenylidene OsHCl(=CIndPh){κ3-P,O,P-[xant(P i Pr2)2]} (4) and the osmanaphthalene OsCl(C9H6Ph){κ3-P,O,P-[xant(P i Pr2)2]} (5). Protonation of 4 with HBF4 leads to the elongated dihydrogen complex [OsCl(η2-H2)(=CIndPh){κ3-P,O,P-[xant(P i Pr2)2]}]BF4 (6), while the protonation of 5 regenerates 2. In contrast to 4, complex 6 evolves to a half-sandwich indenyl derivative, [Os(η5-IndPh)H{κ3-P,O,P-[xant(P i Pr2)2]}][BF4]Cl (7). Phenylacetylene also provokes the 1,3-hydrogen shift in 3. However, it does not participate in the migration. In contrast to water, alcohols, and aldehydes, it stabilizes the resulting alkenylcarbyne to afford [Os(≡CCH=CPh2)(η2-HC≡CPh){κ3-P,O,P-[xant(P i Pr2)2]}]Cl (8).

Conocimientos, actitudes y prácticas del personal de salud del componente de tuberculosis en relación a la estrategia de tratamiento acortado estrictamente supervisado (TAES) en 5 municipios priorizados, Región Sanitaria Francisco Morazán, Honduras, Febrero 2019 / Knowledge, attitudes and practices of the health personnel of the tuberculosis component in relation to the strictly supervised shortened treatment strategy (TAES) in 5 prioritized municipalities, Francisco Morazán Health Region, Honduras, February 2019

La muestra fue de 50 trabajadores (auxiliares de enfermería, médicos y licenciadas en enfermería), en 5 municipios priorizados en el componente de Tuberculosis, se le aplicó un instrumento CAP y se realizó una guía de observación donde se revisaron 49 expedientes de pacientes con diagnóstico de Tuberculosis, toda la información se procesó en una base de datos; procesada en Excel. Los resultados fueron 76% de promedio, actitudes 92% y las prácticas 89% observando que en actitudes del personal es la mejor calificada, continuando las prácticas y con un menor porcentaje los conocimiento se espera que el personal de salud tenga más alto el conocimiento, continuando las actitudes y con menor porcentajes lasprácticas, es importante destacar que en la encuesta realizada las preguntas de conocimiento tenían que ser sustentados describiendo sus respuesta para evitar el sesgo en la investigación y esto hizo que el porcentaje alcanzado fuera más bajo en relación a la actitudes y prácticas. En relación al conocimiento se puede observar que el personal de salud conoce la estrategia TAES igual los esquemas de tratamiento y duración, en cuanto a las baciloscopias de control el personal de salud conoce el momento de realizarlo, tiene conocimiento cuando un paciente es egresado como curado, conoce el concepto de resistencia y de fracaso; con un menor puntaje el concepto de perdida en el seguimientodel paciente. El personal de salud no domina de la misma manera todos los conceptos unos los conoce más que otros, se identifica que el conocimiento en relación al TAES y conceptos básicos es bajo

There is no benefit in the use of postnatal intravenous immunoglobulin for the prevention of relapses of multiple sclerosis: findings from a systematic review and meta-analysis.

OBJECTIVE: Multiple sclerosis (MS) is a complex autoimmune and neurodegenerative disease of the central nervous system. Since MS affects mostly fertile women, pregnancy issues often arise in daily practice. The present study assessed the use of postpartum intravenous immunoglobulin (IVIG) in MS. METHODS: The authors individually searched for records using PubMed, Medline, EMBASE, Cochrane, SciELO, LILACS, and Google Scholar, using the terms "multiple sclerosis" OR "MS" AND "pregnancy" OR "gestation" OR "partum" OR "post-partum" OR "puerperium" AND "immunoglobulin". RESULTS: The initial search returned 321 papers. There were 11 eligible articles selected for the review. In total, 380 patients had received post-natal IVIG to reduce the number of postpartum relapses. The unadjusted number needed to treat was 6.3 for the quantitative and 5.8 for the qualitative analyses. CONCLUSION: The therapeutic effect of IVIG for prevention of postnatal relapses in MS could not clearly be established in this meta-analysis.

High levels of alexithymia in patients with multiple sclerosis.

