Manifestaciones clínicas post supresión de sedoanalgesia en pacientes adultos de una terapia intensiva / Clinical manifestations after suppression of sedoanalgesia in adult patients in intensive care

Introducción: en la unidad de cuidados intensivos (UCI), las personas asistidas con patologías relevantes se encuentran bajo sedación, una vez que estas se encuentran bajo los principios de supresión de la sedación, es importante identificar cuáles son las manifestaciones que presentan, propias de las sedaciones. Objetivo: describir las manifestaciones clínicas del síndrome de supresión de la sedoanalgesia presentes en pacientes asistidos en un Hospital Público de la Ciudad de Corrientes de enero a diciembre del 2022. Metodología: estudio cuantitativo, descriptivo, transversal y observacional. La muestra incluyó pacientes adultos de UCI. El cálculo del tamaño muestral se realizó a través del método probabilístico aleatorio simple resultando de éste una muestra de 100 historias clínicas. Para la recolección de datos se utilizó la observación y como instrumento un formulario semiestructurado, de carácter anónimo. Cada formulario contenía datos específicos donde se categorizan las variables en estudio como ser edad, sexo, comorbilidades, tiempo de sedoanalgesia, tipo de sedación, sedoanalgesia utilizada, agitación, confusión, alucinación, diaforesis, taquicardia. Resultados: en cuanto a la edad se obtuvo un promedio de 49 años, el sexo predominante fue el masculino con 52%, en cuanto a las comorbilidades más frecuentes, el 20% presentó Insuficiencia Respiratoria Aguda y el 16% Insuficiencia renal. El motivo de ingreso a UCI en mayor medida con el 33% fue por dificultad respiratoria y Post Quirúrgicos complicados 32%. Los fármacos de mayor elección fueron midazolam 94%, seguido del fentanilo 80%. En cuanto al tiempo de sedación de los pacientes, se encontró una media de 1265 horas. Las manifestaciones clínicas que se observaron en la muestra en mayor medida corresponden a taquicardia 70%, agitación 52%, un 37% confusión e hipertensión y un 24% alucinación. Conclusión: las manifestaciones que se presentaron con mayor frecuencia fueron taquicardia, agitación, confusión, hipertensión y con menor frecuencia alucinación[AU]

Introduction: in the intensive care unit (ICU), people treated with relevant pathologies are under sedation. Once they are under the principles of sedation suppression, it is important to identify the manifestations they present, typical of sedations. Objective: To describe the clinical manifestations of sedation suppression syndrome present in patients treated at a Public Hospital in the City of Corrientes from January to December 2022. Methodology: quantitative, descriptive, cross-sectional and observational study. The sample included adult ICU patients. The calculation of the sample size was carried out through the simple random probabilistic method, resulting in a sample of 100 medical records. Manifestaciones clínicas post supresión de sedoanalgesia en pacientes adultos de una terapia intensiva. Observation was used to collect data and a semi-structured, anonymous form was used as an instrument. Each form contained specific data where the variables under study were categorized, such as age, sex, comorbidities, sedation time, type of sedation, sedation used, agitation, confusion, hallucination, diaphoresis, tachycardia. Results: regarding age, an average of 49 years was obtained, the predominant sex was male with 52%, regarding the most frequent comorbidities, 20% presented Acute Respiratory Failure and 16% Renal failure. The reason for admission to the ICU to a greater extent with 33% was due to respiratory difficulty and complicated Post-Surgeries 32%. The drugs of greatest choice were midazolam 94%, followed by fentanyl 80%. Regarding the sedation time of the patients, an average of 1265 hours was found. The clinical manifestations that were observed in the sample to a greater extent correspond to tachycardia 70%, agitation 52%, confusion and hypertension 37% and hallucination 24%. Conclusion: the manifestations that occurred most frequently were tachycardia, agitation, confusion, hypertension and, less frequently, hallucination[AU]

Introdução: na unidade de terapia intensiva (UTI), as pessoas tratadas com patologias relevantes estão sob sedação. Uma vez sob os princípios da supressão da sedação, é importante identificar as manifestações que apresentam, típicas das sedações. Objetivo: Descrever as manifestações clínicas da síndrome de supressão da sedação presentes em pacientes atendidos em um Hospital Público da Cidade de Corrientes no período de janeiro a dezembro de 2022. Metodologia: estudo quantitativo, descritivo, transversal e observacional. A amostra incluiu pacientes adultos internados em UTI. O cálculo do tamanho amostral foi realizado pelo método probabilístico aleatório simples, resultando em uma amostra de 100 prontuários. A observação foi utilizada para a coleta de dados e um formulário semiestruturado e anônimo foi utilizado como instrumento. Cada formulário continha dados específicos onde foram categorizadas as variáveis em estudo, como idade, sexo, comorbidades, tempo de sedação, tipo de sedação, sedação utilizada, agitação, confusão, alucinação, sudorese, taquicardia. Resultados: em relação à idade obteve-se uma média de 49 anos, o sexo predominante foi o masculino com 52%, quanto às comorbidades mais frequentes, 20% apresentavam Insuficiência Respiratória Aguda e 16% Insuficiência Renal. O motivo de internação na UTI em maior proporção com 33% foi por dificuldade respiratória e pós-cirúrgicos complicados 32%. Os medicamentos de maior escolha foram midazolam 94%, seguido de fentanil 80%. Quanto ao tempo de sedação dos pacientes, foi encontrada uma média de 1265 horas. As manifestações clínicas mais observadas na amostra correspondem a taquicardia 70%, agitação 52%, confusão e hipertensão 37% e alucinação 24%. Conclusão: as manifestações que ocorreram com maior frequência foram taquicardia, agitação, confusão, hipertensão e, menos frequentemente, alucinação[AU]

Associations between individual cognitive factors, mode of exposure and depression symptoms in practitioners working with aversive crime material.

