A factorial experiment grounded in the multiphase optimization strategy to promote viral suppression among people who inject drugs on the Texas-Mexico border: a study protocol.

BACKGROUND: People who inject drugs living with HIV (PWIDLH) suffer the lowest rates of HIV viral suppression due to episodic injection drug use and poor mental health coupled with poor retention in HIV care. Approximately 44% of PWIDLH along the US-Mexico border are retained in care and only 24% are virally suppressed. This underserved region faces a potential explosion of transmission of HIV due to highly prevalent injection drug use. This protocol describes an optimization trial to promote sustained viral suppression among Spanish-speaking Latinx PWIDLH. METHODS: The multiphase optimization strategy (MOST) is an engineering-inspired framework for designing and building optimized interventions and guides this intervention. The primary aim is to conduct a 24 factorial experiment in which participants are randomized to one of 16 intervention conditions, with each condition comprising a different combination of four behavioral intervention components. The components are peer support for methadone uptake and persistence; behavioral activation therapy for depression; Life-Steps medication adherence counseling; and patient navigation for HIV care. Participants will complete a baseline survey, undergo intervention, and then return for 3-,6-,9-, and 12-month follow-up assessments. The primary outcome is sustained viral suppression, defined as viral loads of < 40 copies per mL at 6-,9-, and 12-month follow-up assessments. Results will yield effect sizes for each component and each additive and interactive combination of components. The research team and partners will make decisions about what constitutes the optimized multi-component intervention by judging the observed effect sizes, interactions, and statistical significance against real-world implementation constraints. The secondary aims are to test mediators and moderators of the component-to-outcome relationship at the 6-month follow-up assessment. DISCUSSION: We are testing well-studied and available intervention components to support PWIDLH to reduce drug use and improve their mental health and engagement in HIV care. The intervention design will allow for a better understanding of how these components work in combination and can be optimized for the setting. TRIAL REGISTRATION: This project was registered at clinicaltrials.gov (NCT05377463) on May 17th, 2022.

Avaliação ultrassonográfica de variações anatômicas entre vasos femorais realizada por estudantes de medicina / Ultrasonographic evaluation of anatomical variations in femoral vessels done by medical students

Introdução: A punção venosa central é um procedimento médico tradicionalmente realizado seguindo os marcadores anatômicos como referência para atingir o vaso, às cegas. No entanto, nem sempre o sucesso nessa técnica é alcançado, fato que se deve principalmente às variações anatômicas. A ultrassonografia point of care (US-POC) é utilizada para auxiliar a cateterização central por visualização direta do vaso, aumentando a segurança do procedimento. Objetivo: Avaliar a prevalência das variações anatômicas de vasos femorais através da utilização da US-POC por estudantes de medicina submetidos a curto período de treinamento. Material e Métodos: Cinco estudantes de medicina, sem experiência prévia em US-POC, foram submetidos a oito horas de treinamento teórico-prático. Foram avaliados os vasos femorais de cem voluntários. Resultados: A veia femoral direita foi encontrada mais frequentemente na posição medial (43%) em relação à artéria femoral direita. À esquerda, a posição posteromedial foi a mais observada (45%).Conclusão: A técnica tradicional de punção de acesso central se baseia em marcadores anatômicos e não leva em consideração as variações anatômicas existentes. Um treinamento de curto período para uso da US-POC é capaz de capacitar o profissional para reconhecer o posicionamento real dos vasos e evitar punções inadvertidas.

Introduction: Central vein puncture is a medical procedure traditionally done following anatomical landmarks as a reference to successfully achieving the vessel. However, this traditional technique is commonly unsuccessful due to anatomical variations that may be found. Point of care ultrasonography (POC-US) is used to assist central catheterization by directly visualizing the vessel, increasing procedure security and minimizing risks. Objective: Evaluate anatomical variations prevalence in femoral vessels, utilizing POC-US, done by medical students submitted to a short period of time training in ultrasonography. Material and Methods: Five medical students, without previous experience on the use of ultrasonography, were submitted to an eight-hour theorical practical training in POC-US. The students evaluated one hundred femoral vessels of volunteers. Results: The right limb femoral vein was found more frequently in the medial position (43%) in comparison to the right limb femoral artery. On the left limb, the posteromedial position was the most found (45%). Conclusion: The insertion of a central catheter following the traditional technique is based on anatomical landmarks, and does not take into account existing anatomical variations. With a short period of training, POC-US is capable of qualifying professionals to acknowledge the real location of the vessel and avoid inadvertent punctures and complications.

