Is a brief self-report version of the Columbia severity scale useful for screening suicidal ideation in Chilean adolescents?

BACKGROUND: Given the high rates of suicide in the adolescent population and the reluctance of this population to seek help, developing proactive and effective strategies to timely detect individuals at high risk for suicide in non-clinical contexts is a worldwide recognized need. A series of brief self-report questionnaires have been developed for this purpose, however there are few studies providing evidence on their capability to accurately classify suicidal risk levels in specific populations. One of the instruments frequently used to evaluate suicide risk is the Columbia-Suicide Severity Rating Scales (C-SSRS). The goal of this study is to provide psychometric evidence about the accuracy of the Suicidal Ideation subscale (SI) of the C-SSRS to classify suicidal risk levels in a sample of Chilean adolescents using Item Response Theory (IRT). METHODS AND MATERIALS: Through the two parameter logistic model (2-PLM), we analyzed the capability of a self-report questionnaire addressing suicidal ideation (SI) to differentiate and classify participants according to their SI severity levels. We tested two main parameters: difficulty (localization) and discriminating power of 6 items extracted and adapted from the Columbia-Suicide Severity Rating Scales (C-SSRS). We administered this questionnaire to a general sample of 1645 adolescents aged 13 to 18. RESULTS: Our results show that the items differentiate symptoms addressing suicidal thoughts according to their severity, providing an accurate classification of the SI risk level. CONCLUSIONS: These findings support the usage of the C-SSRS in Chilean adolescents. Further research is needed to test its predictive value in different populations.

Assessing support needs in children with intellectual disability and motor impairments: measurement invariance and group differences.

BACKGROUND: This study assessed the equivalence of the measurement of support needs between children with intellectual disability (ID) and children with intellectual and motor disabilities (IMD) and compared both groups in the different domains of support. METHOD: The Supports Intensity Scale-Children's Version was used to assess the support needs of 713 children with ID and 286 children with IMD, mainly associated with cerebral palsy. RESULTS: The results supported measurement invariance between the group of ID and IMD, which allowed to conduct comparison between them. Children with IMD scored higher on support needs than did children without IMD, suggesting that children with IMD needed more support than their peers without motor impairments. Furthermore, the ID levels interacted with motor impairments: at the highest levels of ID, groups tended to be similar in support needs, with high scores and low variability. The greatest differences were found in the domains of Home and Community activities. CONCLUSIONS: This study points to the across-condition of the construct of support needs in populations with intellectual and developmental disabilities. However, additional mobility impairments should be considered during the evaluation and planning of systems of support. In this regard, the Supports Intensity Scale-Children's Version might have limitations when discriminating between samples with high support needs.

Sudden loss of vision in an Acute Medical Unit.

We present a case report of young man with Type 1 diabetes who developed acute visual loss after initially presenting with diabetic ketoacidosis. The diagnosis of invasive paranasal sinusoidal aspergillosis was made following CT and biopsy. Although uncommon, visual loss is a recognised complication of disseminated aspergillosis and is more likely in immune-compromised patients and those with diabetes. Early investigation with appropriate sinus imaging and involvement of the Ear Nose and Throat team in recommended when patients with diabetes develop acute visual loss in the context of a non-specific infective illness.

Improving the cytotoxic response of tumor-infiltrating lymphocytes towards advanced stage ovarian cancer with an oncolytic adenovirus expressing a human vIL-2 cytokine.

While the presence of tumor-infiltrating lymphocytes (TILs) associates with improved survival prognosis in ovarian cancer (OvCa) patients, TIL therapy benefit is limited. Here, we evaluated an oncolytic adenovirus coding for a human variant IL-2 (vIL-2) cytokine, Ad5/3-E2F-d24-vIL2 (vIL-2 virus), also known as TILT-452, as an immunotherapeutic strategy to enhance TIL responsiveness towards advanced stage OvCa tumors. Fragments of resected human OvCa tumors were processed into single-cell suspensions, and autologous TILs were expanded from said samples. OvCa tumor specimens were co-cultured with TILs plus vIL-2 virus, and cell killing was assessed in real time through cell impedance measurement. Combination therapy was further evaluated in vivo through a patient-derived xenograft (PDX) ovarian cancer murine model. The combination of vIL-2 virus plus TILs had best cancer cell killing ex vivo compared to TILs monotherapy. These results were supported by an in vivo experiment, where the best OvCa tumor control was obtained when vIL-2 virus was added to TIL therapy. Furthermore, the proposed therapy induced a highly cytotoxic phenotype demonstrated by increased granzyme B intensity in NK cells, CD4+ T, and CD8+ T cells in treated tumors. Our results demonstrate that Ad5/3-E2F-d24-vIL2 therapy consistently improved TILs therapy cytotoxicity in treated human OvCa tumors.