Alexithymia is a personality trait characterized by difficulties identifying and describing feelings. Some researchers describe high levels of alexithymia among patients with multiple sclerosis (MS) but literature data on this subject are scarce. OBJECTIVE: The objective of the present study was to characterize findings of alexithymia in patients with MS. METHODS: This cross-sectional case-control study included 180 patients with MS and a matched control group. Data for patients with MS included disease duration, number of demyelinating relapses and degree of neurological disability, as assessed by the Expanded Disability Scale Score (EDSS). In addition, the Hospital Anxiety and Depression (HAD) scale and the Toronto Alexithymia Scale (TAS) were used. RESULTS: There were 126 women and 54 men in each group, with median age of 37 years and median education of 16 years. Patients with MS had higher degrees of depression (p<0.01), anxiety (p=0.01) and alexithymia (p<0.01) than did control subjects. For individuals with MS, depressive traits (p<0.01), anxious traits (p=0.03), higher age (p=0.02), lower education level (p=0.02), higher degree of disability (p<0.01) and not being actively employed (p=0.03) were associated with higher rates of alexithymia. CONCLUSION: Alexithymia was a relevant finding in patients with MS.

Alexitimia é um traço de personalidade caracterizado pelas dificuldades na identificação e descrição dos sentimentos. Alguns pesquisadores descrevem altos índices de alexitimia em pacientes com esclerose múltipla (EM), porém os dados na literatura são escassos. OBJETIVO: O objetivo do presente estudo foi caracterizar achados de alexitimia em pacientes com EM. MÉTODOS: Este estudo transversal incluiu 180 pacientes com EM e um grupo controle pareado. Dados de pacientes com EM incluíram a duração da doença, número de surtos clínicos de desmielinização e grau de incapacidade neurológica avaliados pela Escala Expandida do Grau de Incapacidade (EDSS). Foram também utilizadas a escala Hospitalar de Ansiedade e Depressão (HAD) e a escala de Alexitimia de Toronto (TAS) foram utilizadas. RESULTADOS: Cada grupo era constituído por 126 mulheres e 54 homens, com mediana de idade de 37 anos e mediana de escolaridade de 16 anos. Pacientes com EM apresentaram maior grau de depressão (p<0.01), ansiedade (p=0.01) e alexitimia (p<0.01) que os controles. Para pessoas com EM, traços depressivos (p<0.01), ansiosos (p=0.03), maior idade (p=0.02), menor nível educacional (p=0.02), maior grau de incapacidade (p<0.01) e o fato de não estar ativamente trabalhando (p=0.03) levaram a maiores níveis de alexitimia. CONCLUSÃO: Alexitimia foi um importante achado em pacientes com EM.

High levels of alexithymia in patients with multiple sclerosis / Altos índices de alexitimia foram observados em pacientes com esclerose múltipla

ABSTRACT: Alexithymia is a personality trait characterized by difficulties identifying and describing feelings. Some researchers describe high levels of alexithymia among patients with multiple sclerosis (MS) but literature data on this subject are scarce. Objective: The objective of the present study was to characterize findings of alexithymia in patients with MS. Methods: This cross-sectional case-control study included 180 patients with MS and a matched control group. Data for patients with MS included disease duration, number of demyelinating relapses and degree of neurological disability, as assessed by the Expanded Disability Scale Score (EDSS). In addition, the Hospital Anxiety and Depression (HAD) scale and the Toronto Alexithymia Scale (TAS) were used. Results: There were 126 women and 54 men in each group, with median age of 37 years and median education of 16 years. Patients with MS had higher degrees of depression (p<0.01), anxiety (p=0.01) and alexithymia (p<0.01) than did control subjects. For individuals with MS, depressive traits (p<0.01), anxious traits (p=0.03), higher age (p=0.02), lower education level (p=0.02), higher degree of disability (p<0.01) and not being actively employed (p=0.03) were associated with higher rates of alexithymia. Conclusion: Alexithymia was a relevant finding in patients with MS.