Factores predisponentes que conllevan a los pacientes a una neumonía asociada ventilación mecánica de la unidad de cuidados intensivos del hospital Teodoro Maldonado Carbo. Periodo 2018 ­ 2019 / Predisposing factors that lead patients to pneumonia associated with mechanical ventilation in the Teodoro Maldonado carbo hospital's intensive care unit. period 2018 ­ 2019

Hay varios factores de riesgo que pueden conllevar a una neumonía asociada a ventilación mecánica, tanto intrínseco como extrínseco, y el porcentaje de la neumonía asociada a ventilación mecánica va en aumento, por lo que el personal médico tiene una dura lucha para tratar de disminuir esta problemática. Objetivo: Determinar los factores predisponentes que conllevan a los pacientes a una neumonía asociada a la ventilación mecánica en la Unidad de Cuidados Intensivos del Hospital Teodoro Maldonado Carbo durante el periodo 2018 ­ 2019. Materiales y Métodos: paradigma positivista, enfoque cuantitativo; de modalidad de campo, no experimental. De tipo descriptivo y transversal. La población fue 285 pacientes y la muestra de 60, seleccionado de manera probabilística y sistemático. La técnica fue la encuesta y el instrumento el cuestionario con 15 ítems, revisados y validados por juicios de expertos en el tema, que dieron una confiabilidad de 95%. Resultados: Se evidenció que los factores predominantes, que aumentan los riesgos de padecer una NAVM son elementos de tipo Extrínseco, entre ellos los más comunes son: intubación prolongada, re intubaciones, aspiraciones de secreciones y el traslado del paciente. Mientras que los del factor intrínseco son: desnutrición, edad y etnia. Conclusión: se evidenció la importancia de un diagnóstico oportuno y seguir las normas de bioseguridad establecidas antes, durante y después del proceso de entubación como mecanismo de disminución de probabilidad de que el paciente desarrolle un NAVM(au)

There are several risk factors can lead to pneumonia associated with mechanical ventilation both, intrinsic and extrinsic, and the percentage of pneumonia associated with mechanical ventilation is increasing, which is why medical personnel have a tough fight to try to reduce this problem. Objective: To determine the predisposing factors that lead patients to pneumonia associated with mechanical ventilation in the Teodoro Maldonado Carbo Hospital's Intensive Care Unit during the period 2018 - 2019. Materials and Methods: positivist paradigm, quantitative approach; field modality, not experimental. Descriptive and transversal. The population was 285 patients and the sample of 60, selected in a probabilistic and systematic way. The technique was the survey and the instrument was the questionnaire with 15 items, reviewed and validated by expert judgments on the subject, which gave a reliability of 95%. Results: It was evident that the predominant factors that increase the risks of suffering from AVM are extrinsic elements, among them the most common are prolonged intubation, re-intubations, aspiration of secretions and the transfer of the patient. While those of the intrinsic factor are malnutrition, age and ethnicity. Conclusion: the importance of a timely diagnosis and following the biosafety standards established before, during and after the intubation process was evidenced as a mechanism to decrease the probability that the patient develops a VAP(AU)

A produção científica brasileira sobre o impacto da atenção primária à saúde: uma revisão integrativa / The brazilian scientific production on the impact of primary health care: an integrative reviewthe brazilian scientific production on the impact of primary health care: an integrative review