Boosting cytotoxicity of adoptive allogeneic NK cell therapy with an oncolytic adenovirus encoding a human vIL-2 cytokine for the treatment of human ovarian cancer.

Despite good results in the treatment of hematological malignancies, Natural killer (NK) cells have shown limited effectiveness in solid tumors, such as ovarian cancer (OvCa). Here, we assessed the potential of an oncolytic adenovirus expressing a variant interleukin-2 (vIL-2) cytokine, Ad5/3-E2F-d24-vIL2 (vIL-2 virus), also known as TILT-452, to enhance NK cell therapy efficacy in human OvCa ex vivo. Human OvCa surgical specimens were processed into single-cell suspensions and NK cells were expanded from healthy blood donors. OvCa sample digests were co-cultured ex vivo with NK cells and vIL-2 virus and cancer cell killing potential assessed in real time through cell impedance measurement. Proposed therapeutic combination was evaluated in vivo with an OvCa patient-derived xenograft (PDX) in mice. Addition of vIL-2 virus significantly enhanced NK cell therapy killing potential in treated OvCa co-cultures. Similarly, vIL-2 virus in combination with NK cell therapy promoted the best in vivo OvCa tumor control. Mechanistically, vIL-2 virus induced higher percentages of granzyme B in NK cells, and CD8+ T cells, while T regulatory cell proportions remained comparable to NK cell monotherapy in vivo. Ad5/3-E2F-d24-vIL2 virus treatment represents a promising strategy to boost adoptive NK cell therapeutic effect in human OvCa.

Respiration indices and stability measurements of compost through electrolytic respirometry.

An experimental technique for compost stability measurements based on Sapromat electrolytic respirometry was optimised and subsequently applied to a sludge composting process. Anaerobically digested sewage sludge mixed with reed was composted during 90 days in a pilot-scale rotary drum with forced aeration. Periodic solid samples were taken, and a previously optimised respirometric procedure was applied in order to measure the oxygen consumption. The respirometric experiments were made directly with a few grams of solid samples, optimum moisture and 37 °C over a period of 96 h. The results obtained showed how the respiration activity of the sludge decreased during the composting experiment under the specific operating conditions. The specific oxygen uptake rate (SOUR) instant values from the oxygen consumption curves were obtained, and two commonly used respirometric indexes (RI(24) and AT(4)) were calculated for all samples. Both RI(24) (a mean of the SOUR values during the 24 h maximum activity period) and AT(4) (total oxygen consumption after 4 days) were the recommended parameters for the estimation of compost stability by the European Union in the second draft of the Working Document on the Biological Treatment of Biowaste in 2001. Both indexes exponentially decreased with the composting time, and a good linear correlation between them was observed. Final values of RI(24) and AT(4) after 90 days were 600 mg O(2) kg VS(-1) h(-1) and 26 mg O(2) gTS(-1), respectively. We also considered if this technique could be classified as a Dynamic or Static method, the two primary respirometric techniques for measuring compost stability. Supposing that the proposed procedure is considered a dynamic method (no limitations on the amount of oxygen supply), the final RI(24) obtained was compared with the dynamic respiration index (DRI) proposed by the EU (1000 mg O(2) kg VS(-1) h(-1)). Our result indicated that stable compost was obtained after 90 d. However, if a static limit was considered (AT(4) lower than 10 mg O(2) gTS(-1) as proposed by the EU), our result would indicate that more residence composting time would be needed. Taking into account these results, the advantages and disadvantages and the validity of the proposed method are discussed.