RESUMO: Alexitimia é um traço de personalidade caracterizado pelas dificuldades na identificação e descrição dos sentimentos. Alguns pesquisadores descrevem altos índices de alexitimia em pacientes com esclerose múltipla (EM), porém os dados na literatura são escassos. Objetivo: O objetivo do presente estudo foi caracterizar achados de alexitimia em pacientes com EM. Métodos: Este estudo transversal incluiu 180 pacientes com EM e um grupo controle pareado. Dados de pacientes com EM incluíram a duração da doença, número de surtos clínicos de desmielinização e grau de incapacidade neurológica avaliados pela Escala Expandida do Grau de Incapacidade (EDSS). Foram também utilizadas a escala Hospitalar de Ansiedade e Depressão (HAD) e a escala de Alexitimia de Toronto (TAS) foram utilizadas. Resultados: Cada grupo era constituído por 126 mulheres e 54 homens, com mediana de idade de 37 anos e mediana de escolaridade de 16 anos. Pacientes com EM apresentaram maior grau de depressão (p<0.01), ansiedade (p=0.01) e alexitimia (p<0.01) que os controles. Para pessoas com EM, traços depressivos (p<0.01), ansiosos (p=0.03), maior idade (p=0.02), menor nível educacional (p=0.02), maior grau de incapacidade (p<0.01) e o fato de não estar ativamente trabalhando (p=0.03) levaram a maiores níveis de alexitimia. Conclusão: Alexitimia foi um importante achado em pacientes com EM.

There is no benefit in the use of postnatal intravenous immunoglobulin for the prevention of relapses of multiple sclerosis: findings from a systematic review and meta-analysis / Não há benefício do uso de imunoglobulina endovenosa para prevenção de surtos na esclerose múltipla: achados de revisão sistemática e meta-análise

ABSTRACT Multiple sclerosis (MS) is a complex autoimmune and neurodegenerative disease of the central nervous system. Since MS affects mostly fertile women, pregnancy issues often arise in daily practice. The present study assessed the use of postpartum intravenous immunoglobulin (IVIG) in MS. Methods The authors individually searched for records using PubMed, Medline, EMBASE, Cochrane, SciELO, LILACS, and Google Scholar, using the terms "multiple sclerosis" OR "MS" AND "pregnancy" OR "gestation" OR "partum" OR "post-partum" OR "puerperium" AND "immunoglobulin". Results The initial search returned 321 papers. There were 11 eligible articles selected for the review. In total, 380 patients had received post-natal IVIG to reduce the number of postpartum relapses. The unadjusted number needed to treat was 6.3 for the quantitative and 5.8 for the qualitative analyses. Conclusion The therapeutic effect of IVIG for prevention of postnatal relapses in MS could not clearly be established in this meta-analysis.

RESUMO Esclerose múltipla (EM) é uma complexa doença autoimune e neurodegenerativa do sistema nervoso central. Uma vez que EM afeta principalmente mulheres em idade fértil, assuntos relacionados à gravidez frequentemente surgem na prática diária. O presente estudo avaliou o uso pós-parto de imunoglobulina (IVIG) na EM. Métodos Os autores individualmente pesquisaram as bases de dados PubMed, Medline, EMBASE, Cochrane, SciELO, LILACS, e Google Scholar usando os termos "multiple sclerosis" OR "MS" AND "pregnancy" OR "gestation" OR "partum" OR "post-partum" OR "puerperium" AND "immunoglobulin". Resultados A pesquisa inicial retornou 321 artigos. Havia 11 artigos elegíveis para a revisão. No total, havia relato de 380 pacientes que receberam IVIG após a gravidez visando reduzir o número de surtos. O número necessário para tratar não ajustado foi 6,3 para análise quantitativa e 5,8 para análise qualitativa. Conclusão O efeito terapêutico da IVIG para prevenção dos surtos pós-parto na EM não pôde ser claramente estabelecida nesta meta-análise.

Systematic review of the published data on the worldwide prevalence of John Cunningham virus in patients with multiple sclerosis and neuromyelitis optica.

OBJECTIVES: John Cunningham virus (JCV) is a polyoma virus that infects humans, mainly in childhood or adolescence, and presents no symptomatic manifestations. JCV can cause progressive multifocal leukoencephalopathy (PML) in immunosuppressed individuals, including those undergoing treatment for multiple sclerosis (MS) and neuromyelitis optica (NMO). PML is a severe and potentially fatal disease of the brain. The prevalence of JCV antibodies in human serum has been reported to be between 50.0 and 90.0%. The aim of the present study was to review worldwide data on populations of patients with MS and NMO in order to establish the rates of JCV seropositivity in these individuals. METHODS: The present review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used the following search terms: "JCV" OR "JC virus" AND "multiple sclerosis" OR "MS" OR "NMO" OR "neuromyelitis optica" AND "prevalence." These terms were searched for both in smaller and in larger clusters of words. The databases searched included PubMed, MEDLINE, SciELO, LILACS, Google Scholar, and Embase. RESULTS: After the initial selection, 18 papers were included in the review. These articles reported the prevalence of JCV antibodies in the serum of patients with MS or NMO living in 26 countries. The systematic review identified data on 29,319 patients with MS/NMO and found that 57.1% of them (16,730 individuals) were seropositive for the anti-JCV antibody (range, 40.0 to 69.0%). CONCLUSIONS: The median worldwide prevalence of JCV among adults with MS or NMO was found to be 57.1%.