Background: There is extensive literature on front-line officers and investigators exposure to trauma and its negative impact on them. However, there are analytical practitioners in law enforcement who indirectly work with the traumatic experiences of other people daily, but are seldom the focus of academic research.Objective: Our goal was to conduct the first international study with these practitioners to identify the risk of depression symptoms and establish whether potentially modifiable risk factors (belief in a just world, mental imagery and thought suppression) and work-related characteristics (medium of exposure) are associated with depression.Method: 99 analysts and secondary investigators employed in police and law enforcement organizations from the UK, Europe and Canada participated in the study. The online survey was advertised to employees via their employers but hosted without employer access. Multiple regression was used to analyze the data.Results: After controlling for age, gender, ethnicity, previous exposure to trauma, and marital status, four potential risk factors were identified. Analytical practitioners with vivid mental imagery, those exposed to crime material via auditory and visual means, those who suppressed intrusive thoughts, and those who believed in a just world reported more depressive symptoms.Conclusions: The majority of our sample reported clinical levels of depressive symptoms. Four potential risk factors accounted for just under half of the variance in depression scores. We consider strategies that can be used to mitigate the potential negative influence of these factors and suggest that these are established as risk factors for depression symptoms via future longitudinal research.

Analytical practitioners are exposed to aversive crime material on a daily basis. The impact of their work and the individual and work-related risk factors are currently unknown.In this sample, 52% of analytical practitioners had moderate depression symptoms, and 37% had severe depression symptoms.Modality of exposure (both auditory and visual exposure), belief in a just world, thought suppression, and mental imagery are potential modifiable risk factors.

Análisis de 23 pacientes con infección por VIH y Covid-19. Estudio descriptivo / Analysis of 23 patients with HIV infection and Covid-19. Descriptive study

Las características clínicas, el diagnóstico, el pronóstico, el tratamiento y la profilaxis de la infección por el coronavirus SARS-CoV-2 en los pacientes infectados por el VIH, son muy similares a los de la población general cuando estos se encuentran con supresión de la replicación viral con el tratamiento antirretroviral y tienen una cifra de linfocitos T CD4 + > de 200 células/uL. El tiempo medio de incubación es de 5 días (entre 2 y 14 días). En sujetos VIH positivos, cuánto mayor es la carga viral plasmática para VIH y el recuento de CD4 + es < 200 cél/uL, el tiempo que transcurre entre la infección por el coronavirus y la aparición de las manifestaciones clínicas es menor. En la población general, el 70-80% de individuos tienen una infección por SARS-CoV-2 leve/moderada, un 20-25% grave y un 5% muy grave que requiere internación en UTI. En los pacientes infectados por el VIH se desconoce esta proporción, aunque estudios preliminares consideran que las proporciones serían del 66%, 22% y 12%, respectivamente25. Se presenta una serie de 23 pacientes con coinfección SARS-CoV-2/VIH y se analizan las características epidemiológicas, clínicas y la evolución en relación con ambas infecciones

The clinical characteristics, diagnosis methods, medical prognosis, treatment alternatives and prophylaxis of coronavirus SARS-CoV-2 infection in HIV infected individuals are very similar in patients under HAART with undetectable viral load and CD4+ > than 200 cell/uL. The mean incubation time is of 5 days (range 2 to 14 days). In HIV-seropositive patients, with high viral load and CD4 < 200 cell/ uL, the time between infection for coronavirus and the onset of symptoms is minor. In the general population, 70% to 80% of individuals infected by SARS-CoV-2 develops a mild to moderate disease; 20% to 25% severe forms and 5% develops very severe clinical compromise that requieres intensive therapy unit income. In HIV-positive patients these percentages would be 66%, 22% y 12%, respectively25. Here we present a series of 23 HIV-seropositive patients coinfected by coronavirus SARS-CoV-2; we analyzed the epidemiology, clinical manifestations and the evolution related with both infections

Achieving the UNAIDS goals by 2030 in people living with HIV: A simulation model to support the prioritization of health care interventions.

OBJECTIVE: We simulated the impact of implementing different health interventions to improve the HIV continuum of care for people diagnosed, on treatment, and virologically suppressed in Spain for the 2020-2030 period. METHODS: The model was carried out in four phases involving a multidisciplinary expert panel: (1) literature review; (2) selection/definition of the interventions and their effectiveness; (3) consensus meeting; and (4) development of an analytical decision model to project the impact of implementing/strengthening these interventions to improve the HIV continuum of care, corresponding to 2017-2019 (87% diagnosed, 97% on treatment, 90% with viral suppression), through the creation of different scenarios for 2020-2030. A total of 19 interventions were selected based on expanding the offer of HIV rapid tests and implementing training/peer programmes, electronic alerts, multidisciplinary care, and mHealth, among others. The effectiveness of the interventions was defined by the percentage increases in diagnosis, treatment, and viral suppression after their implementation, targeting the entire population and specific groups at high-risk (men who have sex with men, migrants, female sex workers, transgender people, and people who inject drugs). RESULTS: Implementing eight interventions for diagnosis, three for treatment, and eight for viral suppression for the target populations during 2020-2030 would increase the continuum of care to approximately 100% diagnosed (remaining residual undetectable cases), 98% treated, and 96% virologically suppressed. CONCLUSIONS: Planification, prioritization, and implementation of selected interventions based on the current HIV continuum of care could allow achievement of the 95-95-95 UNAIDS goals in Spain by 2030.

