La atmósfera psicosocial en la UHTR y su relación teórica con la alianza terapéutica de los pacientes con el equipo multidisciplinar / No disponible

El estudio de la atmósfera de las Unidades de Internamiento Psiquiátrico es una forma de conocer las características de la 'personalidad' de estos lugares; entendida como el conjunto de elementos que las definen y que nacen de las relaciones que se dan entre las personas que permanecen en ellas, en el marco de un tratamiento y en una determinada estructura. La escala de Moos es propiamente un cuestionario (WAS). Consta de 100 peguntas a las que pacientes y personal responden en sentido afirmativo o negativo. La Unidad Hospitalaria de Tratamiento y Rehabilitación, situada en el Complejo Asistencial Benito Menni de Ciempozuelos, es un centro de las Hermanas Hospitalarias, concertado con la Consejería de Sanidad de la Comunidad de Madrid. Es un dispositivo hospitalario especializado en la atención psiquiátrica integral de pacientes con trastorno mental grave, cuya complejidad imposibilita su tratamiento y rehabilitación desde un régimen ambulatorio o de hospitalización breve. El objetivo del presente estudio es relacionar las variables medidas de la atmósfera psicosocial (medida con la WAS) de la UHTR con formulaciones actuales de la Alianza Terapéutica, tomando a los colectivos de pacientes y profesionales como entidades singulares, con el propósito de reflexionar acerca de nuestro programa asistencial de rehabilitación, así como acerca de calidad de las interacciones interpersonales entre los individuos implicados

The study of the atmosphere of Psychiatric Inpatient Units is a way to know the characteristics of the 'personality' of these places; understood as the set of elements that define and born of the relationships that exist between people who stay in them as part of a treatment on a particular structure. Moos scale (WAS) is actually a questionnaire. Comprising 100 questions to which patients and staff respond in the affirmative or negative. The Hospital Treatment and Rehabilitation Unit, located in the Complejo Asistencial Benito Menni de Ciempozuelos, is a center of the Hermanas Hospitalarias, concluded with the Ministry of Health of the Community of Madrid. It is a specialized device in comprehensive hospital psychiatric care of patients with severe mental disorder, whose complexity precludes their treatment and rehabilitation from a brief outpatient or inpatient. The aim of this study is to relate the measures of psychosocial variables atmosphere (measured with WAS) of UHTR with current formulations of the Therapeutic Alliance, taking groups of patients and professionals as singular entities, in order to reflect on our clinical rehabilitation program as well as about quality of interpersonal interactions between the individuals involved

Assembly of Heterometallic Rigid-Rod Complexes and Coordination Oligomers from Gold(I) Metalloligands.

The reactions of TpylC6H4C≡CAuL (Tpyl = 2,2':6',2″-terpyridin-4'-yl; L = PPh3, CNXy; Xy = 2,6-dimethylphenyl) with MX2·nH2O (M = Fe, X = ClO4; M = Co, X = BF4; M = Zn, X = TfO, ClO4) in a 2:1 molar ratio give complexes [M(TpylC6H4C≡CAuL)2]X2. Similarly, the reactions of PPN[(TpylC6H4C≡C)2Au] (PPN = (Ph3P)2N) with an equimolar amount of MX2·nH2O give coordination oligomers [M{(TpylC6H4C≡C)2Au}]nXn (M = Fe, Zn, X = ClO4; M = Co, X = BF4). The complexes and oligomers have been isolated and characterized. The crystal structures of [Fe(TpylC6H4C≡CAuCNXy)2](ClO4)2 and [Co(TpylC6H4C≡CAuPPh3)2](BF4)2 have been determined by X-ray diffraction. The hydrodynamic sizes of complexes [M(TpylC6H4C≡CAuPPh3)2]X2 and coordination oligomers [M{(TpylC6H4C≡C)2Au}]nXn have been studied by NMR diffusion spectroscopy and dynamic light scattering measurements.

Heterometallic complexes with gold(I) metalloligands: self-assembly of helical dimers stabilized by weak intermolecular interactions and solvophobic effects.