Introdução: A Atenção Primária à Saúde (APS) tem por objetivo garantir o acesso do usuário aos serviços de saúde, tendo capacidade de resolver 80% das demandas da população. Assim, torna possível a redução do número total de internações, desafogando os níveis secundário e terciário e diminuindo os gastos totais com o sistema de saúde. Nesta revisão, foi definido como alvo a análise da produção científica sobre impacto da APS no Brasil. Métodos: Revisão integrativa da literatura na Plataforma OMNIS da PUCRS (Pontifícia Universidade Católica do Rio Grande do Sul), em maio de 2018, sobre o impacto da Atenção Primária na saúde com olhar voltado à realidade e produção científica brasileira sobre o assunto. A partir da técnica de Bardin, realizou-se avaliação e discussão dos dados obtidos. Resultados: Após análise cuidadosa de todos os artigos, apenas 13 foram selecionados. Dentre eles, apenas dois possuíam autores que fossem profissionais vinculados à atenção primária. Supõe-se que o déficit de publicações a respeito deste tema está atrelado à falta de incentivo formal à produção científica e às dificuldades práticas encontradas pelos profissionais vinculados à APS. Além disso, o reduzido número de artigos nacionais contrastou expressivamente com os resultados encontrados ao se utilizar descritores na língua inglesa. Conclusão: No presente estudo, observou-se maior produção científica sobre o impacto da atenção primária no cenário brasileiro feita por pesquisadores vinculados a instituições de ensino acadêmicas, com maior presença de estudos ecológicos e concentração nas regiões sul e sudeste. Foi identificada a necessidade de aumentar o fomento de pesquisas no cenário da atenção básica brasileira, principalmente através do incentivo de profissionais vinculados à APS.

Introduction: Primary Health Care (PHC) aims to guarantee the user's access to health services, with the capacity to solve up to 80% of the population's health problems. Therefore, it reduces the total amount of hospitalizations, relieving the secondary and tertiary cares and decreasing total expenditures with the health system. In this review, the analysis of scientific production on the impact of PHC in Brazil was made. Methods: Integrative literature review in OMNIS database of PUCRS (Pontifícia Universidade Católica do Rio Grande do Sul), in May 2018, on the impact of Primary Health Care on health with a look at the brazilian reality and scientific production on the subject. From the Bardin technique, the data obtained were evaluated and discussed. Results: After careful analyze of all articles, only 13 were selected. Among them, only two had authors who were professionals linked to primary care. It was assumed that the lack of publications regarding this theme is associated to the low formal incentive to scientific production and to the practical difficulties encountered by the PHC professionals. Furthermore, the low amount of national articles contrasted expressively with the results found when using the descriptors in English. Conclusion: In this study, it was observed a greater scientific production on the impact of PHC in the Brazilian scenario made by researchers linked to academic institutions, with major presence of ecological studies and concentration on South and Southeast regions. It was identified the need to improve the fomentation of research in the Brazilian primary care scene, mainly through the encouragement of PHC professionals.

Comunicação de más notícias na prática clínica / Breaking bad news in clinical practice

Introdução: O estigma do câncer como doença incurável vem se modificando graças aos avanços dos estudos da biologia celular e da genética dos tumores. A comunicação de más notícias, no campo da oncologia e na saúde como um todo, é um tema pouco abordado na graduação do curso de medicina e requer experiências e conhecimentos para ser bem aplicada na prática clínica. A presente revisão tem como objetivo demonstrar, através de dados científicos, como a comunicação de más notícias necessita de habilidades e que instrumentos podem ser usados para tal. Métodos: Revisão bibliográfica de artigos atualizados utilizando palavras chave como: comunicação de más notícias, relação médico paciente, oncologia. Resultados: Nos estudos aqui apresentados há a comparação de currículos que contemplam formas de treinamento para comunicação com currículos tradicionais, a exposição de técnicas já validadas pelas evidências científicas e que protocolos podem ser utilizados para a melhora na comunicação de más notícias. Conclusão: A revisão apontou a importância da preparação da equipe para lidar com seus sentimentos e com as expectativas do paciente. Informar bem um paciente sensibilizado sobre as incertezas do tratamento, do seu prognóstico e dos impactos da doença em sua vida, se torna uma prioridade para que a confiança na relação médico-paciente não seja prejudicada.

Introduction: The stigma of cancer as an incurable disease is changing thanks to the advances in studies of cell biology and the genetics of tumors. The communication of bad news, in the field of oncology and health, is a subject little addressed in undergraduate medical course and requires experiences and knowledge to be well applied in the clinical practice. The present review aims to demonstrate, through scientific data, how bad news communication needs skills and what tools can be used to do so. Methods: Bibliographic review of updated articles using key words such as: breaking bad kwens, doctor-patient relation, oncology. Results: In the studies presented here, there is a parallel of curriculum that include training methods for communication with the traditional curriculum, the exposition of techniques already validated by scientific evidence, and which protocols can be used to improve communication of bad news. Conclusion: This review pointed to the importance of preparing the health team to deal with their feelings and with the patient's expectations. Informing well a sensitized patient about the uncertainties of the treatment, its prognosis and the impact of the disease on his life becomes a priority so that trust in the doctor-patient relationship is not impaired.