Kinetics of forced aerated biodegradation of digested sewage sludge-reed mixtures at different temperatures.

This work presents a kinetic analysis of the aerobic biodegradation of anaerobically digested sewage sludge and dried reed mixtures at different temperatures. Batch experiments were conducted in laboratory-scale reactors with temperature (T) control and forced aeration of the solid mixture. The biowaste mixture was treated at four different temperatures: 25, 40, 50 and 60 °C, with moisture controlled and samples taken weekly for carbon (C) and volatile solids (VS) measurements. The duration of experiments was either 90 d (at 25 °C) or 60 d (at 40, 50 and 60 °C). Two different kinetic models were used to fit the carbon mineralisation curves: the 2C model, which considers two organic fractions (biodegradable and non-biodegradable) and the 3C model, which considers three fractions (easily biodegradable, slowly biodegradable and non-biodegradable). In both cases, the kinetic rate constants were calculated by mathematical fitting and were compared with previously reported values. The temperature influence on the rate constants was studied for both models using a T-dependent equation. The calculated kinetic rate constants were in agreement with previously published values, and good fitting of the experimental data was obtained with both models. Similar rate constant values were obtained for mineralisation of the biodegradable fraction (2C model) and the easily biodegradable fraction (3C model). The rate constants for the slowly biodegradable fraction (3C model) were much lower. A good correlation between rate constants and T was observed. Different optimum temperature values were obtained for each rate constant depending on which carbon fraction was degraded. The T-dependent rate constant values obtained could be used for modelling the C mineralisation of real variable-temperature composting processes.

Evaluation of carbon degradation during co-composting of exhausted grape marc with different biowastes.

In this work the carbon biodegradation of exhausted grape marc (EGM) combined with other organic wastes using the turned pile composting system was studied. Four different piles were made of EGM in Pile 1, EGM mixed with cow manure and straw (CMS) in Pile 2, EGM mixed with municipal solid waste (MSW) in Pile 3 and EGM mixed with grape stalks (GS) in Pile 4. The results obtained were modelled to determine the main kinetic and stoichiometric parameters. Regarding to the rate constants of the composting processes they were increased from 0.033d(-1), the value obtained when EGM was composted alone, to 0.040 and 0.044d(-1) when MSW and GS were added, respectively as co-substrates. However, the addition of CMS reduced the rate constant. About the biodegradable carbon fractions, it was observed that the co-composting reduced significantly the remanent carbon concentration after composting in all the piles whilst increased the readily biodegradable carbon fractions from 35, the value obtained when EGM was composted alone, to 50 and 60%, respectively when MSW or GS were added. As regards the temperature profiles, only Piles 1 and 4 achieved thermal hygienization values and about the nitrogen losses, the lowest percentage of nitrogen loss took place when GS were added, because of its optimum pH and C/N initial ratio. Thus, though any of these wastes could be used for co-composting with EGM, the use of GS as co-substrate and bulking agent for the co-composting process of EGM was recommended.

Examining relationships between psychotic experiences and suicidal ideation in adolescents using a network approach.

BACKGROUND: Suicide is one of the leading causes of death in young individuals. Timely and adequate identification of individuals with suicidal ideation could prevent from suicidal behavior. Psychotic experiences (PE) have been shown to increase levels of suicidal ideation (SI) in the general population. Therefore, detailed investigation of the relationship of PE and SI is relevant. However, the exact nature of the relationship between these two phenomena remains unclear. Understanding psychopathology as a complex network of interacting symptoms could be helpful to elucidate specific associations existing between PE and SI. METHOD: A specific type of network analysis, the Ising model, was used to examine connections between dichotomized questions on psychotic experiences and suicidal ideation in a cross-sectional study with 1685 adolescents from the general population aged 13-18 years. RESULTS: SI was mostly connected to the PE domains perceptual anomalies (PA) and bizarre experiences (BE), which have higher strength values in the network. Central nodes within these domains, as indexed by higher centrality measures (strength and betweenness) were: auditory experiences (PA1: hearing voices when you are alone), persecutory ideation (BE1: feelings of being persecuted; BE2: conspiracy against you), and social anxiety (SANX) (SANX1: I cannot get close to people). CONCLUSIONS: Suicidal ideation is differentially connected to specific psychotic experiences. Auditory PE, persecutory ideation, and social anxiety symptoms could play a central role in the interconnectedness of the two constructs.