"Mulher, você não precisa disso": discursos em embate sobre a pílula e a supressão da menstruação / "Woman, you don't need this": Negotiation of discourses on the pill and menstrual suppression / "Mujer, no necesitas esto": Discursos en conflicto sobre la píldora y la supresión de la menstruación

Resumo O discurso médico do século XIX listava uma série de desordens físicas e mentais associadas aos órgãos reprodutivos das mulheres (Rohden, 2009). Um fenômeno corporal até hoje frequentemente construído como patológico é a menstruação (Vieira, 2002), para o qual existe uma ferramenta médica de intervenção amplamente empregada: a pílula anticoncepcional. Como o período menstrual é muitas vezes visto como um problema, sua interrupção por meio da ingestão contínua da pílula é recorrentemente propagada como a solução (Kissling, 2013). À luz dessas ideias, analiso como duas mulheres autoidentificadas como feministas negociam significados sobre a pílula, a menstruação e a supressão menstrual em entrevistas orais semiestruturadas. O objetivo do trabalho é investigar como sentidos biomédicos sobre o corpo feminino são discursivamente reificados, desafiados e corporificados.

Abstract Nineteenth century's medical discourse listed a series of physical and mental disorders caused by women's reproductive organs (Rohden, 2009). A bodily function that until nowadays has been frequently constructed as pathological is menstruation (Vieira, 2002), for which there is a widely employed medical tool of intervention: the contraceptive pill. As the period is often seen as a problem, its suppression through the uninterrupted use of the pill is recurrently advertised as the solution (Kissling, 2013). In light of these ideas, I analyse how two self-identified feminist women negotiate meanings around the pill, menstruation and menstrual suppression in semi-structured oral interviews. The purpose of the work is to investigate how biomedical meanings of the female body are discursively reified, challenged and embodied.

Resumen El discurso médico del siglo XIX enumeraba una serie de trastornos físicos y mentales asociados a los órganos reproductivos de la mujer (Rohden, 2009). Un fenómeno corporal que con frecuencia se interpreta como patológico es la menstruación (Vieira, 2002), para la cual existe una herramienta médica intervencionista ampliamente utilizada: la píldora anticonceptiva. Como el período menstrual a menudo se ve como un problema, su interrupción a través de la toma continua de la píldora se propaga recurrentemente como la solución (Kissling, 2013). A la luz de estas ideas, analizo cómo dos mujeres autoidentificadas como feministas negocian significados sobre la píldora, la menstruación y la supresión menstrual en entrevistas orales semiestructuradas. El objetivo de este trabajo es investigar cómo los significados biomédicos sobre el cuerpo femenino son materializados, cuestionados y encarnados discursivamente.

Bispectral index and suppression ratio after cardiac arrest: are they useful as bedside tools for rational treatment escalation plans?

INTRODUCTION AND OBJECTIVES: Myocardial dysfunction contributes to early mortality (24-72 hours) among survivors of a cardiac arrest (CA). The benefits of mechanical support in refractory shock should be balanced against the patient's potential for neurological recovery. To date, these early treatment decisions have been taken based on limited information leading mainly to undertreatment. Therefore, there is a need for early, reliable, accessible, and simple tools that offer information on the possibilities of neurological improvement. METHODS: We collected data from bispectral index (BIS) and suppression ratio (SR) monitoring of adult comatose survivors of CA managed with targeted temperature management (TTM). Neurological status was assessed according to the Cerebral Performance Category (CPC) scale. RESULTS: We included 340 patients. At the first full neurological evaluation, 211 patients (62.1%) achieved good outcome or CPC 1-2. Mean BIS values were significantly higher and median SR lower in patients with CPC 1-2. An average BIS> 26 during first 12 hours of TTM predicted good outcome with 89.5% sensitivity and 75.8% specificity (AUC of 0.869), while average SR values> 24 during the first 12 hours of TTM predicted poor outcome (CPC 3-5) with 91.5% sensitivity and 81.8% specificity (AUC, 0.906). Hourly BIS and SR values exhibited good predictive performance (AUC> 0.85), as soon as hour 2 for SR and hour 4 for BIS. CONCLUSIONS: BIS/SR are associated with patients' potential for neurological recovery after CA. This finding could help to create awareness of the possibility of a better outcome in patients who might otherwise be wrongly considered as nonviable and to establish personalized treatment escalation plans.

Clinical practice guidelines for transsexual, transgender and gender diverse minors.

Some people, including minors, have a gender identity that does not correspond to the sex assigned at birth. They are known as trans* people, which is an umbrella term that encompasses transgender, transsexual, and other identities not conforming to the assigned gender. Healthcare units for trans* minors require multidisciplinary working, undertaken by personnel expert in gender identity, enabling, when requested, interventions for the minor and their social-familial environment, in an individualized and flexible way during the gender affirmation path. This service model also includes hormonal treatments tailored as much as possible to the individual's needs, beyond the dichotomic goals of a traditional binary model. This guide addresses the general aspects of professional care of trans* minors and presents the current evidence-based protocol of hormonal treatments for trans* and non-binary adolescents. In addition, it details key aspects related to expected body changes and their possible side effects, as well as prior counselling about fertility preservation.

Factors related to inhibition of lactation by pharmacological means at birth in a Spanish referral hospital (2011-2017).