Abdominoplasty and thoraco-epigastric flaps for large anterior trunk defects after dermatofibrosarcoma protuberans wide resection: Two illustrative cases.

INTRODUCTION: Excision of large dermatofibrosarcoma protuberans in the anterior aspect of the trunk often results in large surgical defects that frequently dictate the need for microsurgical reconstruction. However, this option is not always available. PRESENTATION OF CASE: The authors describe two patients with very large anterior trunk dermatofibrosarcoma protuberans: one in the epigastric region and the other in the hypogastric region. In the patient with the hypogastric tumor, a classical abdominoplasty flap associated with umbilical transposition was used to cover the skin defect after muscle and fascial plication, and placement of a polypropylene mesh. In the patient with the epigastric tumor, a synthetic mesh was also placed, and the skin and subcutaneous defect was reconstructed with a reverse abdominoplasty flap and two thoraco-epigastric flaps. In both cases, complete closure was possible without immediate or late complications. DISCUSSION: The local options described in this paper present several potential advantages compared to microsurgical reconstruction, namely they are easier and faster to perform and teach; they provide a good skin color and texture match; they are not associated with distant donor site morbidity; follow-up is usually less cumbersome; the post-operative hospital stay tends to be shorter; they are less costly; they are less prone to complete failure. CONCLUSION: The authors believe that these two patients clearly show that local flaps, although frequently neglected, continue to be valid options for reconstructing large anterior trunk defects, even in the current era of microsurgery enthusiasm.

Caracterización clínica y terapéutica de un muestreo portugués de pacientes con esquizofrenia / Clinical and therapeutic characterization of a portuguese sample of patients with schizophrenia

Introducción. El desarrollo de las políticas de salud mental sobre trastornos psiquiátricos graves debe llevarse a cabo con un conocimiento adecuado de las realidades socio-demográficas, y clínicas de los padrones de prescripción. En Portugal, los estudios epidemiológicos no tienen un nivel de detalle que haga posible una comprensión profunda de este fenómeno. En la población portuguesa que sufre esquizofrenia hay una carencia de estudios en profundidad que limitan su comparación con otros países europeos. Este estudio ha sido diseñado con el objetivo principal de conocer la práctica clínica habitual y las características de la esquizofrenia en Portugal. Método. Se trata de un estudio observacional, descriptivo, transversal y multicéntrico, con datos recogidos en la práctica clínica corriente. Se han analizado un total de 474 pacientes. Resultados. El diagnóstico más frecuente la esquizofrenia paranoide (54%), de severidad moderada, con frecuentes complicaciones psiquiátricas (39,7%) y somáticas (28,4%). El 48,6% de los pacientes presentaban consumo de drogas. Aproximadamente la mitad de los pacientes tomaban antipsicóticos atípicos como tratamiento principal, aunque el haloperidol fue el medicamento prescrito con más frecuencia (35,9%). El 59,51% de los pacientes estaban siendo tratados en monoterapia antipsicótica y el 45% con una formulación de larga duración inyectable. Las dosis de los antipsicóticos eran muy variables y con frecuencia fuera de la indicación autorizada. El 37,9% de los pacientes tenían terapia concomitante no farmacológica. Conclusiones. Los pacientes presentan características sociodemográficas similares a las de otros ensayos clínicos naturalistas, pero diferentes de los ensayos clínicos con fármacos. En general, los pacientes se tratan con antipsicóticos atípicos, aunque un gran porcentaje prosigue con formulaciones de liberación lenta en terapia de combinación con dos o más antipsicóticos, en cifras mayores que en otros estudios similares. Las enfermedades somáticas quizás se infradiagnostica no se tratan de manera insuficiente (AU)