Teaching research: the experience in the collective health master program.at the University of Antioquia, Colombia.

The idea that one learns to do research only by taking methodological courses is false, as it is false the idea that one learns how to do research only through investigative practice. We consider both strategies pertinent and necessary and that is the reason we believe graduated courses based on investigation must contemplate both. This study aims to share with the academic community the concept, the intention, the context, and how the Seminar on Lines of Research in the Collective Health Master's Program at the University of Antioquia, Colombia has been developed. This study emphasizes the development and the results of such experience in the education of researchers, describes its onset, the curriculum structure and the relationship with the research groups, the transformation of students and the professor's role.

Effects of copper source and level on intestinal physiology and growth of broiler chickens.

Dietary copper sulfate (CuSO4) and tribasic copper chloride (TBCC) were examined for their effects on intestinal physiology and growth of broiler chickens. In 2 experiments (Experiments 1 and 2), day-old broiler chicks were fed 1 of 4 diets: a basal diet with no supplemental copper (Cu; negative control), a basal diet + 188 mg of Cu/kg of diet from TBCC or CuSO4, or a basal diet + subtherapeutic antibiotics (bacitracin and roxarsone; positive control). In Experiment 1 (recycled litter), CuSO4 and TBCC increased carcass weight (d 45 posthatch) compared with the negative control (P < 0.05 for each). In Experiment 2 (fresh litter), negative control and TBCC increased carcass weight (d 42 posthatch) compared with the positive control (P < 0.05 for each). At d 30 to 31 posthatch, intestinal histology was measured. In Experiment 1 (recycled litter), dietary TBCC, CuSO4, and positive control decreased the number of lamina propia lymphocytes or intraepithelial lymphocytes (IEL), or both, compared with the negative control (P < 0.05). However, in Experiment 2 (fresh litter), TBCC and positive control increased the number of duodenum IEL compared with the negative control (P < 0.05), and negative control and TBCC increased the number of ileum IEL. These data demonstrate that broiler performance and intestinal physiology can be influenced by dietary Cu source and level as well as microbial environment (fresh vs. recycled litter).

The Reliability and Validity of Liu´s Self-Report Questionnaire for Screening Putative Pre-Psychotic States (BQSPS) in Adolescents.

The usage of rigorous analyses based on contemporary methods to enhance psychometric properties of screening questionnaires aimed to address psychotic-like experiences (PLE) is currently being encouraged. The Brief Self-Report Questionnaire for Screening Putative Pre-psychotic States (BQSPS) is a recently created tool addressing PLE beyond attenuated positive symptoms (APS). Its psychometric properties as a screening tool for first step assessment seems to be adequate, but further research is needed to evaluate certain validity aspects, particularly its dimensionality, internal structure, and psychometric properties in different populations. We assessed the reliability, construct validity, and criterion validity of BQSPS in two samples: 727 adolescents aged 13-18 years, and 245 young adults aged 18-33 years. We used exploratory structural equation modeling (ESEM), confirmatory factor analysis (CFA), and Structural Equation Modeling (SEM). The original four-factor structure was not replicated. The best fit in adolescents was obtained by a structure of three-correlated factors: social anxiety (SA), negative symptoms (NS), and positive symptoms (PS). This structure was confirmed in young adult subjects. The three-factor model reached a predictive capability with suicidality as external criterion. PLE are represented by a three-factor structure, which is highly stable between adolescent and young-adult samples. Although the BQSPS seems to be a valid tool for screening PLE, its psychometric properties should be improved to obtain a more accurate measurement.

Antigen retrieval methods and estrogen receptor immunoexpression using 1D5 antibody: a comparative study.

Long-term formalin tissue fixation results in antigen masking, probably through aldehydic linkage between proteins and fixative molecules. Immunohistochemistry results depend on the type of the detection procedure and the type of antibody used for the reaction. Considering the difficulty in working with estrogen receptor (ER) antibodies and the lack of standardization of the antigen retrieval methods, we quantified the immunoexpression of ER using the 1D5 antibody and a standard streptavidin-biotin detection procedure retrieving with microwave oven, steamer, pressure cooker, and water bath in a set of SBR grade 2 invasive breast carcinomas. Pressure-cooking provided the best results. No significant differences were observed in using the other methods. Pressure-cooking should be recommended as the method of choice for standardization of the ER immunohistochemical reaction.