OBJECTIVE: To describe the maternal, neonatal and pregnancy characteristics related to inhibition of lactation (IL) with cabergoline. METHOD: We assessed 20,965 occasions of breastfeeding initiation, according to data collected from obstetric records at the Hospital Clinic of Barcelona (Spain) between January 2011 and December 2017. RESULTS: IL decreased over the study period from 8.78% to 6.18% (odds ratio [OR]: 0.93 per year; 95% confidence interval [95%CI]: 0.90-0.95). Women with a lower educational level (OR: 2.5; 95%CI: 2.0-3.0), mothers living in more depressed areas (OR: 1.08 per 10 extra points over 100; 95%CI: 1.04-1.12), smokers (OR: 2.2; 95%CI: 1.9-2.6), and those with more children (OR: 1.2 for each sibling; 95%CI: 1.1-1.3), preterm birth (OR: 1.8; 95%CI: 1.4-2.3), multiple births (OR: 1.6; 95%CI: 1.2-2.1) and a higher risk pregnancy (OR: 1.3 per risk point; 95%CI: 1.2-1.4) showed a higher prevalence of IL. Compared to women born in Spain, IL was less likely in all other women with the exception of Chinese women (OR: 7.0; 95%CI: 5.7-8.6). These disparities remained during the study period. CONCLUSIONS: Factors related to lower socioeconomic status and poor health were more likely to be associated with IL. The overall use of cabergoline decreased during the study period while inequalities persisted. Taking these inequalities into account is the first step to addressing them.

Meeting the needs of young Latino gay, bisexual, and other men who have sex with men (MSM) and transgender women living with HIV through the weCare intervention in the United States (US).

OBJECTIVE: Young gay, bisexual, and other MSM (men who have sex with men) and transgender women in the United States (US) who are living with HIV, and particularly those who are Latino, have low rates of viral suppression. The weCare intervention uses social media to increase HIV care engagement. METHOD: We used community-based participatory research to develop the intervention as well as theory-based social media messages tailored to each participant's unique context. We analyzed elements and characteristics of weCare, messages sent by the Cyber Health Educator (CHE), and lessons learned to meet the needs of Latino participants living with HIV. RESULTS: We identified 6 core elements, 5 key characteristics, effective social media messages used in implementation, and 8 important lessons regarding relationships between the CHE and HIV clinics, the CHE and participants, and participants and the health system. CONCLUSIONS: Social media offers a promising platform to retain young Latino gay bisexual and other MSM and transgender women living with HIV in care and achieve viral suppression.

OBJETIVO: Los hombres gay, bisexuales y otros HSH (hombres que tienen sexo con hombres) y mujeres transgénero jóvenes en los EEUU que viven con VIH, particularmente aquellos que son latinos, tienen bajos índices de supresión viral. La intervención weCare utiliza las redes sociales para incrementar el compromiso de estos grupos poblacionales hacia su atención médica. MÉTODO: Utilizamos el enfoque de investigación participativa basada en la comunidad para el desarrollo de la intervención y de mensajes teóricos, usando las redes sociales, considerando el contexto de cada participante. Analizamos los elementos y características de weCare, los mensajes enviados por el Educador de Salud Cibernético (ESC) y lecciones aprendidas para atender las necesidades de participantes latinos que viven con VIH. RESULTADOS: Identificamos 6 elementos esenciales, 5 características clave, mensajes efectivos usados y 8 lecciones importantes sobre las relaciones entre el ESC y las clínicas de VIH, el ESC y los participantes y los participantes y el sistema de salud. CONCLUSIONES: El uso de las redes sociales ofrece una plataforma prometedora para mantener la adherencia a los tratamientos médicos y lograr la supresión viral entre los jóvenes latinos gay, bisexuales y otros HSH y mujeres transgénero que viven con VIH.

Introducción de vídeojuegos en el tratamiento convencional de la ambliopía funcional / Incorporation of videogames into the conventional treatment for functional amblyopia

RESUMEN Objetivo: Valorar la efectividad del vídeojuego en educandos que padecen ambliopía funcional. Métodos: Se confeccionó la historia clínica de cada paciente, la cual incluyó la revisión oftalmológica completa, la evaluación de la agudeza visual con la prueba adecuada a cada edad, y se evaluó la presencia de supresión mediante la prueba de filtro rojo y las luces de Worth. Cada prueba se realizó de forma individual según el tipo y la severidad de la ambliopía, y se le indicó la refracción correspondiente. Los pacientes se dividieron en dos grupos: al grupo A se le aplicó la terapia tradicional de la ambliopía, y al grupo B se le siguió la misma pauta que un tratamiento tradicional de ambliopía, pero con la introducción de vídeojuegos. Resultados: Se observó en el grupo A un predominio de los pacientes con agudeza visual inicial entre 0,2 - 0,4 (50 %), la cual se incrementó en dos líneas o más en el (55 %); sin embargo, en el grupo B la agudeza inicial entre 0,2 - 0,4 fue de 56,5 %. Los resultados sensoriales seis meses posteriores al tratamiento, según cada grupo de estudio, mostraron en el grupo B una reducción de la supresión en el 91,3 %, y en el grupo A de un 75 %. Conclusión: La terapia visual combinada con vídeojuego es efectiva; mejora la agudeza visual; elimina y reduce la supresión, por lo que constituye una herramienta que complementa la terapia visual tradicional de la ambliopía.

ABSTRACT Objective: Assess the effectiveness of videogames for students suffering from functional amblyopia. Methods: A clinical record was developed for each patient, which included complete ophthalmological examination, visual acuity evaluation with the suitable test for each age, and determination of the presence of suppression by the red filter test and the Worth lights test. Each test was conducted individually according to the type and severity of amblyopia, and the corresponding refraction was indicated. The patients were divided into two groups: Group A received traditional amblyopia therapy, whereas Group B underwent traditional amblyopia treatment combined with the incorporation of videogames. Results: Group A showed a predominance of patients with initial visual acuity between 0.2 - 0.4 (50%), which increased two lines or more in 55%. However, in Group B initial visual acuity ranged between 0.2 - 0.4 in 56.5%. Six months after treatment, sensory results were 91.3% suppression reduction in Group B and 75% in Group A. Conclusion: Visual therapy proved effective when combined with videogames: visual acuity improved and suppression was reduced. It is thus a suitable tool to complement the traditional visual therapy for amblyopia.