Introduction. The development of Mental Health policies for psychiatric disorders should be driven by a correct knowledge of the socio-demographic, clinical and therapeutic realities of the disease. There is paucity of detailed studies in the Portuguese population that does not allow a direct comparation with other European countries. The objective of the present study is to characterize the sociodemograhic and clinical characteristics of schizophrenia patients in Portugal and the therapeutic patterns. Methods. This multicentric, cross sectional, non interventional study was designed to describe the demographic and clinical data of patients with schizophrenia (n=474), and also the demographic and professional characteristics of their treating psychiatrists. Results. The most frequent diagnosis found was paranoid schizophrenia (54%), with comorbid psychiatric conditions in 39,7% and somatic diseases in 28.4% of the patients. About half the patients were on second generation antipsychotics (SGS) as principal therapy, although haloperidol has been the most frequent drug prescribed as so (35.9 %). 59.51 % of the patients were on antipsychotic monotherapy, and 45% on a depot formulation. Antipsychotic dose vary widely, and they are quite often prescribed on off label doses. Discussion. Our sample is similar to others found in naturalistic studies, however slightly different from clinical trials. In general, patients with schizophrenia tend to be treated with SGA, although have a higher chance to be on a long-term formulation and to be on polytherapy than in other studies. Somatic diseases are maybe under diagnosed and are undertreated (AU)

Clinical and therapeutic characterization of a Portuguese sample of patients with schizophrenia.

INTRODUCTION: The development of Mental Health policies for psychiatric disorders should be driven by a correct knowledge of the socio-demographic, clinical and therapeutic realities of the disease. There is paucity of detailed studies in the Portuguese population that does not allow a direct comparation with other European countries. The objective of the present study is to characterize the sociodemograhic and clinical characteristics of schizophrenia patients in Portugal and the therapeutic patterns. METHODS: This multicentric, cross sectional, non interventional study was designed to describe the demographic and clinical data of patients with schizophrenia (n=474), and also the demographic and professional characteristics of their treating psychiatrists. RESULTS: The most frequent diagnosis found was paranoid schizophrenia (54%), with comorbid psychiatric conditions in 39,7% and somatic diseases in 28.4% of the patients. About half the patients were on second generation antipsychotics (SGS) as principal therapy, although haloperidol has been the most frequent drug prescribed as so (35.9 %). 59.51 % of the patients were on antipsychotic monotherapy, and 45% on a depot formulation. Antipsychotic dose vary widely, and they are quite often prescribed on off label doses. DISCUSSION: Our sample is similar to others found in naturalistic studies, however slightly different from clinical trials. In general, patients with schizophrenia tend to be treated with SGA, although have a higher chance to be on a long-term formulation and to be on polytherapy than in other studies. Somatic diseases are maybe under diagnosed and are undertreated.

[Larrea tridentata. Effect on a non-metabolic model of urolithiasis in rats]. / Larrea tridentata en urofitiasls. Efecto en un modelo no metabólico en ratas.

OBJECTIVE: To evaluate the effect of L. tridentata infusion on the development of urinary calculi in a non-metabolic model. METHODS: Male Wistar rats were divided into two groups (n = 10 each). The experimental group received 1 mL of oral L. tridentata infusion three times daily for 95 days. Control group received 1 mL tap water. Five days after initiating treatment, urolithiasis was induced inserting a series of 15 knots of 5-0 chromic catgut into the urinary bladder. Measurements included body weight and water intake, complete blood counts, glucose, BUN, creatinine, bacterial culture, and weight of urinary stones and sands. RESULTS: No statistically significant differences were found between groups for any variable. CONCLUSIONS: An infusion of L. tridentata was not effective in the prevention of urolith formation in the suture-induced rat model. It produced no alterations in body weight gain, blood counts, or water intake. Future work is needed to completely rule out any effect of the plant on urolith formation.