Internal structure of the Community Assessment of Psychic Experiences-Positive (CAPE-P15) scale: Evidence for a general factor.

BACKGROUND: Psychotic-like experiences (PLEs) are prevalent in the general population and are associated with poor mental health and a higher risk of psychiatric disorders. The Community Assessment of Psychic Experiences-Positive (CAPE-P15) scale is a self-screening questionnaire to address subclinical positive psychotic symptoms (PPEs) in community contexts. Although its psychometric properties seem to be adequate to screen PLEs, further research is needed to evaluate certain validity aspects, particularly its internal structure and its functioning in different populations. AIM: To uncover the optimal factor structure of the CAPE-P15 scale in adolescents aged 13 to 18 years using factorial analysis methods suitable to manage categorical variables. METHOD: A sample of 727 students from six secondary public schools and 245 university students completed the CAPE-P15. The dimensionality of the CAPE-P15 was tested through exploratory structural equation models (ESEMs). Based on the ESEM results, we conducted a confirmatory factor analysis (CFA) to contrast two factorial structures that potentially underlie the symptoms described by the scale: a) three correlated factors and b) a hierarchical model composed of a general PLE factor plus three specific factors (persecutory ideation, bizarre experiences, and perceptual abnormalities). RESULTS: The underlying structure of PLEs assessed by the CAPE-P15 is consistent with both multidimensional and hierarchical solutions. However, the latter show the best fit. Our findings reveal the existence of a strong general factor underlying scale scores. Compared with the specific factors, the general factor explains most of the common variance observed in subjects' responses. CONCLUSIONS: The findings suggest that the factor structure of subthreshold psychotic experiences addressed by the CAPE-P15 can be adequately represented by a general factor and three separable specific traits, supporting the hypothesis according to which there might be a common source underlying PLEs.

Combined mesencephalic and hypothalamic transplants reverse lesion-induced sexual behavior deficits in the male rat.

Studies of sexual behavior in rodent animal models have provided evidence about the relevant role played by the medial preoptic area of the anterior hypothalamus and the central tegmental field within the mesencephalon in the control of this behavior. Bilateral lesions of the anterior hypothalamus or central tegmental field as well as combined unilateral lesions of both these regions result in sexual behavior deficits. Studies using fetal hypothalamic transplants have been shown to reverse sexual behavior deficits induced either by lesions or aging. However, no previous study has evaluated the effect of combined homotopic transplants into both the anterior hypothalamus and the mesencephalon. In the present study male Wistar animals received two electrolytic lesions, one aimed at the ipsilateral medial preoptic area of the anterior hypothalamus and the other at the contralateral central tegmental field. Following these lesions, unilateral homotopic fetal hypothalamic and mesencephalic transplants were placed into the lesioned areas. Sexual behavior recovered gradually and by weeks 14-15 after transplantation, above 90% of animals with bilateral transplants showed mounts, intromissions, and ejaculations. Only animals with viable transplants located within both lesioned areas showed recovery. These results indicate that the behavioral deficits induced by combined unilateral lesions of hypothalamic and mesencephalic regions can be reversed by homotopic fetal transplants and that this recovery could be the result of the restoration of a behavioral relevant circuit between transplants and host brain nuclei separated by as much as 5 mm, which makes this an excellent model to study mechanisms underlying behavioral recovery after transplantation.

Vascular density (tumor angiogenesis) in non-Hodgkin's lymphomas and florid follicular hyperplasia: a morphometric study.