Practical guide on the initial evaluation, follow-up, and treatment of adrenal incidentalomas Adrenal Diseases Group of the Spanish Society of Endocrinology and Nutrition. / Guía práctica sobre la evaluación inicial, seguimiento y tratamiento de los incidentalomas adrenales. Grupo de patología adrenal de la Sociedad Española de Endocrinología y Nutrición.

Initial evaluation of adrenal incidentalomas should be aimed at ruling out malignancy and functionality. For this, a detailed clinical history should be taken, and an adequate radiographic assessment and a complete blood chemistry and hormone study should be performed. The most controversial condition, because of the lack of consensus in its definition, is autonomous cortisol secretion. Our recommendation is that, except when cortisol levels <1.8µg/dL in the dexamethasone suppression test rule out diagnosis and levels ≥5µg/dL establish the presence of autonomous cortisol secretion, diagnosis should be based on a combined definition of dexamethasone suppression test ≥3µg/dL and at least one of the following: elevated urinary free cortisol, ACTH level <10 pg/mL, or elevated nocturnal cortisol (in serum and/or saliva). During follow-up, dexamethasone suppression test should be repeated, usually every year, on an individual basis depending on the results of prior tests and the presence of comorbidities potentially related to hypercortisolism. The initial radiographic test of choice for characterization of adrenal incidentalomas is a computed tomography scan without contrast, but there is no unanimous agreement on subsequent monitoring. Our general recommendation is a repeat imaging test 6-12 months after diagnosis (based on the radiographic characteristics of the lesion). If the lesion remains stable and there are no indeterminate characteristics, no additional radiographic studies would be needed. We think that patients with autonomous cortisol secretion with comorbidities potentially related to hypercortisolism, particularly if they are young and there is a poor control, may benefit from unilateral adrenalectomy. The indication for unilateral adrenalectomy is clear in patients with overt hormonal syndromes or suspected malignancy. In conclusion, adrenal incidentalomas require a comprehensive evaluation that takes into account the possible clinical signs and comorbidities related to hormonal syndromes or malignancy; a complete hormone profile (taking into account the conditions that may lead to falsely positive and negative results); and an adequate radiographic study. Monitoring and/or treatment will be decided based on the results of the initial evaluation.

A neurose obsessiva, veredas freudianas: breves considerações / The obsessive neurosis, Freudian paths: brief considerations / Neurosis obsesiva, sendas freudianas: breves consideraciones

O artigo aborda a neurose obsessiva de acordo com a obra de Freud, usada como ponto inicial para a argumentação do autor, enfatizando a sua dinâmica metapsicológica. Com base na hipótese clínica de que o pensamento torna-se fonte de angústia, destaca o fato do recalque dos componentes sádicos da libido constituir o ponto de partida da neurose. O autor enfatiza que, como escreveu Freud, a luta defensiva é a sua principal característica, distinguindo-a das demais neuroses. Ele sugere que uma fragilidade da estrutura narcísica primária é uma das condições necessárias para a forma peculiar da apresentação da angústia e de suas defesas. Ao argumentar que o pensamento torna-se fonte de angústia, destaca as dificuldades técnicas resultantes e sustenta que o manejo da transferência representa a única solução clínica possível (AU)

Inspired by Freud's work, used as a starting point for the author's arguments, the paper addresses obsessive neurosis, emphasizing its metapsychological dynamics. It starts from the clinical hypothesis that thought turns into a source of angst. It underlines that the repression of the sadistic components of libido constitutes the starting point of neurosis. The author emphasizes that, as Freud has said, the defensive struggle is its main feature, differentiating it from the other neurosis. The author suggests that a frailty of the primary narcissistic structure is a necessary condition for the peculiar aspect on how angst and its defenses manifest themselves. Reasoning that thoughts become source of angst, he emphasizes the consequent technical difficulties, and advocates that managing transference represents the only effective clinical approach.

El artículo aborda la neurosis obsesiva inspirada en el trabajo de Freud, utilizada como punto de partida para el argumento del autor, enfatizando su dinámica metapsicológica. Partiendo de la hipótesis clínica de que el pensamiento se convierte en una fuente de angustia, destaca que la represión de los componentes sádicos de la libido constituye el punto de partida de la neurosis. El autor enfatiza que, como escribió Freud, la lucha defensiva es su característica principal, distinguiéndola de otras neurosis. Él sugiere que una debilidad en la estructura narcisista primaria es una de las condiciones necesarias para la forma peculiar de la presentación de la angustia y sus defensas. Argumentando que el pensamiento se convierte en una fuente de angustia, destaca las dificultades técnicas resultantes y sostiene que el manejo de la transferencia representa la única solución clínica posible

A los diecisiete años desaparecen del EEG las polipuntas y polipunta ondas: a propósito del síndrome de Lance-Adams / At the seventeen years they disappear from the EEG The little and little waves: About the Lance-Adams syndrome

