Electrocardiogram alterations in non-traumatic brain injury: a systematic review.

The presence of abnormal electrocardiograms in individuals without known organic heart disease is one of the most common manifestations of cardiac dysfunction occurring during acute non traumatic brain injury. The primary goal of the present review is to provide an overview of the available data and literature regarding the presence of new-onset electrocardiographic (ECG) alterations in acute non traumatic brain injury. The secondary aim is to identify the incidence of ECG alterations and consider the prognostic significance of new-onset ECG changes in this setting. To do so, English language articles from January 2000 to January 2022 were included from PubMed using the following keywords: "electrocardiogram and subarachnoid hemorrhage", "electrocardiogram and intracranial hemorrhage", "Q-T interval and subarachnoid hemorrhage ", "Q-T interval and intracranial bleeding ", "Q-T interval and intracranial hemorrhage", and "brain and heart- interaction in stroke". Of 3162 papers, 27 original trials looking at electrocardiogram alterations in acute brain injury were included following the PRISMA guideline. ECG abnormalities associated with acute brain injury could potentially predict poor patient outcomes. They could even herald the future development of neurogenic pulmonary edema (NPE), delayed cerebral ischemia (DCI), and even in-hospital death. In particular, patients with SAH are at increased risk of having severe ventricular dysrhythmias. These may contribute to a high mortality rate and to poor functional outcome at 3 months. The current data on ECG QT dispersion and mortality appear less clearly associated. While some patients demonstrated poor outcomes, others showed no relationship with poor outcomes or increased in-hospital mortality. Observing ECG alterations carefully after cerebral damage is important in the critical care of these patients as it can expose preexisting myocardial disease and change prognosis.

Acute Traumatic Pain in the Emergency Department.

Trauma is a major cause of mortality throughout the world. Traumatic pain-acute, sudden, or chronic-is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage". Patients' perceptions of pain assessment and management have become an important criterion and relevant outcome measure for healthcare institutions. Several studies show that 60-70% of ER patients experience pain, and more than half of them express a feeling of sorrow, which can be moderate or severe, at triage. The few studies that have analyzed how pain is assessed and managed in these departments agree that approximately 70% of patients receive no analgesia or receive it with remarkable delay. Specifically, less than half of the patients receive treatment for pain during admission and 60% of discharged patients have higher intensity pain than at admission. Trauma patients are also the ones who most commonly report low satisfaction with pain management. Associated with this lack of satisfaction, we can describe the poor use of tools for measuring and recording pain, poor communication among caregivers, inadequate training in pain assessment and management, and widespread misconceptions among nurses about the reliability of patients' estimation of pain. The aim of this article is to review the scientific literature to explore the methodologies of pain management in trauma patients attending the emergency room and analyzing their weaknesses as a starting point to improve the approach to this, unfortunately too often, underestimated issue. A literature search was performed using the major databases to identify relevant studies in indexed scientific journals. The literature showed that the multimodal approach in trauma patients is the best approach to pain management. It is becoming increasingly crucial to manage the patient on multiple fronts. Drugs acting on different pathways can be administered together at lower doses, minimizing risks. Every emergency department must have staff trained in the assessment and immediate management of pain symptoms as this allows the reduction of mortality and morbidity and shortens hospital stays, contributing to early mobilization, reduced hospital costs, and enhanced patient satisfaction and quality of life.

Lactic Acidosis Related to Pharmacotherapy and Human Diseases.

Lactic acidosis represents one of the most common conditions that can compromise the health of intensive care unit (ICU) patients, increasing the mortality of patients with high levels of Lactate who do not receive a proper treatment within the first 6 h of hospitalization. There are two enantiomers of lactic acid: L-lactic acid (when the concentration increases, it can lead to a state of severe acidemia risking cardiovascular collapse, causing an increase in mortality in ICU patients) and D lactic acid (produced in the human organism by microbiota and its production increases during some pathological status). Generally, increased levels of serum lactic acid could be due to numerous factors, including hypoxia (caused for example by septic/cardiogenic/hypovolemic or obstructive shock), specific pathologies (e.g., liver disease), use of some drugs (e.g., metformin), presence of toxins, and trauma. Since the underlying cause could be fatal for the ICU patient, it is important to understand the root of this clinical status with a view to correct it and prevent the risk of a poor clinical outcome. Prevention and early treatment are the keys to control the negative clinical consequences. The aim of this review is to revise the scientific literature for further confirmation about the importance of early identification of acidotic statuses and to underline how an early diagnosis can prevent the worst clinical outcome, especially for ICU patients who are more fragile compared to the general population.