Tumor angiogenesis is required for tumor growth and metastasis. A statistically significant correlation has been demonstrated between prognosis and the microvessel density (a measure of tumor angiogenesis) of solid tumors, particularly of the breast and prostate, and lymphoid neoplasms. The aim of this study was to establish whether a correlation exists between vascular density and the malignant category of Non-Hodgkin's Lymphoma (NHL) defined by two classification systems (Kiel and Working Formulation). We also tested whether florid follicular hyperplasia (FFH) and follicular lymphomas (FL) behave as new vessel stimulating conditions. Eighty-nine NHL lymph node biopsies were reviewed and categorized according to the Kiel Classification and Working Formulation. Twelve FL were also selected and compared to 12 FFH biopsies. Vessels were highlighted by immunostaining with anti-Factor VIII antibody and quantified both by counting higher vascular density fields and by estimating the proportional vascular area. The results showed a statistically significant difference between low and high grade NHL, when classified in either the Working Formulation (p=0.0015) or the Kiel Classification (p=0.002). No differences were found in vessel counts between Working formulation intermediate and high grade lymphomas. Vascular density is similar when FFH and FL interfollicular areas are compared.

Tumour angiogenesis as a prognostic factor for disease dissemination in retinoblastoma.

AIM: To evaluate tumour angiogenesis as a predictor of prognosis in retinoblastoma. METHODS: This was a retrospective, non-randomised comparative clinicopathological study. The histopathology from 24 cases of Reese-Ellsworth (RE) group V unilateral retinoblastoma treated by enucleation alone was reviewed. Group I consisted of five patients (four RE group Vb and one group Va) who developed disseminated disease at a mean of 10.4 months after enucleation. The remaining 19 patients constitute group II (18 RE group Vb and 1 group Va), none of whom had developed metastatic disease with a mean follow up of 54 months. None of the 24 patients had evidence of extraocular disease at enucleation. The surgical specimens from patients with unilateral retinoblastoma treated by enucleation at Hospital do Cancer AC Camargo between January 1992 and December 1995 were identified, reviewed and the clinical data recorded. Two subsequent histological sections were prepared. One stained with haematoxylin and eosin for assessment of choroidal and optic nerve invasion, and the other for immunoreaction with an endothelium specific marker (antibody anti-CD 34). The main outcome measures were choroidal and/or optic nerve invasion and quantification of the tumour's relative vascular area (TRVA) obtained by Chalkley counting. RESULTS: Choroidal invasion was present in three eyes of group I (all massive) and six eyes of group II (two focal and four massive). Optic nerve invasion was found in two eyes of group I (all post-laminar) and four eyes of group II (three prelaminar and one post-laminar). There was no statistical difference regarding choroidal or optic nerve between the two groups. The TRVA was the only independent variable found to predict disease dissemination (p = 0.008 by Cox analysis). A TRVA equal to or greater than 3.9% had 100% sensitivity and 79% specificity in predicting disease dissemination. CONCLUSIONS: Quantification of angiogenesis, through measurement of the TRVA, can help to identify patients with retinoblastoma at high risk for disease dissemination after enucleation.

Socio-sexual behavior in male rats after lesions of the dorsolateral tegmentum.

The medial preoptic area of the anterior hypothalamus (MPOA/AH) and the dorsolateral tegmentum (DLT) play an important role in the control of sexual behavior. Unilateral lesions of the MPOA/AH (medial preoptic area of the anterior hypothalamus) combined with unilateral lesions of the contralateral DLT result in deficits in male sexual behavior, while bilateral electrolytic lesions of the DLT have similar effects. In the present study, coital and socio-sexual interactions were recorded before and after bilateral electrolytic DLT lesions. Coital behavior was monitored for 15 weeks after surgery and socio-sexual interactions one 1 and 3 weeks after lesion. DLT-lesioned animals showed reduced copulatory behavior throughout the 15 weeks postlesion. This inhibition was associated with changes in exploratory (sniffing), precopulatory (pursuit and genital exploration), and postcopulatory behaviors (self-grooming). No differences were found in the weights of the testicles, prostate and seminal vesicles. These results indicate that lesions of the DLT produced permanent deficits in sexual behavior associated with a generalized modification of sociosexual behavior. These deficits indicate reduced sexual motivation possibly due to the disruption of the output pathway from the MPOA/AH (medial preoptic area of the anterior hypothalamus) to the DLT.