Objetivo: la inesperada ausencia del signo de polipunta o de polipunta onda (PPO) en el electroencefalograma (EEG) de dos casos, de 29 y 51 años, respectivamente, del Síndrome Lance Adams (SLA), que hemos visto y publicado con anterioridad, nos motivó a investigar la edad cuando este signo tiende a extinguirse, dejando de ser obligatorio para diagnosticar SLA a pacientes de edad madura. Métodos: de una muestra de 7137 trazados se incluyeron 6939, tras excluir 198 por referimientos no identificables. Estos EEG del Centro de Rehabilitación y el Centro Médico de la Universidad Central del Este (UCE), fueron realizados con electroencefalógrafos Nervus y Cadwell, de manera respectiva. Se revisaron buscando la presencia de PPO para estudiar la edad, la patología sospechada en cada indicación y el género de los pacientes. Resultados: PPO fue encontrada en 293 casos: 4.22 % de la muestra total. En 272 habría ocurrido antes de los 17 años, con la gráfica mostrando una elevación inicial máxima a las nueve. En cambio, de los 18 a los 65 solo apareció la PPO en 18 casos. 14 pacientes mostraron supresión de paroxismo o patrones de electro depresión sin PPO. Conclusión: la polipunta/polipunta onda prácticamente desaparece a los 17 años, a mayor edad, por lo tanto, el signo PPO deja de ser obligatorio para el diagnóstico del SLA en pacientes mayores. Es más frecuente en epilépticos y en varones

Objective: Unexpected absence of polyspike/polyspike & wave sign (PPW) in the EEG of our 29 and 51-year old published cases of Lance Adams Syndrome (LAS), prompted us to investigate the age when this sign may nearly disappear. This in order of considering it not obligatory for late LAS diagnosis. Methods: Inclusion consisted of a sample of 7137 recordings performed at the Rehabilitation Center and the Universidad Central del Este's (UCE) teaching clinic (Nervus and Cadwell respectively). Excluded were 198 for unidentifiable indications. PPW was searched in order to study patient's age, suspected pathology plus gender. Results: PPW was found in 293cases: 4.22% of the total sample: in 275.it occurred before the age of 17 with curve showing an initial tip at nine while between 18 and 65 only 18 cases showed it. Incidentally 14 patients showed Burst suppression or electro-decrement patterns without PPW. The most common indication pathology was Epilepsy followed by learning disability. Finally it was more frequent in 176(63.9%) male vs. 113(36.1%) in female cases: ratio 1.56 to 1. however not significant for the gender ratio in the total EEG sample is 1.55 to 1. Conclusion: PPW nearly disappears after the age of seventeen, perhaps explaining rarity in advanced aged SLA. It is more frequent in Epilepsy EEG indications and in the male

Electroencephalogram Evidence for Memory Suppression: A Systematic Review / Evidências de Eletroencefalograma para Supressão de Memória: Uma Revisão Sistemática / Evidencia de Electroencefalograma para la Supresión de la Memoria: Una Revisión Sistemática

Abstract Understanding how people forget is one of the fundamental goals of the science of memory. Recent studies indicate that humans can voluntarily regulate awareness of unwanted memories by stopping the retrieval process that would ordinarily bring past experience into awareness. Event-related potential (ERP) research on memory retrieval reveals that electrophysiological effects with specific timing and scalp topography serve as markers of memory processes. This systematic review examines the literature regarding EEG alterations in memory suppression, highlighting their results on electrophysiological indicators. A systematic review from January 2007 to November 2017 was conducted using PubMed, Embase and ScienceDirect databases. As results, 12 studies were eligible for inclusion. Quantitative EEG can be a objective tool for studying the mechanisms involved in memory suppression. There is evidence that a parietal positivity around 400-800ms after cue presentation is an ERP marker of conscious recollection during memory retrieval and a larger N2 deflection during retrieval suppression predicted greater suppression-induced forgetting.

Resumo Compreender como as pessoas esquecem é um dos objetivos fundamentais da ciência da memória. Estudos recentes indicam que os humanos podem voluntariamente regular a consciência de memórias indesejadas, interrompendo o processo de recuperação que normalmente levaria experiências passadas para a consciência. A pesquisa de Potenciais Relacionados a Eventos (PRE) sobre recuperação de memória revela que os efeitos eletrofisiológicos, com temporização específica e topografia do couro cabeludo, servem como marcadores de processos de memória. Esta revisão sistemática examina a literatura sobre alterações de EEG na supressão de memória, destacando seus resultados em indicadores eletrofisiológicos. Uma revisão sistemática de janeiro de 2007 a novembro de 2017 foi realizada usando as bases de dados PubMed, Embase e ScienceDirect. Como resultados, 12 estudos foram elegíveis para inclusão. Há evidência de que uma positividade parietal em torno de 400-800ms após a apresentação da pista é um marcador de PRE de lembrança consciente durante a recuperação da memória. Além disso, uma maior deflexão do componente N2 durante a supressão da recuperação sugeriu maior esquecimento induzido pela supressão.

Resumen Comprender cómo las personas olvidan es uno de los objetivos fundamentales de la ciencia de la memoria. Estudios recientes indican que los humanos pueden regular voluntariamente la conciencia de los recuerdos no deseados al detener el proceso de recuperación que normalmente llevaría la experiencia pasada a la conciencia. La investigación de Potenciales relacionados con eventos (PRE) en la recuperación de la memoria revela que efectos electrofisiológicos sirven como marcadores de los procesos de memoria. Esta revisión sistemática examina la literatura sobre las alteraciones en EEG en la supresión de la memoria, destacando sus resultados en indicadores electrofisiológicos. Se realizó una revisión sistemática entre enero y noviembre de 2017 utilizando las bases de datos PubMed, Embase y ScienceDirect. Como resultados, 12 estudios fueron elegibles para su inclusión. Existe evidencia de que una positividad parietal alrededor de 400-800ms después de la presentación de la señal es un marcador PRE de recolección consciente durante la recuperación de la memoria y una mayor deflexión de N2 durante la supresión de recuperación predijo un mayor olvido inducido por la supresión.