How much does climate change threaten European forest tree species distributions?

Although numerous species distribution models have been developed, most were based on insufficient distribution data or used older climate change scenarios. We aimed to quantify changes in projected ranges and threat level by the years 2061-2080, for 12 European forest tree species under three climate change scenarios. We combined tree distribution data from the Global Biodiversity Information Facility, EUFORGEN, and forest inventories, and we developed species distribution models using MaxEnt and 19 bioclimatic variables. Models were developed for three climate change scenarios-optimistic (RCP2.6), moderate (RCP4.5), and pessimistic (RPC8.5)-using three General Circulation Models, for the period 2061-2080. Our study revealed different responses of tree species to projected climate change. The species may be divided into three groups: "winners"-mostly late-successional species: Abies alba, Fagus sylvatica, Fraxinus excelsior, Quercus robur, and Quercus petraea; "losers"-mostly pioneer species: Betula pendula, Larix decidua, Picea abies, and Pinus sylvestris; and alien species-Pseudotsuga menziesii, Quercus rubra, and Robinia pseudoacacia, which may be also considered as "winners." Assuming limited migration, most of the species studied would face a significant decrease in suitable habitat area. The threat level was highest for species that currently have the northernmost distribution centers. Ecological consequences of the projected range contractions would be serious for both forest management and nature conservation.

Tope precondíleo, una alternativa quirúrgica para el tratamiento de la luxación crónica mandibular. Modificación a la técnica de Norman. Experiencia en 12 pacientes / Pre-condylar stop: surgical alternative for the treatment of mandibular chronic luxation. Modification of Norman Technique. Experience with 12 patients

Propósito: Este artículo describe el uso del injerto de mentón para el aumento de la eminencia articular, como tratamiento para la luxación crónica mandibular. Pacientes y métodos: El presente estudio se llevó a cabo en 12 pacientes, con una edad promedio de 44 años a quienes se les diagnosticó luxación crónica mandibular, con sintomatología dolorosa mayor o igual a 8 en la escala visual análoga (EVA), evolución de 1.5 años en promedio, y una apertura bucal de 55 mm o mayor a ésta, tratados en forma conservadora durante por lo menos tres meses sin presentar mejoría. Dichos pacientes fueron tratados con una modificación a la técnica de Norman donde se les realiza aumento de la eminencia articular mediante la colocación de un injerto de mentón, a través de un abordaje preauricular. Resultados: En ninguno de los casos se presentaron nuevos eventos de luxación durante los 18 meses posteriores a la cirugía. Conclusiones: Se demostró que la corrección de la luxación crónica mandibular, mediante colocación de tope precondíleo con injerto de mentón es una técnica eficaz y segura.

Aim: The aim of the present article was to describe use of chin bone graft to increase articular eminence as preferred treatment for mandibular chronic luxation. Patients and methods: The present study was undertaken with 12 patients, average age 44 years. Patients had been diagnosed as suffering from chronic mandibular luxation (dislocation), with pain symptomatology rating 8 or more in the Analogous Visual Scale (AVS). Patients had experienced an average 1.5 year evolution and 55 mm or more oral opening. Patients had been conservatively treated for at least three months, with no visible improvement. Patients were then treated following a modified Norman technique, in which an articular eminence augmentation is performed with a chin bone graft placed through pre-auricular approach. Results: None of the patients presented new dislocation events during the 18 month follow up period after surgery. Conclusions: The present study showed the fact that mandibular chronic dislocation correction with placement of pre-condylar stop with chin bone graft is an effective and safe technique.

Incidencia y tratamiento de mordedura de vívoras / Incidence and treatement of snakebites

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