New gold(I) alkynyl metalloligands bpylCCAuL, bpyl'CCAuPPh3 , and PPN[Au(CCbpyl')2 ] (bpyl or bpyl'=2,2'-bipyridin-5-yl or -4-yl, respectively; L=PMex Ph3-x (x=1-3), P(C6 H3 Me2 -3,5)3 , PCy3 , XyNC) have been synthesized. Ligands bpylCCH and metalloligands bpylCCAuL (L=PPh3 , PMePh2 , PCy3 , CNXy) react with MX2 (M=Fe, Zn, X=ClO4 ; M=Co, X=BF4 ) to give complexes [M(bpylCCZ)3 ]X2 (Z=H or AuL). In most cases, these complexes are mixtures of fac and mer isomers in a statistical distribution, in both CH2 Cl2 and MeCN. However, for L=PPh3 , the fac isomer is dominant in MeCN. NMR and ESI-MS studies, together with the crystal structure of [Co(bpylCCAuPPh3 )3 ](BF4 )2 , suggest that this solvent dependence is originated by the formation of helical dimers between two fac complexes in MeCN. These dimers are stabilized by solvophobic effects and multiple intermolecular interactions. Complex [Fe(Ph3 PAuCCbpdiylCCAuPPh3 )3 ](ClO4 )2 (bpdiyl=2,2'-bipyridin-5,5'-diyl) was obtained by reaction of three diauro diethynylbipyridines and Fe(ClO4 )2 .

Triple helicates with golden strands: self-assembly of M2Au6 complexes from gold(I) metallaligands and iron(II), cobalt(II) or zinc(II) cations.

Alkynyl gold(I) metallaligands [(AuC≡Cbpyl)2(µ-diphosphine)] (bpyl=2,2'-bipyridin-5-yl; diphosphine=Ph2P(CH2)(n)PPh2, [n=3 (L(Pr)), 4 (L(Bu)), 5 (L(Pent)), 6 (L(Hex))], dppf (L(Fc)), Binap (L(Binap)) and Diop (L(Diop))) react with MX2 (M=Fe, Zn, X=ClO4; M=Co, X=BF4) to give triple helicates [M2(L(R))3]X4. These complexes, except those containing the semirigid L(Binap) metallaligand, present similar hydrodynamic radii (determined by diffusion NMR spectroscopy measurements) and a similar pattern in the aromatic region of their (1)H NMR spectra, which suggests that in solution they adopt a compact structure where the long and flexible organometallic strands are folded. The diastereoselectivity of the self-assembly process was studied by using chiral metallaligands, and the absolute configuration of the iron(II) complexes with L(Binap) and L(Diop) was determined by circular dichroism spectroscopy (CD). Thus, (R)-L(Binap) or (S)-L(Binap) specifically induce the formation of (Δ,Δ)-[Fe2((R)-L(Binap))3](ClO4)4 or (Λ,Λ)-[Fe2((S)-L(Binap))3](ClO4)4, respectively, whereas (R,R)- or (S,S)-L(Diop) give mixtures of the ΔΔ- and ΛΛ-diastereomers. The ΔΔ helicate diastereomer is dominant in the reaction of Fe(II) with (R,R)-L(Diop), whereas the ΛΛ isomer predominates in the analogous reaction with (S,S)-L(Diop). The photophysical properties of the new dinuclear alkynyl complexes and the helicates have been studied. The new metallaligands and the [Zn2(L(R))3](4+) helicates present luminescence from [π→π*] excited states mainly located in the C≡Cbpyl units.

Mono- and dinuclear Ag(I), Au(I), and Au(III) metallamacrocycles containing N-heterocyclic dicarbene ligands.