Farmacoterapéutica de la anticoagulación. Revisión de la literatura / Pharmacotherapeutic of anticoagulation: review of literature / Farmacoterapia da anticoagulação. Revisão da literatura

La terapia anticoagulante tiene múltiples indicaciones en diversos contextos; va más allá de la prevención de la formación de \r\ntrombos o su propagación y tiene como objetivo final mejorar la calidad de vida de los pacientes. En efecto, la anticoagula\r\n-\r\nción se hace relevante en diversas situaciones clínicas que abarcan desde enfermedades crónicas hasta patologías quirúrgicas \r\ny situaciones especiales (obesidad, enfermedad renal crónica, trauma, cáncer) para evitar desenlaces adversos, tales como el \r\ntromboembolismo venoso, los estados hipercoagulables, el síndrome coronario agudo, la fibrilación y el aleteo (\r\nflutter\r\n) auricular, \r\nentre otros. En este sentido, la comprensión adecuada y la formulación de dosis óptimas de anticoagulantes recobran especial \r\nimportancia. El objetivo de este trabajo fue revisar la evidencia proveniente de estudios clínicos sobre el papel de los principales \r\nanticoagulantes orales y parenterales en el contexto de los pacientes con indicación de anticoagulación por antecedentes pato\r\n-\r\nlógicos, quirúrgicos y en situaciones especiales como las mencionadas. Existen diversos conceptos y recomendaciones sobre la profilaxis y el tratamiento anticoagulante en indicaciones habituales; sin embargo, se debe establecer un consenso de anticoagu\r\n-\r\nlación en situaciones especiales que se presentan en la práctica clínica diaria.

Anticoagulant therapy has multiple indications in diverse contexts; it \r\ngoes beyond preventing the formation and propagation of thrombi \r\nand has as its final objective improving the quality of life of patients. \r\nIn effect, anticoagulation becomes relevant in diverse clinical situ\r\n-\r\nations, ranging from chronic diseases to surgical pathologies and \r\nspecial situations (obesity, chronic kidney disease, trauma, cancer), \r\nin order to avoid adverse outcomes such as venous thromboem\r\n-\r\nbolism, hypercoagulable states, acute coronary syndrome, atrial \r\nflutter and fibrillation, among others. In this sense, adequate under\r\n-\r\nstanding and formulation of optimum doses of anticoagulants gain \r\nparticular importance.\r\nThe objective of this work was to review the evidence from \r\nclinical studies on the role of the main oral and parenteral \r\nanticoagulants in the context of patients with indication for \r\nanticoagulation for pathological, surgical and special situations \r\nlike the aforementioned. Although there are several concepts \r\nand recommendations in prophylaxis and anticoagulant \r\ntreatment in habitual indications, in special situations that are \r\npresented in daily clinical practice with patients, and for which \r\nthere is still no consensus about medications and dosages \r\noptimal, indications of anticoagulation should be established

A terapia anticoagulante tem múltiplas indicações em diversos \r\ncontextos. Além da prevenção da formação de trombos \r\nou sua propagação, ela tem como objetivo final melhorar a \r\nqualidade de vida dos pacientes. De fato, a anticoagulação é \r\nrelevante em diversas situações clínicas que abrangem desde \r\ndoenças crônicas até patologias cirúrgicas e situações especiais \r\n(obesidade, doença renal crônica, trauma, câncer) para evitar \r\nresultados adversos, tais como tromboembolismo venoso, \r\nestados hipercoaguláveis, síndrome coronária aguda, fibri\r\n-\r\nlação e flutter atrial, entre outros. Deste modo, a compreensão \r\nadequada e a formulação de doses ótimas de anticoagulantes \r\nsão particularmente importantes. O objetivo deste trabalho \r\nfoi revisar a evidência proveniente de estudos clínicos sobre \r\no papel dos principais anticoagulantes orais e parentais no \r\ncontexto dos pacientes com indicação de anticoagulação por \r\nantecedentes patológicos, cirúrgicos e em situações especiais, \r\ncomo as mencionadas. Existem diversos conceitos e reco\r\n-\r\nmendações sobre a profilaxia e o tratamento anticoagulante \r\nem indicações habituais. Entretanto, deve-se estabelecer um \r\nconsenso de anticoagulação em situações especiais que são \r\napresentadas na prática clínica diária