In search of the grail: A race for acid suppression. / La búsqueda del Grial: una carrera por la supresión ácida.

Proton pump inhibitors are the reference standards for the treatment of acid-related diseases. Acid suppression in gastroesophageal reflux disease is associated with a high rate of mucosal cicatrization, but symptom response differs among endoscopic phenotypes. Extraesophageal manifestations have a good clinical response in patients that present with abnormal acid exposure (diagnostic test) in the esophagus. Proton pump inhibitors have shown their effectiveness for reducing symptom intensity in nighttime reflux and sleep disorders, improving quality of life and work productivity. That can sometimes be achieved through dose modifications by splitting or increasing the dose, or through galenic formulation. Proton pump inhibitors are not exempt from controversial aspects related to associated adverse events. Technological development is directed at improving proton pump inhibitor performance through increasing the half-life, maximum concentration, and area under the curve of the plasma concentrations through galenic formulation, as well as creating safer and more tolerable drugs. The present review is focused on the mechanisms of action, pharmacokinetic properties, and technological advances for increasing the pharmacologic performance of a proton pump inhibitor.

Perspectivas del síndrome de supresión etílica: tratamiento a la mexicana / Perspectives about withdrawal alcoholic syndrome: Mexican treatment

Resumen El síndrome de supresión etílica es un problema de salud pública de especial atención en hospitales de segundo nivel en México. Clasificado como un padecimiento neuropsiquiátrico, la evidencia actual refleja daño sistémico más allá del sistema nevioso central. El manejo de estos pacientes se efectúa en las salas de hospitalización de Medicina Interna, cuando los síntomas son severos, requiere un abordaje multisistémico en la Unidad de Cuidados Intensivos. Si bien los criterios diagnósticos de la Sociedad Americana de Psiquiatría no se han modificado en las últimas ediciones (DSM-4 y 5), el tratamiento durante la última década se ha extendido por el gran espectro de opciones terapéuticas. El costo de hospitalización es elevado debido a las múltiples comorbilidades acompañantes encontradas en el paciente alcohólico. La finalidad de este trabajo es realizar una reseña de la perspectiva internacional y nacional de las diferentes guías en el manejo del cuadro, remembrando que sobre el clínico avezado recae la decisión terapéutica individualizada en cada caso.

Abstract Alcohol withdrawal syndrome is a public health problem of special attention in second level hospitals in Mexico. Classified as a neuropsychiatric condition, the current evidence reflects systemic involvement beyond the central nervous system. The management of these patients is carried out in the internal medicine hospitalization rooms; when the symptoms are severe, it requires a multisystemic approach in the Intensive Care Unit. Although the diagnostic criteria of the American Psychiatric Society have not been modified in the last editions (DSM-4 and 5), treatment during the last decade has been extended by the wide spectrum of therapeutic options in its management. The cost of hospitalization is high due to the multiple accompanying comorbidities found in the alcoholic patient. Therefore, the purpose of this paper is to review the international and national perspective of the different guidelines in the management of the disease, recalling that on the seasoned clinician falls the individualized therapeutic decision in each case.

The Role of Inner Speech in Emotion Dysregulation and Emotion Regulation Strategy Use / El Rol del Habla Interna en la Desregulación Emocional y el uso de Estrategias de Regulación Emocional

Abstract Recent studies have suggested that emotion regulation (ER) strategies, such as reappraisal and suppression, rely on the use of verbal thinking. Outside the field of ER, verbal thinking, particularly in the form of inner speech, has been largely linked to behavior and cognitive regulation. However, no article has yet directly addressed the potential role of inner speech in ER. In this study, 180 participants completed a survey that included measures of inner speech usage (Inner Speech Questionnaire), ER difficulties (Difficulties in Emotion Regulation Scale), ER strategy use (Emotion Regulation Questionnaire) and symptoms (HADS). Correlational analyses and hierarchical linear regression models were used to explore the potential relationship between inner speech and ER variables. A positive relationship was found between Inner Speech usage and the Difficulties in Emotion Regulation Scale overall score. This relationship was, however, heavily mediated by level of symptomatology. As for the ER strategies, only reappraisal presented a significant positive relationship, of medium size, with inner speech usage, which was independent of the level of symptoms. The results of this study are discussed in relation to the current conceptualization of reappraisal as well as its implications for clinical practice.

Resumen Estudios recientes han sugerido que estrategias de regulación emocional (RE) como la re-interpretación y supresión dependen del pensamiento verbal. Fuera del campo de la RE, el pensamiento verbal, como habla interna, ha sido vinculado con la regulación cognitivo/conductual. Sin embargo, a la fecha ningún estudio ha explorado el rol del habla interna en la RE. En esta investigación, 180 sujetos completaron cuestionarios de uso de habla interna (Inner Speech Questionnaire, ISQ), dificultades en la RE (Difficulties in Emotion Regulation Scale, DERS), uso de estrategias de RE (Emotion Regulation Questionnaire, ERQ) y sintomatología (HADS). Se realizaron análisis correlacionales y modelos de regresión lineal para explorar la relación entre habla interna y variables de RE. Una relación positiva fue encontrada entre frecuencia de uso de habla interna y la puntuación global de la escala de dificultades en RE -relación altamente mediada por el nivel de sintomatología. Respecto a las estrategias de RE, solo la reinterpretación presentó una relación positiva y significativa, de tamaño medio, con la frecuencia de uso de habla interna -con independencia del nivel de síntomas. Los resultados de este estudio son discutidos en relación a la conceptualización actual de la re-interpretación así como su relevancia para la práctica clínica.