Dislipidemia en pacientes con Diabetes Mellitus tipo 2 del Hospital III Daniel Alcides Carrión EsSalud-Tacna durante el año 2006 / Dyslipidemia in Patients with Type 2 Diabetes Mellitus Hospital Daniel Alcides Carrión Essalud III-Tacna in 2006

Se hizo un estudio del perfil lipídico en pacientes diabéticos para determinar el tipo de dislipidemia; factor de riesgo para aterosclerosis asociada a enfermedad coronaria, accidentes cerebrovasculares (ACV) y enfermedad vascular periférica (EVP). Se evaluaron 495 pacientes diabéticos del Hospital III Daniel Alcides Carrión (DAC) de la Red Asistencial Tacna. Se midió en éstos el colesterol total, colesterol-HDL, colesterol-LDL y triglicéridos utilizando métodos enzimáticos. Los resultados mostraron que el 43.6% de pacientes diabéticos tienen niveles aceptables de colesterol total (200 mg/dl). el 29.3% tienen niveles aceptables de triglicéridos (<160 mg/dl) y el 70.7% presentan hipertrigliceridemia; según los rangos recomendados por la Asociación Americana de Cardiología (AAC). De los 495 pacientes diabéticos estudiados el 49.5% (245) tienen hipertensión arterial asociada. En el grupo de diabéticos, así como en el subgrupo de diabéticos hipertensos se encontró niveles disminuidos de coelsterol-HDL y niveles aumentados de colesterol-LDL tanto en aquellos con niveles de colesterol aceptable y con niveles de riesgo; siendo a mayor nivel de colesterol total, los niveles colesterol-LDL también muchos mayores. De acuerdo al índice de masa muscular (IMC) en el grupo de estudio, el 21.2% tiene un IMC y el 78.8% cursa con algún grado de obesidad. A mayor IMC aumenta el colesterol total, colesterol-LDL y triglicéridos, no encontrándose mayor relación con colesterol-HDL. Se concluye que más del 50% de estos pacientes diabéticos y además aquellos con hipertensión arterial aunado al alto porcentaje de obesidad encontrado; tienen un perfil de riesgo aterogénico alto y se hace necesario desarrollar acciones a favor de disminuir este riesgo con un manejo más integral de la dislipemia del paciente diabético, mejorando el estilo de vida y si es necesario con tratamiento farmacológico hipolipemiante.

A study of lipidic profile was made in diabetic patients to determine the dislipidemia type; factor of risk for aterosclerosis associated to coronary illness, cerebrovascular accident (ACV) and vascular peripheral illness. 495 diabetic patients of the Daniel Alcides Carrion (DAC) Hospital III Tacna were evaluated. It was measured the total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides, using enzymatic methods. The results demonstrated that 43.6% of diabetic patients have acceptable levels of total cholesterol (200 mg/dl). 29.3% have acceptable levels of Tryglycerides (<160 mg/dl) and 70.7% present hipertrigliceridemia; according to recommended parameters given by the American Association of Cardiology (AAC). From 495 studied diabetic patients, 49.5% (245) have associated arterial hypertension. In the group of diabetics, as well as in the subgroup of hipertense diabetic was found diminished levels of HDL cholesterol and high levels of LDL cholesterol. As in those with levels of acceptable cholesterol and with levels of risk; if levels total cholesterol are superior, levels of LDL cholesterol are also much bigger. According to the index of muscular mass (IMC) in this study group, 21.2% show a normal IMC and 78.8% present some grade of obesity. If IMC is increased, total cholesterol, LDL cholesterol and triglycerides are also augmented, not found any relationship with HDL cholesterol. In conclusion we can affirm more than 50% of these diabetic patients and also those with arterial hypertension, joined to the high percentage of obesity found in this study group; present a high aterogenic profile of risk, and it becomes necessary developing some actions diminishing this risk with dislipidemia, improving their lifestyle and when necessary with a pharmacological hipolipemiant usage.

O interacionismo social e a investigação da brincadeira infantil: uma análise teórico-metodológica / Social interacionism and investigation in children’s playful activities: a theoretical-methodological analysis

Com base no interacionismo social de Mead (1863-1931), neste artigo é construído um diálogo com a abordagem sócio-histórica de Vygotsky e Leontiev para enfocar a análise da interação social como recurso teórico-metodológico inovador para a investigação da brincadeira na primeira infância. Para a ampliação do debate sobre a temática, o texto recorre a trabalhos de pesquisa desenvolvidos mais recentemente no Brasil, baseados nessa abordagem, com o objetivo de destacar o desdobramento empírico da reflexão teórica sobre brincadeiras infantis.

Multinuclear NMR study of the complexes of 6-phospho-D-gluconic acid with W(VI) and Mo(VI).