Ag(I) dicarbene complexes [Ag(m)(L(n))m]X(m) (L(n) = Im(Me)(CH2)(n)Im(Me), Im(Me) = N-methylimidazol-N-yl-2-ylidene; n = 3, X = PF6, m = 2; n = 6-8, 10, X = AgBr2, m = 1, 2) were prepared by reacting Ag2O with 1 equiv of the corresponding bisimidazolium salt [H2L(n)]A2 (A = PF6, Br). The dibromoargentates react with 1 equiv of AgTfO to afford [Ag(m)(L(n))m](TfO)m (m = 1, 2). The room temperature transmetalation reaction of [Ag(m)(L(n))m][AgBr2]m (n = 3, 5, 6-8, 10) with [AuCl(SMe2)] and AgTfO (L(n):Au:TfO = 1:1:1) affords [Au2(µ-L(n))2](TfO)2 (n = 3, 5, 10), or mixtures of [Au(κ(2)-L(n))]TfO (main product for n = 7) and [Au2(µ-L(n))2](TfO)2 (main product for n = 6, 8). At room temperature, the equilibrium between [M2(µ-L(n))2](TfO)2 and [M(κ(2)-L(n))]TfO is fast for M = Ag, but slow for M = Au, in the NMR time scale. When n ≥ 7 and M = Ag or Au, the equilibrium is shifted toward the mononuclear complexes in the order 8 > 10 > 7, which proves that the (CH2)8 linker has the optimal length for trans chelation. Correspondingly, the high-temperature metalation of [H2L(n)]Br2 (n = 8, 10) with 1 equiv of [AuCl(SMe2)] and excess of NaAcO, affords [Au(κ(2)-L(n))]Br with a small amount of [Au2(µ-L(n))2]Br2. If AgTfO is added to the reaction mixture, [Au(κ(2)-L(8))]2[AgBr3] is isolated instead of the desired triflate, which can be obtained by reacting the mixture of [Au(κ(2)-L(8))]Br and [Au2(µ-L(8))2]Br2 with AgTfO. [Au(κ(2)-L(10))]TfO was isolated after thermal conversion of [Au2(µ-L(10))2](TfO)2. [Au(κ(2)-L(8))]TfO reacts with I2 to give trans-[AuI2(κ(2)-L(8))]TfO, which is the first Au(III) complex containing a trans-spanning bidentate ligand. We have determined the crystal structures of complexes [Ag2(µ-L(3))2](PF6)2, [Ag(κ(2)-L(7))]TfO, [Au2(µ-L(3))2](TfO)2, [Au(κ(2)-L(8))]Br, [Au(κ(2)-L(8))]2[AgBr3], and trans-[AuI2(κ(2)-L(8))]TfO.

Self-assembly of looped triple-stranded helicates.

The reaction of the organogold metallaligand [(AuC[triple bond]Cbpyl)(2)(mu-Ph(2)P(CH(2))(4)PPh(2))] (bpyl = 2,2'-bipyridin-5-yl) with Fe(2+) or Zn(2+) ions gave helicates where the three ligand strands adopt a unique looped geometry.

Endocardite da valva tricúspide em crianças / Tricuspid valve endocarditis in children

Quatro crianças, com idade de 5, 1, 16 e 6 anos, três do sexo masculino, apresentaram endocardite isolada da valva tricúspide. Duas foram submetidas a tratamento cirúrgico. Todas exibiam sinais clínicos de sepse, sopro cardíaco e insuficiência cardíaca. Três apresentaram embolia pulmonar. A ecocardiografia demonstrou, em todos, vegetaçöes na valva tricúspide. Dois pacientes, um deles submetido a tratamento cirúrgico, faleceram. A endocardite da valva tricúspide em crianças com sepse, insuficiência cardíaca e embolia pulmonar é uma condiçäo extremamente grave e a indicaçäo cirúrgica precoce pode diminuir sua alta mortalidade

Four children, three males, with ages 5,1, 16 and 6 years, presented with isolated tricuspid valve endocarditis. Two of them weresubmitted to surgical treatment. Sepsis, cardiac murmur and heart failure were present in all of them. Three presented pulmonary embolism. Echocardiography demonstrated vegetation in the tricuspid valve in all cases. Two patients, one of them submitted to surgery, died. Tricuspid valve endocarditis in children with sepsis, heart failure and pulmonary embolism is a severe condition and early surgical treatment may diminished the high mortality