[Lower socioeconomic conditions are associated with higher rates but similar outcomes in Sepsis in children]. / Condiciones socioeconómicas más bajas se asocian con tasas de sepsis infantil más altas pero con resultados similares.

Sepsis is an important cause of pediatric morbidity and mortality, especially in low-income countries. Data on regional prevalence, mortality trends, and their relationship with socioeconomic variables are scarce. OBJECTIVE: to determine the regional prevalence, mortality, and sociodemographic situation of patients diagnosed with severe sepsis (SS) and septic shock (SSh) admitted to Pediatric Intensive Care Units (PICUs). PATIENTS AND METHOD: patients aged 1 to 216 months admitted to 47 participating PICUs with a diagnosis of SS or SSh between January 1, 2010, and December 31, 2018, were included. Secondary analysis was performed on the Argentine Society of Intensive Care Benchmarking Quality Program (SATI-Q) database for SS and SSh and a review of the annual reports of the Argentine Ministry of Health and the National Institute of Statistics and Census for the sociodemographic indices of the respective years. RESULTS: 45,480 admissions were recorded in 47 PICUs, 3,777 of them with a diagnosis of SS and SSh. The combined prevalence of SS and SSh decreased from 9.9% in 2010 to 6.6% in 2018. The combined mortality decreased from 34.5% to 23.5%. Multivariate analysis showed that the Odds ratio (OR) of the association between SS and SSh mortality was 1.88 (95% CI: 1.46-2.32) and 2.4 (95% CI: 2.16-2.66), respectively, adjusted for malignant disease, PIM2, and mechanical ventilation. The prevalence of SS and SSh in different health regions (HR) was associated with the percentage of poverty and infant mortality rate (p < 0.001). However, there was no association between sepsis mortality and HR adjusted for PIM2. CONCLUSIONS: Prevalence and mortality of SS and SSh have decreased over time in the participating PICUs. Lower socioeconomic conditions were associated with higher prevalence but similar sepsis outcomes.

Latin American Consensus on the Management of Sepsis in Children: Sociedad Latinoamericana de Cuidados Intensivos Pediátricos [Latin American Pediatric Intensive Care Society] (SLACIP) Task Force: Executive Summary.

Objective: The aim of this study was to develop evidence-based recommendations for the diagnosis and treatment of sepsis in children in low- and middle-income countries (LMICs), more specifically in Latin America. Design: A panel was formed consisting of 27 experts with experience in the treatment of pediatric sepsis and two methodologists working in Latin American countries. The experts were organized into 10 nominal groups, each coordinated by a member. Methods: A formal consensus was formed based on the modified Delphi method, combining the opinions of nominal groups of experts with the interpretation of available scientific evidence, in a systematic process of consolidating a body of recommendations. The systematic search was performed by a specialized librarian and included specific algorithms for the Cochrane Specialized Register, PubMed, Lilacs, and Scopus, as well as for OpenGrey databases for grey literature. The GRADEpro GDT guide was used to classify each of the selected articles. Special emphasis was placed on search engines that included original research conducted in LMICs. Studies in English, Spanish, and Portuguese were covered. Through virtual meetings held between February 2020 and February 2021, the entire group of experts reviewed the recommendations and suggestions. Result: At the end of the 12 months of work, the consensus provided 62 recommendations for the diagnosis and treatment of pediatric sepsis in LMICs. Overall, 60 were strong recommendations, although 56 of these had a low level of evidence. Conclusions: These are the first consensus recommendations for the diagnosis and management of pediatric sepsis focused on LMICs, more specifically in Latin American countries. The consensus shows that, in these regions, where the burden of pediatric sepsis is greater than in high-income countries, there is little high-level evidence. Despite the limitations, this consensus is an important step forward for the diagnosis and treatment of pediatric sepsis in Latin America.

Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): a narrative review and the viewpoint of the Latin American Society of Pediatric Intensive Care (SLACIP) Sepsis Committee.