Opilation and menstrual suppression: an 18 th century medical prescription in the new kingdom of granada / Opilación y supresión de menstruos: una receta médica del siglo XVIII en el nuevo reino de granada

ABSTRACT Objective: To present and define the context of a medical prescription dating from the eighteenth century in the New Kingdom of Granada, used for the suppression of menstruation, and to analyze it in the light of current knowledge as to whether its ingredients as a whole, may or may not achieve inhibition of menstrual bleeding. Materials and methods: Documentary search in the Historical Archives of the Octavio Arizmendi Posada Library at Universidad de La Sabana where the prescription "Opilation and menstrual suppression" was found. A review of the literature available in SciELO/proQuest databases was subsequently conducted for the period 1993-2015. Conclusions: The manuscript found describes multiple ingredients that, as a whole, and analyzed in light of current knowledge, are not valid to achieve the alleged suppressive effect. However, the components of the "liquid vitriol of Mars" could be recognized as having antianemic properties, and the potential suppressive effect of prescribing vigorous exercise in the middle of the menstrual cycle, although the recipe does not accurately describe the frequency or intensity of exercising to achieve the desired effect.

RESUMEN Objetivo: Presentar y definir el contexto de una receta médica que data del siglo XVIII en el Nuevo Reino de Granada, utilizada para la supresión de la menstruación, y analizar, a la luz de los conocimientos actuales, si sus ingredientes en conjunto podrían o no lograr la inhibición del sangrado menstrual. Materiales y métodos: Búsqueda documental en el Archivo Histórico de la Biblioteca Octavio Arizmendi Posada en la Universidad de La Sabana, donde se identifica la receta "Opilación y supresión de menstruos", y, posteriormente, se realizó una revisión de la literatura disponible en las bases de datos SciELO/proQuest en el periodo 1993-2015. Conclusiones: En la receta manuscrita hallada se describen múltiples ingredientes que, analizados a la luz de los conocimientos actuales, y en su conjunto, no tienen validez para lograr el pretendido efecto supresor. Sin embargo, se reconocen las propiedades antianémicas del "vitriolo líquido de Marte", y el posible efecto que ejercería el ejercicio excesivo formulado en medio del ciclo menstrual, aunque en la receta no se describe con exactitud la frecuencia ni la intensidad con la que este debería ser realizado para lograr una supresión del menstruo.

Cognitive function in patients on androgen suppression: A prospective, multicentric study. / Función cognitiva en pacientes tratados con supresión androgénica: estudio prospectivo y multicéntrico.

OBJECTIVE: To assess the effect of androgen deprivation therapy (ADT) on cognitive performance (CP) in patients with prostate cancer (PCa) after 6 months of treatment with luteinizing hormone-releasing hormone (LHRH) analogues. MATERIAL AND METHODS: Prospective, observational, multicentre, open-label study of patients diagnosed with nonmetastatic or asymptomatic metastatic PCa scheduled to receive LHRH analogues for≥6 months. We assessed four CP domains at baseline and after 6 months of ADT: 1) Working memory: Wechsler Adult Intelligence Scale III (WAIS III) Digit Span Subtest (WAIS III-Digit); 2) Visual memory: ad hoc visual memory test; 3) Visuospatial ability: Judgement of Line Orientation (JLO) and Mental Rotation of Three-Dimensional Objects (3D-Rotation); and 4) Nonverbal analytical reasoning: WAIS III Matrix Reasoning Test (WAIS III-MRT). Changes outside the baseline 95% confidence intervals were considered significant. RESULTS: A total of 308 patients completed the study. Of these, 245 (79.6%) experienced no statistically significant changes on any test and 63 patients (20.4%) experienced significant changes in ≥1 test. Of these, most presented a change in only one test, distributed evenly between improvements (58 patients; 18.8%) and worsening (56 patients; 18.2%). For individual tests, most patients (87.8% to 91.8%) had no change from baseline; however, the significant changes (improvement vs. deterioration, respectively) were as follows: WAIS III-Digit (6.3% vs. 5.9%); visual memory (5.3% vs. 5.7%); JLO (5.3% vs. 4.5%); 3D-Rotation (4.1% vs. 4.1%); and WAIS III-MRT (4.8% vs. 5.8%). CONCLUSIONS: CP in patients with PCa does not appear to be adversely affected by 6 months of LHRH analogue administration.

Caracterización de casos de maltrato infantil, Dirección de Medicina Forense de Tegucigalpa / Characterization of cases of Child Maltreatment, Dirección de Medicina Forense of Tegucigalpa

El maltrato infantil es un importante problema de salud pública que afecta la salud y vida de las víctimas, que está presente en todas las culturas y estratos socio económicos y que tiene graves consecuencias de salud para las víctimas. Este estudio caracterizó al niño maltratado evaluado en la Clínica Forense de Tegucigalpa, el período 2010 al 2015. Mediante un estudio descriptivo, retrospectivo; se analizaron 267 casos de maltrato infantil. El 95.5% presentó maltrato físico por transgresión. Las características relevantes de las víctimas de maltrato infantil fueron: En su mayoría niñas (57,3%) (t=2,408, df=266, pvalor=0,016), escolares, con 8.6 años de edad promedio, el 46% convivían en el seno de su familia nuclear, el 84,3% fueron agredidas en su vivienda, la madre fue la principal agresora. El maltrato físico por transgresión fue el más reportado, y el cinturón el principal objeto de agresión