Multinuclear ((1)H, (13)C, (17)O, (31)P, (95)Mo, (183)W) magnetic resonance spectroscopy (1D and 2D) has been used to show that 6-phospho-d-gluconic acid forms three complexes with tungsten(VI) and six complexes with molybdenum(VI) in aqueous solution, depending on pH and concentration. Two isomeric 1:2 (metal-ligand) complexes are detected both with tungstate(VI) and molybdate(VI), having MO(2)(2+) centres and involving the carboxylate and the adjacent OH groups in addition to one 2:1 (metal-ligand) complex possessing a M(2)O(5)(2+) centre, with the ligand being coordinated by the carboxylate group and the three consecutive OH groups in positions 2, 3 and 4. Molybdate(VI) forms three additional species, which are not detected with tungstate. One of them is a 2:1 complex with a Mo(2)O(5)(2+) centre, with the ligand being tetradentate via O-3, O-4, O-5 and the phosphate group. The other two are 12:4 species, which can be seen as two 1:2 complexes bound together in a ring through two diphosphomolybdate moieties each derived from heptamolybdate by inclusion of two phosphate groups from the ligands.

Activated clotting time and heparin administration in Sprague-Dawley rats and Syrian golden hamsters.

To determine the activated clotting time (ACT) in rats and hamsters from our colony and to evaluate the response of this parameter to different heparin doses in these species, ACTs were measured using a Medtronic HemoTec ACT measurement system in samples obtained by intracardiac puncture from normal, nonanticoagulated, anesthetized rats and hamsters. Another groups of animals received different intravenous boluses of heparin to determine the dose needed to maintain ACT values > 480 sec for at least 30 min. The ACT (mean +/- SEM) was 48.0 +/- 2.17 sec for the 50 rats sampled and 42.5 +/- 2.35 sec for the 48 hamsters. Rats required a bolus of 1200 IU/kg intravenous heparin to maintain an ACT > 480 sec for 30 min; hamsters required 1000 IU/kg heparin for the same effect. We concluded that compared with humans, rats and hamsters from our colony have short ACTs and low sensitivity to heparin, in terms of the dose needed to reach a target ACT as well as the time required to sustain it. Further the ACT values in these animals showed great variability.

[Clinical, multicentric, and open study to evaluate the efficacy of and tolerance to sildenafil in patients with erectile dysfunction]. / Estudo clínico, multicêntrico, aberto para avaliar a eficácia e a tolerância do sildenafil no tratamento de doentes com disfunção eréctil.

Erectile dysfunction (ED), defined by the Impotence-NIH Consensus Conference as the "persistent inability to achieve and/or maintain erection sufficient for satisfactory sexual activity" affect more than 100 million men worldwide, at particular severity levels. The global prevalence of ED is estimated to affect about 10%, but has been found to increase significantly with age (39% in men 40 years of age and 67% at 70 years of age). In men aged 40 to 70 years, the severe ED prevalence increased of three folds, 5 to 15%. In order to evaluate the efficacy and tolerance of sildenafil, it was conducted a national open, multicentre study on a portuguese population affected by ED. Subjects under ambulatory treatment were recruited in Psychiatry/Sexology Clinical units and Urology/Andrology. The results of the study carried out on a group of 62 men with ED, demonstrate that sildenafil was effective in the recovering of erectile function, increasing the number of attempts to sexual activity and improving their success rates (mainly in severe dysfunction). Fifty one patients treated with sildenafil, at the end of the study referred a global improvement in their erections (92.2%). Doses of 50 mg and 100 mg sildenafil were used and were well tolerated and also effective in the treatment of this pathology (70% and 69% respectively). Being this study a flexible dose one and taking into consideration that the final dose used was found the more suitable to the patients, can be concluded that 43.1% of the patients elected dose of 50 mg whereas 56.9% elected the maximum prescribed dose of 100 mg. Over and above global efficacy experimented by patients, a significant improvement in the sexual activity with partners was occurred. These results make possible a final conclusion--in the studied patients group affected by Erectile Dysfunction, aside from associated somatic pathology, sildenafil use provided a remarkable clinical profit, in what concerns global efficacy, by erectile function mechanisms improvement, concerning patients sensitivity of improvement, occurring in the major part of them, being these of high importance to the lifting up of their self-esteem.