Background: In this review, we discuss some important aspects of paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS), a new syndrome that is temporally related to previous exposure to SARS-CoV-2 infection. This virus has a broad spectrum of presentation that may overlap with Kawasaki disease in terms of presenting symptoms and laboratory and cardiac findings. Our objective was to review and summarise published evidence regarding the most important aspects of PIMS-TS, with special emphasis on the treatment strategies suggested for middle-income and low-income countries. Methods: A systematic review of the literature was performed in the principal medical databases including PubMed, Embase (OVID) and Google Scholar between December 2019 and August 2020. Results: A total of 69 articles were identified in the described databases. Altogether, 13 articles met the inclusion criteria and were eligible. The most frequently described symptoms of PIMS-TS include fever (82%), shock (67%) and gastrointestinal (87%), skin (71%) and cardiac disorders (75%). In most series, it has been observed between 4 and 6 weeks after the pandemic appears in the general population. Multisystem inflammatory syndrome in children is presented as a great systemic inflammatory response syndrome, which sometimes presents as shock requiring fluid resuscitation and vasoactive drug support (26%). Several treatment strategies have been used, including immunoglobulin, steroids, aspirin, anakinra and anticoagulation among others. These general and specific interventions should be guided by an interdisciplinary and multidisciplinary team, especially in settings with limited resources. Conclusions: PIMS-TS COVID-19 is a new type of presentation of SARS-CoV-2 infection, with an exaggerated inflammatory response and frequent-but not exclusive-digestive and myocardial involvement. It is important to describe the clinical course and outcomes in countries with limited resources as well as establish the role of biomarkers for early diagnosis, effective therapeutic strategies and outpatient follow-up schemes.

La tarea implícita como representante de lo inconsciente en los grupos operativos / The implicit task as a representative of the unconscious in the operative groups

La técnica del grupo operativo se estructura a partir de una tarea que tiene un componente explícito y otro implícito. El ensayo define la tarea implícita desde la teoría de Enrique Pichón Rivière, presentando algunas ampliaciones para este concepto desde la psicología analítica. Así, a lo largo del texto lo implícito es asociado con lo inconsciente, desarrollando también algunas experiencias individuales y grupales que permiten comprender esta articulación. Finalmente se muestran las consecuencias que tiene sobre el rol del coordinador la presencia de lo inconsciente en la dinámica grupal, retomando la importancia de acciones como el señalamiento y la interpretación, las cuales derivan en la creación de hipótesis sobre las fantasías inconscientes individuales y vinculares por medio de imágenes o símbolos.

The technique of the operative group is structured from a task that has an explicit component and an implicit one. The essay defines the implicit task from the Enrique Pichón Rivière theory, presenting some extensions for this concept from analytical psychology. Thus, throughout the text the implicit is associated with the unconscious, also developing some individual and group experiences that allow us to understand this articulation. Finally, the consequences of the role of the coordinator in the presence of the unconscious in the group dynamics are shown, recalling the importance of actions such as pointing and interpretation, which lead to the creation of hypotheses about unconscious and individual fantasies by means of images or symbols.

Creando desde Afrodita o Venus: una representación femenina arquetípica del amor, la sexualidad, el cuerpo y la función alquímica de transformación / Creating from Aphrodite or Venus: an archetypal female representation of love, sexuality, the body and the alchemical transformation function

La pregunta por la psique y su relación con lo femenino se encuentra soterrada en la actualidad por una sociedad que privilegia el logos y la tecnología como maneras de hacer lecturas efectivas del mundo y los sujetos. Venus o Afrodita, según su versión griega o romana, plantea en su mito una posibilidad de reflexión profunda acerca de lo femenino en íntima conexión con el psiquismo y el ejercicio de la psicoterapia. El privilegio de lo masculino y sus expresiones sociales en la forma de razón, competitividad, guerra y consumismo, han velado a lo femenino con representaciones que lo proscriben y desvalorizan mediante figuras como Eva o Pandora, en tanto sus presentaciones. La revisión de la "Gran Diosa" antigua y la exaltación de lo femenino como fuerza creadora y transformadora, permiten entenderlo como algo que está más allá de su reducción a la condición de objeto y restituyen al mito su capacidad de comprensión del ser humano a la luz de la psicoterapia como actividad de creación y transformación, en relación con los temas que encarna la Diosa como las emociones, la sexualidad y el cuerpo. Su análisis otorgará interrogantes que podrán contribuir en las construcciones acerca del psiquismo y de las fuerzas que intervienen en su dinámica.

The question for the psyche and its relationship with the feminine thing is buried at the present time by a society that privileges the logoses and the technology like ways of making effective readings of the world and the fellows. Venus or Aphrodite, according to their Greek or Roman version, outline in their myth a possibility of deep reflection about the feminine thing in intimate connection with the psyche and the exercise of the psychotherapy. The privilege of the masculine thing and their social expressions in the reason form, competitiveness, war and consumerism, they have veiled to the feminine thing with representations that outlaw him and they devaluate by means of figures as Eva or Pandora, as long as their presentations. The Great old Goddess's revision and the exaltation of the feminine thing as force creator and transformer, they allow to understand it as something that is beyond their reduction to the condition of objects and they restore to the myth their capacity of the human being understanding by the light of the psychotherapy like creation activity and transformation, in connection with the topics that it embodies the Goddess like the emotions, the sexuality and the body. Their analysis will grant queries that you/they will be able to contribute in the constructions about the psyche and of the forces that intervene in its dynamics.