Aportes al debate sobre investigación teórica o conceptual / Contributions to the debate on theoretical or conceptual research

El presente artículo pretende abonar el debate sobre la delimitación y alcance de lo que en algunos informes de investigación y en la bibliografía existente se ha nominado como investigación teórica o investigación conceptual. Aunque varios autores hacen referencia a este tipo de investigaciones hemos encontrado ambigüedades en el uso de estos términos, así como inespecificidades o superposiciones en estas nominaciones y en las connotaciones y clasificaciones que les subyacen. Algunas de las divergencias relevadas son las que tienden a confundir la investigación conceptual con la investigación cualitativa, la investigación bibliográfica o documental, el estudio de caso, las monografías o incluso lejos de encuadrarse en un cierto tipo de investigación, hacer extensiva la confusión a conceptos metodológicos tales como marco teórico o rastreo del estado del arte. Proponemos revisar los fundamentos, implicancias y alcances específicos de este tipo particular de investigaciones a partir de algunas reflexiones epistemológicas y metodológicas(AU)

This article aims to support the debate on the delimitation and scope of what in some research reports and in the existing bibliography has been nominated as theoretical research or conceptual research. Although several authors refer to this type of research, we have found ambiguities in the use of these terms, as well as non-specificities or overlaps in these nominations and in the connotations and classifications that underlie them. Some of the divergences found are those that tend to confuse conceptual research with qualitative research, bibliographic or documentary research, case studies, monographs or even far from being framed in a certain type of research, extending the confusion to concepts methodologies suchas theoretical framework or tracking of the state of the art. We propose to review the foundations, implications and specific scope of this particular type of research based on some epistemological and methodological reflections(AU)

Cet article vise à soutenir le débat sur la délimitation et la portée de ce qui dans certains rapports de recherche et dans la bibliographie existante a été nommé comme recherche théorique ou recherche conceptuelle. Bien que plusieurs auteurs se réfèrent à ce type de recherche, nous avons trouvé des ambiguïtés dans l'utilisation de ces termes, ainsi que des non-spécificités ou des chevauchements dans ces nominations et dans les connotations et classifications qui les sous-tendent. Certaines des divergences constatées sont celles qui tendent à confondre la recherche conceptuelle avec la recherche qualitative, la recherche bibliographique ou documentaire, les études de cas, les monographies ou même loin de s'inscrire dans un certain type de recherche, étendant la confusion aux concepts méthodologiques tels que cadre théorique ou suivi de l'état de l'art.Nous proposons de passer en revue les fondements, les implications et la portée spécifique de ce type particulier de recherche à partir de quelques réflexions épistémologiques et méthodologiques(AU)

Este artigo tem como objetivo apoiar o debate sobre a delimitação e o alcance do que em alguns relatórios de pesquisa e na bibliografia existente tem sido denominado como pesquisa teórica ou pesquisa conceitual. Embora vários autores façam referência a esse tipo de pesquisa, encontramos ambigüidades no uso desses termos, bem como não especificidades ou sobreposições nessas nomeações e nas conotações e classificações que as fundamentam. Algumas das divergências encontradas são aquelas que tendem a confundir pesquisa conceitual com pesquisa qualitativa, pesquisa bibliográfica ou documental, estudos de caso, monografias ou mesmo longe de estarem enquadradas em um determinado tipo depesquisa, estendendo a confusão a conceitos metodológicos como referencial teórico ou acompanhamento do estado da arte.Propomo-nos a fazer uma revisão dos fundamentos, implicações e alcance específico deste tipo particular de investigação a partir de algumas reflexões epistemológicas e metodológicas(AU)

Exigibilidad y justiciabilidad desde la epidemiología territorial: una construcción inicial con actores/as comunales / Exigibility and justiciability from territorial epidemiology: an initial construction with communal actors

La Epidemiología Territorial Participativa articula conocimientos y técnicas provenientes de las ciencias sociales y la salud comunitaria que potencian prácticas implicadas y transformadoras. Igualdad y no discriminación se conjugan con los imperativos éticos de exigibilidad y justiciabilidad del derecho a la salud. El objetivo del trabajo es transmitir un primer momento de mapeo de actores y análisis de necesidades, demandas, problemas y prioridades de salud de las comunas 3 y 4, de la CABA, desde las narrativas y sentidos de actores sociales. Desde una perspectiva del Análisis Crítico del Discurso y la Investigación Acción Participativa, identificamos situaciones sanitarias locales con efectores de Centros de de Salud y Acción Comunitaria, organizaciones de la sociedad civil, equipos técnicos de defensorías de niñas/os y adolescentes, y docentes de escuelas medias. Triangulamos entrevistas, observación participante y dialéctica con fuentes de datos de registros locales. Visualizamos nudos críticos en la percepción de derechos de ciudadanía de sectores de vecinos, y la incorporación de prácticas y lógicas de inclusión de la diversidad de género, social y cultural.

Territorial Participative Epidemiology articulates knowledge and technologies from social sciences and community health to promote implied practices and social change. Interdiscipline and knowledge's democratization are based on a participative action perspective that includes diverse actors on monitoring and social audit of communitarian problems. Equality and antidiscrimination conjugate with ethical imperatives of exigibility and justiciability of health's right. Our objective is to transmit a preliminary diagnosis of actors and communitarian problems and priorities on collective health in communes 3 and 4, of Buenos Aires City, from the point of view of social actors. From Participatory Action Research and Critical Discourse Analysis, sources of information and instruments are triangulated, in co-management with health and legal local professionals and social organizations. Methodological tools used are: simple, participatory and dialectic observations; in-depth and participatory interviews; analysis of local reports. We visualize critical knots and gaps over perception of rights in population in social vulnerability, and lack of incorporation of practices and logics based in diversity of gender, social and cultural.

Narrativas adolescentes en contextos críticos / Adolescents narratives in critical contexts

Este proyecto explora representaciones y prácticas subjetivantes de adolescentes en contextos de vulnerabilidad, asistentes a escuelas de la Zona de Acción Prioritaria (de Educación) y en situación de calle en el Sur de la CABA. Desde la perspectiva de la Psicología Social Comunitaria pretendemos promover espacios de subjetivación, lazo social y ciudadanía, en territorios de vulnerabilidad social, precariedad y fragilidad de las existencias. Mediante dispositivos grupales, entrevistas y observaciones participantes con adolescentes, docentes, directivos y operadores de programas reconstruimos el contexto narrativo en que articulan concepciones de sí, de otros y proyecciones futuras. Mediante el análisis de contenido, categorizamos emergentes individuales y colectivos, en interdependencia de procesos reflexivos y no concientes, constitutivos de la red simbólica y el entramado social en que viven. La naturalización de la violencia estructural, intragrupal y el embarazo adolescente surgieron como analizadores de construcciones que requieren ser interpeladas, a partir de la exigibilidad de derechos y la equidad de género. Instalamos el interrogante sobre la viabilidad de las políticas públicas y sociales, la sustentabilidad intergeneracional y los entornos de sostén y cuidado con los actores sociales involucrados, desde discursos y prácticas que resistan los modos desubjetivantes que desestabilizan la organización psíquica y favorecen la expulsión social.

This project explores representations and subjectifying practices of adolescents in contexts of vulnerability, attending schools in Priority Action Area (Education) and in street situation in the south of Buenos Aires City. From the perspective of Community Social Psychology we aim to promote opportunities for subjectivation, social bonds and citizenship in territories of social vulnerability, precariousness and fragility of existences. Through group devices, interviews and participant observations with adolescents, teachers, authorities and programme operators we reconstruct the narrative context in which they articulate conceptions of self, others and future projections. Through content analysis, we categorize individual and collective emergents, interdependent with reflective and non-conscious processes that constitute the symbolic and social networks in which they live. Naturalization of structural violence and teenage pregnancy emerged as analyzers of constructions that need to be questioned, based on the enforceability of rights and gender equity. We put forward the questioning of the viability of public policies, intergenerational sustainability and support and care environments with stakeholders, based on discourses and practices that resist destructive ways that destabilize psychic organization and ensure social expulsion.

Salud comunitaria: jóvenes escolarizados y vulnerabilidad psicosocial / Communitarian health: adolescents enrolled in school and psychosocial vulnerability

Desde la Psicología Comunitaria indagamos los efectos de las políticas públicas en ámbitos de prevención y promoción de la salud infanto juvenil en situación de vulnerabilidad psicosocial. Las tensiones entre viejos paradigmas tutelares y los nuevos basados en protección de derechos, son analizados como procesos historizantes y transformadores. Con metodología de Investigación Acción Participativa nuestros objetivos son identificar las construcciones sobre necesidades socioculturales y sanitarias, relevar cuestiones de género y obstáculos a los derechos sexuales y reproductivos, y reflexionar sobre los proyectos de vida. La comunidad participante son adolescentes concurrentes a escuelas de Zonas de Acción Prioritaria en Buenos Aires y trabajadores de educación. Se triangulan fuentes primarias, secundarias y técnicas (entrevistas, encuestas y grupos focales). Los resultados muestran actitudes favorables a los espacios que se constituyen para reflexionar acciones de transformación sobre temas identitarios, sexualidad, violencias y accesos a recursos materiales y simbólicos. Las preocupaciones sobre el cuerpo relacionadas con ideales femeninos de belleza y masculinos de fuerza pueden interpretarse dentro de estereotipos tradicionales. Los problemas de salud vinculados con uso problemático de drogas, violencias, infecciones de transmisión sexual son cotidianidades, a veces naturalizadas en la vida de los adolescentes, y preocupaciones frecuentes de docentes y trabajadores de salud.

Discapacidad, pobreza y sus abordajes: revisión de la estrategia de rehabilitación basada en la comunidad (RBC) / Disability, poverty and their approaches: review of community based rehabilitation strategy (CBR)

El artículo presenta los resultados de una revisión bibliográfica sobre la estrategia de Rehabilitación Basada en la Comunidad (RBC). El mismo fue elaborado en el marco de los proyectos de Beca de Doctorado UBACyT Desempeño ocupacional y salud en personas con discapacidad motriz en situación de pobreza y Proyecto UBACyT Praxis Psicosocial Comunitaria en Salud. Se describen antecedentes, características de la propuesta original, su evolución y algunas experiencias relevadas en América Latina.